Glucose Monitoring

First Shot of Fiasp

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This morning, I woke up to a blood sugar of 8.4. It had come down a little from a 12.7 earlier in the morning, largely thanks to a late dinner of chicken and chips the night before and an inability to keep my eyes open for much longer after that.

Normally, starting my day even slightly out of range would be a recipe for disaster. The high combined with dawn phenomenon and my non negotiable morning coffee would be sure to send me even higher.

However, today I had a new tool at my disposal.

If you haven’t heard of Fiasp, it’s a brand new and faster acting insulin from Novo Nordisk. It begins working within around 5 minutes of injecting, compared to the 15 that I’m used to with my Novorapid. It’s approved for use in people over the age of 18 and was listed on the PBS here in Australia on the 1st of June, meaning that people with diabetes can access it at a similar subsidised cost to other insulins.

Although I’m not visiting my endo until tomorrow, I was lucky enough to be hooked up early with a spare pen from a friend of mine until I receive a script of my own. In return I promised her that I wouldn’t come back and hold her liable for any consequences of my mischief. Which brings me back to this morning.

I got up out of bed, switched on the lights and reached for the spare box of needles in my wardrobe. I screwed the needle onto my Fiasp pen, and injected two units. Half an hour later once coffee was in my system, I was 8.3.

Another 40 minutes later, and my blood sugars were back in range.

But this story still isn’t over.

I was also running a little late out the door this morning. Not having time for breakfast, I decided to wrap up three Weet-bix to take to work. Fun fact: Weet-bix also spikes my blood sugar without a decent pre-bolus. Weet-bix is one of those foods that I instantly think ‘high’ and not worth the effort. I don’t think I’ve ever eaten Weet-bix and not gone high.

So when I arrived at work with around 10 minutes to spare, I injected another 2 units of Fiasp to cover me for the Weet-bix. The highest blood sugar I registered was 7.3 around an hour and a half later, before eventually drifting back down into range.

It was like magic.

Fiasp, I love you already.

Review: Contour Next One Blood Glucose Meter

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Back in August, Ascensia Diabetes Care convened a group of diabetes bloggers in Adelaide for the launch of their new blood glucose meter, the Contour Next One. You can read more about what was discussed during the actual event in this post.

Blood glucose meter accuracy isn’t something I’ve really considered prior to the past two or three years where I’ve taken a more active role in managing my blood sugars. When I was first diagnosed, I just accepted that a blood glucose meter was a blood glucose meter. Since connecting to other people with diabetes, and the emergence of new choices, I’ve come to realise that I can actually choose the devices that best suit my needs.

I was most impressed by the 8-ish percent accuracy that the Contour Next One boasted, which even beats out Roche’s AccuChek Guide which is my meter of choice. I’ve been using it on and off over the past couple of weeks, and I have to say that overall I am impressed.

I really like the sleek design of the meter. There’s a strip port light for testing in the dark, which is a little tricky to find as it does not automatically illuminate when you insert a strip. You’ll need to press your menu button twice before inserting your test strip. Readings are colour coded as red for ‘low,’ green for ‘in range’ and yellow for ‘high.’ The port light will also flash with the corresponding colour to reflect your blood sugar if you wish. I found that annoying and turned it off.

Like the Guide, the Contour will wirelessly transmit blood glucose readings from your meter to the Contour Diabetes app on your phone. It’s a really visually pleasing experience, and my readings seem to sync to the app with more ease than the Guide does.

My favourite feature is being able to see all of my readings plotted on a 24 hour graph, which is the next best thing to having a FreeStyle Libre or CGM. The colour markers are handy in this context. It will also produce time period averages, which can also be further classified (before meal, after meal, exercise etc.) if you place a ‘marker’ on each of your readings.

So far, the Contour also wins out over AccuChek on battery life. Since August, I’ve probably gone through four or five boxes of test strips using the same meter and batteries that came with it. I can’t give you an exact statistic, but it does feel like I’m constantly seeing the low battery icon pop up on my Guide.

Another thing I learned at the summit is that apparently I shouldn’t be paying for meter batteries, much to the amusement of others in the room. Ascensia have explicitly stated that replacement batteries are included with the meter, and can be ordered online. Apparently the same applies to most other brands of blood glucose meters, too!

The test strips come in capped vials, which do seem quite bulky after using AccuChek’s impressive spillproof vials. The meter does give you more time to apply more blood to the strip if your sample is inadequate. I’ve only just pulled out my Guide today and have already been met with a few pesky strip fill errors, making me appreciate this feature even more.

The lancing device also feels very ordinary, albeit with multicoloured lancets.

I have to admit I haven’t purposefully done a lot of testing in regards to the accuracy, but the few times that I have it’s come up very close to the Guide. I’ve also tested on a few dusty fingers at work and the results have been very trustworthy. The readings match with how I am feeling, as well.

One area where the Contour Next One would really excel is by adding a bolus calculator to the app. I feel like I’m flogging a dead horse here in repeatedly saying that diabetes apps have no value for me without one!

Ascensia also expressed their vision of supporting interconnected diabetes management systems, and another area where their meter would excel is in capabilities to transmit blood glucose readings into insulin pumps.

All in all, it’s a really neat meter and I will most likely continue to use it. Ascensia are also offering free meters through their website here, if you wish to try it for yourself.

Disclosures: Ascensia provided me with a Contour Next One meter at the Diabetes Social Media Summit I attended in August. I also accepted hospitalities during the event, details which can be found in this post. I have not been asked or paid to write this blog, and all thoughts expressed here are 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.

Review: FreeStyle Insulinx Blood Glucose Meter

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This week, I’m on a mission to deplete my remaining supply of FreeStyle Lite test strips. My calculations tell me that they should be depleted by early Thursday. The one piece of motivation that’s getting me through these final days is the mental promise of a new FreeStyle Libre sensor at the end of it. As part of this final hurrah, I thought I’d take the opportunity to celebrate the ‘life’ of my FreeStyle Insulinx meter over the past two and a half years.

I was first given an Insulinx back in 2015 after I had reconnected with my diabetes educator to discuss insulin pumping. This was a meter with a built in bolus calculator that would help me to become familiar with counting carbohydrates, which is what I’d eventually have to do on an insulin pump.

I had been using the same blood glucose meter since the day I was diagnosed. I didn’t know too much about diabetes back then, or some of the more ‘modern’ options that were on the market. Or the fact that ‘free’ meters were so easy to come across, because companies actually make money from the test strips!

The Insulinx was my first ‘modern’ glucose meter. I loved the test strips that were conveniently stored in capped vials, rather than being wrapped in foil. The USB cable, which meant that I was able to upload the data to my computer for review. There was a backlight for testing in the dark. It also used a much smaller sample of blood, and gave you an additional 60 seconds to apply more blood. No more annoying strip fill errors!

As much as I welcomed these modern features, I didn’t really make much use of the bolus calculator function. Mostly because I wasn’t motivated to count carbs and log insulin doses at the time.

Fast forward to today where I’ve tried many more meters and am generally more switched on to what my blood glucose levels are doing, the FreeStyle Insulinx simply does not meet my needs anymore.

The ‘Lite’ test strips may require a smaller sample of blood (0.3uL), however I feel that it’s easier for any sweat or moisture on my fingers to affect the blood glucose reading. I’ve been trying to combat this by extracting a larger drop of blood from my finger and making more of an effort to wash my hands prior to testing. I also don’t like not being able to physically ‘see’ the blood going onto the strip like other meters do.

The bolus calculator on the Insulinx isn’t as comprehensive as the one you might find on a pump or smartphone apps such as RapidCalc. Little things like being able to adjust carb ratios while I’m on my feet at work are a big deal for me. During pump breaks and even while using the YpsoPump, I haven’t even considered the bolus calculator that’s contained inside my Insulinx.

All of these gripes aside, I simply haven’t found the results to be as consistent or as trustworthy as my AccuChek Guide. Just last week I had something like a 12.7, a 10.1 and then an 11.6 in a row with clean fingers. Alternatively my AccuChek Guide has chalked up impressive consistency, even when throwing some grubby work fingers into the mix!

Due to its bolus calculating capabilities, the FreeStyle Insulinx is only available from a healthcare professional. If you’re using a FreeStyle Libre, the same bolus calculator is also built into the reader. Just make sure to ask for the code to unlock the bolus calculator.

I’m mindful that I’m a huge adopter of diabetes technology. Perhaps that’s why I’ve gravitated towards wireless systems such as Contour Next One or AccuChek Guide that will sync readings to my iPhone via Bluetooth for instant review.

For people who do want something simple and may not have the latest whiz-bang smartphone, this could be the perfect option for you.

AccuChek, MySugr and Eversense at the Diabetes Congress

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At the Diabetes Congress last month, I had the pleasure of reconnecting with the team at Roche Diabetes Care, whose stand had turned a noticeable shade of green. But more on that in a moment…

The AccuChek Guide is currently my blood glucose meter of choice, and for good reason. Not only is it a meter that I can trust, but it’s also a modern one that’s designed for the 21st century. One of my favourite features is its Bluetooth, which wirelessly transmits blood glucose readings to the Accu Chek Connect smartphone app for instant review.

My biggest gripe about most diabetes smartphone apps are their lack of bolus calculators. I can personally see no benefit in logging things like insulin doses or carbohydrates without the essential ingredient that delivers value to me: a bolus calculator.

Despite using an insulin pump, I have found myself in need of a good bolus calculator several times over the past two and a half years. I’ve taken three breaks from my insulin pump during that time, in addition to also using the YpsoPump which does not have a built in bolus calculator itself.

The bolus calculator contained within the AccuChek Connect app has been disabled for over 18 months now, due to a bug that was over estimating insulin doses. I’ve put out calls for help on Twitter and Googled in search of any hacks with very little luck. I’ve been waiting patiently for an update that is yet to surface.

While the Connect app is still available to use, I was told that there are no plans to resurrect the bolus calculator anytime soon, with Roche now focussing their efforts on MySugr.

MySugr is basically a diabetes logbook app with the aim of ‘making diabetes suck less.’ Hence all the green in the stand. I have not personally used it, but I do hear it is quite fun and motivating to use.

The AccuChek Guide will wirelessly transmit blood glucose readings into the MySugr app. I was also pleased to hear that an extension of a bolus calculator to the app is awaiting regulatory approval. Fingers crossed!

Despite Roche’s exit from the insulin pump market in the US last year, AccuChek insulin pumps are still being manufactured in Europe and I have still been reading headlines about new developments in the pipeline. Roche insulin pumps don’t appear to be a popular choice among Aussies, and I did wonder if the lack of insulin pumps on display was a reflection of this or a lack of confidence in their product. Or perhaps I simply didn’t see the pumps on display…

More excitingly, I have heard that Roche has plans in the pipeline to distribute the Eversense implantable CGM system in Australia. I don’t know much more than this, and the system will of course need to receive regulatory approval first. You can have a read of this guest blogger’s review from Europe over at Diabetes Strong.

While Roche may not be the most well known for insulin pumping or CGM systems, they are clearly leading the way in blood glucose monitoring. Given that most people manage their diabetes using standard blood glucose monitoring, that’s not exactly a bad thing.

More enhancements and innovations that will support people in their chosen therapy is always a good thing.

And a cool new coffee mug. Because more excuses for coffee is also a good thing.

Disclosure: Diabetes Australia covered my travel, accommodation and registration costs to attend the Australasian Diabetes Congress. These are my own views, and not those of Diabetes Australia. My time, including the annual leave I took from work to attend, was my own.