Diabetes Tech

Finding Independence from Continuous Glucose Data

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In my latest column over at Diabetes Daily, I’m talking about how I’ve arrived at a place where I don’t feel dependent on continuous glucose data to manage my diabetes.

“The FreeStyle Libre was my first foray into the world of continuous glucose data. After knowing nothing other than pricking my finger up to 15 times per day for six years, it was amazing to be able to check my blood sugar levels so conveniently. The small round sensor that sat on my upper arm provided me with a blood glucose reading, a trend arrow, and an 8-hour history graph each time I swiped my reader over it.

However, the data was addictive. Within the space of a few months, I felt heavily reliant on this device. When the life of my sensor came to an end, I really missed it. I felt lost, and even a little anxious about how I would cope without it. I had lost a great deal of confidence in my diabetes decision making.”

Check out the full column over at Diabetes Daily here.

Choice.

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I was about to settle in front of the TV on Thursday night (which I’ve been doing a lot of lately hence the blog break), when Twitter exploded with the news of Animas discontinuing the sale of insulin pumps in the US and Canada. Customers with in-warranty pumps will be referred to Medtronic for consumables, before eventually having to choose a different brand of pump.

I knew that parent company Johnson and Johnson had been evaluating their insulin pump business for some time. I also knew that there weren’t really any exciting enhancements in the pipeline for the Animas Vibe, compared to some of the other insulin pump players in the market. Yet the news of Animas shutting up shop was still a real shock to the system.

So what does this mean for Australia? For the time being it’s business as normal, with the delivery of insulin pumps and consumables unaffected. AMSL Diabetes, distributor of the Animas Vibe insulin pump here in Australia, issued a brief statement via Facebook on Friday.

“Animas Corporation, a division of Johnson & Johnson, has announced overnight their plans to discontinue the manufacture and sale of the Animas Vibe insulin pump and exit out of the insulin pump business in the USA and Canada.

We feel that it is important that you understand that this does not affect your supply of consumables, technical support or after sales service. AMSL Diabetes is a distributor for Animas and we are continuing business as usual.”

The press release issued, however, indicates Johnson and Johnson’s intention to eventually exit the insulin pump business globally subject to consultation and timing.

When Animas does exit the market here in Australia, that leaves us with Cellnovo, Medtronic and Roche. Roche also ceased the sale of Accu Chek insulin pumps in the US earlier this year, triggering the following response from one of my contacts at Roche Diabetes Care Australia:

“I was shocked to see Animas’ announcement yesterday. Anything that reduces choice in insulin pump therapy for people is never positive.

Looking at peoples responses on social media I see that a lot of people think Medtronic and, to a lesser extent, Cellnovo are the only options left on the Australian market if Animas should ever exit here. There also seems to be a perception that, because It is no longer available in the US, Accu-Chek Combo been withdrawn globally. This perception is not accurate.

Accu-Chek Combo is manufactured in Europe and continues to be available for people with diabetes in many countries including Australia. Please be assured that Roche Diabetes Care is here to serve people needing insulin pump therapy both now and longer term both with our current tried and trusted Combo and with our exciting and innovative pipeline of products.”

While Animas have signalled their intent to (eventually) exit the insulin pump market globally, Roche have not signalled any intent of exit outside of the US. I hope, for the sake of choice, that they don’t.

I can’t say that I’ve ever felt super excited about my pump. I mean, it does it’s job. Quite nicely, I might add. However it wasn’t until I was wondering around the exhibition hall at ADS-ADEA last month that I began to appreciate why I use what I use. Looking at some of the other options on show that weren’t for me, really made me appreciate having a choice. 

I really, really don’t like seeing Medtronic eating up the market in the US, and I really do hope that the affected Animas and Roche customers will choose a replacement pump option that best suits their needs. One brand of pump should never be the only option for people with diabetes.

With Animas on the way out, Tandem’s t-slim Dexcom integrated touch screen pump would surely be a natural successor to the Vibe for Aussie distributor AMSL diabetes.

Let’s make it happen sometime before my current warranty expires in 2020…

(Choice!)

Technology Changing Diabetes Outcomes at #ADSADEA2017

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Another standout session from my time at the ADS-ADEA conference was a symposium on technologies changing digital health outcomes.

Professor Brian Oldenburg introduced us to the ‘new’ health communications landscape in a digital era, which was nothing new to many of the consumers in the room! The promise of technology is great, but how do we ensure that it has sufficient reach and sustainability? With technology ever evolving and enhancing, keeping up with it is a real issue.

The buzz word of the conference popped up once again, with talk of the need for ‘person centred’ design in these digital technologies. I felt that this would be a great opportunity to engage with digitally savvy consumers, such as the DA People’s Voice team who were all there frantically tweeting in the room! I would hope that the healthcare professionals in the room were reassured by the promise of digital technologies complementing, rather than replacing their fundamental role.

Digital health programs were challenged by their usability, engagement and outcomes. As we were introduced to a digital diabetes coach, I was really struggling to see how such a program would be engaging or motivating. While it’s true there is no judgement in a robot’s voice, there are also no expressions of empathy or other human elements that help us to foster trust. I was also skeptical that older people would have the computer literacy or appreciation for these programs. Many still prefer to be served by a teller at the bank, or by a person at the checkout. I’m a big advocate for providing options and not forcing technology on those who don’t want it. However, I was surprised to hear that these programs were being taken up by both older and younger people.

You can see the digital health coach for yourself and decide:

Bec Johnson of the Telethon Type 1 Diabetes Family Centre was next to take to the stage, talking to us about how digital technologies have played a fundamental role in helping the family centre to reach across the whole of WA. Can I just say how nice it was to sit there as a West Australian, having something that the East Coasters around me envied? You can check out my sneak peek inside the Family Centre right here.

Bec began talking about how isolating type 1 was for her, and her sentiments just echoed among many of the consumers in the room. She shared that it took 10 years until she first began connecting to other people with diabetes through the Reality Check forums here in Australia. Those forums were her saviour, and she knew that online communities would be a pivotal part of building a type 1 community here in WA.

The Family Centre’s closed community Facebook group is about connections, rather than information sharing. I was rather impressed as Bec told us that the group had ‘conditioned’ this culture among the group, with many participants quick to politely call out posts seeking clinical advice. New entrants to the group are screened with a series of questions, in order to maintain a safe space for parents to share some of their deepest darkest thoughts. The Facebook group also allows consultation with the community on events or programs, in order to deliver the needs of the community.

Bec highlighted the Diabetes Detective program, which would not be possible without shared CGM data and remote contact with Diabetes Educator Amy Rush to smooth out any blood sugar issues. Other examples of online education from the Family Centre include the ‘Cyber Carbs’ online carb counting course and Type 1 Babysitters training. Bec also touched on online crowdfunding, raising an impressive $10,000 for the Family Centre for her swim to Rottnest Island earlier this year.

I was only saying last night how it often feels that the contribution of an actual person with diabetes doesn’t feel valued by healthcare professionals, conference organisers, organisations and companies in the diabetes space.

What I loved most about Bec’s talk was how much it proved the value of having a person who has hands on experience in diabetes, working in diabetes.

Also, I’d really love to see the foundation of the Telethon Type 1 Community translate into something for young adults one day.

Disclosures: Diabetes Australia provided me with a media pass to attend the ADS-ADEA 2017 conference, with the view that I was interested in attending and delivering my own, honest insights to the wider diabetes community.

Cellnovo Mobile Insulin Pump Launches In Australia!

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The Cellnovo Mobile Insulin Pump officially launched in Australia last week at the ADS-ADEA conference (ADS-ADEA disclosures are at the bottom of this post). The pump is being distributed by Medical Specialties Australia, and subsidised consumables will be available through the NDSS from October 1. MSA’s Diabetes Division Manager, Aaron Cook, was kind enough to come and meet with myself and a few other consumers last week outside of the trade hall to give us the scoop.

The Cellnovo system consists of a small insulin pump that sits on the skin via a Velcro patch, in close proximity to the infusion set. Tubing is virtually non-existent. The pump is rechargeable, rather than battery operated, with each charge typically lasting 3-5 days. There is a second identical pump included in the box, so that the user can charge one up while using the other.

 

If you know me in person, you’ll know that I’ve dreamt of a touch screen insulin pump that I could control from my Smartphone (yes, I’m well aware of Looping and We Are Not Waiting). Frankly, the interface on my Animas Vibe looks like something out of the 1990s.

So for me, the real selling point of the Cellnovo system is the touch screen mobile handset that connects to the pump via Bluetooth. The screen is bright and colourful. There are menus for insulin delivery settings, bolus calculations, activity tracking and food databases. The handset also has a built in blood glucose meter, which uses Accu Chek Performa strips.

Aaron was telling us something about wax and pistons inside the cartridge (or possibly the pump) that allows for more superior and precise delivery of insulin infusions. Insulin cartridges can only hold 150 units of insulin, which may be a consideration for those on larger doses. I would rarely fit the maximum amount of insulin into my cartridge once air bubbles have been primed out, so this may be closer to 100-120 units of insulin. Your Diabetes May Vary…

There were a few choices of infusion sets, with 5.5mm being the smallest. Aaron informed me that all infusion sets are 90 degrees, which is an issue for me personally as I prefer my 45 degree angled ones. However, I was encouraged to hear that there are options for manual insertion rather than insets. 

Another consideration was the minimum basal profile being 0.05, rather than 0.025. To put this into perspective, my pump gives me the option of delivering 0.300, 0.325, 0.350 or 0.375 units of basal insulin per hour. The Cellnovo would reduce this to 0.300 or 0.350 units of insulin per hour. For some this might not be an issue, but during overnight fasting 0.025 does make a massive difference between a steady or a steadily dropping blood glucose level.

I’m also a little concerned about sleeping or lounging comfortably with the pump stuck to my stomach, so placement of the infusion site would be a big consideration. That being said, consumers overseas are happily wearing the Omnipod tubeless pump in similar fashion. Diabetes Educator Fiona was also questioning how well the pump would stick to the Velcro patch, however I thought that it indeed looked very tough.

Aaron describes Cellnovo as a medium sized startup company. They have been in the UK for around 2 years. Aaron is currently the only sales representative for Australia, and is basically travelling where the demand takes him. I am a little concerned around how well they will be able to handle customer service issues, although I am told this will soon change. Updated: I am told there will be a full customer service team in the office to deal with any issues. They are the same team who looked after the Cozmo pump.

It is really, really exciting that we have a new insulin pump option on the market. I can’t wait to hear from people who do decide to take up this pump, and whether it would be a worthy option for me to consider in two years time. While it won’t be for everyone, I believe that this might be just the thing that some have been waiting for.

Special thanks to Aaron for being so patient with a group of crazily excited people with diabetes and answering all of our questions. No, Aaron does not have diabetes himself…

From the left: Me, Aaron, my friend Tammy, fellow blogger Ashley and Victorian Diabetes Educator Fiona.

Excitement that only someone with diabetes would understand!

FreeStyle Libre: Questions and Answers from #DX2Melbourne

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I’m back home today after a whirlwind two days spent at Abbott’s Diabetes Exchange event in Melbourne. The event was filled with such insightful and stimulating conversation, that my mind was still buzzing at 11.20pm last night when I finally crawled into bed at home.

Abbott covered my travel expenses from Perth to be there, but they did not pay for my opinions here or anywhere else. I am really grateful that Abbott are continuing these consumer conversations after last year’s DX2Sydney event, when they clearly didn’t need to. Perhaps my views are biased because I was a part of these conversations, but I am really enthusiastic about the FreeStyle Libre. My experience with it has been largely positive, and it continues to be a part time member of my diabetes toolbox.

It was fantastic to hear the Abbott team acknowledge and even encourage those little tips and tricks that people out there are already doing, even if they couldn’t technically endorse them. Like letting the sensor sit for a day after application before starting it up. Or the Rockadex patches and other adhesives that people are buying from small businesses online. I loved that they were somewhat aware of what people are doing out there in the real world.

Through my blog, through e-mails and through my circles here in Perth, I have received a great deal of feedback on the FreeStyle Libre. People either love it or hate it. Today, I thought i’d start by sharing some of the feedback I received from Abbott over the past two days. While I’m doing my best to relay what I heard and talked about, I can’t guarantee that these words are 100% accurate.

External adhesives.

Hands up if you’ve had a sensor fall off? During the days of warm weather, t-shirts and outdoor activities, that sensor is simply not sticky enough for me. Jessica Shi, Abbott’s QA and RA Manager, tells me that any external adhesive needs to be of medical grade in order for it to be officially endorsed.

Inaccuracy of the sensor when levels are high.

Ever had the Libre tell you that your blood sugar was 18mmol, while a fingerstick gave you a reading of 13mmol? There was definitely a conscensus among the room that some of us had difficulty trusting the sensor at times.

Bruce Passingham, Abbott’s Scientific Affairs Manager, told us he’s interested in hearing about each individual’s circumstances. There might be other conditions or medications that could be affecting results. He also touched on hydration as well, which is a no brainer for me when my levels are a little stubborn.

The biggest takeaway here is to make sure you call customer service. I am so surprised at the number of people who tell me that they haven’t bothered to. All of my issues have been resolved through customer service, and a few bloggers in the room praised the express shipping of replacement sensors.

When will we see the Libre funded by the Australian government?

Earlier this year, the Department of Health was seeking submissions from consumers to potentially get the FreeStyle Libre funded through the National Diabetes Services Scheme. It’s currently a bit of a watch this space…

Are there any plans to add alarms to alert users of dropping blood glucose levels?

In reference to the likes of Dexcom and Medtronic, Abbott have reminded us that their product is not a Continuous Glucose Monitor. It is a replacement for finger sticks.

How many people will an automated insulin delivery system actually reach?

Recent headlines out of the US have surrounded the partnership between Abbott and Bigfoot Biomedical, makers of an automated insulin delivery system. “Next generation” FreeStyle Libre sensors will supply glucose data, which Bigfoot’s system will use to automatically deliver insulin and regulate glucose levels.

My question to the team was around how many people the end product will actually reach. I was told that this next-gen Libre sensor can also be paired with a Bluetooth enabled insulin pen, which will provide smart dosing advice for those on Multiple Daily Injections. Abbott expect that their product will reach a greater number of people through the options for people with type 1 on Multiple Daily Injections, and those with type 2 diabetes.

Obviously, don’t expect to see anything like this to hit Australian shores for a long, long time…

This doesn’t even begin to scratch the surface of a very stimulating two days of diabetes conversation, and I’ll have more to follow in the coming days. You can also keep an eye on these bloggers who were in attendance, for their perspectives on the event.

Further disclosures: Abbott supplied me with a new FreeStyle Libre reader, two sensors, and a lovely goodie bag with some pens, paper and a few other bits of branded stationery. I was put up in a room at the Blackman Hotel in Melbourne for one night. I was also fed and watered across the duration of the event.