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Diabetes Tech: A Cure of Sorts?

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It’s no secret that my cure faith is not very strong. I don’t really live my life expecting, or hoping that my diabetes will be cured tomorrow. This post sparked a fair bit of conversation two weeks ago.

For the record, I define a cure as a means to regulate my blood glucose levels without any action from myself. No finger pricks, no carb calculating, no insulin injections, no treating hypos and no thinking about the whole diabetes thing! Long, uninterrupted nights of pure sleep and leisurely days free from the stress of managing diabetes would be very much preferred.

Although I’m hardly a diabetes veteran, technology has only come in leaps and bounds over the years. And I believe that’s what we are going to have to accept as a cure, of sorts, for the time being.

I believe that the right kind of technology could be a cure of sorts. There’s talk in the Diabetes Online Community of “closing the loop” – i.e. insulin pumps and Continuous Glucose Monitors (CGMs) that “talk” to each other. There’s artificial pancreases in development, and there’s always research surrounding insulin producing cells that could one day be a game changer for us all.

Technology will inevitably make diabetes easier to manage, going forward.

Technology is spectacular. Technology means a lot to many who already use it to manage our diabetes, evidenced here. Technology would be life changing to many, evidenced here and here. Technology provides our health with the best of prospects. And I know that I am extremely lucky to be living with diabetes in 2015, rather than 1915.

But technology is damn expensive, too. And that’s the one thing that worries me.

Research and development into new diabetes technology is costly. Then there’s marketing, promotion and distribution costs. And then of course, the business is a business and needs to make a nice profit from their efforts, too.

But where does that leave the humble young adult from suburbia, working his way through life on a less than spectacular wage? Where does that leave the parent of a young child, managing diabetes on top of family and work commitments? Where does that leave the person living in a developing country, unable to access basic healthcare and diabetes supplies? Did I mention these people are all affected by diabetes?

The sad truth is that diabetes technology, and the closest thing we have to a cure, is still out of reach for many of us. I refuse to adopt a CGM, because I can think of a million other things that I’d rather invest my hard earned money into. I count myself lucky that I am in an independent situation where having a CGM is not a necessity for the time being. For many people with diabetes, it certainly is.

Research and development needs to be conducted with an end game in mind – the consumer. These advances in diabetes technology need to be accessible and affordable to the consumer. Otherwise, I fail to see how we are doing anything to help people living with diabetes. Other than making them feel marginalised, deprived and isolated.

I don’t want to place the blame on any one party. Personally, I’d just love to see government, researchers, diabetes tech companies and diabetes organisations come together to find a solution. I know, easier said than done.

The only cure that I would give everything for, is a proper one. A cure with a one time cost that leaves me forever free of diabetes. A cure that is not reliant on devices, consumables, batteries, cable cords and credit cards. Now that, I would happily give all of my life savings for.

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A CGM, and a Second Option In My Diabetes Drawer

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Two weeks ago, I attended an information evening on insulin pumps. And to a lesser degree, Continuous Glucose Monitoring. For the former, I am still deliberating. I am still plagued by two lines of thought. Will an insulin pump actually help me, and give me more ease over my diabetes management? Or will it just be the same old diabetes management but with a fancy device? And will the learning curve, and frustrations be too much to handle? I don’t know. That’s a question for my diabetes educator next week.

For the latter, however, I do have a clearer train of thought. I’ve been writing about the issue here a lot lately, and advocating for more affordable access here in Australia. And I have come to (somewhat of) a conclusion, based on my own diabetes, and my own individual circumstances.

I do not use a Continuous Glucose Monitor. For me personally, it’s estimated cost of $5,000 per year is a very large chunk of my annual salary at a time where I am looking towards my future. I would rarely spend that sort of money on myself, and I can think of a thousand other things that I would rather put that money towards.

I don’t think I could handle having access to results 24/7. I actually forced myself to stop testing so often earlier this year, because it was doing more harm to me than good. There was a time where I couldn’t handle seeing imperfect numbers. I was prematurely correcting post meal highs, only to end up hypo two hours later. Glucose numbers are always going to naturally rise after a meal. But they are going to naturally come back down as well. Sometimes I think that mentally, it’s better not to see those numbers inbetween. Out of sight, out of mind, right?

Nor do I like the idea of potentially having two devices attached to me, at a time where I am currently considering an insulin pump. I like to keep my pockets as light as possible at all times. I cannot stand jingling pockets full of crap weighing me down while I’m running around at work! Thinking about that device being attached to me all the time feels like a physical reminder of my condition. And at the moment, that feels a little demoralising to me.

Bear in mind that I have never lacked the motivation to check my blood glucose levels. I am quite comfortable checking my levels. I will sometimes test as often as 10 times a day, because it gives me a certain level of comfort. It gives me a sense of certainty, control and grounding over my condition. Without my meter I would be completely lost.

I realise that I have lived the bulk of my life with diabetes at a mature age. An age where I relish having independent control, and management over my condition. I am also still a relatively “young” diabetic, who is yet to go through a serious burnout. Perhaps my attitude towards Continuous Glucose Monitoring will change with time.

That being said, if I did have easier, cheaper access to a Continuous Glucose Monitoring device tomorrow, I would certainly take it. I would trial it. It would certainly be handy to have on me when I go on holiday, when I am frustrated, and when I just want to have a break from diabetes. It would be a useful learning tool to have, and a shield against the unpredicatability of diabetes and glucose levels.

And I am certain that every other Australian would accept glucose monitoring technology tomorrow if it were more affordable, and accessible. Either as a regular management tool, or as a second option. If you would like to see Continuous Glucose Monitoring technology subsidised by the government, I urge you (again) to write to your local Member of Parliament, and the Minister for Health, Susan Ley.

I dream of one day seeing my own Continuous Glucose Monitoring device when I open my diabetes drawer. Beside my hoard of test strips, needles and insulin pens. Sitting there patiently, as a nice second option for me to take advantage of whenever I feel like doing so.

The Case for Subsidising CGM in Australia

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It’s good to see the issue of Continuous Glucose Monitoring getting more attention in the news at the moment here in Australia.

The Danii Meads Barlow Foundation have been doing a fantastic job at the moment of getting the word out into the media. A couple of weeks ago, this foundation provided Catherine Rowley with the support to address our leaders on the Q and A program regarding CGM support from the Australian government. You can read about that here. Their advocacy work also resulted in a report on Today Tonight yesterday, raising awareness of the founding couple’s daughter who passed away from unnoticed hypoglycemia during the night. The foundation are currently advocating for the government to provide $5,000 per year towards the cost of maintaining Continuous Glucose Monitoring device consumables.

Rebecca Johnson, who lives with type 1 and manages the Telethon Type 1 Diabetes Family Centre here in Western Australia, also wrote a pretty powerful piece in The West Australian newspaper yesterday. She hits the nail on the head perfectly.

“Managing type 1 diabetes comes at a cost. It costs me dignity, like the time I was spoon fed honey on the floor at a party because my blood glucose was so low I couldn’t see or talk. It costs me time: countless hours calculating insulin doses, testing my blood, counting carbohydrates. It costs me opportunities, at work and in life. It also costs a lot of money.

To monitor my blood glucose around the clock I use a thousand dollar machine that runs on a battery that costs $500 to replace. The sensors which I insert beneath my skin to read my glucose level cost $100 and must be replaced every six days.

The government does not fund continuous glucose monitors. It comes out of my pocket and it costs me, a young person with diabetes, more than $5000 a year to run. I fund it because I want to live a healthy, complication-free life, away from emergency admission and hospital stays, dialysis, eye laser treatments, chronic wound care and amputation surgery. Continuous glucose monitoring can prevent hospital admissions and expensive long term medical care for people with type 1.

In a time of extraordinary healthcare costs attached to diabetes care, our Federal Government needs to recognise that by supporting people with type 1 to take the very best care of themselves, the burden on the health system will be significantly reduced.

This device can save my life. My monitor is set up to sound a loud alarm when my blood glucose level is dropping. It wakes me in the night when it identifies a dangerous downward trend before my glucose is so low I can’t move or help myself.

To me, continuous glucose monitoring technology is the single most important innovation in diabetes management since the invention of synthetic insulin. It gives real time glucose information to people with diabetes to identify trends in their levels and fine tune their diabetes control. This essential biofeedback is something that every person with type 1 diabetes needs to better understand and manage their condition.

It is also the only technology that can help prevent “dead in bed” syndrome, where people go to bed with normal glucose levels and are found dead in the morning from massive, undetected overnight hypoglycemia.

Continuous Glucose monitoring is streets ahead of pricking your fingers up to 10 times a day to test your blood for glucose. Testing like this is relatively easy in daylight hours, but often many hours are left unmonitored overnight. Unmonitored glucose levels are fraught with danger. Glucose levels that are too high damage every organ and system in the body, increading the risk of kidney failure, heart disease or blindness. And if glucose levels drop too low, the sleeping person can seize, fall into a coma, and die.

A hospital admission for a single severe hypoglycaemic event costs the public system over $5,000. Treatment of diabetes related complications can cost more than $11,000 a year per patient.

It takes a visionary government to invest in new technology, and the case for funding continuous glucose monitoring is compelling. It will save the public system money, time and resources immediately and in the future. It will also give me and other sufferers a daily blessing. We will wake up in the morning.”

I am certain that every person with diabetes would accept CGM technology if it were more accessible here in Australia. If you would like to see CGM technology subsidised by the Australian government, then I urge you to write to your local Member of Parliament, and to the Minister for Health Susan Ley (click for contact details).