Insulin Pumps

Perspectives on Pumping.

4 Comments

I recently had a student reach out to me for insight on a research project titled ‘Positive and Negative Social Impacts of Insulin Pumping.’ I really, really loved these questions. I was never asked how diabetes made me feel after my diagnosis. I got a pump because I felt like it was my last chance to gain some control over my blood sugars. I never really thought about how a pump would make me feel. 

***

Did you ever feel excluded or underestimated because of diabetes? Was this also impacted based on the treatment you use?

Being diagnosed with type 1 at the age of 17, I had lived all of my life to that point without diabetes. Naturally, I felt very conscious of ‘introducing’ and managing my new condition around others.

Diabetes also felt extremely isolating. I didn’t know a single other person with type 1. Management tasks like checking blood sugar levels and calculating insulin doses were largely invisible to those around me. It was difficult to lean on my loved ones for support, as I didn’t feel that they would be able to completely understand the complex nature of this condition.

To answer your question, I don’t think that these feelings would be any different with either pens or a pump. It’s the diabetes itself!

Did the insulin pump change your lifestyle or encourage you to start new habits? 

The insulin pump definitely motivated me to start counting carbohydrates, rather than guessing my insulin doses. I started paying more attention to my diabetes and learned how to better respond to many of the different factors that affected blood sugars. And, of course, it offered an element of convenience in my insulin dosing over needles. The variance in my blood sugars improved a lot within a few months of pump therapy.

I also found that the insulin pump produced more low blood sugars during exercise than injections ever did. Having rapid acting insulin as my basal, rather than a long acting insulin used with injections, made it easier to go low while I was on my feet at work or doing housework at home. Physical activity with a pump requires a lot more planning, which for me is a little discouraging if I feel like going for a spontaneous afternoon walk around the block.

Has diabetes inspired or motivated you to join different groups? Has it, generally speaking of social impacts, improved your life?

Absolutely! Although, I don’t think I would have been keen on meeting other people with diabetes in the initial years after my diagnosis.

I began using Twitter with more of a diabetes focus when I started my blog in 2015, which connected me to a vibrant online community of people with diabetes from all over the world. This community was so valuable to me, and eventually motivated me get out and meet other people with diabetes.

Diabetes has given me a lot of confidence in regards to being more open about my condition, and I’d like to think that this confidence has extended beyond just my diabetes. Peer support has definitely improved my mental wellbeing. Diabetes is such an isolating condition to live with, and having peers to talk to and laugh with are a constant reminder that I am not alone in this.

How flexible are you with the insulin pump?

The pump will give you more flexibility if you’re prepared to put the hard work in.

For me, the pump has offered me the most flexibility in being able to customise basal insulin to the time of day. For example, being able to deliver a higher rate of basal insulin in the early hours in the morning to combat what is known as dawn phenomenon – a surge of hormones that triggers the liver to dump additional glucose into the bloodstream.

But again, the pump is only as smart as the person pressing the buttons. In this example, I’ve had to make the commitment to monitoring my blood sugars, identifying trends and making adjustments to my basal rates accordingly.

Does the changing of the cannula take a lot of time and patience?

It was definitely a learning curve in the beginning. I had to make sure that I didn’t pick an overused spot on the stomach that could bruise or bleed, that the cannula didn’t kink on the way in, and that there weren’t any air bubbles in my pump line that could impair insulin delivery. Site changes did create a little anxiety in the beginning. If it wasn’t successful and I wasn’t getting my insulin, my blood sugar would go high pretty quickly and I could be in Diabetic Ketoacidosis within a few hours.

Today, it’s just another ‘chore’ that I have to stop and get around to doing every three days.

Any additional positive or negative impacts of the treatment on the social aspect?

I’m pretty neutral on this. The pump does make things more convenient in social settings and when I’m on the go. It’s worth noting that lots of people dislike needles, so the pump is a big help there. But there’s also a lot of maintenance you need to keep on top of and more consumables you need to keep handy, so it depends on how you look at it!

I feel it’s the nature of diabetes as a whole, rather than a particular insulin therapy, that may have an influence on social aspects of life. I feel its more important that people with diabetes receive adequate support to accept their condition and live well with diabetes – from their healthcare professionals, peers, loved ones and even mental health professionals.

The YpsoPump Launch Event

1 Comment

My first week with the YpsoPump saw me in holiday eat-and-bolus-without-really-thinking-too-much-about-diabetes mode. Not to mention that it was my return to insulin pumping following a month long break. Week two saw me back at home with one of the worst Winter colds I’ve had in years and some of the craziest insulin resistance I’ve seen. It’s now week three and I’m just beginning to return to some sense of normality with the ‘betes.

Safe to say, I feel as though I’ve already been through a lot with this pump in the short time we’ve known each other. I really am enjoying the YpsoPump for its sleekness and light weight nature, and you can also check out my Instagram stories for more insight here. I’ll have some more to share here soon, I just don’t think I can fairly review a pump without using it for a good few weeks.

I had never even heard of the YpsoPump prior to searching the TGA website earlier this year in desperation for any signs of new insulin pump choices following the demise of Animas. I then noticed fellow blogger Ashley of Bittersweet Diagnosis had been trialling the YpsoPump, indicating that an Australian launch was on the horizon. A bit later on, I was fortunate enough to receive my own invitation to a launch event held in Sydney three weeks ago.

We were introduced to a Swiss company called Ypsomed (pronounced “Ipsomed”). As a manufacturer of tailor made insulin injection pens and autoinjectors, the company vision is to make self care simpler and easier. We were told that the company had a long, successful history of insulin pumps in the world, dating back to 1985. The YpsoPump had been designed to fill the gap in a market filled with complex, medical looking devices.

Ypsomed’s portfolio of diabetes products fall under the company’s Mylife Diabetescare brand. Encouragingly, their portfolio extended to people on Multiple Daily Injections and structured blood glucose monitoring. Products included clickfine needles, lancets, injection pens and a new Unio Neva blood glucose monitor using a custom brand of test strips. Not to mention that YpsoPump’s companion ‘Mylife’ smartphone app would also be useful to people not on a pump (it’s a free download from your App or Google Play store).

We were shown a roadmap of future upgrades to the YpsoPump system. This included the addition of the Unio Neva blood glucose meter that would send blood glucose readings to the Mylife smartphone app via Bluetooth. Ypsomed are also in discussions with manufacturers to add CGM integration into the pump. The YpsoPump will eventually be able to be controlled remotely via the smartphone app, but this looks to be at least 12-18 months away.

Ypsomed is also manufacturer of the wildly popular Omnipod tubeless insulin pump, which received TGA approval some time ago but has not yet managed to surface. The NDSS funds insulin pump consumables here in Australia, while private health insurers fund the actual device. Ypsomed have not been able to find a way to fit the funding model here in Australia due to the disposable nature of the Omnipod.

In response, we were told that a smaller ‘YpsoPod’ is currently in development with an expected 2021/22 completion. One half is disposable while one half is durable, meaning that this pump would fit the funding model in Australia.

Everything sounded really encouraging, with Ypsomed assuring us that they are here to stay and committed to the Australian market. This includes a dedicated Australian based customer service team. I’m also looking forward to catching up with a member of the Ypsomed team visiting Perth this week.

At the end of the day, more choice for people with diabetes is always a good thing. A massive thank you to Ypsomed Australia for having people with diabetes there.

Disclosures: Ypsomed Australia covered my travel and accommodation expenses to attend the launch event in Sydney. I was fed and watered across the duration of the event. I also received a YpsoPump and consumables to take home and trial. There was no expectation that I would blog about Ypsomed or the YpsoPump. My opinions and my time, including the annual leave I took from work to attend, are my own.

Breaking Up With My Health Insurer.

2 Comments

When a loyal customer informs you that they will be taking their business elsewhere for sake of better value for money, you would think that the appropriate response would be to do everything possible to convince you to stay.

When I walked into my local HBF branch on Friday to do just that, the member service advisor (who actually had a connection to diabetes) simply told me that she completely understood.

I’d be lying if I said that I don’t feel a little stung by the health insurer that my family have been loyal to for as long as I can remember. I can remember impatiently waiting at the HBF branch at Karrinyup on many occasions as a kid when my parents had claims issues to deal with. When my Mum and Dad brought me to HBF after I first commenced full time work to take out a policy of my own, I did not even think about choosing anyone else to look after my health.

I genuinely liked that HBF were a West Australian business, with a family feel to it. There were plenty of local branches nearby where I could go and talk to an actual person, rather than deal with a matter over the phone with the call centre on the East Coast. We haven’t ever had a problem with them over the years.

However along with insulin pumps, HBF no longer covers dialysis, cochlear implants and surgical weight loss procedures on basic tier hospital policies. Meanwhile, I can receive claims or discounts for ‘wellness’ products and services which have no value to me on my health cover.

I find it ridiculous that I am forced to have my health insurance cover packaged with other products and services that I have no use for. Admittedly, my new health insurer is no different either. In an ideal world I would go into a branch, tell the insurer what I need coverage for, and have a package that is tailored to my own individual needs.

Over the four year lifespan of my insulin pump, my current premiums (inclusive of the 25% rebate contributed by the federal government) have covered roughly 60% of its cost. Not to mention that many people would not be upgrading their insulin pumps as soon as the four year warranty period is up. Moreso at the moment as we are waiting patiently for the new pump options to hit our shores (watch this space).

Of all people with diabetes, those with type 1 who are the predominant users of insulin pump therapy represent only 11%. Of those 11%, I believe that insulin pumpers would be in the minority. They weren’t encouraged or talked about by my own healthcare professionals. I only came to know more about them from talking to other people with diabetes – and that, in itself, was a massive step for me to make.

I have now broken up with HBF, a decision which will save me at least $550 per year. Diabetes is one awfully expensive condition that I did not ask to get, and I can think of hundreds of other things that I would much rather put that money towards each year.

But for now, I will happily divert that extra $550 per year toward things like insulin pump consumables, batteries, test strips, hypo treatments and insulin. 

As Elaine would say, “you just lost a customer!”

(Clearly, you can tell that I’ve been binging on far too much Seinfeld at the moment…)

Insurance, Insurance.

1 Comment

I’m currently shopping around for health insurance. I don’t feel as though I can do this post any justice given that I have not come to any conclusions yet. So I’m offering you one long, conclusion-less post instead.

So, I said that I was shopping around for health insurance.

Why? Because HBF, my current insurer, have recently announced that insulin pumps will no longer be covered on lower tier hospital policies. A visit to my branch recently revealed that it will now cost me an extra $500 a year to retain that coverage for my pump.

My excess for a stay in hospital will also jump from $100 to $500, which is insane considering that I could just as easily admit myself to hospital as a public patient and pay nothing!

I’m a young, healthy adult. I don’t claim a lot. I can’t remember the last time I went to hospital. There’s a good chance that I won’t even need any of the additional extras included on that mid hospital policy. It sucks that there’s not an add on where I could just pay solely for insulin pump coverage. I’m simply being penalised for having diabetes, a health condition that I didn’t ask for.

I am really sad about the possibility of leaving HBF, given that they are West Australian owned, not for profit, and have plenty of branches around the place where I can visit and speak to an actual person – rather than someone in a call centre on the East Coast. Maybe I am being too hard. Is an extra $500 a year such a bad deal for the $10,000 device that I’m getting in return?

I will need a new insulin pump when my upgrade is due in two years time. With Animas going out of business, the day will come where consumables to service my late Vibe will no longer be available. I suspect that new pump options may be rolled out to eligible Animas customers sooner rather than later. Not to mention that if the Vibe packs up after my four year warranty period has lapsed, I won’t get a replacement. So, pump coverage is really not optional.

Another option is to remain on my current level of cover, which would see me lose my insulin pump coverage, and revisit the issue in 12 months. If I waited until then to upgrade, I would likely need to serve out a 12 month waiting period that would be completed just in time for my pump upgrade in May 2020.

But as I said, I highly doubt that Animas will have the capacity to service in warranty pumps for up to another four years. I suspect that new pump options may be rolled out to eligible Animas pumpers sooner rather than later. With last week’s announcement of Tandem’s tslim touch screen insulin pump finally hitting our shores later this year, that is one boat that I do not want to miss.

Then there’s the option of searching for a new health insurer. Yes, other health insurers do cover insulin pumps on lower tier hospital policies. You do need to ring them up and ask though, given that pumps aren’t commonly listed on health insurance websites. Of course, there’s always the possibility that they may make changes to insulin pump coverage in the future, leaving me with the same dilemma to deal with.

I have been following the many health insurance conversations going on in Facebook groups, and speaking to some friends with diabetes. But the reality is that everyone has different needs, so I can’t really compare what someone else pays for health insurance with my own policy.

So, now I am left trying to compare apples with apples. Comparing what I have covered on my current hospital policy, with offers from other health insurers. Thinking about what I need, and what I don’t need from my health insurance.

Safe to say, my brain is fried.

Ironically, I also happened to pull my pump off over the weekend.

So maybe I won’t be needing a new one after all…

Why I Am Waiting.

3 Comments

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.