Diabetes Musings

Diabetes on an Assembly Line

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Direct material, direct labour, manufacturing overhead.

Direct material, direct labour, manufacturing overhead.

Direct material, direct labour, manufacturing overhead.

If you’re not a member of the #AccountantsOfTheDOC club, the aforementioned statements are the sum of total manufacturing costs incurred by an entity that’s in the business of producing and selling products.

These words have been drummed into me by my tutor for weeks and weeks on end. In the midst of my study procrastination, I’m applying these costs to my diabetes.

Direct materials are the items that are consumed in the process of managing my diabetes, and are physically incorporated into the finished product. Which is a living, breathing (and hopefully happy) me. Throw in some Novorapid insulin, an AccuChek Guide blood glucose meter and some test strips. Add in some intermittent FreeStyle Libre sensors and a durable reader. Throw in a #TslimForFrank, some Tandem luer lock insulin cartridges and Animas Comfort infusion sets. Oh, and don’t forget the batteries, USB adaptor and cord.

Direct labour is the cost of salaries and wages for the personnel who work directly on my diabetes. As the sole ‘personnel’ responsible for working on my diabetes, I’ll bill for blood glucose monitoring 10-20 times throughout the day. Add in the labour of carb counting for breakfast, lunch, dinner and every other time I wish to eat. Mix in site changes every three and a half days, and refills to my insulin cartridges twice a week. Throw in the labour of reaching for glucose tabs every single time a hypo hits. Double time if it happens in the middle of the night. Not to mention a hint of intuition for when your pump’s suggested correction doesn’t feel quite right.

Manufacturing overhead refers to all of the indirect costs of managing my diabetes. Oh boy, are there a lot. What about all of the endo appointments, visits to the doctor, blood tests, eye check ups and visits to the podiatrist? Or the time spent overthinking something that doesn’t feel quite right? How about the exhaustion after a particularly taxing day simply because I have to do diabetes on top of life? Or the emotions that stem from the numbers we are so heavily invested in? Not to mention the costs of remembering to carry all of my diabetes junk around with me.

By far, the most worthwhile indirect cost-that-doesn’t-really-feel-like-a-cost would have to be the time spent connecting with others in the diabetes community. Having a space to seek out the experiences of others, to vent my frustrations and to bask in the fruits of my diabetes labour is truly invaluable.

Back to the books I go. Have a great weekend, folks!

Hypo Hangover.

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It was twenty minutes past ten. I knew that I would be stopping for morning tea within the next ten or twenty minutes. A scan of my Libre registered 4.6 and steady, and I gave a pre bolus for the hot cross bun that I was about to eat.

By the time I was seated at the table and buttering my toasted hot cross bun, my insulin pump registered that twenty minutes had passed since my bolus.

As I sat there in my seat, a weakness swept through me. An uncomfortable sweat broke out across the entirety of my upper body. The thought of getting up to wash my plate felt far too difficult, leaving me paralysed in my seat.

I eventually willed myself back up, made my way down the hall and sank into the chair behind my desk. A scan of my Libre registered 2.3 and slipping downwards. I didn’t have the energy to grab the meter that was in arms reach of me to double check. I was tempted to correct with a glucose tab, but I knew that the hot cross bun wouldn’t take long to bring my blood sugar back up.

As I slowly devoured about three quarters of the refreshing cold water in my drink bottle, the weakness began to subside and I began to reassess how I ended up here.

The 4.6 was bordering hypo territory, meaning that I didn’t have as much room for a pre bolus as I normally would. It was also a Libre scan, and a finger prick could have been as much as half or 1mmol lower. Add to that, I hadn’t eaten breakfast earlier because I wasn’t particularly hungry, which could have heightened my insulin sensitivity.

Most of the time, hypos don’t really stop me from what I’m doing. It’s usually nothing more than the odd glucose tab to ward off a downward trend arrow, sometimes more.

But paralysing moments like these? They remind me of just how much weight rests on the decisions that I have to make each and every day.

New Year, New Adventure.

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I went back to uni a little over a month ago.

It wasn’t the easiest decision to make as an adult with ‘adult’ responsibilities and a full time job, but ultimately it’s a decision that I hope will be a good investment in my future.

This year I have traded in my evenings to attend ‘virtual’ classes, and my weekends for assignments. It’s been challenging, to say the least. I’m the kind of person who likes to get a good head start on things. The downside to getting ahead is that there have been many fleeting moments when I’ve felt like there’s been nothing more to my existence than study.

I’m studying accounting, which is something I once swore I’d never do because every man and his dog seemed to do it. But it seems to be a profession that’s in demand, and I wasn’t half bad at it when I last did it in high school.

Oh, and my diabetes is still there too. It hasn’t been giving me too much grief. But if there’s one thing that I’ve missed more than anything, it would have to be connecting with others in the diabetes community. While I’ve still been lurking around, I’ve been oddly reminded of what my life was like before I found the DOC four years ago. I know that my wellbeing is far better when I’m an active part of this amazing community.

I submitted my two assignments for the semester this week, and I’m very much looking forward to actually enjoying some of my upcoming weekends. I’m not too sure what will become of my blog this year, but I’m hoping I’ll be able to check in here a little more often than I have been.

So if you’ve made it this far, I guess the morale to this post is that you’re never too old to take a great big leap of faith. And that I’m not going to let diabetes be an excuse for the regrets I might have had down the track.

Champagne Bubbles

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I stirred in my sleep.

A glance at the alarm clock behind my bed indicated that it was almost 3am.

I stuck my arm out from under the covers, fumbling around on the bedside table for my Libre reader.

A quick scan of my arm registered 8.6.

I knew what was wrong.

I gave a generous correction of 2 units, but I knew it wasn’t enough. I contemplated a temp basal rate, but I knew that I would only be putting band aids on the real problem.

Besides, I knew that I wouldn’t be able to lie still while knowing what I needed to do.

I sprang out of bed, switched on the lights and reached for the box of t:slim cartridges from my wardrobe. I made a dash through the hall and the dining room, making a beeline for the bar fridge where cold insulin was sitting.

I had swapped out my insulin cartridge just after dinner several hours earlier. I knew I hadn’t chosen the best timing before bed, but at the same time I prefer to run my insulin down to the wire if I can.

I knew I had drawn a lot of those fizzy little champagne bubbles into my syringe as I was drawing the air out of my empty t:slim cartridge. Part of me suspected that I hadn’t successfully drawn all of the air out of my t:slim cartridge amid those champagne bubbles.

I’ve had my fair share of moments like these in the four months since I’ve been using the t:slim. As much as I love this pump, it’s beauty, it’s wearability and it’s positive impact on minimising my device fatigue, I absolutely hate that I can’t see what’s going on inside those insulin cartridges. Which means that I’ve had to learn to rely on intuition.

I’ve come to assume that when I haven’t properly drawn all of the air out of my cartridge prior to filling it with insulin (a.k.a. champagne bubbles), the delivery of insulin from the pump is compromised. My blood sugars feel sluggish and harder to manage, even if I can’t see any visible signs of air bubbles in my pump line.

I’m slowly but surely working on my technique. Making sure my insulin is as room temperature. Pushing insulin from my penfill cartridge into my syringe using a pencil, rather than pulling. Holding my cartridge upright. Being really gentle with my syringe when I’m drawing from it.

Who knew diabetes was such a fine art?

The Cost of Living with Diabetes

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I think about the cost of living with diabetes. A lot. Moreso as I get older. When I think about building financial security for myself, my number one motivator is to make sure that I will be able to meet the costs of living with diabetes today, and into the future. Which don’t come cheap.

FreeStyle Libre Sensors: $1,140

I currently wear a FreeStyle Libre in a 2 weeks on, 2 weeks off pattern. Because a) it’s expensive, b) I don’t want to become too reliant on one if I can’t afford it in the future and c) I become too overwhelmed with the data after wearing one for too long.

1 sensor sets me back a cool $92.50. Let’s assume I use around 12 per year, which adds up to $1,140 per year. Admittedly, this is a luxury that I could do without if need be.

Test Strips: $476

I would go through at least 15 test strips to monitor my blood sugar each day for the 26 weeks of the year that I’m not wearing a FreeStyle Libre sensor.

That’s 2,730 test strips a year.

Or 28 boxes of 100 test strips a year.

A box of test strips will set me back $17, which costs me a beautiful $476 each year.

Insulin pump infusion sets: $217.10

I would change the infusion set on my insulin pump every three days. Let’s assume that the 4 week pump break I have taken in the past 12 months, where I wasn’t using infusion sets, will cancel out the cost of infusion sets that have failed on me or lasted less than three days.

Thats a total of 122 infusion sets each year.

Or 13 boxes of 10 sets per year.

A box of infusion sets will set me back $16.70, which totals a fantastic $217.10 a year.

Insulin pump cartridges: $111

I’m replacing the insulin cartridge in my pump once every four days since starting on the t:slim (where cartridges aren’t as easily reusable).

That’s 92 cartridges per year.

Or 10 boxes of 10 cartridges per year.

A box of cartridges sets me back $11.10, which adds up to a cool $111 each year.

Rapid acting insulin: $79

A 3ml cartridge of NovoRapid insulin lasts me roughly 7 days.

That’s 52 cartridges a year.

Or two scripts per year, each containing five boxes of five NovoRapid cartridges.

A script of NovoRapid penfill cartridges sets me back $39.50, which is a cheap as chips $79 per year.

Long acting insulin: $19.75

I use an insulin pump, which means that I only use rapid acting insulin. However, I like to keep long acting insulin on hand in the fridge in case a) my pump dies or b) I’m ready to throw it at a wall and need to go back to injections for the sake of my sanity.

A script of long acting insulin will set me back $39.50.

The insulin has a shelf life of two years, which comes in at a cool 50% off, setting me back $19.75 per year.

Private Health Insurance: $996

I wouldn’t want to be without a private health insurance policy. It covers the cost of any hospital visits, treatment, as well as rebates on other services such as dental and optical. It’s a small price to pay for the peace of mind, as well as the $9,000 insulin pump that was fully covered under my policy in 2016!

I pay $83 per month, which comes in at just under a cool 1k, or $996 per year.

General Practitioner: $32

I’ve visited my GP four times in the past year. When I’m not feeling well, if I’m in need of a more potent drug, a doctor’s note or a fresh script of insulin inbetween endo visits. Or if I’m dying.

After a Medicare rebate, I’m usually left to pay $8 out of pocket, which adds up to an awesome $32 per year.

Hypo Treatment: $40

My go-to treatment for hypos are Skittles.

I buy them in party buckets.

I would buy four party buckets a year.

A party bucket sets me back $10, which totals a nice $40 a year.

Diabetes care: Free

I’m currently accessing all of my diabetes care at the diabetes outpatient clinic in a public hospital, which is completely free thanks to the Medicare system in Australia. Sometimes the wait times are long, and the continuity of care isn’t always there, but it’s free. I’m pretty switched on and well connected with my diabetes today, so that is enough for now.

My annual eye and foot examinations and are also bulk billed through Medicare, even though I access these privately, leaving me with no out of pocket expenses.

Grand Total – $3,110.85

I could assign a dollar value to the sum of all of these various costs associated with living with diabetes, and whinge about how I’m sacrificing coffees or Spotify subscriptions or overseas travel.

However, the real price tag on all of the above is my life.

Without insulin, test strips, needles, hospitals or healthcare (to name a few), I would not be here today to tell the tale.

Sadly, this is still a reality for many who don’t have the privilege of being born into countries as lucky as ours.

You’ve more thank likely heard of the Spare a Rose campaign going through the diabetes community at the moment, so I’m just going to leave this very self explanatory graphic here.

Your donation will enable Life for a Child to provide life saving insulin to a child in need for a month, as well as support ongoing efforts to provide blood glucose monitoring and diabetes education to children in 42 different countries.

Please consider making a donation this month by simply hovering your cursor over these words, and spread the word around.