Insulin Pumps

YpsoPump: The First Few Weeks (Part One)

4 Comments

I’ve been staring at my chunky old Animas Vibe with its holes in the coating and an interface from the ‘90s, thinking about how I will possibly be able to while away another two years before its warranty is up. I’ve been dreaming up scenarios in my mind where new pump options would arrive on our shores and be rolled out to existing Animas customers sooner rather than later.

But I never, ever, really imagined that I would have one of these exciting new options in my hands so soon.

(This is the part where I tell you that Ypsomed Australia provided me with a YpsoPump and consumables to take home and trial. Followed by the part where I tell you that was no expectation that I would write, or even trial the pump itself. Followed by the part where I remind you that there’s a bias in place and that you should take my enthusiasm with a grain of salt).

I’ve been YpsoPumping for almost four weeks, and I am absolutely loving how sleek and light it is. When I started pumping insulin two years ago, I wanted it purely for the benefit on my blood sugars. I never thought that this sleekness was something that I could ever ask for, or want, in a pump.

It weighs eighty three grams, inclusive of a AAA alkaline battery and filled insulin cartridge. To put that into perspective, It’s about half the size of my wallet and a third of the size of my iPhone. Did I mention that it’s slimmer, too? I hardly notice it in my pocket when I’m lounging on the couch or in bed at night.

It’s also way quieter than my late Animas Vibe. I no longer hear the swish of insulin boluses being delivered. Or that little ‘tick’ every three minutes as the pump infuses basal insulin into my body.

The interface is made of up of predominantly symbols and numbers, rather than words, which definitely took some getting used to.

It also has a touch screen, which can only be switched on by pressing the button on the side of the pump. The main menu also has a three tap access code before you can go in and administer insulin.

Basal rates can be set in increments of 0.01 units per hour, which gives greater customisation than the 0.25 units on my late Animas. The biggest challenge for me is that they can only be set on the hour, rather than the half hour. So when I wake up at 6.30am, I can only set my elevated waking basal rate to run from either 5am or 6am, rather than my ideal time of 5.30am. I’ve been experimenting with some basal tweaks this week, and hopefully I’ll be able to work around this.

I’m also liking the vibrating reminders when my temporary basal rate is finished running. I tend to sleep over middle of the night alarms, but the pump has even woken me up during the night to let me know a temporary basal rate has finished running. It’s a really handy feature to have, reminding me to check my blood sugar and evaluate whether I need to run it for longer.

The biggest difference to my late Animas is that the YpsoPump does not contain a bolus calculator. That is contained in the companion mylife smartphone app. Or any other bolus calculating app, for that matter. So you would need to open your app, work out your bolus, and enter that number into your pump. The app then syncs with the pump via Bluetooth to obtain insulin data. At the launch event, we were told that the pump could eventually be controlled from the app.

I have no problem using a phone app to calculate insulin boluses. I’ve done it before when I’ve taken pump breaks. But I found it frustrating having to wait a good 15 seconds for the app to sync with my pump so that I could do a bolus calculation. I’m so used to being able to quickly glance at my insulin on board during the day before various activities. Not to mention that having my Bluetooth constantly switched on is a drain on both my pump and iPhone battery. As a result, I must say that I’ve been slacking off on bolus calculations.

I expressed to the rep last week that it would be helpful if the bolus calculator worked independently of having to sync with the pump. After suggesting that I could switch my insulin therapy settings to Multiple Daily Injections, I’ve been able to do just that. So long as I’m logging all of my bolus calculations and insulin doses in the app, I’ll be able to see my insulin on board without having to sync the pump via Bluetooth.

The pump can deliver insulin boluses in increments of 0.1 units, which is slightly less than the 0.05 my late Animas allowed. The bolus calculator automatically subtracts insulin on board from a bolus calculation, which might not always be necessary. It also lacks the flexibility to make adjustments to insulin to carb ratios or insulin sensitivity factors for things like physical activity. However, it is working a lot better for me in MDI mode.

I know just how hard a good bolus calculator is to find, and for me a diabetes app without one simply has no value. Ypsomed do appear to see the bigger picture of people who don’t use pumps and CGMs, and I’m confident that the company is working hard to make Multiple Daily Injections and glucose monitoring ‘smarter’ as well.

If you are looking for a bolus calculator, you can search for the ‘mylife app’ in your Google Play or App Store.

Come back tomorrow for part two of my review of the YpsoPump!

Updated: Find part 2 here!

Perspectives on Pumping.

4 Comments

I recently had a student reach out to me for insight on a research project titled ‘Positive and Negative Social Impacts of Insulin Pumping.’ I really, really loved these questions. I was never asked how diabetes made me feel after my diagnosis. I got a pump because I felt like it was my last chance to gain some control over my blood sugars. I never really thought about how a pump would make me feel. 

***

Did you ever feel excluded or underestimated because of diabetes? Was this also impacted based on the treatment you use?

Being diagnosed with type 1 at the age of 17, I had lived all of my life to that point without diabetes. Naturally, I felt very conscious of ‘introducing’ and managing my new condition around others.

Diabetes also felt extremely isolating. I didn’t know a single other person with type 1. Management tasks like checking blood sugar levels and calculating insulin doses were largely invisible to those around me. It was difficult to lean on my loved ones for support, as I didn’t feel that they would be able to completely understand the complex nature of this condition.

To answer your question, I don’t think that these feelings would be any different with either pens or a pump. It’s the diabetes itself!

Did the insulin pump change your lifestyle or encourage you to start new habits? 

The insulin pump definitely motivated me to start counting carbohydrates, rather than guessing my insulin doses. I started paying more attention to my diabetes and learned how to better respond to many of the different factors that affected blood sugars. And, of course, it offered an element of convenience in my insulin dosing over needles. The variance in my blood sugars improved a lot within a few months of pump therapy.

I also found that the insulin pump produced more low blood sugars during exercise than injections ever did. Having rapid acting insulin as my basal, rather than a long acting insulin used with injections, made it easier to go low while I was on my feet at work or doing housework at home. Physical activity with a pump requires a lot more planning, which for me is a little discouraging if I feel like going for a spontaneous afternoon walk around the block.

Has diabetes inspired or motivated you to join different groups? Has it, generally speaking of social impacts, improved your life?

Absolutely! Although, I don’t think I would have been keen on meeting other people with diabetes in the initial years after my diagnosis.

I began using Twitter with more of a diabetes focus when I started my blog in 2015, which connected me to a vibrant online community of people with diabetes from all over the world. This community was so valuable to me, and eventually motivated me get out and meet other people with diabetes.

Diabetes has given me a lot of confidence in regards to being more open about my condition, and I’d like to think that this confidence has extended beyond just my diabetes. Peer support has definitely improved my mental wellbeing. Diabetes is such an isolating condition to live with, and having peers to talk to and laugh with are a constant reminder that I am not alone in this.

How flexible are you with the insulin pump?

The pump will give you more flexibility if you’re prepared to put the hard work in.

For me, the pump has offered me the most flexibility in being able to customise basal insulin to the time of day. For example, being able to deliver a higher rate of basal insulin in the early hours in the morning to combat what is known as dawn phenomenon – a surge of hormones that triggers the liver to dump additional glucose into the bloodstream.

But again, the pump is only as smart as the person pressing the buttons. In this example, I’ve had to make the commitment to monitoring my blood sugars, identifying trends and making adjustments to my basal rates accordingly.

Does the changing of the cannula take a lot of time and patience?

It was definitely a learning curve in the beginning. I had to make sure that I didn’t pick an overused spot on the stomach that could bruise or bleed, that the cannula didn’t kink on the way in, and that there weren’t any air bubbles in my pump line that could impair insulin delivery. Site changes did create a little anxiety in the beginning. If it wasn’t successful and I wasn’t getting my insulin, my blood sugar would go high pretty quickly and I could be in Diabetic Ketoacidosis within a few hours.

Today, it’s just another ‘chore’ that I have to stop and get around to doing every three days.

Any additional positive or negative impacts of the treatment on the social aspect?

I’m pretty neutral on this. The pump does make things more convenient in social settings and when I’m on the go. It’s worth noting that lots of people dislike needles, so the pump is a big help there. But there’s also a lot of maintenance you need to keep on top of and more consumables you need to keep handy, so it depends on how you look at it!

I feel it’s the nature of diabetes as a whole, rather than a particular insulin therapy, that may have an influence on social aspects of life. I feel its more important that people with diabetes receive adequate support to accept their condition and live well with diabetes – from their healthcare professionals, peers, loved ones and even mental health professionals.

The YpsoPump Launch Event

1 Comment

My first week with the YpsoPump saw me in holiday eat-and-bolus-without-really-thinking-too-much-about-diabetes mode. Not to mention that it was my return to insulin pumping following a month long break. Week two saw me back at home with one of the worst Winter colds I’ve had in years and some of the craziest insulin resistance I’ve seen. It’s now week three and I’m just beginning to return to some sense of normality with the ‘betes.

Safe to say, I feel as though I’ve already been through a lot with this pump in the short time we’ve known each other. I really am enjoying the YpsoPump for its sleekness and light weight nature, and you can also check out my Instagram stories for more insight here. I’ll have some more to share here soon, I just don’t think I can fairly review a pump without using it for a good few weeks.

I had never even heard of the YpsoPump prior to searching the TGA website earlier this year in desperation for any signs of new insulin pump choices following the demise of Animas. I then noticed fellow blogger Ashley of Bittersweet Diagnosis had been trialling the YpsoPump, indicating that an Australian launch was on the horizon. A bit later on, I was fortunate enough to receive my own invitation to a launch event held in Sydney three weeks ago.

We were introduced to a Swiss company called Ypsomed (pronounced “Ipsomed”). As a manufacturer of tailor made insulin injection pens and autoinjectors, the company vision is to make self care simpler and easier. We were told that the company had a long, successful history of insulin pumps in the world, dating back to 1985. The YpsoPump had been designed to fill the gap in a market filled with complex, medical looking devices.

Ypsomed’s portfolio of diabetes products fall under the company’s Mylife Diabetescare brand. Encouragingly, their portfolio extended to people on Multiple Daily Injections and structured blood glucose monitoring. Products included clickfine needles, lancets, injection pens and a new Unio Neva blood glucose monitor using a custom brand of test strips. Not to mention that YpsoPump’s companion ‘Mylife’ smartphone app would also be useful to people not on a pump (it’s a free download from your App or Google Play store).

We were shown a roadmap of future upgrades to the YpsoPump system. This included the addition of the Unio Neva blood glucose meter that would send blood glucose readings to the Mylife smartphone app via Bluetooth. Ypsomed are also in discussions with manufacturers to add CGM integration into the pump. The YpsoPump will eventually be able to be controlled remotely via the smartphone app, but this looks to be at least 12-18 months away.

Ypsomed is also manufacturer of the wildly popular Omnipod tubeless insulin pump, which received TGA approval some time ago but has not yet managed to surface. The NDSS funds insulin pump consumables here in Australia, while private health insurers fund the actual device. Ypsomed have not been able to find a way to fit the funding model here in Australia due to the disposable nature of the Omnipod.

In response, we were told that a smaller ‘YpsoPod’ is currently in development with an expected 2021/22 completion. One half is disposable while one half is durable, meaning that this pump would fit the funding model in Australia.

Everything sounded really encouraging, with Ypsomed assuring us that they are here to stay and committed to the Australian market. This includes a dedicated Australian based customer service team. I’m also looking forward to catching up with a member of the Ypsomed team visiting Perth this week.

At the end of the day, more choice for people with diabetes is always a good thing. A massive thank you to Ypsomed Australia for having people with diabetes there.

Disclosures: Ypsomed Australia covered my travel and accommodation expenses to attend the launch event in Sydney. I was fed and watered across the duration of the event. I also received a YpsoPump and consumables to take home and trial. There was no expectation that I would blog about Ypsomed or the YpsoPump. My opinions and my time, including the annual leave I took from work to attend, are my own.

Pump Complacency.

4 Comments

What I have neglected to mention here is that, until arriving in Sydney, I had been disconnected from my insulin pump for almost four weeks.

You know what? It had been working pretty damn well. To the point where I was really starting to re-evaluate things. I was actually packing for Multiple Daily Injections, and had no intention of bringing any pump supplies along for my week in Sydney.

On the day prior to my departure, I began to think about how I may regret not having the convenience of a pump while trekking around Sydney. So, in my usual last minute indecisive fashion, I attached a new infusion site to my stomach prior to my birthday dinner on Tuesday night. I shoved a few spare infusion sites and insulin cartridges into my carry bag. I returned all of my pump junk back into my travel case.

But I still wasn’t sure.

I stuck with Lantus for the first day of my trip, and decided that I’d just use the pump for boluses. That was, until the moment I heard that I would be given my own loaner Ypsopump to take home and roadtest on Wednesday night. I have not given another shot of Lantus since.

I’ve drafted a few versions of this post, plagued with thoughts of sounding too wishy washy or having said it all before. I’ve had a few interesting reactions around why I would do such a thing as take off my insulin pump.

I felt as though I had been consistently correcting high blood sugars with little effect throughout much of April. Rapid acting basal insulin was beginning to feel very inconsistent, and mealtime insulin wasn’t doing its job properly as a result.

In hindsight, I do feel that my pump was also making me complacent. I tend to take it for granted after a while, not doing the things that I should be. Like pre bolussing for meals, waiting for my blood sugar levels to fall back into range prior to eating and avoiding insulin stacking.

What I do know is that my blood sugars were amazing throughout much of that four week vacation. Insulin was working far better with Lantus as my basal, rather than rapid acting. Of course, it’s worth noting that insulin sensitivity is far better when I spend more of my day in range.

I’ve expressed time and time again just how monotonous it is to do the same thing day in, and day out when managing my diabetes. That’s why new accessories, tools, devices and even a shake up to insulin therapy helps to keep me feeling fresh and energised in the daily grind of diabetes management.

I don’t believe that one is better than the other when it comes to pens versus pumps. Nor do I believe that one form of insulin therapy will necessarily be the right thing for me, forever. Each has their positives and negatives, and the ‘right’ insulin therapy is the one whose flaws bother me the least.

This week, I have been ‘non compliant.’ My levels have looked pretty much like the typical holiday blood sugars you’d expect from eating more carbs than normal and being out of routine.

I am roadtesting the Ypsopump as we speak, but I’m not ruling out other options once I’m settled back into my usual routine.

 

YpsoPump Lanches In Australia!

6 Comments

Did you just say that we’re getting a pump?

Yes.

To keep?

Yes. If you’re going to write about it, you need to know all of the facts.

All of the other bloggers were convinced that I must have misunderstood Ypsomed Australia’s General Manager, James Mayjor. I was convinced that perhaps he was just leading me on.

I walked away with the brand new YpsoPump, that officially launched in Australia today. Consumables are listed on the NDSS, meaning that Ypsopumpers will be able to access subsidised supplies just like any other pump.

I believe that a large group of Diabetes Educators will also be coming to Sydney for pump training over the next two days, so if you are thinking of starting on the Ypsopump there’s a good chance you’ll be able to find a trained CDE near you.

So, disclosures. My Life Diabetes Care covered my travel expenses and accommodation in Sydney to attend the launch of the Ypsopump. The team from My Life Diabetes Care kindly gave us a platform for the consumer voice to be heard, as well as hearing all sorts of crazy dinner conversations last night! If that wasn’t generous enough already, I was also given a Ypsopump, some infusion sets, reservoirs, pump cases and an inserter to trial.

So before you read any further, there is a pretty big bias in place. However My Life Diabetes Care have not paid for my time or my words which are, as always, my own.

First up, hooray for new pump choices in Australia!

Secondly, I honestly cannot believe just how sleek and lightweight the Ypsopump is compared to my chunky Animas Vibe that’s looking increasingly like something from the last decade. The My Life Diabetes Care team did highlight that the Ypsopump had been designed to fill the gap in a market filled with complex, medical looking devices.

I was also most impressed to hear about the My Life Diabetes Care portfolio of products, which included things like needles, pen injectors and blood glucose monitoring for people on Multiple Daily Injections and Structured Blood Glucose Monitoring. The tech is not for everyone, and offering choice to consumers is extremely important.

The pump is touch screen, although not a full colour pump. The biggest difference to my late Vibe is that the bolus calculator is not contained in the pump itself, but rather done in the My Life Diabetes app. So, I would calculate my bolus in the app, and then administer the recommended dose using the pump. The pump then connects all of my insulin dosing data to the app via a Bluetooth connection.

Infusion sets come in either steel or teflon, are available in a variety of lengths, and also have the option of manual insertion. Another noticeable difference for me compared to the Animas was the lack of a 45 degree angled cannula.

If you hadn’t noticed my enthusiasm already, I obviously hooked up straight away. It’s still very early to draw any more conclusions, but I will have more to share in the coming weeks. For the time being, I’m more than happy to stow my late Animas Vibe away in my pencil case.

P.S. A photo where I’m actually smiling!

P.P.S. Could we have thought of a better product placement? From left to right: Ashley (@hangrypancreas), Melinda (@melindaseedt1d), Renza (@RenzaS), Rachel (@yoga4diabetes), Me (@FrankSita) and CDE Blogger Extraordinaire Jayne (@JayneEdHealth).