Glucose Monitoring

DX2 Sydney

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Two weeks ago, I had the privilege of attending Abbott’s Diabetes Exchange event in Sydney (see below for disclosures). I went into this event excited about trialling the FreeStyle Libre, and meeting some of the other Australian bloggers in person. Having only communicated with PR ladies Hannah and Laura prior to the event, I was surprised to learn that there was an Australian based Abbott team. I was also pleasantly surprised that they were such a core part of our proceedings over the two days.

Peter, Bruce, Michael, Pamela and Jen were with us throughout the whole two days worth of proceedings. They each presented in front of us, but they were also very much with us in a social context, too. They dined with us on Thursday evening, they sat next to us during the formal proceedings, and they also put their cooking skills to the test with us on Friday afternoon at the Sydney Fish Market.

Paella 2

Going into this event, I honestly wouldn’t have thought I’d have anything in common with these guys. They were there to sell us a product, after all. However, I had some really great conversations with most of them. Although not all of them had diabetes themselves, I could see how genuinely passionate they were in the work they did. I could see how genuinely interested they were in us. Not just about the diabetes, either. I recall speaking with Jen, in particular, for at least an hour at dinner on Thursday.

One of the highlights of the event was hearing from Udo Hoss, who talked us through the “science” of the FreeStyle Libre.

We learned about how the Libre sensors were clinically proven to produce accurate and consistent results across their whole 14 day life. I learned about the term Mean Absolute Relative Distance (MARD) from regular blood glucose checking. From memory, the MARD must be below 15% in order to be a reliable indicator of glucose levels. The Libre system achieved a MARD of 11.4% across its 14 day sensor life, making it accurate enough to make insulin dosing decisions from. For this reason, Abbott are pitching the Libre as a replacement for finger pricks.

Given that the MARD is slightly higher during the first 24 hours, I cheekily put my hand up and suggested that we should receive an extra day’s worth of sensor life to compensate. There was a lot of laughter in the room, but sadly no leeway!

There were also three conditions where we were told to confirm a Libre scan with a finger prick.

  1. When glucose levels were low.
  2. When symptoms don’t match glucose readings. (Corrected)
  3. When glucose levels are rapidly changing.

We raised the question of how we would be able to push the sensor life beyond it’s 14 days. Unfortunately they automatically shut down, as Abbott cannot guarantee their accuracy or safety beyond the 14 day life.

We were also told that the data lagged by about 6 minutes.

It’s easy to sit behind a computer and complain about something being too expensive, or something else being difficult to access. Trust me, I’m guilty of it. Yes, Abbott are a business, and like any business they are trying to sell us a product. I acknowledge how privileged I am to be able to try this product free of charge. The $95 price tag for each sensor will place it out of reach for many, I’m sure.

That being said, sitting in with the team from Abbott really gave me a greater appreciation for the whole product. I had a much greater appreciation for the whole research and development process, and not just the item that I see on the shelf at the Chemist.

Group Photo 2

Thanks again to the team at Abbott for your great hospitality, and for having me at DX2 Sydney.

You can learn more about the Australian launch of the FreeStyle Libre at freestylelibre.com.au.

Disclosure: Abbott paid for my travel expenses to and from Sydney. I received a FreeStyle Libre reader and two sensors free of charge. There was no compensation, or expectation that I would blog about the event. All opinions expressed here are my own.

Glucose Monitoring Doesn’t Tire Me. Diabetes Does.

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I rely heavily on glucose monitoring in order to manage my diabetes. I check before, and two hours after every meal. I check before I go to bed, during the night and when I wake up in the morning. If there are times when my blood sugar is irregular, I find myself testing every hour. I have spoken out frequently about glucose monitoring, and how strongly I feel about it.

I was very keen to take part in the yourSAY (Self Management and You) research a few months ago, looking into the attitudes towards glucose monitoring in Australia. I was very much looking forward to reading the results that were released last week by Diabetes Australia, Abbott and JDRF Australia.

YourSAY Glucose Monitoring Survey_INFOGRAPHIC

Monitoring my blood sugar has become second nature to me. I can’t say that I’ve ever lacked the motivation to test. I hardly even think about it anymore. Glucose monitoring is not something that I see as a choice. It’s a way of life.

In that regard, I was surprised at how many people reported that they became “tired” of glucose monitoring. I think I’m more “tired” of diabetes itself. Diabetes is to blame for the lows that force me to stop what I’m doing. The stubborn highs that just won’t go down. The nights where my sleep is interrupted by blood sugar swings. The food that I feel guilty for eating. My glucose meter is only the messenger, telling me what’s going on. My meter gives me a sense of control over the unpredictability of diabetes, and I wouldn’t want to live without it. (Unless diabetes is cured, of course. Then I would love to live without it…)

While my attitude remains unchanged, glucose monitoring is without a doubt inconvenient. When I’m sitting at my desk at home with my meter within arms reach? Easy. When I’m going out for a few hours, and forced to carry that crap around with me? Not so much. I’ll often leave my stuff at home and fly blind for a few hours just for the sake of convenience. I would love to see an affordable, minimalistic device that offered greater convenience while travelling.

I was also interested to read that type 1s checked their glucose on an average of 6 times each day. Yet our National Diabetes Services Scheme only subsidises 5 test strips per day. 2 in 3 people do not always check their glucose as recommended by their GP. The survey itself highlighted a number of benefits of glucose monitoring in managing diabetes: adjusting insulin, managing illness, avoiding hypos or hypers, and peace of mind. Yet I was once made to feel guilty for purchasing too many test strips. Surely, removing these limits would be the first logical step towards encouraging glucose monitoring?

Finally, I was disappointed that these findings did not outline or commit to any solutions to lessen the “burden” of glucose monitoring. I can only hope that this research will trigger conversations and change in the not too distant future, for the sake of the people who took the time to contribute their valuable and personal insights.

You can read the full results of the yourSAY survey here, and the media release here.

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.

Glucose Testing Behind The Wheel

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One of the topics that really spoke to me while completing the yourSAY survey was the issue of glucose monitoring before getting behind the wheel of a vehicle.

To be honest, having to go to a doctor every two years to have my “assessment to drive” completed is a bit demoralising. I don’t like having my “medical condition” branded on my drivers license. I don’t often ask for special considerations because of my diabetes, and I hate that I have to ask my doctor for it every two years in order to operate a vehicle.

I get that operating a vehicle, or machinery is a pretty serious responsibility. For anybody. With or without diabetes. I get that I have a condition that could potentially put others at risk on the road if not managed properly. But I also know that I am a responsible driver. A responsible driver of my own vehicle, and of my own diabetes management. Both of which I take very seriously.

I do not test every time that I am about to get behind the wheel of a vehicle. Not because it’s inconvenient, not because I don’t like to and not because I don’t carry my testing supplies on hand. I don’t test every time that I get behind the wheel simply because I don’t feel that it is necessary to do so.

I am the designated driver in the vehicle of my diabetes management. And it’s my right to make that decision of whether or not it will be necessary for me to test before getting behind the wheel today. It’s my ability to judge a hypo, or hyper coming on. They’re my blood sugar levels that I place the confidence in to remain stable while on the road. Not yours. Not the government’s. Not my doctor’s. And not anybody else’s.

Every day in the news we hear of drunk drivers, traffic offenders and criminals endangering our roads, and the individuals on them. I am not suggesting it is, but I would hate to think that mandatory glucose testing in a vehicle would somehow be legally enforced here in Australia ahead of these other more serious issues.

I realise that this is probably easier for me to say compared to someone who is not as confident with their diabetes management. But at the end of the day we must empower, and give this responsibility to the individual.

I will be guest moderating tonight’s Oz Diabetes Online Community chat. Join me by following the #OzDOC hashtag on Twitter from 8.30pm AEDT/5.30pm AWST.

How Can We Change Attitudes to Glucose Monitoring With Limited Subsidies?

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I recently completed the yourSAY (Self-management And You) study, where I was invited to give my insights into diabetes self management and glucose monitoring behaviour here in Australia. As I was answering the questions, it became evident to me that the survey was trying to hone in on people’s attitudes and behaviour towards blood glucose monitoring.

One of the survey questions asked me to identify when I would check my blood glucose levels. Would I check when I wake up? Before meals? 2 hours after meals? Before bed? When I feel unwell? When I feel my blood glucose might be high or low? Before I drive a motor vehicle? Before I exercise? During the night? Or “just to check?” Naturally, I ticked all of the boxes.

If you’re a long time reader of this blog, you’ll know how strongly I feel about blood glucose monitoring. How it helps me to feel grounded and in control over my diabetes. How it gives me a sense of certainty, and peace of mind over this rollercoaster of a disease. And how lost I would feel about it. I have never, ever needed any motivation to check my blood glucose levels in the years that I have been living with diabetes. But as I was completing this survey, it became apparent to me that many people might not be as motivated to do so (no judgement either way).

I might be wrong, but it seemed to me that this survey might have an end view of encouraging people with diabetes to check their blood glucose levels more often. And when I think of this issue, one thing comes to mind. 

How am I supposed to check my blood sugar levels that often when our test strip subsidies here in Australia are so limited? How am I supposed to check my blood sugar levels when I get behind the wheel, when I exercise, when I feel unwell, before a meal, after a meal, when I feel low, when I feel high, when I’m unsure and during the night – when our National Diabetes Services Scheme only subsidises 5 blood glucose tests a day? How am I supposed to check my blood sugar levels when I am being told that I consume too many diabetes supplies? (You can read more about this in the column I wrote for Insulin Nation in July).

If this is indeed the end game that our diabetes regulatory bodies are seeking, then surely the sensible approach would be to re-evaluate our healthcare policies.

I must say that completing the yourSAY survey was rather stimulating. It certainly made me reflect on my diabetes management strategies here in Australia, and I’ll be sharing some more of my thoughts here in the days to come.

If you are a person with diabetes living in Australia, you can complete the yourSAY survey by visiting yoursay.org.au.