Diabetes Tech

Frank’s First Week on the t:slim!

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Frank still can’t believe that he has a t:slim tucked away in his left pocket.

It feels so surreal.

(In his determination to get a t:slim, Frank has even began referring to himself in the third person in his own head, which he really should stop doing now).

As trusty and reliable as my late Animas Vibe was, it was definitely outdated. Quite frankly, it looked like a game of tetris from the ‘90s. It wasn’t particularly attractive. The skin quickly began to peel. It wasn’t particularly easy to navigate, when compared to the smartphones we use today. Animas had failed to throw research and development at that pump to bring it into the 21st century, which is likely a big part of why they decided to exit the market.

I know all of these things may sound superficial, but when you’re talking about a $9,000 device that is attached to my body 24 hours a day, it really does matter.

I’ve only been using this pump for a little over a week, but quite honestly the transition has been seamless. The t:slim combines the features that I’ve come to rely on in my Animas Vibe, with many enhancements that I’ve been longing for in quite some time.

The bright touch screen on the t:slim is so much more convenient and sophisticated (although not exactly easy for oversharing bloggers to photograph). I am no longer reliant on up or down buttons to navigate through the pump. I no longer need to scroll to reach my desired number to input into the pump. I can simply touch the menu item on the screen, and type in my numbers.

Another feature that is proving useful is the basal profiles. Within each time segment, I can also set custom carb ratios and correction factors. So when I’m on my feet at work at 9am on a Monday morning and more sensitive to insulin, I can set a custom carb ratio to reflect that, rather than having to manually adjust every single time. Thoughtful little things like that really do make a difference to my life.

I’m also really happy with the wearability of the pump. When I’m at work, it truly is slim enough to tuck into the waistband of my trousers, leaving my pockets completely free. While it is a little heavier than my late Animas Vibe, it’s hardly noticeable thanks to its size and sleekness.

A big shift from Animas is the rechargeable battery. Unlike a smartphone, I have been told that I do not need to worry about damaging the battery with my charging patterns. I’ve been plugging it in before I jump into the shower every day. It charges super fast, and so far that ten or fifteen minutes in the bathroom keeps the pump battery topped up at close to full capacity.

I’m really happy that I can continue to use the Animas sets that I’m most comfortable with, so no massive adjustment needed there. The nobbly luer lock connection, which was concealed on my Animas pump, is a little annoying when I go to tuck the pump line away or pull it out again. But it does guarantee me lots of options should I need to switch infusion sets in the future.

Filling an insulin cartridge is a little different as well. Insulin is basically drawn into a syringe, and then injected into that little white hole at the top of the cartridge (next to the line). Given that I can’t see inside the black insulin cartridge, the key is making sure there are absolutely no air bubbles in my syringe. I’ve only filled a cartridge twice so far, but it seems simple enough.

I also like that the cartridge can hold 300 units of insulin, which conveniently uses up a whole penfill cartridge in one sitting. Although apparently I’m only supposed to be filling three days’ worth to minimise the risk of insulin spoiling? I’ll leave you to guess what I’m doing with that one…

Most of my bolus deliveries take a good minute or two to complete, due to a back and forth motion happening inside the insulin cartridge that slowly infuses bolus deliveries. It’s just something to be mindful of when delivering a larger bolus.

The one thing I dislike about my t:slim is the pump clip, which I have been unable to use. The clip is attached to the rather chunky t:case, rather than the pump itself. This doesn’t exactly make the t:slim all that slim!

Another irritating thing about this pump is how demanding it is. The screen blacks out with three mis-taps. I’m frequently alerted when I don’t complete a bolus, or if I’ve been running a temporary basal rate for a prolonged period of time. While these may be helpful to some people, my pump should be able to realise how switched on I am.

While pump data can be uploaded to Diasend for review, I’m also looking forward to the t:connect app eventually launching here in Australia. Just like wireless blood glucose meters, it’ll be great to wirelessly sync my pump data to my iPhone for instant review.

It’s still early days, but it’s hard for Frank to find much fault in his t:slim.

It’s nice to finally have an insulin pump as modern as my smartphone and the other devices that I use to manage my diabetes.

#TslimForFrank!

Disclosures: AMSL Diabetes bumped me up to a priority transition to the t:slim after seeing all of my cheeky #TslimForFrank comments on social media. As an existing AMSL customer using an in warranty Animas Vibe, I was eligible for a free upgrade to the t:slim as per their transition program. The upgrade was treated as a replacement for my late Animas Vibe, which I was required to send back. I have not been asked or paid to write about the t:slim, and these opinions are entirely my own.

Dawn Phenomenon, Spring Style.

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My levels have been a bit of a mess over the past couple of weeks.

A few weeks ago, I began to notice my blood sugar levels slowly but steadily rising through the night. I found myself waking up to blood sugars of 8 or 9 at around 2am and giving a correction, only to find it had little effect by the time morning rolled around.

After I had ruled out any after effects of afternoon snacking or evening meals, I began increasing my overnight basal rates until I had curbed that steady rise.

But I still hadn’t quite managed to clean up the spill.

To add to my woes, the FreeStyle Libre sensor I’m wearing at the moment to fine tune those rates has been producing long flat red lines through the night – the kind of ‘LO’ readings that make me a walking talking miracle. Thankfully, multiple finger prick readings quickly confirmed that Libre is at fault, and not me.

I’m usually quite tuned into carb counting, protein and how I bolus for my meals when I’m on my feet at work. Yet morning after morning, I would bolus for my breakfast and find my blood sugar spiking into the teens. Those highs would carry through into my morning tea and lunch.

Eating is something that I can’t really afford to be skipping at the moment. I’m working on packing more into my meals to fuel my active days so that I don’t feel so dreadfully exhausted and limping into bed at night. I’m a better person for it.

As I was setting up the basal profiles on my brand new tslim over the weekend, a mental lightbulb flicked on in my head.

If I had increased my basal rates through the night to cover my dawn phenomenon, why hadn’t I increased them to cover my insulin resistance the moment I wake up?

I have been tinkering my overnight basal rates back and forth since I began pumping insulin two and a half years ago.

I have a theory that the lighter mornings during Spring and Summer enhance that insulin resistance in the wee hours of the morning, compared to the darker days of autumn and winter.

After upping my waking basal rates by 25%, in line with what I had done through the night, I’m hoping I have a better week in store for me.

In Memoriam

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Nobody really knew what to expect from her presence when she entered into this world on May 16, 2016. But she was something that had been wanted for a long time. A very long time.

From the moment she came out of the box, she was loved.

She may have been seen as a foreign object, but she quickly made herself at home. She could often be found clipped securely to the left pocket of trackpants, shorts, sleep pants and trousers.

Her first official piece of business took place over a plate of bacon and eggs in the hospital cafeteria, and it sure was an exciting moment.

She was a far more than just a material being that departed the hospital on the afternoon of May the 16th. She represented hope. A way forward. A fresh start, for the companion that she would be servicing.

There were several times over those first few months of her life where her capabilities were seriously doubted. Site failures, air bubbles, stubborn highs, weakening lows, unicorns and basketfuls of emotions were weathered.

She was a little chunky. And clunky. As she got older, her skin began to peel. She often inflicted feelings of complacency over the course of her life. She served three remarkable stints inside a drawer for a month at a time, delivering a basal rate of zero.

But there was something that could always lure her back out of hiding. She offered a great deal more convenience. Her basal coverage was far better than what her predecessors could ever offer. She was a great motivator to watch blood sugar levels more vigilantly, and learn about the gazillion things that affected them. For the majority of the time, her benefits were seen to outweigh the constant attachment.

Throughout her lifetime, she upheld a dependable reputation. While residing in Perth, she travelled to Sydney, Adelaide, twice to Melbourne and back. She weathered many coffees, cannoli, pasta nights and chocolate. She endured constant handling during daily physical activity, relied upon for temporary basal rates and frequent glances at insulin on board.

She may have been taken for granted at times, but she never complained one bit.

She departed this world at 9am on October 11, 2018, surrounded by her nearest and dearest. She would love to have been laid to rest in the company of the companion she had faithfully serviced for the last 30 months, but it was sadly not to be.

Instead she is destined for a body bag addressed to distributor AMSL Diabetes in NSW, where she will finally be laid to rest.

To my trusty Animas Vibe, my first insulin pump and the very thing that has given me back a life with type 1 diabetes.

Your legacy will live on forever.

May you forever Rest In Peace.

16.05.2016 – 11.10.2018.

Trust.

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When I first started on an insulin pump two years ago, my diabetes educator prescribed me with insets. During those initial weeks, site changes were an awfully overwhelming experience, causing several hours of anxiety following each change.

The pressure from the ‘inset’ insertion device would often trigger bruising and bleeding on my very lean body. I would spend hours watching my site and my blood sugars like a hawk, just waiting for signs of failure. I could really feel the sites ‘digging’ in as I crashed on the couch watching a movie or laid in bed at night. It wasn’t uncommon to feel stinging when I administered mealtime insulin boluses, either.

Then there was one tumultuous night where I discovered a kinked cannula hours after a site change, as I was on the verge of DKA (when all I really wanted to do was kick back and watch Serena Williams play in Wimbledon).

I’d be lying if I said I didn’t question whether insulin pumping was the best option for me.

Thanks to the help of the diabetes online community, I eventually found an infusion set that went in on an angle, and was inserted manually with my own two hands and a needle. And it’s quite honestly the very reason that I am still able to use an insulin pump with confidence today.

Although I never believed it would be possible at the time, I now realise that I very rarely have infusion sets fail on me. I can place an infusion set with ease, alternating around the left and right sides of my stomach, and go about my day without giving it a second thought.

I guess I’ve been reminded of this in recent weeks as I’ve tried to reconnect to my YpsoPump, which does not have angled sets, on several occasions (more about the YpsoPump here and here).

The 90 degree sets simply don’t agree with me.

When I spend relentless hours of my life managing diabetes, the very last thing I have time for is tending to tethering issues with the devices that I use.

My Animas Vibe gives me the option that I trust the most to infuse insulin into my body 24 hours a day, and that’s why I’m happily sticking with it for the time being (although I wouldn’t say no to a #TslimForFrank, either…)

Christmas Day, For a Person With Diabetes

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Imagine one massive room, that you could wander around at your leisure. A room that had all of the latest and greatest diabetes tools and technologies on show. A place big enough that you were free to go and chat with any of the exhibitors that you wish to approach, without having sales reps from competing companies clamouring all over you. An opportunity for you to actually hold a blood glucose meter in your hand, have a play with an insulin pump, and ask all of the questions that have been sitting on your mind for the last few months.

There might even be a few coffee bars with complimentary chocolates on the counter to help get you through such a massive day. Ideally, there might even be a few freebies such as a new blood glucose meter, a mug or a sample of glucose tablets to take home. But above all, you have the opportunity to really learn and get excited about all of the options available on the market to support you in the self management of your diabetes.

This is actually a reality for healthcare professionals, researchers and people working in the diabetes industry. I’ve been lucky enough to experience what I can only describe as Christmas Day for a person with diabetes through my attendance at the Australasian Diabetes Congress over the past two years.

Several weeks ago over a coffee with one of the players in the diabetes space, I was asked what I would like to see more of from their brand. My answer was simple. More direct to consumer initiatives like the ones that I’ve been lucky enough to be involved in as a diabetes blogger.

One good example of such initiative is Abbott’s FreeStyle Libre group set up sessions. To my knowledge, people with diabetes are invited to attend a group session with both a diabetes educator and an Abbott representative. They are provided with a complimentary FreeStyle Libre reader and sensor, and learn how to use the product during the session (depending on the place of setup, CDEs may charge for the session).

Both Diabetes Victoria and Diabetes NSW have held large diabetes expos in the past. While I don’t know a lot about the nature of these events, I believe that these are weekend events held in Convention Centres with a combination of exhibitors and information sessions.

Another personal highlight for me was the technology night designed by my fellow Young Adult Diabetes Committee members in Perth last year. The evening brought together representatives from Abbott FreeStyle, Roche, Cellnovo, AMSL and Medtronic Diabetes. There were also a selection of the Committee’s favourite diabetes accessories on sale.

Most importantly, the evening was designed by people with diabetes, for people with diabetes. There were Committee members speaking about their own personal experiences with such technology, as well as healthcare professionals explaining how the technology works. Seeing people in attendance who were only hearing about such technologies for the first time really highlighted the importance of holding events like these.

I get that there are regulations around the direct ‘marketing’ of pharmaceuticals to consumers. I have been told that the pharmaceutical players in this space are free to support any events that are initiated by third parties, but there are restrictions on events initiated in house. In fairness, I don’t want to see events where diabetes sales representatives are smothering innocent consumers who may be unable to see through the heavy spin.

However, the reality is that not enough consumers know about all of the available options on the market to manage their diabetes. Would it not be in the best interests of pharmaceuticals to be able to reach the actual users of their products in the same way that they can reach healthcare professionals?

There was a time before this blog existed where I didn’t really know a lot about diabetes and the options available. It took me five years until I moved on from the blood glucose meter that I was given on diagnosis, having learned about something more modern and better suited to my needs. There was a time where I never would have dreamed that I would be a candidate for an insulin pump, because I thought they were only for kids or people who were really struggling to manage their diabetes.

As I follow Tweets from the European EASD conference happening in Berlin this week, I am reminded of just how lightening fast these advancements in the treatment of diabetes are happening these days.

It doesn’t necessarily mean that newer or more ‘tech-ier’ will be better, but people with diabetes have a right to know and make an informed decision that best suits their needs. I try to share as much of what I learn here on my blog, not because I am in the pockets of big pharma, but because getting that information out there is a mission which I truly believe in.

I distinctly remember emphasising the importance of healthcare professionals relaying word of these new technologies back to people with diabetes throughout this year’s Congress. Equally, I know that there are many person centred healthcare professionals who will do just that.

People with diabetes have a right to know about all of the options out there.

We need more opportunities like these.