Insulin Pumps

Deciding to Switch To An Insulin Pump

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Diabetes has never felt more difficult to manage in these past couple of months. Quite frankly, insulin injections are just feeling like a lot of hard work.

The best results seem to come if I eat similar foods, consume a similar number of carbs and do the same level of activity every day. I can remember my diabetes educator telling me that most people have around 10 to 15 meals they have in rotation. Theoretically, once I knew the correct insulin doses for all of those meals, managing my diabetes should be a piece of cake.

However, that’s not always practical when you’re a human being.

Sometimes I feel hungrier than normal. Sometimes I don’t feel like eating. Other times I go out and I want to eat more than normal. I don’t always eat the same foods together on my dinner plate. Sometimes I’ll indulge if there’s leftover desert in the fridge. Above all, I don’t enjoy eating exactly the same thing each day.

I’d like to think I have a really good understanding of the effects that different foods have on my body. Some foods need a delayed bolus, some need a pre bolus and others need a bolus when I eat them. I have a good idea of the carb content in most of my foods, but I don’t rigorously count or weigh my foods. So, my insulin doses are generally a good old guesstimate.

Usually, guesstimates work well for me. However, I still like to test 2 hours after a meal in case I need to correct a high reading, or to stop a low in its tracks. If I eat something with a higher fat content later in the day, I can expect a spike after bedtime. If I’m eating something that’s digested really slowly, like pasta, ditto. Then there are the Lantus Adjustment Struggles. Will my Lantus dose will be enough, or not enough to match the food I’ve eaten in one day?

I cannot remember the last time that I did not have to endure the Nightly 1am Glucose Checks. I don’t enjoy them, but they are necessary. It’s been a long time since I’ve felt confident that my glucose levels will remain stable through the night. I absolutely hate waking up high. The thought of a blood sugar out of range for the 8 hours I’ve been asleep puts me in a really bad mood. I don’t like starting my day on that note. Night time testing helps a great deal. More often than not I do wake up in range, which makes it all worthwhile.

Which brings me to a big decision. To Pump, or Not to Pump?

Drumrollllllllllll……..

After much deliberation, I’ve decided that I’m going to give the insulin pump a go.

I’m hoping that with the pump’s ability to continuously deliver insulin, some of that work to regulate my levels in the background might be made a little easier. My hba1c level has fluctuated over the years, so I’m hoping that the pump might help me to achieve a little more stability.

Sure, it’s going to be a big learning curve. Sure, the pump is only as smart as the person operating it. Sure, I’m still going to have diabetes after it all…

But I really have nothing to lose. My Private Health Insurance will cover the cost. I’ll have as much support as I need from my diabetes clinic. And I can always go back to injections if I don’t end up liking it.

I’m thinking about the Animas Vibe pump, because of it’s compatibility with the Dexcom CGM which everyone raves about. I’m not really interested in a CGM at the moment, but it’s always nice to have that option for the future. My other options here in Australia are Medtronic and Roche. Opinions anyone?

It was a big decision for me to make, and I’m glad I took the time to think it through. I can’t thank you all enough for your friendly words of advice and support over these last few months.

I’m off to see my diabetes educator next week, and hopefully I can get this looooonnnng process started. Wish me luck!

Wishing one of my readers, C, the best of luck for her pump day today. 

The Severity of My Illness

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I am constantly reminded of the severity of diabetes in the media.

In the past, I haven’t often worried about my diabetes and it’s impact on my long term health. I am finding, however, that as my diabetes is getting older and I am taking more of an interest in my health (cue this blog), things are changing. During restless nights on the couch or in bed, I do find myself thinking about how my body is handling unpleasant blood sugar swings. Can it handle them? And for how much longer?

I’m sure I’m scaring myself silly. But as I’m reading through some confronting statistics in Diabetes Australia’s Insulin Pump Therapy in Australia: The Case for Action, the severity of the very disease that I live with hits home.

The incidence of type 1 diabetes in Australia has grown at a rate of 30% in the past decade, and there are over 3,000 new cases of type 1 diabetes every year.

High average hba1c levels are a strong indicator of the risk of developing long term diabetes complications.

The annual cost of type 1 diabetes to the Australian health system is $570 million, and the average cost per person is $4,669.

Finally, some people with type 1 diabetes cannot achieve optimal blood glucose control without the use of diabetes technology.

Sure, those haunting statistics aren’t intentionally targeted at me. Diabetes is rather an invisible condition. A lot of the people around us don’t see, or realise what we go through day by day in order to stay alive. As one of my readers, Maria, pointed out last week, sometimes we have to get serious in order to get our point across to those people who matter (politicians anyone?).

Yet, in spite of all of these factors, there are still so many barriers in Australia that prohibit us from doing what we are told to do.

The NDSS only subsidises around 5 test strips per day.

Potentially life changing Continuous Glucose Monitors are out of reach for many, as they are costly and not currently subsidised by the Australian government.

There are so many barriers to insulin pumping in Australia. Cost. Location. Income. Ability to afford private health insurance. Availability of health care professionals.

I also feel that more could be done to encourage diabetes technology, social media and other innovations in d-management. If you are a part of the Diabetes Online Community on Twitter, you’ll find a lot of enthusiastic insulin pumpers and CGM users. You’ll find a lot of engaged, passionate people who are always willing to provide helpful advice and friendly support. You’d be hard pressed not to be inspired and motivated by such an amazing community of people.

But thinking about my own journey prior to finding the diabetes community, the sad reality is that DOC is probably not representative of the entire diabetes population.

That, in my opinion, is the severity of this illness.

Finally, please wish Rodger Federer best of luck in tonight’s Australian Open Semi Final! 

The Barriers to Insulin Pumping in Australia

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Decision day for the pump is fast looming. To Pump, Or Not To Pump? One resource that I finally got around to reading was a PDF created by Diabetes Australia titled Insulin Pump Therapy in Australia: The Case for Action. It’s well worth a read, check it out here.

Since I was diagnosed five years ago, I’ve attended a Diabetes Clinic in a Public Hospital. I’ve had free access to all of my diabetes specialists there, and I really have nothing to complain about. I’ve managed my diabetes on Multiple Daily Injections ever since, and I never really knew any differently.

I’d heard of insulin pumping. I knew it was expensive. I can’t say I completely understood the concept. In my world back then, it seemed fairly uncommon. I thought that it was something for people who were struggling with their diabetes management. My diabetes care team never really suggested, or encouraged insulin pumping as an option for me.

It wasn’t until finding the Diabetes Online Community last year that I really began to consider insulin pumping as an option for my diabetes management. I began connecting with many others who were using insulin pumps. I read their stories about them. I saw how significant a part pumping played in their diabetes management. I read the all of the news reported on diabetes technology, and I realised what a big deal insulin pumping was in the diabetes world. I even found myself compelled to write about and advocate for technology that I wasn’t even using.

Reading that PDF today, I’m not surprised to see that only 12% of Australians with type 1 diabetes have access to insulin pump therapy. I need only look at my own situation to see how many barriers there are towards switching from Multiple Daily Injections to an insulin pump.

My healthcare professionals have never suggested, or encouraged me to consider insulin pumping in the five years that I’ve lived with diabetes. Sure, I was diagnosed as a young adult. Sure, on paper my chart is probably among the cream of the crop. My endo told me “this is the best I could hope for” as her patient. But that doesn’t mean I wouldn’t see benefits from insulin pumping. I’d like to bring my hba1c down further, because my diabetes isn’t getting any younger. I’d like better stability overnight without having to pour my blood, sweat and tears into doing so. I would love to be able to eat more spontaneously when the occasion calls for it, and be less stressed about doing so. However, it was me who had to spark this ignition towards considering an insulin pump.

I could qualify for a pump through the Australian Government’s Insulin Pump Program. This program would subsidise up to 80% of the total cost of an insulin pump. However, funds from this program are being allocated towards the cost of pump consumables, despite their availability at a subsidised cost through the National Diabetes Services Scheme. The end result is that my chances of being allocated funds for a pump would be significantly lower. And because I am over the age of 18, I wouldn’t qualify for a pump as my need for one is considered secondary to those younger than me.

So, thank goodness for my Private Health Insurance, right? They will cover the cost of an insulin pump of my choice. However, in order to get my private health insurance to pay for the pump, their policy dictates that I stay in hospital. Which means that I have to find a hospital bed which so many others are in genuine need of, when the pump could easily be administered in a clinic setting.

Then, if my pump malfunctions outside of it’s warranty and within the next four years, I will have to bear the cost of a replacement. Why? Because my private health insurance will only provide a benefit once every four years.

Finally, if I do choose to switch to the pump, there will be at least a three month wait. I’m in a public hospital diabetes clinic where there are more patients than there are resources and time. As a patient, I was quickly weaned off of diabetes education as soon as I was able to manage things on my own. Where pumping is concerned, a block of four consecutive education sessions won’t be available for three months. Which sucks when I’m at a stage where I’m absolutely sick of Multiple Daily Injections and ready for a fresh start.

Seriously, I love our health system here in Australia. But surely it’s time that we cut some of the red tape.

 

Dragging Diabetes Through the Christmas Season

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It’s definitely starting to feel like the end of the year. And I, for one, am feeling plain exhausted. Nothing out of the ordinary. Just that end of the year, over-it-all exhaustion.

I’ve had a lot of late nights recently. I’ve often sat down in front of the laptop with the intention of surfing the web for Christmas gift ideas. That’s often ended with me at the eBay checkout at midnight, after hours deliberating over goodies for myself. Last week it was a new phone case, a longer iPhone charging cable and some headphones with an extension cord. I was also hunting down an iPad, a new Medic Alert bracelet and a few diabetes books.

Work is beginning to feel plain monotonous. I don’t feel like I’m a human being during the mornings as I’m getting myself up and ready. I can no longer be bothered bringing my lunch from home. I feel about half as motivated than normal during the day. I stubbornly told myself that I’d work through it and save up my annual leave a few weeks ago. Now I feel like I am well and truly in need of a break.

I have zero motivation towards managing my diabetes well at the moment. There are get togethers and festive meals planned over the next couple of days. Boxes of chocolate, shortbread, Pannetone and candy canes are beginning to pile up at home. And there’ll be plenty of leftover food and deserts in the fridge to indulge in during the aftermath. I’m giving insulin injections my best guess, and closely monitoring my blood sugar levels about twice as much than normal.

Yet amidst all of this, I still somehow look forward to this time of the year. Going to the Christmas tree farm and cutting down our third real, live Christmas tree.

Seeing the suburbs light up in colourful Christmas lights in the middle of the Australian summer.

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Making the most of the sunshine and cool Summer weather before the heat sets in for the rest of the season. And yes, I can even spend Christmas at the beach!

Seeing family (some of them, at least!). Good food. Collapsing on the couch feeling stuffed and happy. Post Christmas bargain hunting (although I think I’ve already started on this one!)

Managing diabetes is hard work. I feel it more than anything at this time of the year, when everyone and everything else is taking time out to unwind at the end of the year. I would love to have the option for diabetes to shut up shop at this time of the year.

While that’s not a possibility for me, I am still proud to be able to enjoy this time of year. I can confidently say that diabetes hasn’t made Christmas too different since I was diagnosed. And in my eyes, that makes all the hard work and extra attention well worth the effort.

Merry Christmas. Wishing you a happy, and safe festive season.

– Frank

Revisiting Gwen

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I know that the decision to switch to an insulin pump is not something that I should take lightly. I’ve been deliberating the matter for a while. I wrote about it earlier this week here. I also recently went to see my diabetes educator, Gwen, for some advice.

Gwen is a truly amazing person. You can read about just how amazing she is right here. Gwen’s stated goal was to arm me with the knowledge and skills to manage my diabetes, so that her position as my educator would eventually become redundant. And it sure did. The last time I had a session with Gwen was back in 2010, towards the end of my first year living with diabetes.

I knew that Gwen was always available to me outside of appointments if need be. I had her phone number, e-mail address, and I can even remember her squeezing me in once during her lunch break when I was anxious about too many hypos. I can remember giving Gwen a box of chocolates on the first Christmas after my diagnosis, because she had just been so wonderful during that first year of diabetes. I’ve seen her a few times in passing at the clinic when I go to see my endocrinologist. However, since transitioning from the ‘young adult’ to ‘adult’ diabetes clinic, I’ve seen her less frequently.

I was extremely nervous to go back and see Gwen a few weeks ago, after such a long time. In the car on the way there, I was reciting over and over in my head what I would say to her. Would she take what I needed to say seriously? Would she be supportive of insulin pump therapy? Would I talk to her about my blog, and my involvement in the Diabetes Online Community this year? Would she even remember me?

But walking into her office that day, my nerves were instantly settled. As she began reviewing our last session five years ago, she was so thorough. As she talked through the results of my last endo appointment and hba1c result, she was so familiar and so well prepared for me. As her patient, it felt as though that last session five years ago could have taken place just yesterday.

So, Gwen’s verdict on pumping, in a nutshell?

A pump is a big commitment.

Pumping is not any “easier” than Multiple Daily Injections.

However, a pump can give me more “flexibility.” A pump delivers insulin constantly in order to regulate glucose levels, as opposed to injections which are given at set times of the day. The rate at which a pump delivers insulin can be adjusted throughout the day to factor in activities such as work, physical activity and sleep. The units of insulin delivery on pumps are so precise that you can bolus for something as small as the milk in your coffee!

There are also a few requirements for pumping in Australia.

First up, I must have an appropriate level of Private Health Insurance for a period of at least 12 months, in order for the cost of a pump to be covered. Big tick there.

Second up, I need to show that I qualify for a pump. Translation: I have type 1 diabetes and I’m a good student who will show up to my education sessions. Big tick there.

Third up, a pre education session with Gwen (big tick there), where paperwork is completed and passed onto my endo for sign off (not quite there, yet).

Finally, pump fitting day followed by 3-4 daily sessions with Gwen in order to fine tune the pump. Sadly, there’s a 3 month waiting list at my diabetes clinic for this.

I’m really glad that I did go and get another perspective from Gwen that day. Gwen was plain thorough. She discussed the matter with the seriousness that it deserved, without trying to sway my decision either way.

So, as the session came to an end, I sensibly decided that I would go home and think about it, and come back in the New Year for another check in. Class dismissed!