Insulin Pumps

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.

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.