Pump

YpsoPump: The First Few Weeks (Part Two)

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I’ve been road testing the new YpsoPump that launched in Australia last month. If you missed the first half of my review, you catch up here. 

I must admit that I was a little intimidated at the prospect of using Ypsomed’s Orbit inserter to place infusion sets on my stomach. When I last used the Animas insets two years ago, it was a terrifying experience. The insertion process with the disposable plastic insets were so clunky, leaving me with little confidence in whether my insertion was a success, or whether the cannula had kinked on the way in. I can still recall one tumultuous night where I didn’t pick up on a kinked cannula until several hours later when I had high blood sugars and moderate ketones.

Thankfully, I’m finding that the YpsoPump’s reusable Orbit inserter device does a far more efficient job. The plastic cannula that sits underneath the stomach feels much stronger than the Animas sets, which would also help with kinking as well. The infusion sets can also be inserted manually.

The area does feel a little tender after the pressure from the insertion, compared to the gentler manual Animas sets that I’ve been using. Thankfully, this hasn’t been a sign of any site failures. I’ve been cautiously doing my insertions 12-24 hours prior to switching the site, so that I’ll be able to pick up any signs of a site failure. I’ve had one bad site placement so far, and I was able to pick it up straight away (it was just a bit of blood).

I really like that if you do happen to place your site badly, you can simply clip it back onto the Orbit inserter and try again, compared to an inset which is rendered useless once it comes away from the insertion device. It’s also nice to have a reusable inserter device that doesn’t create so much plastic waste like the disposable insets.

Ypsomed’s Orbit infusion sets are cleverly designed to rotate 360 degrees. The end of the pump line clips into place over the top of the infusion site, rather than having to be clipped rigidly into the side of a set.

The downside to this design is that it is challenging to check the skin where the infusion set is placed for any signs of bruising and bleeding. I’m slowly getting used to seeing through the purple coating, with a little help from my iPhone torch.

The sets seem to stick well enough at the centre, although they do tend to come loose around the edges after showers. One thing I am enjoying is less sticky residue left on my skin after removing an infusion site.

There is a choice of Orbitsoft plastic infusion sets (6mm and 9mm) and Orbitmicro steel infusion sets (5.5mm and 8.5mm), with each available in lengths of 45cm, 60cm, 80cm and 110cm. I did try one of the steel sets, but I think I am a bit weirded out by having a needle permanently underneath my skin. While it worked just fine for three straight days, I can’t say that it was as comfortable as the plastic.

Ypsomed’s glass reservoirs hold 1.6ml of insulin, which is slightly less than the 2ml capacity of Animas and may be a consideration for people on larger insulin doses. We were told that insulin in the glass reservoirs could be used in the YpsoPump for up to 7 days, or stored in the fridge for 30 days.

I was also in disbelief as the pump continued to run for up to five minutes while I was changing the battery. There’s no more having to rewind and re prime the insulin cartridge, or worry about losing information about insulin on board. Since I stopped syncing with the mylife app and switched off the pump’s Bluetooth last week, I’m expecting to get around 3 weeks from the AAA alkaline battery.

When I caught up with one of the Ypsomed reps in Perth last week, I expressed just how much I want to hear from other people who have used new diabetes tools and technologies. Even during the pilot phase when I had no idea that I would be getting a pump, Ashley’s insights were so valuable.

People with diabetes need to be part of the conversation, and I’m super grateful that Ypsomed included us in their launch – which is especially generous considering they are relatively new to Australia.

The YpsoPump is available in Australia now. Subsidised consumables are available through the NDSS, although I’ve been told to expect a 7 to 10 day delay as my Pharmacy’s supplier doesn’t carry them. Which is understandable, given it’s a new product and the demand probably isn’t there yet.

A large group of Diabetes Educators attended pump training in Sydney last month, and Ypsomed has also been travelling around to various clinics around the country to train further healthcare professionals. So if you would like to get started on this pump, I am confident that you will be able to find a trained healthcare professional near you.

According to CDE Amy Rush of the Telethon Type 1 Family Centre in Perth, you may be able to get a YpsoPump before your pump replacement is due and Ypsomed will liaise directly with your health fund. I don’t know the details personally, but you can watch Amy’s video here.

If you haven’t already noticed the enthusiasm in this post, I genuinely am still brimming with enthusiasm for this pump four weeks in. I think the size, weight and sleekness of this pump are the real selling points for me.

After the pump complacency and health insurance issues that I’ve dealt with recently, the YpsoPump could not have come along at a more perfect time to help me feel re-energised in the daily grind. I officially ordered a second box of infusion sets last week, and am feeling quite optimistic about our future together.

Insulin Gone Bad.

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I couldn’t help but notice the reading of 14.1. Is that high? My friend asked me from across the table as I was demonstrating my FreeStyle Libre.

Yeah, I obviously haven’t given enough insulin for the banana bread, I replied, pulling my pump out of my pocket and bolusing for another 30 grams of carbs ever so casually.

I had already bolused a very generous 60 grams of carbs for the slice of banana bread and iced coffee I had ordered at the local cafe, but I wasn’t overly surprised to see the upward trend arrow on my Libre.

My blood sugar was still skyrocketing by the time I arrived home an hour later, with my Libre clocking in at a lovely 17.4. I bolused for another 10g of carbs, bringing the total for my mid morning coffee catch up to an overly generous 100g of carbs. I was certain that all of this insulin was bound to kick in any minute now.

After another hour had passed and my Libre clocked in at 25, I had figured that banana bread was the devil. After a prick of the finger came in at 20.4, I ignored all insulin I had on board and gave a full 4 unit correction. I also set a temporary basal rate of 100% to help get things moving in the right direction.

After a bucketful of insulin, my blood sugars slowly but surely began moving in the right direction over the course of the afternoon.

When dinner time rolled around and I was back in range, I bolused for the 50 grams of carbs on my plate. I drank a glass of water. I stepped outside and turned the sprinklers on. I washed some strawberries that I planned on having post dinner. I drank yet another glass of water. I stepped outside again, and switched the reticulation off. After distracting myself for a good 20 minutes or so for the bolus to kick in, I finally tucked into my dinner with the hope of avoiding another blood sugar rollercoaster.

Fast forward to me in front of the television 2 hours later, and my blood sugar clocked in at 16.1 with an upward trend arrow on my Libre.

I scrolled back through my pump history, noting that my last prime was four and a half days ago. As I swapped out the infusion site, my brain began to cotton on to other moments of particularly difficult-to-manage post meal blood sugars in recent days.

The lone milky coffee that sent my blood sugar upwards of 10. The hot cross bun that I’d carefully pre bolused for, but landed me close to 20. Rising blood sugars, despite a long walk fuelled by 10g of chocolate beforehand. Even a pasta meal had been extremely difficult to manage.

As I connected all of these recent occurrences together, I eventually recalled another occurrence of skyrocketing levels when my insulin had spoiled 2 years ago.

My insulin had spoiled! There was my answer! 

So, maybe Banana bread wasn’t the devil after all.

Pump-less in December

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I was staring at the infusion site on my stomach that needed to be changed on Friday night, and all I could think to myself was I really don’t want to do this. 

I thought about the stressful week I had just had. I thought about all of the running around I’ve been doing lately, and the hypos that accompanied the running around. Spontaneous activity is so friggin hard to plan for. How can I possibly guess when I’m going to get the urge to vacuum my bedroom floor, fiddle around with the Christmas lights that have fallen, or water the garden – and set a temporary basal rate an hour in advance to stop me from going low? This was hardly an issue on Multiple Daily Injections.

It was 37 degrees on Friday, and the pump just added to the hot weather discomfort. That lump in my pocket was a cozy comfort during the Winter, but now it just annoys me. Every time I sprawl out on the couch, or lay down in bed, its there. Every time I have to stop and tuck the excess pump line back into the waistband of my shorts, only to have it emerge again soon after. Every time it weighs down my shorts with all of the other crap I carry around when I leave the house, and I’m left pulling up my pants every five minutes.

I’ve definitely been cruising a little more than I would normally allow myself. Hello, December. I had two iced coffees last week. At 69g of carbs a pop, it’s not something I can usually justify consuming, especially being in liquid form. I’ve been treating myself more often than I would usually allow, and carb considerations cross my mind less often than they usually do. Maybe a break would give me time to refocus?

I love my insulin pump. I love the added precision, and extra flexibility that it allows. Having an insulin pump has really motivated me to more actively manage my blood sugar levels and count my carbs. In seven months, I don’t think I’ve ever seriously considered abandoning my insulin pump.

But I was already daydreaming of being free from my pump. I was excited by the idea of shaking things up and doing something different, in the same, refreshing way that going Libre-less was.

I have learned so much about my insulin dose requirements since starting out on a pump, and I couldn’t help but wonder if I could apply this logic and newfound diligence into Multiple Daily Injections a second time around.

With Christmas just around the corner, I doubt that this pump break will last very long. But for a few days at least, I will savour the freedom of not having to feel for a flying pump every time I get up off the couch, and the extra space in my pockets.

First hba1c Result Post-Pump

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The very last thing that I was expecting to hear was that my hba1c had gone up after three months on an insulin pump.

I mean, I wasn’t expecting dramatic improvement straight away. I knew full well that my pump is not a magic wand. I knew that my glucose levels were fluctuating far too much pre-pump. When we looked at my Ambulatory Glucose Profile with Gwen back in May, she said just as much to me.

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But I definitely believe that this variance is much tighter today. I feel I don’t peak above 15mmol half as often as I used to. Lows aren’t too bad either, but they are definitely a work in progress. I’ve been putting so much work into my diabetes. More than I used to on injections.

So I guess I went in there, mentally prepared to hear that my a1c result was the same. But definitely not half a point higher than my last one.

For a while now, I’ve stared at half decent a1c results. The doctors have been quick to dismiss me, but I’ve never truly felt satisfied with my results. Deep down, I knew that my levels were fluctuating far too much. I knew that I was peaking way too high after meals, and having far too many lows. I knew that my a1c result was not an accurate representation of what was going on with my levels. But I never had the courage to ask for help. I pushed these thoughts to the back of my mind, telling myself I would fix that problem before my next check up in six months time.

But I never quite got around to it.

So, I guess there was a damn good reason for the rise in my hba1c result last week. For the first time in a long time, I have a clear picture of where my glucose levels actually sit. It definitely means that I have made some progress. But at the same time, my goal post feels a lot further away. I am realising just how much hard work lies ahead of me in order to get that a1c to where I want it to be.

As I made a long drive home in peak hour traffic and pouring rain, it was hard not to feel disappointed. It was really hard not having Gwen, who recently retired, there with me that day. She had been with me all the way through my journey, and I’m sure that she would have understood exactly where I was at. I’m sure she would have known exactly what to say.

I dream of the celebratory dinner I’ll have when I get my a1c to where I want it to be. I dream of the satisfaction I’ll feel. The grin on my face. The sense of achievement. The victory. Feeling somewhat in control of this unpredictable disease. And the cake.

I am motivated. I know that I have made some solid progress in these last three months. I know that I am going make it to that dinner table one day.

In Conversation With a Type 1 Mum

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Mum and I had a rather interesting conversation with a type 1 Mum at the insulin pump information evening that we attended last week.

I’m always drawn to stories of type 1 parents and younger children. I was diagnosed at the age of 17, where I was able to manage my diabetes independently most of the time. My parents didn’t have such a “hands on” role as they may have if I was diagnosed at a younger age. I guess, overall, we would both have completely different experiences in diabetes management.

Type 1 Mum was at the insulin pump evening for her 9 year old daughter, who was diagnosed with type 1 diabetes at the age of 4. She was also interested in a Continuous Glucose Monitor, as her young daughter would often neglect to test her blood glucose levels at school or fib about the numbers. Obviously at such a young age, her daughter does not fully realise the importance of why she has to test her blood glucose.

At school, her daughter had a close group of friends who all knew about her diabetes. This year, however, has proven more challenging with class groups being swapped around. The children will often share food at lunchtime, without fully understanding the implications of her daughter eating something like a lollipop. The school also has an aid in the classroom to help with blood glucose tests and insulin injections. However since turning 9, she is expected to be able to manage diabetes on her own at school. She is lucky, however, that the aids there for other children will also check on her at lunchtime.

Out of my own curiosity, I asked Type 1 Mum whether she regularly checks her daughter’s blood glucose levels during the night. She told me that she would normally test once during the night, at around 1am. Her daughter would normally sleep through the nightly blood glucose tests. If the result showed up low, they would “sleep-feed” her glucose tabs and juice boxes.

She also asked me about if I test through the night, being an older person. I told her that, obviously, for myself, I am very motivated to check my blood glucose levels. The decision to test during the night would come down to how confident I am that my BGL will remain stable. If I eat junk food in the late afternoon, I know that the fat will send my BGLs up after I go to bed. But there are other days where I have eaten well, and I am confident I will remain stable.

It was great chatting with you, Type 1 Mum. Best of luck with the decision you choose to make.

A cracking walk on a cracking #DOCtober Friday.