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.

T1D: A step-by-step assembly guide

Happy WDD everyone!!!

This post goes out to everyone in my life who doesn't understand what it means to be pancreatically challenged.

Type 1 Diabetes: A How To Guide

Step One: - You have just been told your pancreas has gone on permanent vacation. Please commence feelings of sadness, loneliness and despair. Mourn your dead pancreas. Continue this for a few days, weeks, months or years. Maybe forever.

Step Two - Withdraw a couple of Hundred $$ from your bank. Go to your chemist. Buy syringes, needles, insulin, testing supplies, jellybeans, ketone sticks, a sharps container. Maybe some other stuff. But these are the basics you will need to survive. DO NOT leave the chemist until all your money is spent. 

Step Three: - Learn to inject yourself with insulin and prick your fingers. The chemist probably sold you a crappy lancing device (finger-pricker). Poke your finger before and after every meal, whenever you want to drive, and before, during and after any physical activity you do (and yes, sex is a physical activity). If your fingers don't feel bruised and/or are covered in black/red dots, you aren't poking enough. Stab insulin into your stomach 5 - 7 times per day. Expect lots of bruises, lumps, red marks and pain. Occasional stinging feelings are to be expected. 

Step Four: - Try to keep blood glucose levels between 5 - 8 at all times. Ignore feelings of failure when you cannot achieve this 80% of the time. 

Step Five: - Prepare a meal. Do a complex maths equation to estimate the number of carbohydrates you are about to consume. Work out how much insulin to give yourself. Give yourself the insulin. Cross your fingers and hope that it all works out OK and you don't get hypo or hyperglycemia from miscalculation. Success rate is probably about 30% correct. Don't take it to heart, there's always next time you eat to try again.

Step Six: - Its time to exercise. Exercise helps to regulate blood sugars, so this step is important. Before you head off find a bum bag, spibelt or similar. Play tetris and try to cram your glucose meter, testing strips, lancing device, mobile phone, spare cash, keys, and juice into it. Once you have successfully attached all of these items onto your body, you can commence exercise. During & after exercise, be aware that you may experience hypoglycemia.

Step Seven:  - Prepare for bed. Please ensure you have checked your blood glucose before brushing your teeth. We do not recommend mixing OJ & toothpaste together. If blood glucose is lower than 5mmol/L, consume carbohydrate foods regardless of hunger levels. Go to bed. Lay awake for a few minutes and convince yourself you will still be alive in the morning. Set an alarm for 3am to check blood glucose levels to help ensure that you will wake up in the morning.

Step Eight: Wake up. Check blood glucose levels. Repeat Steps 3 through 7 daily for your expected life duration.

Occasionally you will need to repeat step 2, particularly if you are looking into insulin pump therapy.

Every few months you will need to add in a maintenance step (step nine).

To fully prepare for maintenance you will need to undergo a diagnostics test. See your nearest pathology laboratoty to have blood drawn for this. 

Step Nine: -  Your diabetes specialist visit is today. You have just spent all your money on Step 2. Call your parents and ask for money to see your doctor. Go to your diabetes specialist. They will focus on the things you are doing wrong, because you don't need help with the stuff you are doing right. Try not to take it to heart. Reward yourself for going with a slice of extra-chocolaty cake.

Congratulations! You have now assembled the parts required for a 'working diabetic'. Commence use of this model immediately, as it will supersede all 'working pancreas' models previously available on the market.

Diabetes Blog Week Day 5: Diabetes Life Hacks

Share the (non-medical) tips and tricks that help you in the day-to-day management of diabetes.  Tell us everything from clothing modifications, serving size/carb counting tricks to the tried and true Dexcom-in-a-glass trick or the “secret” to turning on a Medtronic pump’s backlight when not on the home-screen (scroll to the bottom of this post). Please remember to give non-medical advice only! (Thank you Rachel of Probably Rachel and Kelley of Below Seven for this topic suggestion.)


Diabetes Life Hacks? I probably don't have anything original that I haven't picked up from other blogs or D-forums/chat rooms.

I guess I struggle with remembering how diabetes devices affect my body - like lancing devices, set changes, etc. So whenever I need hacks these are the things I look for. 

For the 1st 6 months I was diagnosed I have a favoured finger that took the brunt of testing. Consequently that finger is now very calloused and require 1 1/2 whole lancing points above my other fingers to draw blood. Eventually I worked out a system where I assigned each finger to a meal or a specific testing reason. My thumbs are for my pre and post breakfast, index fingers for pre and post lunch and middle fingers for pre and post dinner/before bed. My ring finger (and the equivalent on the opposit hand) is for pre-driving checks and my pinkies, because they bleed much more readily are reserved for hypos. In doing this my fingers have a chance to heal and the callous on my favoured finger is slowly softening. 

As well as this, I change my lancet on pay day every fortnight, which is the same day I buy my strips and other diabetes supplies, so I am just able to start with everything fresh. Failing every fortnight if I buy supplies in bulk, I try for at least once a month


My next hack is to remember when I last did my set change as I always forget and will just wait for the insulin to run out. I calculated an average of how much insulin I use per day and I fill my insulin up with this exact amount for 3 days, plus approximately 6 - 7 units for prime/air bubbles. It also helps to curb overeating because I have to remember I have only given myself x amount per day, so if I pig out one day I take it easy the next to save premature set-change.


The other hacks I use most often are about remembering carb counts for things. When I package up sausages I will write on the outside in marker how many carbs are in the serve I just froze so Its not something I have to look up later. Or for cereal I find a small bowl, scoop, etc that is roughly the size of a serving and have attached to it a label with all the cereals I eat and how many carbs is in 1 scoop - so that way  I never have to weight it and can just quickly use the scoop to get out an exact amount of carb. I tend to cycle through about 3 different cereals so the scoop has all 3 written on it and I just move it from one box to the next. 

Not over exciting hacks, but they help make diabetes care just that little bit easier for me.

Diabetes Blog Week Day 1: Tell Me a Story

For the 2nd year now I am taking part in Diabetes Blog Week. Today we are supposed to be talking about the diabetes causes and issues that really get us fired up.However, I think I do this on all-to-regular basis and I'm just not in an advocate and cause mood, so I decided to go with the 'Tell me a Story' WildCard instead. 

Write a short story personifying a diabetes tool you use on a daily basis. A meter, syringe, pump, pill, etc. Give it a personality and a name and let it speak through you. What would it be happy about, upset about, mad about?  (Thank you Heather of Unexpected Blues for this topic.)


The dark is all around as I wait, crammed against many more of my kin. We all stand, patient, knowing that one day, we will see the light. One day it will be Bob's turn, or Mary's turn, or my turn.

Outside, I can hear a snap. I am rattled about in my prison. A grubby, pin-pricked finger reaches in. Is this is it? Is it my turn? I cannot bear to stay here, in the stifling blackness anymore. The finger passes me by. Now is my chance; I stick myself firmly onto the warm pink flesh.

Now. The light is everywhere, flooding me with warmth. I bask in the world around me as I am roughly shoved into the care of a higher intelligence. A little care, please. I am here to help, after all.

I tense with anticipation as I see the red shadow near. What I was made to do. Fulfilment. I drink in the deep iron flavour of the blood as the finger tries to steady beside me. I relay the flavour to my God, a very sweet tasting blood. My duty fulfilled.

Now. I am finished with the obligations, I can help no more. But I am not ready for this adventure to be over. The world outside my confinement is so big, so bright. As I am wrenched free of my god, I deftly twist and manage to fall. I drop a long, long way and strategically land on a tile in similar colour to my own body. Eyes lumber close, stupidly blinking. However I am a master of disguise. They will never find me. At the first opportunity, I see a dark passage and wriggle away underneath, somewhere I may rest to plan my forays into the world.

I am halfway there when a creature of too much hair sees me. It pounces and attacks, dragging me off to a corner as I fear for my life. It appears my end is not today, as the creature is frightened away by shoe-clodden feet. A foot passes by me and I quickly swing under the footfall of the 2nd step, gripping tightly to a shoelace as it lifts.

I ride to freedom. The greens of the great outside await me. I drop off and into a pot plant. I plan to scale the heights of the washing line and spend my night in a comfortable looking sock. My adventure, the adventure of Harry, a test-strip who dared to dream, is just beginning.