Day 2 at the Australasian Diabetes Congress

Welcome to day 2 of the Australasian Diabetes Congress, the annual scientific meeting of the Australian Diabetes Educators Association and the Australian Diabetes Society. I’m lucky enough to be here as part of Diabetes Australia’s ‘People’s Voice’ team of consumer reporters.

Tech news first! It was great to catch up with Sylva and James from Ypsomed, who this morning announced some infusion sets with Luer Lock connectors. This opens up the Orbit range of infusion sets to people using other insulin pumps with Luer lock connections.

Leanne from AMSL Diabetes also had the chance to catch up with her favourite customer. Dexcom G6 and Basal IQ, the low glucose suspend update to the Tandem t:slim insulin pump, has not yet received regulatory approval. The hold up may have something to do with all CGM products on the market requiring reclassification from Class 2 to Class 3 from the powers that be (or something like that). Leanne wouldn’t speculate on a timeframe for approval, but in the meantime we have a new hashtag going, #BasalIQForFrank. Get behind it!

On my way to this morning’s session, I ran into superstar endocrinologist Kevin Lee after some back and forth interaction through the #OzDOC. He was exactly as I imagined online. Great to meet you, Kevin!

I sat in on the National Association of Diabetes Centres (NADC) symposium this morning and was glad for the opportunity to gain a better understanding of the work that they do.

The first part of the session dealt with findings from the Australian National Diabetes Audit. The audit has collected data from over 6,000 patients to date from diabetes service centres around Australia. Each centre then receives a custom report comparing their performance to other centres across the country. I felt the measures surveyed were comprehensive, and it was particularly pleasing to see measures such as quality of life and diabetes distress covered. The gaps identified among patients were unsurprising: difficulties around blood glucose monitoring, taking medication, physical activity and following a prescribed diet.

The second part of the session dealt with the type 2 diabetes ‘models of care’ toolkit. This project identified existing models of care that were providing improved care delivery, patient satisfaction and improved outcomes – exploring how these models could be applied to different geographical locations and more integrated diabetes care across providers. Well done, team NADC!

After morning tea I went into a session on diabetes and the gut microbiome, which seems to be the latest craze. In people with type 2 diabetes, delivery of prebiotics and probiotics had shown promising results. Things like improved fasting glucose, hba1c, triglycerides and other markers. However when Iranian research was removed from these findings, prebiotics and probiotics showed no benefit for type 2 diabetes.

The session touched on artificial sweeteners. My understanding was that because the composition of each person’s gut is different, some people absorb the sweeteners while others build up a defence to them. Which might explain the theory as to why some people are unaffected by artificial sweeteners, while other people (like me) spike. Lucky I prefer the real stuff!

This afternoon I was presenting at a ‘Consumer Voice’ symposium which looked at collaboration in diabetes care with three other panellists. It was great to hear fresh (to me) perspectives in optometrist Amira, and Diabetes Australia’s Chris who shared his personal experiences with type 2 diabetes in Aboriginal communities. In line with previous years, it is generally the diabetes educators who tend to come along to sessions like these and want to learn from lived experience. While it would have been nicer to see more healthcare professionals tag along, I do want to thank the Australian Diabetes Educators Association for providing us with this platform.

Disclosures: Diabetes Australia covered my travel, three nights accommodation, some meals and registration costs to attend the Australasian Diabetes Congress as part of their ‘People’s Voice’ initiative. I gave up my own time to attend the Congress and am sharing my own thoughts here, as always.

Day 1 at the Australasian Diabetes Congress

I’m in Sydney today for the Australasian Diabetes Congress, which is the annual scientific meeting of the Australian Diabetes Educators Association and the Australian Diabetes Society. I’m here with the support of Diabetes Australia as part of their ‘people’s voice’ team of consumer reporters.

Most exciting news of the day: there’s a new tubeless patch pump for Australia! Roche have launched their new Solo insulin pump today. It comprises of a remote handset, a pump base that needs replacing every four months, a reservoir and cannula. The reusable components will be funded by private health insurance like other insulin pumps, and the disposable components are expected to be listed on the NDSS in November.

I did have a brief hands on with the pump this morning, and it looked really encouraging. It looks much smaller than the late Cellnovo. Unlike the Omnipod, the pump can easily be unclipped from the site as needed, meaning that you can see what’s going on underneath your infusion site. I also liked that you don’t need to throw away the whole ‘pod’ should the site fail. More on that in another blog!

The opening plenary was a little disappointing, focussing on diabetes in China. As the opening session ‘psyching’ delegates up for the Congress, I feel it could have benefitted from a more engaging speaker and broader topic. But hey, that’s only my two cents.

After morning tea, I dipped into a presentation on the PREVIEW study, which looked at lifestyle interventions for the prevention of type 2 diabetes. Participants shed most of their weight during the first eight week phase of this study, through a very low energy diet of meal replacements. During the second phase of the study, eligible participants received support to implement diet, exercise and behaviour change. Participants were randomised to two diets and exercise plans. Diets comprised of low to moderate protein and low to moderate glycemic index, while exercise was HIIT training.

The study followed participants for three years, with the support becoming more remote from the 12-36 month mark. Of the 945 people who completed the lifestyle intervention study, only 4% of people developed type 2 diabetes after 3 years and weight loss maintenance was excellent. I’m not an expert, but I think the key to weight maintenance is balancing kilojoule consumption with energy expenditure, and it’s inevitable that a structured plan will produce the results. For some of these research participants, the meal replacements were the most nutritional thing they’d eaten in some time!

After lunch I headed to an ADEA symposium. The most interesting presentation was a case study at Blacktown Hospital in one of Western Sydney’s ‘diabetes hotspots,’ which was placing a strain on hospital resources and wasting patients’ valuable time. A review of the diabetes clinic saw many implementations to optimise time prior to appointments. This included the implementation of a central point for clinic referrals that were coming in from many different places, tended to by the appointment of an enrolled nurse. The clinic also made reminder phone calls prior to appointments, chased pathology results and had a nurse download data from patient’s glucose meters. This is definitely what person centred care looks like!

It was fantastic to finally meet CDE/Nurse/Midwife Belinda Moore after lots of back and forth online through #OzDOC over the past few years. It was also great to catch up with former Roche-turned-B-Braun diabetes division manager Nicky who makes a noticeable effort to keep up with some of us #OzDOC folk.

The final session of my day was the ADS Clinical Young Investigators session. The most interesting session here looked at reducing glycemic variability among people with type 1 diabetes, which I think is often overlooked after a day of research presentations so heavily focussed on hba1c.

In this study, research participants were given education in conjunction with bolus calculations to reduce glycemic variability. In both insulin pumpers and Multiple Daily Injections, breakfast was the most challenging time of the day in terms of glycemic variability. Which, as a person with diabetes, makes total sense when combined with dawn phenomenon. I know that my insulin needs change while I’m sleeping depending on where my blood glucose levels are sitting, how well I have been eating and sleeping, and even how early the sun is rising in the morning!

Research presented suggested that insulin pumpers may have a better quality of life. Insulin pumpers in this study ate breakfast an hour later than those on MDI, and tended to eat more. I know for myself alone, a pump (combined with learning more about my diabetes) has definitely helped me to find more freedom to eat to match my feelings of hunger. The sleeping in…well, it still needs to be planned to an extent.

Disclosure: Diabetes Australia covered my travel, registration and three nights accommodation in Sydney to attend the Australasian Diabetes Congress as part of their ‘People’s Voice’ initiative. I gave up my own time to attend, and am sharing my own thoughts as always.

#OzDSMS

Earlier this afternoon I took part in the second Oz Diabetes Social Media Summit. Hosted by Ascensia Diabetes Care, #OzDSMS brought together a group of (highly privileged) diabetes bloggers in Sydney. It is always an honour for me to participate in discussions with this close knit group of people with diabetes who are all doing amazing things in their own communities. Renza’s comment around Aussies being the most considerate of the needs of people with diabetes outside of their own backyard really summed up it up for me.

As a relative newcomer to the market, Ascensia seem to be one of those companies who genuinely want to be a part of the diabetes community, and not just talking to the community. We were reaffirmed of their commitment with two additional summits being held in Europe and America following the inaugural (and best) Aussie summit held in Adelaide last year. I’ve also been really impressed at being kept in the loop on company comms from their head Joseph over the past 12 months.

There were some robust discussions around advocacy, and more specifically, representation in the diabetes community. While I’m not a big fan of the word ‘advocate,’ others in the room were happy to wear the term on their sleeve. Kim’s comment around advocating for the value of lived experience resonated with me the most.

I feel that there’s a big difference between being a personal advocate and a broader diabetes advocate. From my own personal experiences, I find it frustrating when people expect me to be the one to bring about change. Believe it or not, diabetes is not my job and there are plenty of other things that I hope to achieve in my life. It’s not one person’s job to bring about change. We need collaboration, and we can always do more to bring the voices of more people with diabetes to the table.

Special guest speaker Grumpy Pumper crashed our summit and spoke about challenges in being able to engage people to talk about diabetes complications. We were shown some new resources that have been developed in collaboration with Grumps for Ascensia’s social media channels. Bionic Wookiee David Burren (who was listening in over the phone) added an outstanding comment around why diabetes complications are called diabetes complications. Aren’t they simply health conditions that are exacerbated by diabetes?

We touched on backup plans, and it was pleasing to see a resource that’s in the works from Ascensia on the very subject. While I certainly carry everything around with me, the one thing I haven’t brought with me on my travels this time is long acting insulin. I know that a) AMSL Diabetes will be in the Exhibition Hall at the Diabetes Congress should my pump fail, and b) I’m surrounded by many friends with diabetes who’ll be able to hook me up should the worst happen.

The highlight of my day was hearing Greg Johnson, CEO of Diabetes Australia, talk about access and advocacy around diabetes technologies.

There is currently a hold up on getting the FreeStyle Libre added to the NDSS. The Department of Health and manufacturer, Abbott, are currently in price negotiations over the product. Health Minister Greg Hunt was advised on a fair price that the government should reimburse to Abbott for the product. The advice was provided by an independent committee, based on health economics. The ‘reimbursement’ that Abbott are seeking for the product is above this price.

I did flag recent news reports around comments by the Health Minister about Abbott not complying with the recommended safety, but I have been told that there are absolutely no safety issues with the product and it was likely a slip of the Health Minister’s tongue.

Professor Johnson is confident that an agreement will be reached soon, and that Flash will be added to the NDSS. Encouragingly, he expressed that there was enough funding available that could potentially see Libre made available to people beyond the current eligibility criteria for CGM. Watch this space.

How can people with diabetes work together with diabetes organisations to achieve shared goals? Professor Johnson pledged his support towards the power of people telling their stories in the many different ways that we do. He said that reviewing the discussions that were happening in the diabetes community were always a big factor when deciding on a course of action at Diabetes Australia. I did express my sentiments about the need for more ‘progress updates’ on policy work, so that it doesn’t just feel like that campaign that was running a few months ago has been forgotten about.

Check out #OzDSMS on Twitter for more Tweets from some of the other bloggers who participated in the day. I’d like to thank Ascensia Diabetes Care for extending hospitality once again, and to all of the people in the room who participated. I couldn’t wipe the smile off my face at the chance to get my own grumpy photo!

Disclosures: Ascensia Diabetes Care provided hospitality throughout the afternoon which included lunch, drinks and canapés. Diabetes Australia have covered my flights and three nights accommodation in Sydney to attend the Australasian Diabetes Congress this week. I have given up my own time to participate, and am sharing my own views as always.

What the Cannoli.

“I’ll have a Latte and a Ricotta Cannoli please.”

I didn’t even have to think twice about my order. A truly spectacular day had conveniently come to an end with a ferry cruise of Sydney Harbour in all of its night time glory, leaving me just metres away Rossini Cafe at Circular Quay.

Rossini, in my humble opinion, is home of the best Ricotta Cannoli I have ever eaten. To be completely honest, it’s one of the reasons why I so look forward to visiting Sydney. I think I’ve set myself a new record this time around, having been here for a whole 48 hours without a visit there.

My levels have been bouncing around since I arrived here, largely due to lots of spontaneous eating and not much of a game plan in regards to insulin. That’s what holidays are for, right? So, trying to muster up a better game plan than the past 48 hours, I bolused for 50 grams the minute I placed my order.

The Cannoli was brought to my table, and I began browsing through my photo library looking back on some spectacular memories from today as I waited for the coffee to arrive.

The coffee came, and I began to sip on it. I left my Cannoli on the plate, scooping up a little bit of the delicious Ricotta filling with a spoon while I continued to drink my coffee and peruse through my phone.

Excuse me sir, is there something wrong with the Cannoli?”

I turned around, kind of startled.

I assured the waitress standing behind me that there was definitely nothing wrong with the Cannoli. Looking at the empty coffee glass sitting next to the untouched plate of Cannoli, I can see how she had come to that conclusion.

But to me, however, it made perfect sense. I didn’t even have to think about what I had subconsciously done, leaving my Cannoli to one side until the pre-bolus had kicked in.

I would love to have told her exactly why I was waiting to eat my cannoli. But did she really need to know all of that? Probably not. Could I be bothered explaining all of that at the end of a long day? Definitely not.

I ate my Cannoli and paid my bill, feeling the pressure to leave.

Just another day in the life of diabetes, where the people around us are none the wiser.

Don’t Call Me ‘Advocate’

This blog has always, always, always been my own personal blog about my own life and thoughts about living with diabetes. To the people who’ve checked in here over the years, and who’ve identified with what I’ve had to say here, I’m truly humbled. If you haven’t, that’s more than okay too. How boring would the world be if we all agreed on everything?

I’ve done a lot of things in the time that I’ve been blogging here. Speaking, writing, travelling, networking, conferencing, committee-ing, advocating, passing on information to the wider community and continually adding to my amazing tribe of people with and connected to diabetes.

I absolutely love that diabetes has given me the opportunity to take a massive step outside of my comfort zone and do all of these things. I love that the DOC has connected me to people from all over the world, and given me the opportunity to take an interest in what’s important to other people outside of my eyes as a highly privileged person living in a country that affords me so many privileges.

While this role might seem ‘special’ or ‘important’ or ‘exciting’ or ‘privileged,’ I don’t really see it as anything more than being a person with diabetes. I’d probably be the first person in the room to make it abundantly clear that I do not represent any other person with diabetes. I have no interest in representing any other person with diabetes, nor could I possibly do so. The absolute last thing I am qualified to do is provide advice to other people with diabetes.

I hate the word ‘advocate,’ because it implies that I am advocating for all people with diabetes. Or that I am somehow better than another person with diabetes. While advocacy might come easier to some than to others, it’s not something that anyone else couldn’t do. Even the smallest act of explaining diabetes to somebody else, or asking your healthcare team for something that you want – is advocacy.

That’s not to say that I don’t have the interests of the wider diabetes community at heart. It’s just that I would not possibly be able to highlight every single issue around diabetes in the world. Not to mention that my interests, such as peer support and psycho-social issues, would be totally different to that of someone who might be interested in nutrition or science.

I laugh every time friends tell me how articulate I am, because so many different people have said it and it is so true. But in reality, I can only ever advocate for myself, drawing upon my own experiences as a person living with diabetes.

That does not make me a diabetes advocate.

I’m simply a person who lives with diabetes.

And while we’re at it, the hashtag #AADEDSMS on Twitter is well worth a read, with a lot of discussion around being inclusive from a recent Ascensia summit in America.