Type 2 Diabetes

A Type 2 Diabetes ‘Shake?’

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Last weekend, we were on the hunt for a dog friendly café to keep this little guy entertained.

My sister suggested a place, before casually mentioning to me that they had a ‘type 2 shake’ on the menu.

What, is that like a health shake or something? I asked.

No, it’s actually a shake that’s got lots of sugar in it, she replied.

We eventually drove there to find the place closed.

After we had driven elsewhere and I was finally caffeinated, I began googling this place in search of a menu. Indeed, it was an indulgent shake that the user was encouraged to try ‘at your own risk.’ I then migrated over to Facebook, where I eventually found a recent post promoting the menu item in question.

I was so frustrated. Yeah, they had specified the type of diabetes, but that wasn’t the point.

Nobody intentionally asks to get diabetes.

We all know that sugary treats in excess aren’t good for us. We all know that in excess they may eventually lead to obesity, insulin resistance and type 2 diabetes.

But that isn’t always necessarily the case.

We also know that some people are genetically predisposed to developing type 2 through things like family histories or previous gestational diabetes. Others are ethnically or geographically predisposed to developing type 2 diabetes. Then there are those who don’t have an equal chance because they may lack things like the basic education or quality healthcare that I take for granted.

The last thing that people living with diabetes need is reminders that make them feel guilty, blamed or shamed for their choices.

The last thing that people living with diabetes need are messages that further stigmatise a condition that is already surrounded by, you guessed it, a great deal of stigma!

Yet here was this shake that was making a mockery of people with diabetes. I’d be willing to bet that a Cancer shake would never appear on the menu, so I don’t know why the owners of this cafe felt that diabetes was okay to joke about.

So, back to that Facebook post. You bet I left a comment on it. There was no swearing or personal attacking in said comment. But it was a little strongly worded – something I regret in hindsight – indicating that blaming, shaming and stigmatising was not helpful to people with diabetes.

24 hours later, a notification popped up in my Facebook feed. I was expecting some kind of acknowledgement or explanation.

But nothing could have prepared me for the response I received in return.

To paraphrase, I’m a miserable troll who should pull my head in and stop being a keyboard warrior (they obviously had no idea who I was). This ‘type 2 shake’ was apparently a ‘statement’ that the sugar it contains is not good for you. But what do I know, apparently type 2 diabetes is a great catchline to sell a product!

With no time for such negativity in my life, I thanked the café for their kind words. After expressing that it was a shame that they were unable to the larger issue, I wished them a lovely day and bowed out of the conversation.

With every red notification icon that popped up on my Facebook, I was expecting to see others chime in with more ignorant replies to my comment.

Surprisingly, quite the opposite happened.

The diabetes community rallied behind me.

Within a mere three hours, I had at least ten comments on that post in support of what I had said. People were tagging their friends. I honestly don’t think it was the shake itself that was triggering commentary anymore. It was about the sheer ignorance that came from their comment.

Had the Facebook post survived few more hours, and it surely would have gone viral.

But it mysteriously vanished not long after.

While the cafe clearly didn’t like the negative attention that they were getting, I highly doubt that I got my point across given their highly ignorant response.

I can’t really say that it’s worth throwing any more of my energy towards.

I only know that I won’t be going back there again.

V-Go Insulin Pump Launches in Australia!

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Also launched alongside the t:slim x2 insulin pump at the Diabetes Congress last month was the V-Go disposable insulin delivery device. It’s been available in the US since 2012 through a company called Valeritas, and AMSL diabetes have signed on the dotted line to distribute this baby in Australia.

Designed for people with type 2 diabetes, this patch pump holds a 24 hour supply of rapid acting insulin. It delivers a fixed rate of basal in the same continuous fashion as a regular pump, and comes in three different sizes delivering 20, 30 and 40 units of basal insulin respectively. The basal rate cannot be adjusted, and the size you are prescribed will depend on your weight and insulin needs.

Each V-Go can also hold an additional 36 units for bolus insulin as needed. Boluses are delivered at the push of a button on the pump itself, with each click delivering 2 units of insulin. If you are on smaller doses of insulin, this pump may not be suitable for you.

The pump does need to be replaced daily, which could be a hindrance, although I don’t see why you couldn’t pre-fill a few days’ worth in advance. Any leftover bolus insulin in the V-Go at the end of the 24 hours cannot be reused, so bolus insulin needs are definitely something to be mindful of when pre-filling your V-Go.

Each V-Go is pre filled with insulin using an Ez-Fill device. The insulin delivery device slides in at the bottom, your insulin vial sits at the top and then insulin is pushed into the V-Go using the plunger. I am told that the Ez-Fill is designed for use with insulin vials only.

Once the device is filled, you simply stick the patch onto your skin. It’s approved for use in the arms, thighs, abdomen or legs. A press of the needle button on the surface will release the needle contained within the pump and commence the delivery of insulin. The needle retracts once you’re ready to remove the device.

The V-Go system is sold in a 30 day kit which contains 30 insulin delivery patches and an Ez Fill device. It does seem a little wasteful to include a new Ez Fill in every kit!

The V-Go is not currently subsidised through private health insurance here in Australia, meaning that users will have to bear all of the out of pocket costs. The 30 day kit retails for $250, which works out to approximately $8.30 per day. This is considerably more than both Multiple Daily Injections and the subsidised insulin pump consumables we have available to us through the NDSS. However, I do like that this would be easy to trial without a larger commitment if its not for you.

Overall I can see why this device might appeal to someone with type 2 diabetes, and also the older individuals who are modelling the device in the demo kit. It’s mechanical in nature and free from any programming. The application looks far easier than an infusion site. Click to bolus looks both easy and discreet. The demo kit also indicated that many people missed their insulin doses due to needles not fitting into their lifestyle.

The main criticism I have noted in forums is that this device may not be suitable for people with heavier insulin resistance and larger insulin doses. I was also unimpressed to read so much focus on ‘improved patient adherence’ throughout the demo kit. Language Matters!

I am told that people with diabetes are free to complete the V-Go order form which can be found on the AMSL diabetes website. However, users should go through their endocrinologist or diabetes educator to prescribe the basal and get set up.

As tempted as I am to trial the demo kit of my own that I received, the fixed basal rate won’t meet my needs as a type one. Although it was suggested that I try it next time I have a pizza night! I also enquired as to whether there was a way to use it for bolus insulin only, but unfortunately there is no way to stop the flow of basal insulin once the needle is released.

Overall, I think it’s great to see more options to meet the needs of all people with diabetes. I really do hope that AMSL will try to involve some people with type 2 diabetes in the launch of this product, as they would be better equipped to talk about it than I am.

Disclosures: Diabetes Australia covered my travel, accommodation and registration costs to attend the Australasian Diabetes Congress. These are my own views, and not those of Diabetes Australia.

AMSL Diabetes hosted me at a bloggers evening during the ADC, which was primarily focussed on the t:slim insulin pump. I was fed and watered across the duration of that evening and received a small bag of stationery.

I later visited the AMSL booth in the Exhibition Hall to learn more about the V-Go, where I was given a demo kit of my own to take home. I was not asked to blog about AMSL or the V-Go. My opinions and my time, including the annual leave I took to attend the ADC, are my own.

T1 Talk: National Diabetes Week Edition

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We’re back!

My friend Bec of Sweet and Sour Diabetes and I originally designed these conversations as a way to highlight the uniqueness of our experiences with type 1 diabetes, despite both being diagnosed just days apart with only a few years difference in age.

We’ve slacked off a bit with these conversations this year, but we did make up for it with some great conversation while taking in the breathtaking sights of the Parramatta river when we finally met up earlier this year. This is another amazing example of how diabetes has made my world a lot smaller. 

Today, we’re back to dissect all things National Diabetes Week.

The theme of this year’s National Diabetes Week is ‘It’s About Time,’ focussing on knowing the signs and symptoms of both types of diabetes. Would you have benefitted from a greater awareness of the signs and symptoms of type 1 diabetes when you were diagnosed?

Frank: I presented to my doctor with all of the typical symptoms of type 1 diabetes – feeling tired, thirsty, going to the toilet a lot and a looking much thinner. In hindsight, it’s hard to believe that this doctor was unable to recognise any of these symptoms. He diagnosed me with a simple virus, ordering bed rest and lots of hot fluids. Three days later I wound up in hospital vomiting, panting and an extremely rapid heart rate.

Obviously nobody wants to wind up in hospital. Physically, I definitely would have benefitted had that doctor, or the people around me, known those 4 Ts of type 1 diabetes. Mentally, I’m not too sure how I would have handled that diagnosis had I been diagnosed in my doctor’s office. Initially, having type 1 diabetes was nothing compared to having all of those physical symptoms finally relieved.

Bec: It’s so easy for doctors to miss the signs, because they do mimic that of a virus. I agree, for me it would have been a much faster diagnosis if I knew the signs. I was chronically thirsty for such a long time, but I didn’t know that could be a sign of type 1. I delayed going to my doctor for so long that when I eventually got there my blood sugar was in the 40s.

Let’s talk about type 2 diabetes. What do you think people at risk of developing type 2 diabetes need to know?

Frank: As a guy, we tend to only go to the doctors when we’re dying. Overall, people tend to just soldier on when they’re unwell, rather than stopping to look after themselves and recover sooner (our workplaces and cultures could do a lot more to support self care). Furthermore, it’s a lot harder for people with type 2 because the onset is much slower and most will feel quite normal.

Honestly, I think anyone at risk of developing type 2 could minimise that risk by simply staying in touch with their healthcare professionals, maintaining their regular checkups and bloodwork. Just as you and I already do because we live with diabetes.

Bec: I completely agree there is a lot more we could be doing to prompt people to seek medical attention and take care of themselves. People with a known risk of developing Type 2 absolutely need to know the signs, and surround themselves with a good healthcare team as early as possible. This means they have support should the need arise.

I think there also needs to be more education on what Type 2 diabetes is. It’s not all their fault, and I think that assumption and misconception is what delays people seeking medical attention.

What do you think are some of the barriers to people being diagnosed with either forms of diabetes earlier?

Frank: Too many people don’t know the signs and symptoms of type 1 diabetes. Our stories both demonstrate that. It’s scary to still hear stories online of people dying from undiagnosed diabetes today.

I think a lot of people diagnosed with prediabetes or type 2 diabetes don’t have supportive healthcare professionals. Many people are sent home by the doctor being told to lose weight and exercise more, without being referred to an expert such as a Credentialled Diabetes Educator. People will often feel guilty, confused or even in denial while the condition progresses further.

Bec: Type 1 is completely unknown unless you have a personal link to it. I guess all we can do is share our stories to try and combat that. It takes time for diagnosis because we don’t know what we’re looking for, and Type 1 isn’t the first thing that pops into your head.

Type 2 again has so many misconceptions that it puts people off seeking help. Why go in when you’re just going to be told the same thing time and time again- eat well and exercise. There needs to be more support from health professionals, more awareness of the real nature of Type 2 and more compassion from everyone. No one chooses to get a chronic illness.

The 4Ts of Type 1 Diabetes

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Happy National Diabetes Week! This year, it’s once again all about raising awareness of the signs and symptoms of both type 1 and type 2 diabetes. I know that I’ve been critical of diabetes campaigns in the past, but hit play and let me tell you why I think this a really good one.

(If you listen carefully, you might even be able to hear the whirl of the washing machine in the background…)

‘Instant Diabetes’ Jokes

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Am I supposed to get angry and explode with rage every time I hear an incorrect comment about diabetes?

Am I supposed to bring to a hault an incorrect comment about diabetes, and politely correct that comment with fact?

Or should I just stand there and listen to the umpteenth diabetes joke, having done both of the aforementioned more times than I can keep track of, and accept that I’m never going to be able to change other people’s pre-conceived perceptions of diabetes?

The latter is sounding like the more tempting of these options lately.

I’m not really a fan of seeing rage ensue over an inaccurate comment about type 1 diabetes. I don’t think anyone should be crucified for a mistake, unless of course they fail to see any sign of wrongdoing.

I knew absolutely nothing about diabetes in the first seventeen years of my life without it. I get it. When I first heard the words ‘diabetes’ in the Emergency Room, my whole body flooded with guilt as I thought about every bag of chips, plate of ice cream and can of soft drink that I enjoyed as a kid. 

I later learned that I had type 1 diabetes, an autoimmune condition whereby an unknown trigger caused the insulin producing cells in my body to begin attacking themselves. Type 2 diabetes, on the other hand, is a condition whereby the body becomes resistant to insulin over time and often has more definitive causes. These can include age, genetics, ethnicity and sometimes lifestyle choices.

I’ve lost track of how many times I have explained the concept of type 1 diabetes to some of the people around me. And hey, I don’t mind being asked about it. I sure as hell don’t mind explaining it.

But you would think that being around someone who manages type 1 diabetes all the time might help you to at least not make those jokes about ‘instant diabetes.’

Yet, these comments still ensue right in front of me during conversations about that mouth watering, sugar laden dessert that was served at the dinner table last night.

Or, on the other end of the spectrum, this.

This is where I throw my hands up in the air, and accept that life’s too short to let the ‘instant diabetes’ jokes bother me.

The triple chocolate Flake birthday cake I made a few weeks ago that is most definitely not a cause of diabetes!