Diabetes Blog Week Day 3: Wild Card - My Day in Food

Some people track every bite they eat, some might not remember at lunch time what they had for breakfast or if they even had breakfast. For one day, document everything you or your loved one with diabetes eats and drinks. The good, the bad, the ugly, the proud, the ashamed, the...whatever. We promise not to judge!!

I am intrigued by this topic. I am an advocate of the notion that being fed is better than not being fed, and so therefore encourage no judgement on any food consumed. The topic, even though it is judgement -free, is still asking me to evaluate what I put in my mouth and when.

So it is with trepidation that I start about evaluating my food choices for the day.

BREAKFAST:
 A bowl of cereal, not measured, eaten hurriedly at my desk at work. I eat Special-K because my husband tells me it has an acceptable protein level. I don't really care about that, but he does, so I continue to eat my cardboard tasting cereal. I don't know what happened today, but my BGL afterwards was 16, when normally for the exact same meal every morning my BG is at 6 - 7. I guess diabetes just wanted to remind me that its still hanging around.

MORNING TEA:
BGL back to normal! I had a meeting at 10am, so made a hot chocolate and had a half an oaty slice muesli bar to tide me over until lunch.

LUNCH:
I was *swear word-ing* lazy this morning when I got up, and skipped the making lunch part of getting ready. There's not too much open for lunch right near my work, so I went to Maccas to have a banana bread. Banana bread is basically my thing. I would sell my kidney for a good slice of banana bread, and Maccas do some of the best, even though I refuse to eat anything else off their menu.

AFTERNOON
Its the afternoon, so I was dropping. I had the last half of my muesli bar and some crackers that I found in my snack drawer at work. It did the trick and I was able to drive home without having to down an over-heated popper. Score.

DINNER
Still bloody tired, so I napped when I got home and didn't plan dinner. The result was a Grill'd burger and some sweet potato fries.


Typing this list shows me that I still hate seeing what I have eaten. From morning tea onwards I can only tell myself that I am a horrible human being when it comes to food. At least tomorrow I have a later start and will have time to make a salad sandwich for lunch.

For more blog posts on this topic, click here.

Diabetes Blog Week Day 2: The Other Half of Diabetes

We think a lot about the physical component of diabetes, but the mental component is just as significant. How does diabetes affect you or your loved one mentally or emotionally? How have you learned to deal with the mental aspect of the condition? Any tips, positive phrases, mantras, or ideas to share on getting out of a diabetes funk? (If you are a caregiver to a person with diabetes, write about yourself or your loved one or both!)

I'm taking a break from reading yesterdays blogs to type this. Because Australia is often the first country to participate each day, I find that the best catch-up time for me is the next day, when the rest of the world has woken up to share their thoughts. 

I think the best way to answer this topic is with a question of my own. How doesn't diabetes affect me mentally and emotionally? The emotional side is the part of diabetes that I struggle with the most. I don't like needles, set changes, finger-pricks, blood, insulin, hypos, hypers and all the rest that comes along with diabetes. But all those aspects are much easier dealt with when I take away the mental and emotional side of diabetes. They're all just actions really. It's when I start to think of how each action I take, each number I see, each set I change, each change to my bolus or basal insulin affects me that diabetes really begins to...affect me.

I have developed a way of coping that I am not sure is really conducive to my health, but it gets me through each high and low reading, so I'll share it anyway. I tell myself that tomorrow I get to start fresh. Its probably a little bit of denial about the bad things that happened to my diabetes, but if I forgive myself for the things that didn't go right, I can start the next day wanting to try. If that doesn't work, a good old cry in the shower or rant about nothing usually does the trick. You just have to get through now to get to the next moment when you can feel good about yourself and happy again.

In an odd twist, diabetes has in fact aided my mental health. Pre-diagnosis I struggled a lot with anxiety, to the point I would pass out. In forcing myself to forget the consequences of whatever I did to make my BGLs behave as they do, and telling myself it was ok to let go for now, I have had more control over my anxiety. I still get anxiety - and sometimes it is diabetes related - but I am much better at knowing how to control it and move myself on quickly. I haven't passed out once since diagnosis.

The mental aspects of diabetes will never go away, so long as diabetes keeps insisting on following me around. I have just learnt not to let them get me down for too long.

Diabetes Blog Week Day 1: Message Monday

Lets kick off the week by talking about why we are here, in the diabetes blog space. What is the most important diabetes awareness message to you? Why is that message important for you, and what are you trying to accomplish by sharing it on your blog? (Thank you, Heather Gabel, for this topic suggestion.)

I open my mouth, and opinions come out. My blog is a space where I can vent, rage, be happy, hopeful, sad, and educate; hopefully without judgement.

One of the reasons that I did start writing my blog was as a way to self-support. Support is often the message that I want to convey the most. Diabetes is a critical and hard disease to cope with, and support in dealing with diabetes can make or break a bad diabetes day.

I find that a lot of my messaging highlights how the general community can help support us, through educating them further about all types of diabetes, how language use can impact on us, and trying to correct untruths told about diabetes.

I look to give myself emotional support. Sometimes I just need somewhere to write down all my frustrations. I am one of those people that needs to get bad feelings out of my system. If I can have a rant or whinge or cry about something and lay all my feelings out, I can move on quite quickly and go back to my normal happy self. Most of the times, I completely forget who or what it was that I was even cranky about in the first place.

I look to support others living with Diabetes. Earlier today I finished tapping out my response to the CGM announcement (self-support), and made a point of the lack of support that I feel as an adult with Type 1 Diabetes. When I was first diagnosed with diabetes, I didn't have any familial support. I didn't have any support from my friendship circles. People either did not want to or did not know how to help support me through my diagnosis. My first month living as a T1D was hands-down the loneliest month of my life. I created my own support, but I never again wanted to see anyone struggle to get support like I did.

I have since created a face to face support group for young adults, and talk regularly with group members, some of whom have become close friends.

Raising awareness of issues is one way that I can help to support others with T1D.

Reading other blogs helps me feel supported.

CGM Brain Jumble

On my Facebook, in my messages, on T.V. All day yesterday I watched news cycle around about the CGM-funding announcement that came from Turnbull's office.

The announcement that, if elected, the coalition will invest $54 million in subsidies for as many as 4000 children (up to the age of 21) to receive CGM funding each year. 

I tried to write about my feelings yesterday, and found that I couldn't. I stopped, started, stopped and went for a walk to try to sort through what I wanted to say. Finally, I wrote down all the crazy jumbled feelings in a document so that I could try to sort through them. I don't know if I'd ever felt so confused about a diabetes announcement in my life. I had to reconcile with myself the conflicting feelings of happiness, sadness, anger, hope, and utter deflation. 

It wasn't until I read Bec's blog that I could even start to sort out why I had spent the day feeling so off about it all. 

I was of course, immediately happy about the announcement. CGM is an invaluable tool, and I am so happy that it was finally being recognised and may potentially be offered to kids who could really use it. And I was happy that it meant that Type 1 was being talked about for once - and even all day long! Something was actually spotlighting us. 

I was hopeful that now that the conversation had been started, that it might continue. Hopeful that one day CGM would be more financially accessible, if this much attention was being paid to it. Hopeful that all the hard work of those groups campaigning would pay off, and they would be rewarded for their efforts.

But after that happiness came the disappointed anger, that Type 1 was being shamelessly bandied about as a way to garner votes, with no set-in-stone promise to show for it. After the election there is every possibility that it may not be mentioned again given the lack of timelines and delivery mentioned, so I felt scared about how it was being used as an election tool, aimed directly at those who had made the most noise - the parents of Type 1 kids.

There was guilt. A lot of it. Knowing that I will more than likely be voting against the technology, because I care about the bulk-billing system and other agendas more. I am hoping that the Labor party will announce a similar pledge to ease my troubled mind. But as an adult with Type 1, trying to save for a home loan, I see a bulk-billed GP and rely on my blood tests to be bulk-billed so that I can afford to see my diabetes specialists. I cut money in a medical-sense where I can to ensure that I can pay for the specialist help that I need to adequately control my diabetes. It has been made very clear that the Turnbull government are still going ahead with the cuts to pathology, no matter what the papers are reporting. It would mean more personal cost to me, to vote this policy in. Its a hard thing to ask someone to do, when you give them the choice to either betray their peers or accept a significant personal cost to themselves, with no guarantee that the cost will even end up being justified. 

I feel a loss on behalf of Type 2 patients. The CGM funding, if it progresses past policy stage, will be added to the NDSS. With the recent cuts to the NDSS in regards to the ability of a Type 2 patient to acess subsidised testing strips, it feels a bit like robbing Peter to pay Paul. 

I feel left-out. Again. As an adult with Type 1 Diabetes, there's not much on offer, and we are severely lacking in support. There are programs for schools, youth transition services, camps and pump-funding grants aimed towards children; there are telephone peer support programs and educational programs for Type 2 patients, and programs, a dedicated website and telephone support program for women with GDM. There's nothing listed under support for adults with Type 1. This was just another area in which we are being overlooked and underfunded, despite the fact that we face the exact same consequences from not using CGM as those under the age of 21. (In fact, in the report by Tu et al in The Medical Journal of Australia 2008, the mean age for dead in bed is well into the adult years, at age 30.2). 

I would be glad and happy to see young type 1 children be given the opportunity to grow up with a little less stress so I am in no way begrudging the children who may receive this subsidy. A very long time ago, when I found how hard it was as an adult to even qualify for a pump, I made peace with the fact that people don't really care what happens to you when you outgrow your childhood chubby cheeks. An acknowledgement of my loss of opportunity doesn't hurt though. That's probably one of the biggest reason that I had a small tear-fest yesterday. My loss, our loss, in this celebration wasn't even given the briefest of mentions. By any party involved. Even though we campaigned right along side all the parents.

I guess I'll play it by ear, and whatever happens, happens. Given that I had the audacity to both age past 21, and get diabetes as an adult, I'm not holding my breath that the funding will ever extend to me. It will just be a nice surprise. Either way, I hope Labor comes to the table so that the kids of the future will have the tools they need to help manage their diabetes at their disposal.

Basal Tune Up

One of the (many) reasons I love wearing an insulin pump is because it uses only short-acting insulin. Short acting insulin, because it wears off much faster, allows you to more closely mimic the functions of a type zero pancreas in ways that long-acting background insulin can only dream of.

Throughout the day, my insulin needs can fluctuate by a lot. At my most insulin sensitive, I am using less than half of the insulin that I use when I am least sensitive.

Trying to calculate how much insulin I need, hour by hour, is not easy. What works for me one week, doesn't work the next. I lost my rhythm a year ago, and it has taken me that whole year, and constant CGM use to find a basal pattern that puts my A1c within reach of my target.

My background insulin is another way for me to tell the story of my life, for anyone who knows how to read the numbers.

19.00 to 04.00 - 0.9

The night-time shift. It took me many many months to get this basal pattern right. This basal rate holds me steady during dinner, steady at bedtime when my body is still chasing some straggling carbs floating around, and keeps me level all throughout the night. It is one of my higher basal rates, showing the effects that inactivity while sleeping has on blood sugar levels. It can't account for any spikes I might see from nightmares, or lows caused by any extra activity the day before, but nothing can really, except an actual pancreas.

04.00 to 08.00 - 1.1
It seems a small rise - only .2, and some would wonder wether it is truly needed. At around 4am, my body starts to wake up - releasing a bunch of 'time to get up now' hormones. Hormones and diabetes are not friends. I employ this small amount of extra insulin at wake-up time to help enforce law and order in my blood sugar levels. You don't give diabetes any unsupervised play time at night - the dry-mouthed, over-tired consequences are not worth it.

08.00 to 15.00 - 0.8
 My job is mostly sedentary, accounting for a higher basal rate. When I previously worked at a video store on my feet all day, I had a lower rate. From 8am until 3pm, I am mostly sitting at my desk. . This rate is also slowly dropping, as my work place has recently supplied us with those fan-dangled sit-stand desks, allowing me more activity during the day.

15.00 to 19.00 - 0.4
 I aim to exercise at 4.30pm (when I get home from work) everyday.  I have a delayed blood sugar response to this, and the blood sugar drop that corresponds with the extra movement of my limbs happens from about 3pm the following day (22.5 hours after I do the exercise). From 3pm, my blood sugar levels drop sharply, and I require little (or no) insulin until I sit down for the night. I also do my housework and cook dinner during these hours. Its pretty amazing to see how simple little daily activities can affect blood sugar levels.


People associate the pump with freedom - it is. It also isn't. Every thing that is programmed into my pump assumes that I will follow the same pattern of living day in, day out. Theoretically, the pump allows me to get up at 6am to exercise one day, and 4pm the the next. Yes, I can do this and have no ill consequences whilst I exercise, but I also can't do this because of the patterns that the insulin follows. It creates a logistical nightmare the next day, when all of a sudden my insulin needs drop at 4.30am (when I have the most basal insulin, leaving me prone to an overnight hypo) instead of at 3pm (when I use the least basal insulin). 

Ecologically Diabetic

Diabetes guilt comes in many forms, including the shiny plastic packaging that each and every one of my diabetes supplies comes in.

I really started to notice my diabetes waste in early February when I was trying to cram 30 days of diabetes in the small spaces between my thermal underwear, toothpaste and multitudes of scarves for my Europe Honeymoon.

For every box of test strips, I was filling my recycling bin with a cardboard box, a round tube (as I stuffed all the test strips from one box into one canister) and some folded up paper (presumably instructions) that I have never ever read. For each box of canula sets I folded down way more cardboard than was actually needed. Everything that I needed to stay alive was compacted down into one small black packing cube, and one big pile of environmental guilt.

Fitting all this....

...into this!
 (for reference, this bag is roughly the same size of an A4 piece of paper, and about 5cm deep)

In Italy trash was just part of the scenery on a train trip, forcing my mind to the bags of waste that filled my bin every week back home.

When I got back to Australia, I started researching how to live in ways that were more ecologically sustainable.

There isn't much I can do diabetes wise, but where there are small ways to cut back on what ends up in Landfill, I will. Buying one of those monster kilo chemist bulk bag of jellybeans is better than buying cartons of poppers. Buying test strips that come in boxes of 100 instead of boxes of 50 means I am halving my box-waste, and wearing CGM means using and producing less test strip waste. Fingers can be wiped just as well on the back of a dark pair of pants as a disposable finger wipe (I actually had some DB wipes for a millisecond, but refused to use them on the principal of producing less waste).

I also reuse reservoirs until the markings have completely faded from them, but that was probably more of a wallet-friendly decision as opposed to a green decision. It just sort of serves a dual purpose.

If I was really creative, I could probably go down the route of Ciara Carew and design some fashion from old reservoirs and strips, but I will leave that to the pro.

Diabetes is not the only waste-producing culprit in my household. I was super excited to ditch all those little plastic baggies that you stick meat and veggies in and order some fresh produce bags, a bread bag, and some reusable beeswax cloth wraps to wrap foods in (like my cut cucumber and sandwich, below).

As we use sauce jars, I wash them out and stock them in a newly cleared space in the cupboards, ready to store deli meats and to freeze foods in.

An unexpected gain of my ventures into trying to buy and store foods with less waste, is that buying in this way somewhat forces you to make healthier, fresher food choices. I look for the items that come with little or no man-made wrappings, which is basically the fresh produce sections. I always know what veggies I have, because I marked all the mesh bags - whenever one runs out, I pop it straight into my bag so I can see at a glance which veggies I need - and I know instantly if I can make the recipe that I want at home or if I need to pick something up. When I'm prepared, I eat less take-out. Bread is now straight from the bakery, where I pick up high fiber-low GI, sliced and placed straight into my cute blue bread bag. Meat is bought fresh - I am that crazy lady who shops with her own containers, and asks the deli workers to place it straight into my tared jars. No plastic.

Win for the environment, win for my body, win for a guilt-free mind (and probably, an inadvertent win for my BGLs!)

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

Leaving the House with Diabetes in Tow

I do a lot of cleaning in my life. I like order, neatness and surfaces with nothing on them. My house probably gets 'spring-cleaned' 4 times a year. Once I'm done spring-cleaning my house, I'll move on to my paperwork, my computer & my emails.

I'm up to emails right now, and I'm happy to say I only have 4 emails in my inbox, all with actual useful information in them.

One of them, I can delete once this post is done. My husband sent me the picture below, and I never did anything with it until now. There was no explanation in the body of the email. There was no body of the email at all, just a subject line of "You Perty" (Thanks Hun, you perty too).

There wasn't really an explanation needed. We don't have kids. I do have diabetes though, and that's close enough. 

Some very bad photoshop skills later, and this is what I came up with:

Welcome Back King

At 1.30am on Tuesday morning I should have been sleeping, but I wasn't. Ignoring the fact that Brisbane was still almost too hot to exist at 94% humidity (Seriously Brisbane, we're mid-way through Autumn now), I had another reason to be blearily rubbing my eyes and yawning out any and all curse words I could think of. I was happily tossing and turning, kicking the sheets away and generally taking over as much bed space as possible when my husband shook me awake.

My pump was blaring away about something. I mashed some buttons, assuming it was nothing I needed to know about. It blared again, so I forced myself to crack open an eye and read the screen. Some sort of message about power failure and basal being stopped. I sort of knew it was coming because it had asked for 2 battery changes within 48 hours. I probably should have called the helpline then - but laziness and denial are some of my best friends. If I had called, I would have found out that apparently you can fix that particular power failure problem yourself, and it would have saved a lot of hassle afterwards. But 1.30am. 

I was tired and I just wanted to go back to the land of nod. I decided to set up my back-up pump, took the battery out of the malfunctioning pump, and shoved it deep within my sock drawer while it continued to beep about it's battery being removed. 

I called the helpline the next day, and they talked me through the power failure. Unfortunately, I had already set up my back-up pump with a sensor. I had swapped the transmitter to my old MiniMed transmitter when the pump malfunction happened, not wanting to waste a sensor that I had only put in 3 hours beforehand.

I am pretty impressed with the life of my MiniMed transmitter. I think that transmitter warranty life is about a year, but it has been kicking along for 3 and a half years now, and still holds charge well, whilst somehow seeming to give more accurate readings the older it gets. Though that could just be that I know all the tricks now.

So at least I have my back-up transmitter and pump working, but it's driving me nuts. I'm definitely a spoilt princess of diabetes land, and I'm used to my new technology.

I have to press the esc button to see my sensor readings, rather than having a beautiful, colourful graph and SG displayed on the screen at all times.

The sensor doesn't suspend before low - only on low. I actually have to treat hypos myself. I have a toothache right now because I've been having to have juices, when normally the sensor just catches me and I don't even think about it.

I have to scroll into a menu to set a temp basal. Being my lazy self, it just means that I haven't set a temp basal since swapping onto the old pump. With the 640G, the shortcut to a temp basal is on the screen, and only takes 2 seconds to set-up.

My meter doesn't connect!!! I have to save things manually in capture event. Sadly, my educator will just have to scroll through my meter because I am not bothering to capture that many events. And wearing a dress this week has been hard, not being able to bolus from my meter. Many, many strangers have seen my undies this week.

Don't get me wrong, I still love the old MiniMed, but I am so used to the 640G and its more intuitive programming. I swear, it can tell what I'm thinking and what I need. Its just a lot less thinking and time spent actually using the pump on my part. I kind of just let the 640G do its thing.

Thankfully I am connected back up to the 640G again with a new sensor due to start tomorrow morning. I'm going to treat this as an exercise in the art of appreciation.

NDS-What?

A week ago I received a letter in my mail from the NDSS, informing me that the way I received my pump consumables would change. I vaguely glanced at it, shrugged, and aimed it at the garbage for 2 points. I'd had a stressful week and wasn't in the right frame of mind to really comprehend what that horrible little letter contained, but it was still in the back of my mind.

The contents of the letter were dragged from the depths today when I had an email from my pump company, Medtronic, wanting to warn pump users of the impending consumables apocalypse. 

"Whilst the change-over date has been made clear, the timing and process for the transition is still very unclear...we are unsure of the impact of the transition and how you access your pump supplies during May and June....

To ensure you don’t run out, we urge you to consider stocking up now. This way you will have peace of mind during the next 4 months of supply transition."

This email was in response to the recent announcement:

"The Federal Government has announced that it will implement changes to the National Diabetes Services Scheme (NDSS) from July 1, 2016...diabetes-related products will no longer be distributed through Diabetes Queensland or via other agents of Diabetes Australia interstate.

  

From July 1, subsidised NDSS products, such as needles, syringes, blood glucose test strips, urine test strips and insulin pump consumables will remain available, but through community pharmacies.'

From what I can gather, based on the wording in the article, is that this was a Federal Government decision, and not a good decision. I'm guessing that they think having pharmacy point collection is a good way to cut costs, either through being able to cut funding somehow if DA is no longer needed as an access point, or by cutting postage. Probably a brutal-budget mix of both.

The email from Medtronic today was essentially to say that so far, the federal government hasn't felt the need to clue them in on how this change of access points is going to happen. In an online-group discussion tonight, it was pretty clear that no-one knew how it was going to happen - including those group members who worked in NDSS pharmacies. 

At this point, the alarm bells going off in my brain have moved beyond a constant ringing to full-on emergency bomb-blast sirens screeching.

If the pump companies themselves and the NDSS access point pharmacies don't know what's going on, its probably time to panic, do as they suggest, and start hoarding supplies for the long haul. Winter is coming. I'm not trying to be a dramatist or anything, but I did just max out my bank card bulk-buying enough supplies to last a good 6 months.

I can only imagine that this warning telling everyone to start stocking up is going to impact on pump consumable stocks. Black-markets for hard-to-find pump supplies will start popping up soon. I better work on my haggling skills, and be ready to trade my first-born.

What's not also clear is:

1. - What the deal is for those who live rurally? They are likely to be impacted quite a lot by this move. Rural pharmacies may also be less likely to stock items if they only have 1 customer buying the product.

2. - How pharmacies will handle this in terms of stock levels? One of the reasons I like ordering online so much is because I can bulk order - and I always have, I usually order 4 months worth of supplies at once. Bulk ordering comes in handy not only for lazy people like myself, but those who are wanting to travel (I ordered so many supplies before I went overseas!), and again, those who live rurally and remotely. Pharmacies often place irritating self-imposed limits on how many of one item you can buy - for example they may allow you to only buy 1 or 2 boxes of test strips at a time. This will limit the ability to bulk order

3. - How are pharmacies expected to stock the necessary consumables? The test strips that I use are not stocked in store - presumably because pharmacies tend to only stock a few different types of test strips due to space restrictions. Same goes for pump consumables. Where are they finding the room to keep all the many, many different types of strips, reservoirs and canulas? Will they just have a wall devoted to diabetes care? With the amount of pump users in Australia, its not likely.

4. - If they're not stocking the consumables in store, are they ordering them on an 'in-demand' or 'special-order' basis? If so, how is this any different at all to letting us just order through DA? Same amount of postage because they'd just be getting small shipments in for each customer all the time. They wouldn't be able to wait until a certain amount of orders were reached - because again, there's not many Type 1's to begin with, let alone the much smaller number on pumps.

Another factor to consider, that I highly doubt the federal Government has even thought about it, is that this may directly impact on donations made to DA. Thus cutting support even further. I always include a donation every time I order - I factor it as 'postage costs' (seeing as we don't pay postage) and just hand it over as a donation instead. I don't miss the donations that I make, because they're small enough not to impact, but they can tot up to a fair bit over the year. I will of course still donate, but I run the risk of not remembering unless reminded. 

 I'm going to need to see a proper plan before I'll start to believe that this was ever a good idea on the federal government's behalf. Until then I'll be making sure I keep my hoard of supplies well stocked.