Where Have All the Test Strips Gone?

Imagine if you were told you were no longer allowed to access the tools that you needed to make proper decisions about your diabetes care. In a disease that requires us to constantly analyse our healthcare decisions, how would you manage your highs and lows if you didn't know they were even happening? How do you know how much that extra mouthful of dinner affect your glucose levels? Does the thought of having no way to tell how your body is being affected by your diabetes scare you? 

Stop imagining. This is now the reality for a lot of Australians living with Type 2 Diabetes.

"From July 1, all people with type 2 diabetes who are not using insulin can purchase an initial six months’ supply of subsidised blood glucose test strips.

After six months, people with type 2 diabetes who are not using insulin can access subsidised test strips if their doctor or an authorised health professional wants them to continue testing. This change follows the independent advice of the Pharmaceutical Benefits Advisory Committee.

Importantly, if a person needs access to subsidised blood glucose test strips for clinical reasons, they will continue to receive access. This may include people with gestational diabetes, on certain medications or people with inter-current illnesses."

Its hard to process exactly how awful these changes really are. I have Type 1 Diabetes, so I will continue to recieve subsidised test strips. However, all types of diabetes can end in the same dire consequences if we are not given the tools we need to adequately control our diabetes. 

The message that is being given to people with Type 2 Diabetes is that their diabetes care, and by extension, total health care, is not important or a priority. That their feet, eyes, kidneys or even lives are easily expendable in order to subsidise the debt and expenditure of Queensland Nickel. 

Many of the messages that people with diabetes see about their disease are the messages of prevention - the message that you should not end up like us, to be healthy, exercise, eat well, take the stairs, quit smoking and never drink alcohol. Yet in this case, that message is quite the opposite. Blood glucose testing is a reliable, in the long-run inexpensive way to prevent complications that are far more costly to the healthcare system than test strips. Furthermore, people with diabetes are encouraged to enjoy a healthy lifestyle to help prevent these complications  - but being healthy is much harder when people with diabetes are being denied access to an integral part of their diabetes care. Oral medications for Type 2 Diabetes can cause hypoglycaemia, which can be very dangerous, and needs to be treated immediately. Exercise may become a thing of the past to those who do not have access to test strips, as it can be very hard to manage safely, which anyone using any form of hypoglycaemic agents will know. 

Without access to blood glucose testing supplies, how do those with Type 2 Diabetes know when its time for them to move on from diet control to medication, and from medication to insulin? Without test strips, a person might remain hyperglycaemia for months on end with no idea, especially if they are not receiving regular HbA1c tests (which, with the changes to medicare subsidies for pathology tests, is more likely. I have even told my doctors that I will be moving from 3 monthly to 6 monthly blood tests in light of the extra costs). In some early-stage Type 2 Diabetics, where they are managed by a GP, they might only have an annual diabetes check-up. You also have to include those patients that are not inclined to seek medical advice often, and may ignore high symptoms if they are not encouraged to test their blood sugar levels.

The fact that there have been no provisions made for a patients right to take control of their own health is appalling. As stated, the ability to procure subsidised test strips will rest entirely with health professionals, and if they want the patient to continue testing. This further alienates the patient from their own healthcare, if they are not given the right to decide how closely they wish to monitor and control their own chronic illness. Access to doctors in some areas can be quite limiting, and this could negatively impact on the ability of a patient to receive that recommendation that they should continue testing. 

Having done my licence renewal recently, I note that this new policy doesn't seem to account for the requirement for anyone on any hypoglycaemic agent, oral or otherwise, to test their blood glucose levels before driving to ensure that they are above 5 and safe to drive. 

The implications of the decision to limit access to blood glucose testing strips to people with Type 2 Diabetes are already there. I hope that they will be realised before irreversible damage is done to any individual with diabetes.

Credit: Insulin Nation

3282

Yesterday, I talked about the 'T1D Looks Like Me' campaign which you can access here if you would also like to smurfify yourself.

Today, I'd like to show you what a different aspect of T1D looks like.

A year ago, on WDD2014, I started a collection, of sorts. The 'D365' project. It's not quite complete, but I thought I would share a preliminary look with everyone now that the initial collection is finished.

This is what a year with Type 1 Diabetes looks like:

125 Set Changes. 

125 times I pushed a cannula into my leg, stomach or back. That's  1 cannula every 3 days.

Some of them hurt. Alot. Some hurt for the entire 3 days they were in. We don't have any way to x-ray ourselves & find the nerve clusters before we put each cannula in.

3282

3282 Testing Strips. That's how many times I poked a sharp needle into my finger, hard enough to make them bleed. 

3282, is an average of 252 tests per month, 62 tests per week and 9 tests a day. Even when my fingers ache.

208. The number of hypoglycaemic events experienced. The number of times that my blood sugar was not high enough to sustain life long term and required immediate attention. That's 1 low blood sugar every 1.75 days. Sometimes, you can have 4 in one day, and sometimes, none for a week.

There is no way to predict a hypo (or trust me, we wouldn't have them!).

But in Diabetes land, we have this amazing tool to help us manage our diabetes. It's called CGM.

CGM is expensive. But it can stop hypos. Want to know why I was hypo free for 5 days straight? CGM. 

Think 3282 is an awful lot of pricking & poking? CGM gives my fingers a much-needed break.

I'm not holding out for a cure. I don't believe in one and I don't particularly feel like I need one. I can and do live my life just fine with my T1D. What I do want are the tools to HELP ME live with this disease, day in, day out. Like CGM. And in future, the artificial pancreas, or closed loop system, or the smart insulin patches.


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Reasons Why I'm Hypo:

The counter has been reset. I went Christmas shopping.

WDD15

Happy World Diabetes Day everyone!!

Since the start of November, my facebook has been awash with pictures of smiling, happy, blue people. For those who don't know it, November is Smurf Awareness Month. 

Juuuust kidding. There is a reason for the blue take-over.

November is Diabetes Awareness month (and lung health awareness month too....so look that up) and today is WORLD DIABETES DAY!

This year, we T1's have adopted JDRF's campaign: 'T1D looks like Me' - putting a face to what T1D looks like:

There are a great many things that T1D looks like: Test strips, jellybeans, blood and needles. But what I think we're highlighting most is that we are just normal people. Yes, we walk among you, and you don't even know it. Acting like normal people. We eat the same foods as you. Watch the same movies. Go to social events.

Like baby showers (For a diabuddy, but hey). Where you get to eat blue themed food, just to further the spirit of WDD. 

(Yes, that is blue zero-sugar lemonade))

(...and a blue strawberry)

I feel like I filled my quota of blue. What did everyone else do for WDD this year?

_________________________________________________________________________________

Reasons Why I'm Hypo: 

Last Hypo Incident:

5 days since last incident

Fantasy Diabetes Device

Whenever Blog week rolls around, there always seems to be a topic on fantasy diabetes devices. I usually ignore that topic and run off to find a suitable wild card topic. There's never been anything that I needed a diabetes device to do that we don't have already. I mean, an app on your phone where you take a picture of your food and it tells you how much carbs are on your plate would be cool, but I don't really need it. I've got chocolate all figured out already, so really, I'm good here carb-counting my own meals.

But now I've thought of something. Guys - it's going to get a little girly in a second, so if that isn't your cup of tea - kindly click away to another, less feminine, post.

One of the awful truths about being female is that whether you want her to or not, your Aunty Flo wants to drop in every month or so for some female bonding time. You learn to live with it. My problem is that my diabetes loves Aunty Flo. He's always acting out whenever she comes to stay, trying to get her to notice him. But then the diabetes tantrums start once she leaves and he realises he's been left all alone again.

Its only a recent problem. Despite sulking objections from all my HCP's, a few months ago I quit taking the birth control pill after deciding I couldn't live with the side effects anymore. Best decision ever! Unless you talk to my HCPs who weren't too happy with the decision. Sadly for them, I don't care to listen to their opinions on the matter at all and am rudely ignoring their pleas to think about the possible unplanned children. I don't really plan on having any unplanned children, so I don't know what they're worried about really.

Since ditching the pill I have no idea what diabetes wants anymore. I know that I have a pattern that follows my menstrual cycle but by the time I can be bothered to change onto another pattern in my pump I've moved on from the low stage to the high stage.

So basically, what needs to happen is that someone needs to add a new kind of pattern to the pump that follows a set cycle of time before it loops back. Currently I have 3 different patterns set into my pump - 'nomal', 'A' & 'B' - normal for when my BGLs are behaving, A for luteal and B for follicular phases of my cycle. I'm ridiculously lazy and would rather spend a week hypoing a minimum of 5 times a day than simply switch my pump to my A or B pattern. And I won't even consider setting a temp basal every day. Its just more to think about.

My fantasy diabetes device is a pump, that upon set-up, asks if you're a female or male. You can select female and set a basal cycle length - i.e. 28 days. You can then set patterns inside a pattern - so tell it to have one pattern for say 5 days, before automatically switching to the next pattern, which may deliver less or more insulin, and so on and so forth, to follow your cycle.

Does anyone realise how much easier this will make my life? Why is this not a thing yet? Medtronic, are you listening?

Diabetes Control: As Easy as ABC

My H2B (that's Hubby-to-Be in Bridespeak) likes to watch ABC for some reason that I can't quite grasp. I strongly suspect he's under the illusion that they're more truthful. Or he just likes watching old people talk in monotone, maybe its a soothing thing to him.

Yesterday, he put on ABC as he does in the middle of the day on a weekend. They advertised a segment to appear last night on diabetes and a 'miracle cure'. My spidey sense was tingling, alarm bells were ringing and the word poppycock flashed into my mind in Neon letters.

So at 9.30pm last night I settled down with a big bowl of popcorn, prepared for some entertaining comedy. I lie. I didn't have popcorn, can't eat the stuff because it tops out my 'reasons why I'm Hypo' list.

As predicted, ABC had no idea what they were prattling on about. Everyone listen up, Blueberry Tea is gonna kick your diabetes into gear. That's actually a new one. Hallelujah we are saved!! The Menzies institute has your back. If you look up the Menzies institute and search for their diabetes research you are met with this very succinct and to the point description of how they interpret diabetes: 'Diabetes is a disease'. Their words radiate such a strong understanding of my medical condition, so I'm definitely going to just shut up now and drink the blueberry tea.

Sorry I lie again. Seems to be a problem with me tonight. I'm not going to drink the blueberry tea. Because blueberry tea is not going to cure or help my Type 1 Diabetes, as ABC so informs me:  "A herbal tea with blueberry as its base has attracted the attention of medical researchers at the Menzies Institute for its potential to reduce insulin dependence in diabetics."

Not only are they blanketing all types of diabetes again, but they specifically mention insulin dependence, which lends people to relate the report more towards people with Type 1 Diabetes. The article is based off a single-person case study - an elderly Type 2 patient on insulin. They also talk to a nutritionist who says she has done some trials of her own and that those who drank the tea had better glycaemic control. I'm no medical officer, but if patients have bothered to go to a nutritionist, it is likely that they have made other significant changes to their dietary habits alongside drinking the tea that would aid glycaemic control.

How does this miracle cure work, you ask? A senior researcher has the very simple answer: "The tea has enabled that hormone, insulin, to improve glucose uptake into muscle and by doing that it lowers blood glucose levels and it does that by stimulating blood flow,".  How amazing, so does Viagra. Basically, if the ABC are saying a healthy lifestyle will help to aid control in diabetes, then the article is not really telling us anything we don't already know.

As a person with Type 1 Diabetes I only have 1 point to make really. Don't drink the tea. Well you can, but only drink it because you like to drink tea. Don't stop taking your insulin. We're called insulin dependent for a reason. Because our insulin-producing beta cells are effectively dead. You can test it out if you want - go dig up your poor old dead bunny Flopsy from the garden and give her a hit of this so-called good stuff. Chances are, if Flopsy doesn't come back to life spontaneously, neither will your beta cells.

640genius

Let's start this post off with something amusing. A few days ago my 3 hour CGM trace totally looked like a cat. Excuse the bad BGL. Apparently my supposed carb-free meal that I bolused 2 units for anyway is not all that carb free.

Moving onto the important stuff. Yesterday, a 4 year old boy from Perth recieved the 1st MiniMed 640G pump. I had the opportunity to play with one of the pumps last week, so I thought it only fitting that I should wake myself up enough to ramble about the new pump, and how in love I am. And how super jealous I am of that 4 year old kid.

This is just a first impression based on an hour of asking my rep loads of questions; but I'm preeeeeety sure if I was one of those people who married mundane random objects then I would be saying my vows to the 640G pump come May instead of my fiance. If you're reading this my dashing H2B, sorry darling. Girls just like men who save their lives. And my pump does it more than you do.

The 640G. Here we go. Aesthetically, if you're a boy, you're gonna love it. If an insulin pump could have muscles, this one could have rivaled Arnold Schwarzenegger at his peak. It looks strong, and sturdy, and ready to do some life-saving business. I will definitely be upgrading to the pink model (the 640G comes in pink, blue, opalescent white, black and purple) come upgrade time, because I am a girl....and I like my pumps to look pretty. All the pumps have a black base, with a coloured front. You can choose to stick the colour onto the back as well or leave it plain. Personally, I hope they release decals or gel cases for it as with the previous models of pump. Size wise this baby is only a few mm more than the previous models, probably to help with all that new waterproofing!

The new 640g

Now here's the fun part, all the exciting features that I am still trying to wrap my head around. As always with me, let's do a list!

• Bigger, brighter, better screen. Actually I don't think its bigger, but it is certainly brighter and better. The screen is now colourful and has a light-sensor that will change the back-light according to your surroundings. No more squinting in the sun and groping around blindly at night.
• The screen displays more stats at a glance. It tells you how much active insulin you have on board without having to go into a stat screen anymore. If you have CGM on the graph is displayed all the time. There is a display at the top of the meter for insulin left in the cartridge & battery, as well as a visual for when your next calibration is required for CGM. There's probably some other stuff that I forgot already.
• Menus are almost the same, but with some added features, such as the ability to choose which bolus types you want to have activated. For example I use Normal & Dual Wave boluses quite often but I haven't got the foggiest idea what a Square bolus is...so no need to have that activated.
• There are options now for a pre-set temporary basal. As with the last pump you can add more than 1 basal pattern, but you can now add temporary basal patterns of a predetermined time length and strength. So you can pick a preset exercise temporary basal, etc. You can also NAME these patterns, so you don't have to remember what pattern A, B and C are meant to stand for.
• Again 2 reservoir sizes :)
• Waterproof!!!! Although I never needed it before as I am such a bad swimmer, I do feel confident in the fact that I can accidentally fall into a pool with my pump on now if I should wish it. Or get caught out in the rain, which is actually very likely for me as I love love rain.
• Customisable alarms.
• Meter that talks to the pump, with a better margin spec than the original (15% as opposed to 20). The Meter also has a strip port light for late-night testing. And my personal favourite that totally won me over to actually trying the meter: DOUBLE-DIP strip technology. Yep, you read that right. NO MORE NOT ENOUGH BLOOD ERRORS! Does anyone else realise how much money I will save on wasted strips because I didn't get enough blood. (Just clarifying: double-dip technology means you can add more blood to the strip if you didnt put enough on the 1st time).
• Glucose meter boluses for the pump. It does not use the bolus wizard, but you can use preset boluses on it. Eg. you can save a 'breakfast', etc. bolus if you eat similar carbs for that meal and just select that bolus on your meter. Soooo if you were like me, and say, getting married and did not want to pull your pump out all the time, you could do your wedding tasting prior to your wedding, count the carbs and save it as a specific bolus that you could access off your meter. Not counting carbs on wedding day? Check. Also perfect for girls who don't want to grope around their tops to bolus on nights out.
• Glucose meter is the download USB. I have 3 and I have lost them all, but I don't lose my meter.
• Infusion Set change alarm. Yep, you can tell it to remind you. Which is perfect for me because I forget and then find out halfway through the day that I have run out of insulin. Whoops.
• The pump clip acts as the battery-opening tool. So you can finally bank all those 10c pieces you keep lying around just for this use.
• You can stop a bolus delivery in progress with a quick stop bolus button during delivery, instead of going through the menu and having to suspend the whole pump and then restarting the whole pump again.

The new 640G, Sensor & meter in real life compared to the brochure

There's probably a bunch more stuff that I didn't get to see.

Which brings us to the CGM. New Smartguard technology. I know they would have done some trials and if I did a Google search I would probably find some statistics to throw at you about how well it really works and all that jazz. But honestly, I'm diabetic, I deal with enough numbers already, I don't want to look at statistics. I just want to look at what it does. Which is to try to stop hypos, before they happen.

So while my current pump has low glucose suspend, which suspends the pump on low glucose, Smartguard has predicted low glucose suspend. Basically it will try to head off the big bad hypo bear before it even attacks by suspending insulin delivery before you get hypo to keep you in a hypobear-free territory. Once your glucose is stable or rising again the insulin pump will resume insulin delivery so you don't get high as a kite either.

It is a good point to note that the transmitter is different - it has a G written on it (and probably is more advanced too) - so you cannot carry over your old transmitter to use with the new system. However I have always gotten my transmitters on great deals, so I wouldn't be surprised if they offered you a deal on sensor start to help with set-up costs.

I should probably leave it there for now and let you all revel in the fact that technology is 1 step closer to the closed-loop/artificial pancreas system.






Disclaimer: Medtronic did not ask me to review or write about the new pump. I just like new technology and wouldn't have left them alone until they let me see the new technology for myself.

Dear Jamie Oliver (An Open and Angry Letter)

Dear Jamie Oliver,

I don't know what you hoped to achieve with that blown-up piece of ass that you put on display today. Something about clean water apparently. Unfortunately, That's not what I saw. I just saw someone being wrong about diabetes. Again. So I will let you know that you are not making a new and profound statement about the correlation between certain foods and drinks and Type 2 Diabetes (Yes - there is more than 1 type of diabetes...something you clearly did not even consider when erecting your gigantic 'advert about how little you know of diabetes' coke can)

I guess you did achieve something: You once again brought diabetes to attention in a light that practically begs us to be ashamed of ourselves for having diabetes. You once again told the public that this is something we are doing to ourselves (through our decision to drink certain drinks or eat certain foods). The public doesn't make the connection to stop drinking coke as it MAY be a causation to diabetes. The public just sees you purporting to play the blame game with PWD's (person with diabetes). They will see this and follow suit.

You are not making any statement at all that the public hasn't been told at least 1008103427 times already by various health organisations. So here's a tip: stay out of it. Because at least the health organisations do it with tact, and facts. The health organisations don't just go about erecting huge signs of ignorance everywhere they go to try to make their point.

In fact, for your point to have been even remotely construed as close to a real fact you would have needed to label that coke can with: "Type 2 Diabetes proven to be caused exclusively by drinking coke all day, where the patient has undergone studies to prove that they exercised, ate otherwise healthily, had no family history of type 2 diabetes, had never taken any drugs or medications that might aid in developing type 2 diabetes and been blessed with amazing genetics, not be caused by having an old and tired pancreas and not be of Aboriginal, Indian, Chinese, or any other ethnicitiy that predisposes to Type 2 Diabetes". It might have taken up a lot more space on the can, but at least it wouldn't be insulting or degrading to anyone who currently has diabetes. And it might have actually informed the general public about diabetes and its causes instead of continuing to instill the mistaken sense that 'we did it to ourselves' towards diabetics, that trust me, we already feel from the general public.

I have had Type 1 Diabetes (not related to an intake of Coke in any way, shape or form) for nearly 3 years now. I haven't had a drink of coke in over 5 years now. I bet your mind is blown right now. Somebody who was young, fit, healthy and DIDN'T drink coke got diabetes.

Diabetes isn't the only obesity, coke-drinking related disease out there. If you wouldn't plaster 'Stomach cancer' across the abomination that you dragged out today, don't drag diabetes into it.

Jamie Oliver, for some reason your ability to make food has made you somewhat of a celebrity. You have the power to influence people. And today you abused that power to bring diabetes into something that it didn't need to be brought into. You are talking about access to clean drinking water in Californian schools. What does diabetes have to do with this? You could have talked about dehydration, which I would assume would be more prominent if clean water for drinking is not provided. Or kidney problems, probably miles more relative than diabetes,

In fact, as 1 commentor on your post pointed out - Coke can actually SAVE the lives of people with diabetes (all types) during hypoglycaemic episodes.

Given that celebrity is as celebrity does and doubtless you'll stick your hand into the diabetes pie again, I hope that you can grow from this experiance, and consult with the people you are hurting before you hurt them. Maybe approach your local diabetes body and get their advice?

You might find it'll be better recieved next time if you do.

Most sincerely,

-Someone your ignorance hurt.

I Spy With My Little Eye...

....diabetics. Everywhere I turn.

It's National Diabetes Week this week. We wouldn't have a national diabetes week without diabetics, and I seem to have run into a lot of them this week. One of the best things about having diabetes (look at me go - saying there's good things involved with diabetes) is meeting other diabetics. Getting to know their stories. No two stories are the same.

Lately, I seem to be meeting them left, right and centre. It gives me such a buzz every time, knowing there's other people walking around with broken pancreases.

I was at Garden City the other day and had just sat down to my extremely fatty, carbohydrate loaded lunch - the kind of lunch that would give my endo a coronary just to see the number written down in the carb column. I had just bolused when I heard a distinctive 'beep' coming from the table next to me. There's no mistaking that beep - the beep of a glucometer, springing into action.

My head instantly snapped over towards the source of the sound, and I saw a girl probably just a bit older than me stashing her meter away in her bag. I think I kind of just sat there in a happy daze as she pulled out an insulin pen, dialed up the number and proceeded to give herself the good stuff. "Look! Another diabetic" I basically punched my fiance in the ribs getting him to spot the other diabetic. Her husband, or partner, or brother or whoever he was must have overhead me, or otherwise noticed me staring weirdly at his wife, partner sister or whoever she was to him.

I guess the smart part of me was a little slow off the mark, because I know its rude to stare when you're doing your diabetic business. So I declared myself: "I'm diabetic too! Sorry, I didn't mean to stare. Its nice to know you're not alone." He nodded at me, as she had already begun eating. "It's ok, she feels the same way too."

As I left, we exchanged a friendly, 'in the club' smile.


Yesterday, the first day of National Diabetes Week, I was standing in a line for some delicious crepes at the Abbey Medieval Festival. Wearing a deep blue Medieval Dress, my purple people eater pump, Vernon, was clipped onto the top of my dress...I didn't think it would be very ladlylike to go fishing about in my bra to bolus. Pumps must be some sort of beacon for other pumpers...next thing I knew I had another young lady in front of me saying she "liked my pump",  as she pointed out her own purple Medtronic pump.

As we stood and waited for our crepes we swapped diagnosis stories and dates. We found out we had gone onto pumps at nearly the same time. Eventually we got our crepes and parted ways to enjoy the festival - but not without first wishing each other good BGLs for the day.

After the festival I came home to a facebook message from someone I knew a long time ago, who had just been diagnosed with T1D recently. I hadn't spoken to this person in about 6 or 7 years, but wanted to ask me some advice after finding out through a mutual friend that I had had T1D as well for the past few years. And that's the thing with diabetics. We reach out to each other, constantly, and I have not met a diabetic yet who isn't happy to help.



For me, it isn't National Diabetes Week. I'll leave that to the Diabetes Organisations. For me, it's National Diabetics Week. I'm going to celebrate all the amazing people who live with diabetes every day of their lives.