Insulin Pumps

Cellnovo on Show at the Diabetes Congress

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I had the pleasure of reconnecting with the Cellnovo team at the Australasian Diabetes Congress last month.

The Cellnovo insulin pump launched 12 months ago, with the availability of consumables on the NDSS eventually delayed by a month. The system consists of a small rechargeable pump that sticks to a velcro patch on the body, a very short line and an infusion set that sits within close proximity to the pump. The system is controlled wirelessly via a mobile handset. You can read more of my observations from last year’s launch here.

There were rumours circulating earlier this year around the system being unable to withstand the heat of the Australian summer. I was told that this issue was nothing more than a temperature sensor in the pump that alerted users when insulin was at risk of spoiling, such as during hot days at the beach (Tandem’s t:slim pump also contains an insulin thermometer). I believe that the system may have since been upgraded to address the uber-sensitivity of the alarms.

Last year Aaron Crook was the sole sales rep, travelling all over Australia where the demand took him. There are now several new additions to the team. I was pleased to meet a dedicated sales rep for Western Australia, who reminded me that we had met previously when she had worked for Roche (and shown me how to use the eject button on the AccuCheck Guide!)

Cellnovo will soon be rolling out a new handset to all of their customers. The upgrade features a larger screen than its predecessor, and is also much slimmer and sleeker to hold in my hands. I am told the primary reason for this upgrade is enhanced performance. The team are also in disagreement on its new colour scheme, which gets a thumbs up from me.

The upgrade has come at the expense of the test strip port that was built into the handset. For the Cellnovo customer who may not be too keen on attachment, the prospect of now having to carry a blood glucose meter may be a big deal.

For the time being, users will need to manually enter their blood glucose readings into the handset to use the bolus calculator. However I was told that the handset will soon be compatible with a variety of wireless blood glucose meters, meaning that readings will wirelessly transmit to the handset via Bluetooth.

I really like the idea of having a separate handset to control the pump. With the emerging integration of diabetes management into smartphone apps, phone performance and battery drain has definitely been very noticeable for me in recent months. It’s also good to know that I could leave my phone on my desk if I wish to.

Cellnovo may not sit in the ranks of Medtronic or Tandem, but they are clearly focussed on filling a gap in the insulin pumping market. There are many people who don’t wish to take up insulin pump therapy for the sake of attachment and pump lines and weight and complexity.

I feel that Cellnovo is the option that may get many to reconsider their feelings toward insulin pump therapy.

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. My time, including the annual leave I took from work to attend, was my own.

Medtronic 670G System Closer to Approval in Australia

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Medtronic Diabetes made an announcement last week regarding their 670G hybrid closed loop system, and last week I had a chance to catch up with the team at the Australasian Diabetes Congress to clear up some of the confusion.

Medtronic’s 670G hybrid closed loop system consists of an insulin pump and a CGM that, when combined, will automatically adjust basal insulin based on CGM readings to regulate blood glucose levels. Of the many hybrid closed loop systems currently in development, Medtronic’s is likely the closest to hitting the market.

Last week’s announcement was the approval of the 670G insulin pump. What has not been approved, however, are the CGM sensors that are compatible for use with the 670G pump. Without approval of the sensors, the system is not yet available for use in Australia.

It’s hard not to overlook the fact that AMSL were also launching the Tandem t:slim at the time of Medtronic’s announcement. We have relatively new options in Cellnovo and YpsoPump, that are also shaking up the pump landscape here in Australia.

Medtronic’s hybrid system is now available in the US. Clinical trials undertaken with this system have been going on in Australia for quite some time. Melbourne endo David O’Neal presented some early clinical trials back at Diabetes Advocates Day last year. I have spoken with a few people who have trialled this system – both blinded and unblinded – and their reactions have clearly been life changing.

The 670G system can be used in both manual and auto (hybrid closed loop) mode. My understanding is that the user will need to use the pump in manual mode for a few days for the system to collect insulin data, before being able to switch to auto mode.

Most notably, this system will only correct blood glucose levels to a target of 6.6mmol/L. For some, this target will be fantastic, while for others it won’t be acceptable. I see this reason as twofold. Firstly, this ‘safer’ target range likely makes a system of this nature easier to receive approval. Secondly, this will also pave the way for Medtronic to sell an enhanced system down the line with a better blood glucose target. I believe that there is a 690G system in the pipeline already!

During the Congress, several clinical trials undertaken using the 670G were referenced. CDE Sue Wyatt told us that there was still another six months to go in a study she was referencing with the 670G system, which was rather telling about a timeframe for approval of these 670G compatible sensors.

Medtronic are currently offering new customers who take up insulin pump therapy (currently a 640G system) a free upgrade to the 670G system when it is approved for use in Australia. New pumpers are also being offered six months of free Continuous Glucose Monitoring with no further obligation, which can be used anytime between now and March 2019.

Despite being told that Medtronic were committed to making the latest technology available to people with diabetes, this offer excludes existing Medtronic customers – including our very own DAPeoplesVoice team member Melinda Seed. Having recently upgraded her pump, she will have to wait four years before having the option of this system available to her. Shall we start a #670GForMelinda?

Another criticism would definitely have to be the size of this pump. Many users have expressed disappointment that Medtronic have been making their insulin pumps larger than previous iterations. After briefly holding the 640G pump on show, it stacked up bigger than my late Animas Vibe, YpsoPump and t:slim I played with last week.

I also don’t regret highlighting to Medtronic the importance of not making Multiple Daily Injections feel shameful in marketing their products. Admittedly, it has been some months since I have seen such material surface and I do feel that they are taking this feedback on board.

One year ago, the insulin pumping landscape was looking very dire for people with diabetes. Today, we have a several choices for people considering insulin pump therapy here in Australia.

At the end of the day, more choice for people with diabetes is always a good thing.

Disclosure: Diabetes Australia covered my travel, accommodation and registration to attend the Australasian Diabetes Congress. My time, including the annual leave I had taken from work to attend, was my own. These opinions are also my own and do not reflect those of Diabetes Australia.

Tandem t:slim X2 Insulin Pump Launches in Australia!

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Tandem’s t:slim X2 insulin pump officially hit Aussie shores last week at the Australasian Diabetes Congress. It will be distributed by AMSL Diabetes here in Australia as a successor to Animas, which is in the process of exiting the pump market. AMSL invited me to a launch dinner in Adelaide last week, where I had the opportunity to play with (but not keep) this new diabetes toy.

AMSL diabetes will be upgrading all of their customers with an existing, in warranty Animas Vibe insulin pump to the t:slim over the course of the next 12 months at no extra cost. Customers will need to return their old Animas pumps within one week as a condition of receiving the upgraded pump. This is a part of AMSL’s contract with Animas.

This upgrade is basically treated as a replacement for the pump I have already paid for two years ago. Then, in two years when my warranty period is up, I will be eligible for another through my private health insurance. It makes complete sense. Besides, AMSL will only have limited capacity to service Vibe pumps now that Animas have gone out of business.

AMSL have a dedicated transition team looking after upgrades, and they will be getting in touch with eligible customers over the next twelve months. You will need to go through a healthcare professional, which is regulatory, but frustrating considering I already know how to use an insulin pump! I hear that upgrades are expected to commence in October, however customers who wish to remain on an Animas Vibe will also be supported.

During the evening we heard from Aymeric Lecanu-Fayet, Senior Director at Tandem Diabetes Care in the States. The t:slim was designed based on over 6,000 interviews of people with diabetes, attempting to close the gaps that prevented people from using an insulin pump. Things like making it look modern like a smartphone, easy to use and easy to learn.

Kerri Bandelin, International Clinical Manager at Tandem then took us through a workshop with the pump.

The tslim has the option of integration with a Dexcom CGM, and the battery is rechargeable. The charge will last for 5 days if you’re using it with CGM integration, or 7 days if you’re using it standalone. The rechargeable battery is also covered under warranty in the off chance that it does get damaged. Those non diabetic lines sure are something to envy!

Users are normally encouraged to recharge their pumps while they’re in use. Suggestions were while on the couch, in front of a computer or while in the shower. We were also told that there is no such thing as over charging this pump, something I’m always mindful of when leaving my iPhone plugged in for too long. A full charge takes 1.5 hours on a dead battery, but I also got the impression that short charges of 15 minutes won’t do any damage to the pump’s battery.

We were told that the pump can be used with Animas infusion sets, but not insulin cartridges. Tandem consumables are on the ship as we speak, and I’m pleased to hear that there will be an option of angled sets. I was also pleased to hear that Australia will be receiving t:slim pumps with an updated algorithm that won’t trigger unnecessary occlusion alarms.

Insulin goes into a black hole, which is a bit concerning for detecting air bubbles. The minimum fill is 95 units, with the cartridge having a capacity of 300 units. We were told that there is also a thermometer inside the cartridge which can alert to risks of spoiled insulin. Carb ratios could be adjusted in increments of 0.1 when going past the 1:10g mark. There are also 6 different basal profiles with 16 different time segments.

The most promising feature for me is the ability to receive upgrades to this pump in the same fashion as upgrading your iPhone’s software. Basal IQ with Dexcom G6 is expected to launch this Australian summer, but is not yet approved. The system predicts glucose levels 30 minutes ahead and suspends insulin if levels are expected to drop below 4.4mmol.

We were told that this upgrade would be free, however I wasn’t impressed to hear that I would have to go through a healthcare professional every time there is an upgrade. I know there are regulations. But considering I already know how to use an insulin pump and spend relentless hours managing my diabetes on my own, it definitely feels like an insult to my lived experience.

Also in the pipeline is Control IQ. This upgrade would automatically adjust basal insulin levels in response to CGM readings, as well as deliver automated correction boluses. I would stress that this is only in its infancy, with a current 6 month study happening in Germany. Tandem would also not confirm whether this update would be free or not. I also got the impression (not an official comment) that the blood glucose target on this system would be better than the 6.6mmol target on the Medtronic 670G.

We were told that the pump would fit inside the coin pocket of a pair of jeans. What I didn’t like was the bulky case with a clip that added significant bulk to the pump. It was heavier than the YpsoPump at 113g, and here’s how it stacks up against the late Animas Vibe that I was wearing. We were told it is the size of a credit card.

It felt refreshing being able to type in numbers, rather than scrolling through until reaching your desired number. Nice and modern and sleek to use, just like the YpsoPump.

While I don’t think CGM will be in my budget anytime soon, I do feel hopeful that we are getting close to finally closing the loop.

Finally, we have a hashtag happening. A completely selfish one.

It’s #TslimForFrank.

Please jump onto social media and use it generously.

I have been dreaming of this little pump hitting our shores since forever, and I would love nothing more than to provide you with a user experience.

Disclosures: AMSL Diabetes hosted me at a dinner on Wednesday evening with a group of other Aussie diabetes bloggers. I was already in Adelaide for the Diabetes Congress as a guest of Diabetes Australia. I was fed and watered across the duration of the evening, and received a small bag containing a powerbank, information packets and an AMSL penguin. There was no expectation that I would blog about the t:slim. My opinions and my time, including the annual leave I had taken from work to be there, are my own. 

Lack of Back-Up.

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I was in the bathroom at work when I first noticed it. A small, deep purple bruise was forming beneath the clear plastic window of my infusion site.

I was a little surprised, given that it had already weathered 24 hours worth of insulin boluses and a good night’s sleep. But I was also not surprised, given it was placed smack bam in the centre of my stomach where I have the least meat on me.

My mind wandered to the pencil case sitting on my desk, however I soon realised that the spare infusion set sitting in there belonged to my YpsoPump. Not a match for the late Animas Vibe I had replaced it with three weeks ago.

My mind wandered to the demi pen and needles that I carry around with me. However, I soon realised that there was no insulin cartridge in there because I’ve been feeling a little paranoid about insulin going bad until recently.

My mind wandered to the Chemist outside, which would probably loan me some insulin if I presented my NDSS card and promised to return with a script. However, I soon realised that it would be wasteful given all of the insulin I had in my fridge at home.

My mind wandered to the low carb chicken salad that I had packed for lunch. However, I soon realised that there were also amazing croutons in there that I had baked with the chicken juices. Not to mention that my blood sugar might also be a little high if the site was failing.

My mind wandered to the needle that was contained in my YpsoPump infusion set. However, I soon realised that there was no way that I would be able to macgyver it to reapply my failing infusion set into a fresh spot.

My mind wandered to my lunch hour, where I would probably have enough time to drive home and come back. However, I soon realised that even though I lived close enough, I could not be bothered rushing there and back and wolfing my lunch down afterwards.

My mind wandered to my Dad, who I felt super guilty for bothering, but who I also knew wouldn’t ever complain about having to deliver an infusion set to me at work.

It’s been a long time since I’ve had an infusion site fail on me well after placing it. I guess in the back of my mind I’ve been putting off updating my travel kit, telling myself it won’t happen. 

I bring my pencil case carrying all of my diabetes back ups with me almost everywhere I go. I hardly ever need to fall back on it when I’m out and about. And yet the one time I do, I don’t have the right stuff in there!

Do Your Insulin Needs Increase During Winter?

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I could feel my blood boiling.

With every single swipe of my FreeStyle Libre reader against the sensor on my arm, I felt increasingly frustrated.

Despite being pretty confident in what I’d eaten and covered with insulin for dinner, my levels dipped slightly before slowly but steadily ascending once again. A pattern that had become somewhat typical over the past couple of weeks following meals.

Despite correction after correction, my blood sugar levels were yet to budge.

My mind wandered back to the pump break I had taken in late April and May. I thought about how easy blood sugar levels had been to manage with pens and needles. How free my mind had been from frustration.

That pump complacency I felt on the night I disconnected my pump in late April had returned. I didn’t want to be feeling it, but it was there, plaguing my thoughts against my own will.

Then, I just had this sort of ‘epiphany.’

I set a temporary basal rate increase of 10% on my insulin pump, hoping that it would help my correction doses to start working better.

When my insulin still seemed ‘sluggish’ a few hours before bed, I increased it to 20%. After a few more days had passed, I went into my pump settings and permanently adjusted the basal rates upwards by 20%.

I’ve heard it discussed before in the diabetes community. I’ll be the first to admit that I never brought into the whole concept of insulin needs increasing during the Winter. And decreasing during the Summer, for that matter.

I don’t know what causes it. There’s been no significant change in my activity levels. I’m very active during my work day as usual, and don’t go anywhere near the gym or a pair of running shoes when I’m at home. My routine is the same. Admittedly, I probably spend less time outdoors or in the sunlight at the moment. Maybe there’s an increased inclination to drink coffee, eat cannoli and watch Australian Survivor.

More than anything, I think it may be an environmental or physiological factor.

I’m just grateful that my insulin is working again and that I can spend more of my day in range, fighting less of an uphill battle in doing so.

After eight years, I’m still learning new things about my diabetes. I truly believe that the more time and experience I have under my belt, the better equipped I am to live with it.