Insulin Pumps

Four Foods I Cannot Bolus For To Save My Life

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I remember starting off on vague insulin doses of 5 to 10 units at every meal instructed to me by the hospital. Then I saw a diabetes educator, and learned to carb count. Adding up every gram of carb on worksheets supplied by my dietician only led to frustration over why logic was not translating into steady blood sugars. (Of course, little did I know about the gazillion other factors that could affect my blood sugar back then…)

For a few years in the middle, I just swaggered by and thankfully lived to tell the tale.

Fast forward to today where I’m using an insulin pump, carb count nearly everything I eat at home and have a pretty good idea of what most foods that I eat will do to my blood sugars. I know exactly why my blood sugar is high as I’m typing this right now (hello, potato bake with no pre-bolus). Overall, I feel pretty comfortable with being able to eat, give insulin and manage my blood sugar levels today.

That being said, there are still a few select foods that I cannot bolus insulin for if my life depended on it.

Pasta.

If there’s one food that confuses the life out of me, it’s Pasta. You can’t go by what’s on the packet, because most packets only refer to the uncooked weight. Seriously – who in the world eats dry pasta? If you were to make that mistake, I‘d be surprised if you weren’t chugging down litres of coke or making a dash to the emergency room.

Logic tells me that Pasta has around 28% carbs in it. The carb counts in our plates of pasta at home would be huge, because who on earth can only eat 1 cup of pasta? But if I were to give a massive insulin dose for all that carby goodness, I’d be eating glucose tabs for dessert.

All the extended boluses in the world can’t keep me from the Pasta lows, which can only mean that Pasta must be a really really really slowly digested food. These days I tend to settle for bolusing for 50 to 60% of the carbs at the time of the meal, accepting that the remaining 40% of the carbs that have absolutely no effect on my blood sugar whatsoever must be magic.

Soup

If there’s one meal that I despise purely for diabetes reasons, it’s soup. Who on earth can count the carbs in all those lentils, veggies and pastina that have been sitting there in the pot stewing all afternoon?

Then there’s the hassle of attempting to drain all of the liquidy goodness from the soup ladle for the purposes of weighing my plate, and then scooping up only liquid from the pot to add to my dry plate.

Add to this the same principles as pasta – all of those lentils and pastina are really slowly digested and would send me low quite easily. With carb free veggies and meat in the mix, I’ve sort of settled on bolusing for about half the number of carbs I would with Pasta.

Bananas.

Fun fact: I cannot eat a Banana without going low. Which is shit, because I actually happen to like them a lot. I very much look forward to my mid morning coffee and banana, while other times I slice it up to mix in with my Overnight Oats.

Logic tells me that a Banana with skin intact has around 13% carbs in it. But if I were to weigh my banana and bolus that much, I would be low within the hour. I’ve sort of settled on bolusing for around 50 to 60% of the carbs in my bananas, and some days this does the trick while other days it does not.

Steak and chips. Or Pizza. Or any kind of restaurant meal, really…

I have a love hate relationship with pub meals. I love how delicious and mouth watering and salty a steak and chips are, but I absolutely hate the night sweats and resilient high blood sugars that follow in the aftermath.

After learning that restaurant meals tend to be higher in fat to make them more delicious, I tend to set a temporary basal rate increase of 50% on my pump for 8 hours to combat the insulin resistance. I don’t prebolus for anything, given that fat slows down the digestion. I might also bolus for 40 to 50% of the protein in my steak after the meal is over, using a extended bolus over 2 to 3 hours.

Get the insulin in too early, and you go low. Get it in too late, and my blood sugars go up, up, up. It’s definitely a case of hitting the sweet spot.

***

Ahh, food and insulin…if only it were as easy as counting the carbs, giving an insulin dose and catching a unicorn 2 hours later.

Diabetes at 3.14am

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I stirred in my sleep, registering the blaring red 3.14 on the clock radio beside my bed. Pulling my left arm out from under the covers, I fumbled around for the switch at the base of my bedside lamp. When my desk was finally illuminated in cosy warm white light, I heaved the remainder of my body up from the bed, reaching for my meter and test strips.

This certainly wasn’t the number that I was expecting to see, considering the full 2 unit correction that I had given prior to bedtime for a 10.7. (And in case you’re wondering, I’m only using the OneTouch Verio to deplete my final box of strips…)

I immediately ripped my pump away from it’s resting place inside my inner left pocket, and gave another full correction of 3.3 units for that very uncomfortable number. My frustration was only further fuelling my actions, as I set a 50% basal rate increase for the next two hours on my pump to ensure that this correction insulin did its job.

As I flicked off the lamp and rested my body back onto my bed, I couldn’t get back to sleep. I could feel the heat emulating from my pillow, and flipped it over to the cool side. My whole body felt stuffy, presumably a consequence of the higher blood sugar.

As I lay there, tossing and turning, my mind was quickly consumed with guilt.

I wasn’t happy that it had taken me this long into the night to finally stir in my sleep and check my damn blood sugar. I felt terrible for the fact that I had been sitting there, at that very uncomfortable level, for the better part of five hours. I felt frustration, because a mere two weeks ago I was super insulin sensitive and today I feel like I’m not getting enough.

Second guessing my prior decision in the darkness, I reached for my pump and lowered that 50% temporary basal rate to 30% before clipping it back inside my pants pocket.

Trying to purge those thoughts from my mind, I began thinking about all of the positive things that I am doing in managing my diabetes, reminding myself that numbers like those are isolated occurences nowadays.

If this had happened in the middle of the day, I’d have corrected the high without giving it a second thought. But laying there in the middle of the night with nothing else on my mind to worry about, was a completely different story.

By the time I woke up on a grey Sunday morning, last night’s occurrences felt like nothing more than a dream.

“Do You Ever Get Sick of It?”

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“My daughter’s friend has diabetes, and she had to have needles all the time. What a pain that would be! Do you have to do that?”

“Not anymore now that I have the pump,” I replied as I pulled it out of my pocket and began gesturing wildly. “So, the pump does two things. It gives insulin continuously in small increments to keep me steady in the background. Then I enter insulin doses myself to cover the foods that I eat. So yeah, the pump is really convenient when I’m out and about or at work,” I concluded in response to her remark.

“Do you have to do that thing where you prick your finger all the time as well? My daughter’s friend said she had to do it 10 times a day! You would think there would be some kind of technology that could do that for you by now!”

“Yeah. I’m wearing this at the moment” I said, picking up the FreeStyle Libre reader that was sitting on top of my iPhone. “So, I wear this sensor on my arm,” turning sideways and showing it to them. “And then I just swipe the reader over it and it tells me my blood sugar. So that’s a pretty good reading,” I said, holding it up and showing them my unicorn and graph.

“I’ll have to tell her about it.”

“Yeah, it’s really good for figuring out trends and things. But it’s expensive so I don’t wear it all the time. And the numbers do my head in sometimes.”

“Can you have a lot of this stuff?” She asked me, gesturing at the hot cross buns and chocolates on the table.

“Yeah, of course I can. I need insulin for most food that I eat, so that my body is able to convert it into energy. I would look at this,” I said, picking up a marvellous creations wrapper from the plate of Cadbury Favoutites on the table, “and say its about 8 grams of carbs. I know that I need 1 unit of insulin to cover every 8 grams of carbohydrate, so I would give a unit with my pump.”

Do you ever get…sick of it? I know that you would probably be used to it by now…

“I wouldn’t say I get sick of it. Most of it is second nature to me. If anything, it just feels really, really monotonous. Getting up and doing the same thing over and over again every day. Looking at the same items and devices all the time. I get bored of it.”

Why I Am Waiting.

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Unless you’ve been living under a rock, you’ve likely heard of the whole We Are Not Waiting movement. You know, a bunch of people who are hacking their diabetes devices in order to enhance their functionality. Such as transmitting blood glucose data to other devices, turning a FreeStyle Libre into a CGM with alarms and even closing the loop between an insulin pump and a CGM.

You need look no further than the name of this movement to find the reason for it. People with diabetes really are at the mercy of device companies, regulatory bodies or, in the case of the snippet I read in yesterday’s paper, researchers who are currently attempting to regenerate organs in sheep!

I don’t see a cure on the horizon in the next ten, twenty or even thirty years. The business of business is business. Advancements no longer feel like a solution, but rather a pathway to the next enhancement or product. Both consumers and device companies seem too focused on feeding this diabetes technology frenzy.

The most realistic advancement that I do see on the horizon is a commercial closed loop system. That is, an insulin pump that communicates with a Continuous Glucose Monitor to automatically regulate blood glucose levels. There are a few systems currently in development in the US. Yet I don’t realistically see any of these getting into my hands here in Australia in the next five, dare I say ten, years.

I need look no further than the current insulin pump situation here in Australia. If online communities are anything to go by, Aussies are crying out for a new insulin pump option to hit the market here. There are insulin pumps listed on the TGA website that can be legally sold here in Australia, and yet we are left waiting at the mercy of distributors, device companies, marketers, financial strategists, and all of the other powers that be.

Better yet, it’s 2018 and people are still forced to do all sorts of questionable things in the name of INSULIN, the drug with a price tag that is skyrocketing by the day.

I have been reading up on the likes of hacking a FreeStyle Libre system and closing the loop over the past couple of months. There is a growing community of people here in Australia who are buidling and running homemade closed loop systems, and you can lurk or join them here.

I, however, have made the regrettable decision that I will have to wait.

For starters, I would have to commit to full time Continuous Glucose Monitoring. This is not currently subsidised for adults like me here in Australia. Nor is this, as well as the other hardware required, in my current budget while I am working toward other financial and career goals. Secondly, I don’t own a pump that is loop-able, and I don’t like my chances of being able to get my hands on one.

Finally, I’m not sure that I would be able to give any ‘we are not waiting’ efforts the due focus that they would inevitably require at the moment, with a lot of other priorities on my mind for the year ahead. As one Facebook group admin puts it, don’t bother asking for the idiots guide as these solutions aren’t for the faint headed!

I am frustrated. Not because I’m envious of others who do have the means to do so. Not because I can’t manage. Not because I don’t have good health, excellent access, good people around me or a good quality of life.

I am frustrated, because people with diabetes deserve so much better than what they’re currently getting.

Implications of the Animas Exit For Australia

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In October, Animas signalled their intention to cease the manufacture and sale of their insulin pumps. While this news was initially limited to the US and Canadian markets only, the view was to eventually exit the market globally.

Yesterday, the news we had all been expecting was finally confirmed, with news that Animas had exited the market globally.

So what does this mean for Australia?

In the US, Animas referred their customers to Medtronic for the supply of consumables for in warranty pumps. Medtronic will continue to supply Animas consumables until September 30, 2019, after which consumers will need to make the switch to another brand of pump. Medtronic, Insulet (makers of the Omnipod tubeless pump), and Tandem (makers of the t-slim pump) have all provided options for Animas customers to make the switch prior to September 2019. More details about the US transition can be found here.

Australian distributor AMSL Diabetes has stated this will not be the case down under. AMSL will continue to supply pump consumables, replace in warranty pumps and provide 24/7 customer service, with further announcements to come. If you are thinking about starting on an Animas pump, there is apparently still some limited stock available.

Most importantly, there’s no need to panic. For the time being, nothing will change and in warranty pumps will still be serviced.

However with the manufacture of Animas pumps now ceased worldwide and limited new stock available, one has to wonder just how equipped AMSL will be to replace an in warranty pump at fault.

With a timeframe of September 2019 to cease the supply of consumables (albeit in the US), one would also be thinking that in-warranty customers will eventually need to be serviced by another brand of pump.

Will we be referred to Medtronic? Are AMSL hoping to acquire a new pump to distribute here in Australia? Will the manufacture of Animas consumables continue beyond September 2019 to service Australia? Time will tell.

My feeling is that someone starting on an Animas insulin pump today won’t be able to get a full four year’s use from it.

(And I’m feeling a little excited at the prospect of not having to wait until May 2020 to get that new pump feeling again).

AMSL’s announcement is here, and indicates that there are more developments to come.

Overnight, Johnson and Johnson (JNJ) have announced their intention to exit the insulin pump market globally. This follows an announcement in October last year that it was withdrawing from the US and Canadian markets. JNJ’s decision to close down its operations has been made for commercial reasons.

AMSL Diabetes will continue to provide the same high level of support our customers currently receive and customers will still receive a replacement if their pump develops a fault while under warranty. Warranty and replacement pumps, as well as consumables, will not be affected by this announcement.

Animas has also announced that in select countries it is working with a partner to transfer customers to another pump brand. Each market is being approached differently and in Australia, AMSL Diabetes will continue to work with Animas directly.

AMSL Diabetes have been proud partners of Animas for 15 years since launching the IR1000. We will continue to offer our leading 24/7 Australian-based customer service, technical support, and offer our full range of Dexcom CGM, Lifescan blood glucose meters, HypoPak fast acting glucose and accessory products.

For more information on how this announcement may affect you, please contact AMSL Diabetes on 1300 851 056 or email diabetes@amsl.com.au.

We will have more updates and information on these latest developments soon. Make sure you follow us on our social media platforms (Facebook, Instagram or Twitter) to stay updated.