Diabetes Musings

Full disclosure: I have entered into a sponsorship agreement with AMSL Diabetes. AMSL have provided me with a three-month trial of the Dexcom G6 Continuous Glucose Monitoring system, with one of the sponsorship expectations being this blog post. Because AMSL have sponsored me, their regulatory team has reviewed this post for the purpose of ensuring compliance with regulations governing the distribution of medical devices in Australia. All words and opinions expressed here are my own. 

After many months of anticipation, the Dexcom G6 Continuous Glucose Monitoring system has finally hit our shores here in Australia. This newest iteration of the Dexcom features a slimmer profile, 10-day sensor wear and no requirement for calibrations with a finger stick. I’ve been using the system for 20 days now, having recently completed my second sensor. 

Application: There was an important first step where I had to input a code printed on the back of my sensor into the G6 app on my phone, in order for me to proceed without the need for any calibrations. 

The sensors now come encased in a one touch insertion device. I was admittedly a little nervous about this. I prefer manual inserts where I can, as it gives me a lot more confidence that everything has gone in correctly and I haven’t bruised my precious real estate. That being said, insertion was so much simpler and quicker than its predecessor. All I had to do was stick the sensor onto my skin, remove the safety lock and press the orange button. 

What I’d most like to see improved here is the ability to reuse or recycle the large plastic insertion device. 

Transmitter: The G6 transmitter sits on top of the sensor and sends blood glucose readings to the Dexcom G6 app on my phone every five minutes via Bluetooth. The transmitter features a much slimmer profile than the G5, and I definitely noticed an improvement while I was sitting on the couch or laying in bed. Transmitters are a costly component of running a CGM, and I would have liked to see this last longer than three months. 

Sensor wear: I’m always wanting to get more out of my diabetes gear, so it’s good to see that G6 sensors are now approved for 10-day wear. Although as someone who tries to line most of my diabetes tasks up with the weekend, 10 days is admittedly inconvenient. Saturday, next Tuesday, the following Friday… 

The sensors stuck well enough for me over the 10 days. My first sensor showed more signs of wear and became loose around the edges towards the end. I also received one sensor error on days 7, 8, 9 and 10. This occurs when the G6 app stops receiving readings for a short period of time. My second sensor stuck better than the first, and I didn’t receive any sensor errors here. External adhesives can also be used to secure the edges if needed. 

Dexcom G6 app: The G6 app was really easy to set up, with step by step instructions guiding me through pairing my transmitter and inserting and starting my sensor. 

There are the usual alerts which can be customised to notify you when your blood sugar is high or low, rising or falling. My foolproof alert is the tone ‘High.’ As much as I can’t stand that sound in the middle of the night, it never fails to wake me up so that I can correct and avoid waking up high. 

One new feature is the urgent low soon alert, which will give you a 20 minute warning when blood glucose is predicted to fall below 3.1mmol. It feels like your Mum nagging you to do something about it, even though you’ve already been told. Not necessarily a bad thing…

As someone who does often adjust my target ranges at night, another feature I really liked was the alert schedule. In the G6 app, I was able to create a customised schedule between the hours of 11pm and 6am with a tighter target range than my default schedule. I am being a little easier on myself right now, but I’ll definitely try this some point. 

Accuracy: I’m still adjusting to the way that the G6 behaves. The trend arrows feel more immediate than what I was used to on the G5. I feel like I see the impact of a meal or activity more quickly on my CGM graph. I’ve had to adjust my behaviour a little in order to avoid being too reactive to trend arrows. It’s also left me questioning how effective my pre bolusing has been. 

I started checking my blood sugar in the morning and evening, in line with my usual G5 calibration schedule. Almost all of my meter results were within 1mmol of the reading on my G6. I’ll also add that I’m paranoid about checking my blood sugar on clean hands. Generally, I found that my G6 reading was on the higher side of my meter reading. 

Overall, I found the accuracy to be excellent. I’ve only calibrated the system once over the past 20 days, which was in the first 24 hours of a new sensor. For the most part, I didn’t feel the need to calibrate this system because there was rarely a time where it didn’t feel accurate. 

Another time I found accuracy to be superb was when my blood sugar was dropping. In my experience using G5, I expected less accuracy when I was comparing my meter with a diagonal trend arrow. But the G6 was spot on. 

Verdict: I went into this trial sceptical that the Dexcom G5 could be bettered, however the Dexcom G6 has definitely exceeded my expectations. As someone who would be paying for this product out of pocket, I’m still undecided as to whether I would continue using this beyond my trial. However, it is a step in the right direction to see G6 priced considerably lower than G5. 

Dexcom G6 is currently available to purchase in Australia from distributor AMSL Diabetes – www.amsldiabetes.com.au. AMSL are currently working with the government to get G6 listed on the NDSS, however there is no confirmed date as of yet.

Footnote from AMSL: If your glucose alerts and readings from the G6 do not match symptoms or expectations, use a blood glucose meter to make diabetes treatment decisions. Always read the label and use only as directed. Read the warnings available on amsldiabetes.com.au/resources before purchasing. Consult your healthcare professional to see if this product is right for you.

Last year, one of the units I was studying at uni was, well, really badly organised. The major assignment for the semester was due within a week of the topic it was based on being taught.

I absolutely love studying as a fully online student for the convenience it offers me, but for the most part it’s an isolating experience because you’re left to work largely on your own. Not too dissimilar to living with diabetes. The support often isn’t there in the same way that on campus students get, but I do acknowledge that this is the path I have chosen.

I posted something on the message board for this unit, joining other students who were expressing similar frustrations over this assessment. Later that very night, I received a message from an old friend from high school, asking me how my assignment was going.

‘How do you know that!?’

As spooky as it sounded, his girlfriend was doing the exact same unit as I was. He must have seen my post on the message board, and he’d probably heard just about every complaint I’d ever had with this particular unit throughout the semester.

We’ve been in touch a bit over the past few months. He’s been asking me about the units I’m doing, how my exams went and those all important results. Pretty similar to our days studying accounting together in year 12, without the rivalry over who got the better test result (it was usually him, with what looked like about half the effort that I put in).

A week or so ago, I ran into this friend in person. He introduced me to his girlfriend, who was doing the same course that I was. As I was expecting to start talking about uni, he said something else.

‘She’s got diabetes, too! he said to me. ‘Go on, show him your pump!’ he gestured to her.

While I thought that was really cool, I told her that she did not have to fish out her pump on my account, as he urged her on.

My friend knows that I have diabetes, and that I do a lot in diabetes advocacy. I just thought it was so cool, that in all those months of messages, his girlfriend’s diabetes hadn’t come up once.

As much as I devote my online life to oversharing about diabetes, as happy as I am to wear diabetes as a badge of honour for the sake of raising awareness, there is so much more that defines us than just living with diabetes.

A few more diabetes tech tidbits as we enter August.

I’ve been tuning into Mylife diabetescare’s excellent ‘T1 Connects’ webinar series which has been running fortnightly throughout Winter. Last week’s final instalment featured James Major, head of the Aussie division, who provided some insight into upcoming developments.

An update to the mylife app, which is currently used for bolus calculations and to sync data from the YpsoPump via Bluetooth, is expected in November. This update will provide integration with the Dexcom G6, which was announced earlier this year. The app can also be used in MDI mode for those not using pumps, so I would assume it would offer the same functionality here as well.

A further update is expected around April 2021, which will add the long awaited promise of being able to remotely control the YpsoPump from the mylife app. This would definitely set apart the YpsoPump from any other pump on the market right now.

I will stress that these are only expected dates that are yet to be confirmed. As we’ve seen with a lot of diabetes tech, PWD are often promised the world but spend more time actually waiting for those promises to be fulfilled.

The company introduced luer lock infusion sets some time ago, which generously opens up Ypsomed’s orbit infusion sets up for use with many other insulin pumps. There are more infusion sets which are launching soon, which I’m led to believe will more closely resemble the Unomedical range manufactured for Medtronic, Tandem and AccuChek pumps – but there are no plans for angled sets. This has all been in direct response to customer feedback, so well done to James, Sylva and the team.

Also. unknown to me, mylife diabetescare will also replace batteries free of charge for YpsoPump users.

Medtronic have a new insulin pump which I would expect to see rolled out in Australia imminently. It’s listed on the Australian Register of Therapeutic Goods (ATRG) and has been added to the Prosthesis list alongside other pumps covered by Private Health Insurance here in Australia.

Dubbed the ‘770G’, this pump is capable of running the current 670G algorithm. It can then be updated to the new (and presumably improved) algorithm which will run in the upcoming but yet to be approved 780G system. With mixed feedback for the 670G and promised updates being a big selling point for Tandem’s t:slim, updatable software might just give Medtronic more of a competitive edge.

Finally, the Dexcom G6 Continuous Glucose Monitoring system is here. I have been trialling the system for the past three weeks (distributor AMSL Diabetes have provided me with a trial of the new system at no cost). It features a much easier one touch applicator device, slimmer profile transmitter, 10 day sensor and no requirement for calibrations. Watch this space for a review very soon. Don’t expect any belly shots, though…

Last but not least, thoughts to all in Victoria who are dealing with the impacts of Coronavirus lockdowns this week. Please look after yourself.

Have a great weekend.

I don’t exactly dread my diabetes screenings, but I can’t say that I look forward to them either. I feel like I am just waiting for the day that bad news will arrive, no matter how irrational or illogical that may sound.

I’m about two months overdue for my eye screening this year. I put it off because I was feeling pretty overwhelmed with uni back in June, which was largely a result of COVID. But I figured now that I’m well rested after a Winter study break, and while Western Australia is relatively safe and open, now is the time to get some of those things on the to do list done.

My endo would probably tell me that once every two years is enough based on my numbers and having only just exceeded 10 years with diabetes. But I force myself to make this an annual date, because it makes this appointment so much easier to approach.

I know that not a lot changes in 12, or in this case, 14 months.

I also know that if or when the bad news arrives, it will be picked up early enough that it will probably only be a very small change that will be easily treatable.

Not to mention that my local Specsavers will do the gold standard eye-dilation inspect the back of my eyes at my own convenience completely bulk billed under Medicare.

It also helps that I have an awesome optometrist who doesn’t make screening for a potential complication feel so daunting.

He’s got a history of diabetes in his family, but he hasn’t once made an assumption about me or my diabetes. I love how interested in diabetes he is, particularly my pump, and his questions show that genuine interest.

He’s all too familiar with retinopathy and other diabetes complications, as he pointed to images on the wall showing what those eye scans would look like in contrast to my healthy ones. He began telling me, not in any way to scare me, about a patient who had come in for an eye test only to find signs of damage to the eyes that were a result of undiagnosed diabetes.

‘How often would you have to give bad news to someone with diabetes?’ I asked.

‘Once a month. That’s once a month too many.’

I put my chin on the plate and leaned forward while he shone that warm white laser across my dilated pupils for my final test.

‘You can sit back, now. You’ve got a clean bill of eye health.’

If you need any more motivation to stay on top of your eye screenings, register for Diabetes Australia’s free eye check reminder tool, Keep Sight – www.keepsight.org.au.

When I’m out and checking my blood sugar on the go, test strips usually end up scattered on the bottom of my spares bag, in the pockets of my clothing, on the floor of my car or the inside of my satchel.

Back when I was on pens, I only used to change my needle once a day. In hindsight, it hurt after my fifth jab of the day. It wasn’t the most responsible strategy in terms of travelling prepared either, but it was convenient while I was on the go.

I can also recall having to scramble, right before a holiday, to find a container that was just the right size to fit all of my sharps. Finding something portable and practical amongst milk bottles, coke cans, spice jars or spreadables in such a short space of time was quite the challenge. I’ll even admit to placing sharps straight into hotel bins.

Travelling with diabetes takes up a lot of space. While I’ve slowly become more responsible in travelling prepared over the years, I still don’t want to carry anything more than I absolutely have to.

So when a company called IBD Medical reached out and asked if I’d like to try any of their ‘Glucology’ branded diabetes accessories, I chose this.

The pen needle pocket container holds 25 pen needle tips in addition to used lancets and test strips. There’s a green locking mechanism on the underside, with a custom insert allowing you to simply insert the tip of your pen and twist the needle off – which means you don’t need to handle used sharps.

I really like that it didn’t look overly ‘medical.’ It could easily be mistaken for another piece of stationery. I used mine mostly for test strips, however I also found it well suited for the small sharps found in my insulin pump consumables. It’d be quite handy for the unexpected middle of the day set change.

These are designed for single use, with the secure lock allowing for safe disposal when full. An order does also come with a very generous three bins. However, I’d definitely be tempted to try and empty this into my sharps container at home and reuse.

It fitted nicely inside my pocket, pump belt and satchel. For me, the most practical way I’d carry this is inside my diabetes spares bag. It would definitely be a great solution for my next trip in 2050.

I also chose these finger cleaning wipes. I’m a bit paranoid about having clean hands when checking my blood sugar. These were really nice for those middle-of-the-night or first-thing-in-the-morning checks, saving me from dragging myself out of bed to wash my hands. They were also handy for wiping the residual blood off from my hands, rather than wiping it off on the side of my test strip like I normally do.

IBD Medical – who sent me these products – are a Sydney based online retailer. Their Glucology line of diabetes accessories do look very stylish, providing discrete and innovative solutions for people with diabetes. They’ll ship worldwide.

The ‘Glucology’ line of diabetes accessories can be found here.

I also have a discount code ‘TYPE1WRITES’ which will give you 10% off at the checkout and free expedited shipping.

To make this a review a little more fun, I have a small prize of two pocket sharps containers and some finger wipes to give away to one of my Aussie readers (this part is not sponsored). To enter, send me a message through my contact page (click here) before 5pm WST Sunday, telling me in 50 words or less which State you are from and why you’d like them. I will send these to any valid Australian postal address. A winner will be chosen by me and contacted next week.

Happy Friday!

Disclosure: IBD Medical sent me the products mentioned in this blog post at no cost for review purposes. All thoughts and opinions expressed here are my own.