Diabetes Musings

Be Responsible.

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I don’t ever like to think of my blog as giving advice. I share my own perspective on life with diabetes, you digest that however which way you wish. But today I’m going to break that rule and step on my soapbox for the next couple of minutes.

Earlier this evening, I came across a thread in a closed Facebook group. Not a diabetes one, for the record. The post in question was asking whether she was required to follow her employer’s request to self isolate at home for 14 days following upcoming overseas travel. For the record, her employer was rightly following direction from the Australian government.

What was worse was the commenters that followed. There were comments indicating no awareness of the requirement to self isolate, comments indicating no intention to self isolate following upcoming overseas travel, and comments suggesting that they were at equal risk in a retail workplace.

Not to mention that earlier this week, I learned that a friend had been in contact with someone who had not self isolated upon returning from overseas travel.

I just cannot believe that this is up for discussion.

This is not about what other people are or aren’t doing to precaution the spread of the Coronavirus.

This is not about how ‘fine’ you are feeling after overseas travel.

This is not about how ‘unlikely’ you are to observe symptoms.

This is not about how ‘low risk’ we currently are here in Australia.

This is not even about how disadvantaged you might be from not being able to go to work.

This is about protecting the people around you. The people you come into contact with every day and love and enjoy spending time with and hopefully don’t want to see harmed. It’s about minimising the spread of, from what I’m hearing is a highly contagious virus. It’s about minimising the burden on our health system here that will have to deal with this.

I count my lucky stars that I live in Australia every single day, and I really hope that the situation here remains the low risk that it currently is. I truly believe that responsibility rests on each and every one of us.

If you have returned from overseas travel, please think of the people around you and follow the government’s direction to self isolate at home for 14 days. If you are not feeling well, please think of the people around you and stay at home (or seek medical attention). Please wash your hands regularly. I’ve been doing this for years, and quite honestly it’s been my best defence against illness. Touch wood. And try not to touch your eyes, mouth or face.

A lot of this is simply common sense, regardless of what is currently happening.

I don’t believe that we need to panic, but we do need to be responsible.

I’ll leave a link to the Department of Health website here.

I’ll also leave a link to this post from Diabetes Daily around Coronavirus and diabetes.

I’m also finding the Twitter ‘Moments’ that pop up on my search page extremely useful for news updates on Coronavirus.

I’ll step down from my soapbox now.

Thanks for coming to my Ted Talk.

Diabetes Tech Updates: March 2020

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A flurry of diabetes tech announcements of late, so in no particular order here’s what I have been hearing.

Dexcom G6 CGM Receives TGA Approval for Use in Australia.

The Dexcom G6 CGM system finally received approval in Australia last week from the Therapeutic Goods Administration (TGA). This new iteration of the system has been much anticipated for it’s slimmer profile, 10 day sensor wear and zero calibrations.

Presumably Aussie distributor AMSL Diabetes will now be figuring out their launch plans. I imagine this might include obtaining supply of the product into Australia, training customer service teams and healthcare professionals, marketing and pricing the product, transitioning customers over from G5 to G6 as well as getting it listed on the NDSS. Mid-year seems to be a conservative estimate at the moment.

For those of us using rebatteried transmitters, I think it’s worth noting that the G6 is unlikely to be as affordable as the G5. My understanding is that the transmitter’s internal clock cannot be reset, meaning that the transmitter will automatically shut down after 110 days. Have a read of Katie’s post here. Given how popular rebatteried transmitters are here in Australia, I’ve no doubt that AMSL and Dexcom will be looking to phase out the G5 eventually.

Tandem’s Basal IQ Update to the t:slim Insulin Pump

The other piece of the puzzle is Tandem’s Basal IQ update. This is a low glucose suspend software update to the t:slim pump, used in conjunction with the Dexcom G6. The TGA has approved the pump (t:slim), the CGM (G6), and will now have to approve the system (Basal IQ).

We have no indication that Basal IQ has been approved in Australia as of yet. My understanding is that local distributors receive no insight into clinical trials or other considerations that get a system like Basal IQ approved by the TGA. Approval of the G6 would be a positive indicator that it’s not too much further away. I’m confident that it may be ready for a ‘surprise’ launch at the Australasian Diabetes Congress in August.

FreeStyle Libre on the NDSS

FreeStyle Libre is finally available through the NDSS for Aussies who meet the eligibility criteria for the CGM subsidy scheme. The hold up was due to Abbott and the Department of Health being unable to agree on a price for the product for almost a year.

As NDSS Access Points, pharmacies are now able to supply the Libre. This also gives consumers who don’t meet the eligibility criteria the option of purchasing the product through their local pharmacy. Many people have reported on social media that the pharmacy price of Libre is around $130 – which is around $37.50 more than ordering direct from Abbott. It would seem that Abbott obtained the price that they were seeking from the Department of Health over the past year.

That puts Abbott’s 14 day sensor roughly on par with the reimbursement that Dexcom receive for their 7 day sensor. I find it interesting that Abbott’s reimbursement is on par with CGM, given they have traditionally held the stance that their product is not a CGM and have lobbied for funding considerations separately to other systems. A lower reimbursement price may have enabled the subsidy to reach a wider group of people.

Mylife Diabetescare/Ypsomed YpsoPump

I caught up with my local rep from Mylife Diabetescare at the Young Adult Diabetes Committee’s event over the weekend. The company is considering (but not yet confirmed) moving away from the Mylife Diabetescare brand and using the more well known ‘Ypsomed’ brand. Ypsomed is the manufacturer of the YpsoPump and consumables, Mylife Diabetescare is the branding applied to the products. I think…

A CGM partner is expected to be announced this year. My understanding is that this will allow the user to integrate CGM data into the Ypsomed app, rather than an update to the handset. Ypsomed’s cloud based data management software also now has the ability to connect to Diasend, which was something I specifically remember trying to do when I trialled the pump in 2018.

Finally, I’m still waiting on greater choice of infusion sets, which is what would get me back onto the YpsoPump. I’m told that they’re on the way. I would also love to see an update to the app so that syncing pump data isn’t as slow!

AccuChek meters in Woolworths supermarkets

Last week, Roche sent through a media release indicating that select blood glucose monitoring products will be available in Woolworths supermarkets from March. The products include AccuChek 5 Instant Blood Glucose Meters, Instant Test Strips and Softclix lancets.

The product range focusses on glucose monitoring products that are not currently subsidised through the NDSS. My understanding is that the target market may be people who cannot access these products as easily – such as people with type 2 diabetes, pre-diabetes or people who may be at risk of diabetes.

Kudos to having more choices and greater access!

Complications Have Names, Too.

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If you’re on Twitter, or if you follow The Grumpy Pumper online, you’ve probably seen his many posts chronicling long term treatment for a foot ulcer (or a foot condition – my memory is a bit patchy here). Grumps quickly realised that there was a lot of stigma attached to diabetes complications, and that not that many people were inclined to talk openly about them.

That’s where the hashtag #TalkAboutComplications was born. Grumps hosted a series of guest posts on his blog, where people began to share their own stories around dealing with diabetes complications. There’s also a Facebook group ‘Talk About Complications’ run by the International Diabetes Federation where people can find peer support around diabetes complications.

Renza Scibilia jumped on board, doing what she does best in addressing the need for better language and attitudes around diabetes complications in order to remove the stigma associated with them. Because, #LanguageMatters too.

Ascensia Diabetes Care are also working in consultation with Grumps to encourage more open discussions online. At the ADC in August last year, I learned that the goal was to bring the active conversation that was happening on Twitter over to Facebook and Instagram, among broader social media platforms.

There’s currently a new campaign running on the Contour Diabetes Solutions page on Facebook. It started recently, I believe that there is still more content to come.

Earlier today a Tweet caught my eye, observing that complications are still presented as an end point, posing the question as to how can we do better.

Which brings me to my next point. I say this as someone who certainly isn’t a diabetes veteran, or experienced a diabetes complication of my own.

I don’t like the words ‘diabetes complications.’ From the minute my diabetes educator brought them up as a possibility of what could happen when I was first diagnosed, they felt like dirty words.

Associating health conditions with diabetes infer that I got them because I did something wrong. Because I didn’t manage my diabetes well enough. I read the phrase diabetes complications, and I personally see blame on my diabetes straight away.

I wonder why we don’t simply call these conditions by their actual names. I have a very rough idea of some of the diabetes related conditions that may pop up, but I definitely don’t know enough about them. Maybe if we were more specific about what diabetes complications are, instead of focussing on them being a result of diabetes, it might be easier for me to learn more about them. Because ‘diabetes complications’ aren’t exactly clickbait to me.

We human beings have this insatiable need to know how or why something happened. In my experience, at least, Italians love to talk. Everyone has to know how something happened. Just think about loss, for example.

Does it really matter how I developed another health condition? Does that really bring any comfort to the person actually going through it?

Complications have names, too.

Photo credit: Ascensia Diabetes Care.

Urgh

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I woke up this morning to the gentle sound of my sleep cycle alarm. It was a lot darker than usual, because I was waking up a lot earlier than usual today.

My first thought was that I hadn’t stirred during the night. Nor had my CGM gathered my attention for the last eight hours.

I reached for my iPhone and swiped left.

‘Oh, shit!’ I exclaimed at the widget on my home screen as a wave of furiosity instantly hit me.

I’d spent the past three hours riding around the 11 mark. Possibly higher, because I forgot to check my blood sugar for reference which I like to do when I’m high.

I wondered how on earth I was only finding about this now, and unlocked my iPhone with a press of my thumbprint. When I opened up the Dex app, I found the culprit in a high alarm that had been completely turned off.

I have no idea whatsoever how that happened. I distinctly remember opening the app and lowering my high alert from 8mmol to 7mmol last night, like I do every other night before bed.

As I flipped my phone sideways and traced that high back through the night, I was even more furious to find that it had risen from pretty much the minute I rested my head on the pillow at around 10pm.

But it also made complete sense, given I’d consumed a fair few carbs to absorb the dinner I’d over bolused for. I also can’t bring myself to treat hypos with glucose tabs anymore, so there may or may not have been a few raids of the cupboard involved. But I’m making sure I buy some juice today, for a change.

As I bolused super early for my breakfast, got out of bed and jumped into the shower, how that high alert escaped me is still a complete and utter mystery.