Insulin Pumps

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…)

V-Go Insulin Pump Launches in Australia!

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Also launched alongside the t:slim x2 insulin pump at the Diabetes Congress last month was the V-Go disposable insulin delivery device. It’s been available in the US since 2012 through a company called Valeritas, and AMSL diabetes have signed on the dotted line to distribute this baby in Australia.

Designed for people with type 2 diabetes, this patch pump holds a 24 hour supply of rapid acting insulin. It delivers a fixed rate of basal in the same continuous fashion as a regular pump, and comes in three different sizes delivering 20, 30 and 40 units of basal insulin respectively. The basal rate cannot be adjusted, and the size you are prescribed will depend on your weight and insulin needs.

Each V-Go can also hold an additional 36 units for bolus insulin as needed. Boluses are delivered at the push of a button on the pump itself, with each click delivering 2 units of insulin. If you are on smaller doses of insulin, this pump may not be suitable for you.

The pump does need to be replaced daily, which could be a hindrance, although I don’t see why you couldn’t pre-fill a few days’ worth in advance. Any leftover bolus insulin in the V-Go at the end of the 24 hours cannot be reused, so bolus insulin needs are definitely something to be mindful of when pre-filling your V-Go.

Each V-Go is pre filled with insulin using an Ez-Fill device. The insulin delivery device slides in at the bottom, your insulin vial sits at the top and then insulin is pushed into the V-Go using the plunger. I am told that the Ez-Fill is designed for use with insulin vials only.

Once the device is filled, you simply stick the patch onto your skin. It’s approved for use in the arms, thighs, abdomen or legs. A press of the needle button on the surface will release the needle contained within the pump and commence the delivery of insulin. The needle retracts once you’re ready to remove the device.

The V-Go system is sold in a 30 day kit which contains 30 insulin delivery patches and an Ez Fill device. It does seem a little wasteful to include a new Ez Fill in every kit!

The V-Go is not currently subsidised through private health insurance here in Australia, meaning that users will have to bear all of the out of pocket costs. The 30 day kit retails for $250, which works out to approximately $8.30 per day. This is considerably more than both Multiple Daily Injections and the subsidised insulin pump consumables we have available to us through the NDSS. However, I do like that this would be easy to trial without a larger commitment if its not for you.

Overall I can see why this device might appeal to someone with type 2 diabetes, and also the older individuals who are modelling the device in the demo kit. It’s mechanical in nature and free from any programming. The application looks far easier than an infusion site. Click to bolus looks both easy and discreet. The demo kit also indicated that many people missed their insulin doses due to needles not fitting into their lifestyle.

The main criticism I have noted in forums is that this device may not be suitable for people with heavier insulin resistance and larger insulin doses. I was also unimpressed to read so much focus on ‘improved patient adherence’ throughout the demo kit. Language Matters!

I am told that people with diabetes are free to complete the V-Go order form which can be found on the AMSL diabetes website. However, users should go through their endocrinologist or diabetes educator to prescribe the basal and get set up.

As tempted as I am to trial the demo kit of my own that I received, the fixed basal rate won’t meet my needs as a type one. Although it was suggested that I try it next time I have a pizza night! I also enquired as to whether there was a way to use it for bolus insulin only, but unfortunately there is no way to stop the flow of basal insulin once the needle is released.

Overall, I think it’s great to see more options to meet the needs of all people with diabetes. I really do hope that AMSL will try to involve some people with type 2 diabetes in the launch of this product, as they would be better equipped to talk about it than I am.

Disclosures: 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.

AMSL Diabetes hosted me at a bloggers evening during the ADC, which was primarily focussed on the t:slim insulin pump. I was fed and watered across the duration of that evening and received a small bag of stationery.

I later visited the AMSL booth in the Exhibition Hall to learn more about the V-Go, where I was given a demo kit of my own to take home. I was not asked to blog about AMSL or the V-Go. My opinions and my time, including the annual leave I took to attend the ADC, are my own.

Dressing for Diabetes

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Most of the time my insulin pump sits clipped safely inside the left pocket of my track pants, pyjama bottoms, jeans or shorts. I’m pretty grateful that pockets are the norm in most of the clothes that I purchase these days.

I’ve tried clipping my pump to my waistband, but to be honest it just doesn’t feel comfortable there. It’s harder to reach, more work to put back and easier to knock into things.

Most of the time, my insulin pump doesn’t bother me inside my left pocket.

Until I get dressed for work, and tuck my business shirt into my trousers.

Then, my insulin pump definitely bothers me.

I don’t particularly like seeing my pump line protruding from my waistline all the way to my left pocket. I don’t enjoy having to rein my line back in through the day as it comes loose from constant movement. I hate having to navigate my iPhone around my pump line every time that I dive into my left pocket to reach for it.

The other morning as I was getting dressed for work, I could really feel the frustration.

In a moment of diabetes randomness, I pulled my insulin pump band out from inside my diabetes junk drawer. I pulled the blue band over my head and shoulders, pulled my arms over and settled it low around my waist until it finally started to feel comfy.

I grabbed my pump and concealed it inside the pockets of my blue waistband, shuffling it around on my waist trying to find somewhat of a comfy spot. I finally settled just past my left hip, heading closer towards my back. After a bit of fidgeting, I tucked my shirt in and it didn’t feel all that bad.

An hour later I was at work, moving around. I could feel my pump band shifting away from my comfy low zone and slowly creeping up my waist. I could feel myself going low, instantly regretting the 1 unit I had given myself for the eggs I’d eaten for breakfast.

As I walked back to my desk and popped open my jar of glucose tabs, I remembered exactly why I’d never done this before. As I instinctively reached for my pump to check how much insulin I had on board, I was reminded why I liked having my pump clipped in my left pocket rather than anywhere else.

Some days I glance at my pump in the mirror while getting dressed and feel so comfortable having it there to help better manage my blood sugars for me.

Other days I feel dirty, weighted down and different for having it there.

The size of diabetes devices really do make a difference to my mindset and quality of my life.

For the time being, it’s just something that I’ll have to learn to live with.