TSlim, YpsoMed, Cellnovo, Roche & Medtronic Choices!!

Melinda Seed

Yes, that’s right we’ve gone from  1 viable insulin pump choice to now having a choice of 5. I checked out what’s available at the Australian Diabetes Congress (#18ADC), formerly known as ADEA-ADS conference.

After the demise of the Animas Vibe, everyone’s been excited about the announcement that the Tslim is coming to Australia.  All existing Animas pumpers will be upgraded to the Tslim (as part of Animas’s contract with J&J).  I and some other bloggers were invited to a launch of the Tslim at a dinner on the first evening of the conference (AMSL provided the food and drink but there was no expectation or requirement that we comment, write about or mention their product).

The Tslim insulin pump is small and “sexy”. It has all the features of the much larger and clunkier Medtronic 640 pump BUT it’s considerably less bulky and has a touch screen.

                               

Features:

  • 3ml reservoir (it can sill be so small because the reservoir is a pouch/bladder rather than a syringe).
  • Talks to Dexcom CGM
  • The software is automatically updatable, so tech changes don’t have to wait 4/5 years for an upgrade.
  • All bolus calculators etc builtin
  • 16 different profiles for basal and bolus rates.
  • Rechargeable battery.

 

As I’ve said before it’s great to have more choice and whether this is the right pump for you will depend on your lifestyle. It is quite a heavy pump despite its size and the removable metal clip that encases the pump makes it heavier. If you spend time off the grid, then the rechargeable battery is going to be limiting. For me, whose idea of camping is a hotel with a view of the mountains, not having to make late night dashes to the 7-11 to buy batteries would be a definite bonus.

Frank Sita of Type1writes  has an Animas Vibe and the Tslim is the pump of his dreams, he is so keen to start on the Tslim that we’re trying to help him out with the #TslimforFrank campaign. Please AMSL, let Frank be one of the first to get the Tslim upgrade (what else are friends for but to beg on your behalf) #TslimforFrank

I am a still a fan of the Ypsomed pump, because it’s small, lightweight and doesn’t require a load of button pushes when all I want to do is a quick bolus. I’ve reviewed the Ypsomed here.  I am looking forward to it talking to a cgm or flash device, I understand there is talk this may happen within the next few months.

Cellnovo were also at the Congress. This is another option for people who want something a bit more like a patch pump. My comments on it from last year’s D conference here .

Finally I did visit the Medtronic stand, they announced the ‘launch’ of their 670 pump system. There is a “but” though, the CGM that goes along with the 670 doesn’t have TGA approval yet, so they’ve announced a launch even thought the new pump isn’t available yet. To stop people rushing off to consider other pumps, they are offering that if you are upgrading or moving to pump therapy now, you will get a 64- PLUS 6 months worth of CGM AND they’ll upgrade you to the 670 when it becomes available.  I spoke to the reps, and a really senior business manager and they weren’t to be drawn at all about when regulatory approval might be received for the 670 CGM. Also if I were in the position of deciding whether to go with Medtronic I’d be asking for some sort of guarantee about when the upgrade will occur once TGA approval is received.

 

NEW ASCENCIA METER WITH APP & IT’s AVAILABLE FREE

Sometimes if you hang about on social media too much, it can seem like everyone is using CGM or Libre and it’s only us Luddites who still fingerpick.  Of course the vast majority of us with type 1 D still prick our fingers. Ascension (formerly Bayer) have launched a new meter, tiny and tests assure us that it’s extremely accurate. It also has an App that you can download that gives you loads of info about trends etc.  It also allows you to have a second go at getting enough blood on the strip-this avoids the annoyance of wasting strips.

You can request a free (!) meter online.  “To request a CONTOUR®NEXT ONE meter, visit www.contournextone.com.au. The CONTOUR®DIABETES app is now available to download from the Apple App Store (iOS) and Google Play (Android).”

 

 

A big thank-you to Diabetes Australia for inviting me to be part of #DAPeoplesVoice, DA covered my accommodation and travel expenses and arranged a media pass for the conference. Any opinions expressed about the conference are entirely mine and do not represent those of DA.  Ascencia and AMSL provided food and drink whilst showing us their products but any opinions are entirely my own and there was no expectation from either company that I would write about their product.

 

Diabetes Congress Day 1

So it’s been a busy time here in Adelaide. As part of #DApeoplesvoice at the Australasian Diabetes Congress #18adc I’ve been to two product launches, presented at a symposium on co-design and tweeted my heart out at a full day of sessions and it’s only the first day!

So a few of the major things from day 1:

The tslim pump has launched in Australia (more on this later) but suffice to say it has all the features but a really small size. It looks set to be very popular. I put my money on Frank Sita being one of the first to switch over!

Diabetes Australia has stepped bravely into the low carb ‘discussions’ by issuing a position statement.     https://static.diabetesaustralia.com.au/s/fileassets/diabetes-australia/8b4a8a54-f6b0-4ce6-bfc2-159686db7983.pdf

After tackling low carb I guess they decided “in for a penny in for a pound” and have tackled DIY diabetes tech as well.  It’s refreshing to see that there is a patient focused approach in which the main point is that health care professionals shouldn’t abandon patients who are using this tech.

https://static.diabetesaustralia.com.au/s/fileassets/diabetes-australia/ee67e929-5ffc-411f-b286-1ca69e181d1a.pdf

Some interesting sessions on hypos. There seems to be generalised agreement that the correlation between low a1c and severe hypos observed in the DCCT is no longer relevant. New insulins, new tech enable improved a1cs and reduced hypos.

Its a slow burn to get the voices of people with diabetes into the conversation. I think this year is a little easier than last year. The co-design symposium at which Renza, Frank and I presented got some really positive responses, thanks to Renza and Kirsty Bell for organising this.

Its been so great as always to spend time with some of the tribe.

More info including some tech updates coming soon.

 

 

 

Here’s Looking at You, Retinopathy Reminiscences

Through the window the last rays of sunlight are disappearing,  the waiter stops by  “Now you can see each other” he says, putting the flickering candle down between the glasses and the pate. There’s a momentary pause in our chatter, “You have no idea how true that is” Maryanne responds. I nod and toast my thanks to modern ophthalmology as I take a sip of wine.

Maryanne lives in Brisbane, I’m in Sydney and it’s been difficult to organise this catch-up drink. M is visiting Sydney for a conference, the weekend she arrived I was in Melbourne for my own conference so we’re meeting for an afterwork drink on Monday night. We skip lightly over the last 15 years, within a few minutes we’re talking about our eyes. Drawn to share again those dark experiences that nobody else really understands. Those years with impaired vision and the threat of blindness. We were young then, now we’re middle aged and feel as though that experience could have happened to someone else.  We talk about how that fear influenced the decisions we made and the lives we led back then though and how that’s impacted on where we are now.

Next we’re discussing whether or not we should undertake PhD studies and career changes. We know that if our eye problems had happened 20 years earlier we wouldn’t be sitting here, able to see each other, able to drive and contemplate more post-grad study. I feel more able to envisage the future now than I could as a younger diabetic, I worry about what things this disease can still throw at me but so far I’ve survived its best efforts.  If you happen to be deep in the trenches fighting retinopathy or some new complication, take heart, treatments these days are excellent and there is plenty of great life on the other side.

It’s now dark outside and the windows have turned into mirrors. I look up and see my reflection, I tell myself I’m doing okay for almost half a century of diabetes.

All things shall be well and all manner of things shall be well.” Juliana of Norwich

Life in a Virtual Diabetes Community

The other day I saw this non-diabetes related exchange on Twitter and it really resonated:

Over the last few weeks in particular I’ve seen a number of people lamenting a perceived loss of civility/kindness/supportiveness in the diabetes online community.  It grieves me that people would have negative experiences participating in online communities. I have spent the last twenty years involved in this community and in the very early days of RealityCheck and the Type 1 Diabetes Network I invested emotionally, mentally and financially into building a community. During those early years we were attacked by a small number of health professionals (indeed a dietitian contributed nasty jokes about retinopathy anonymously to our forum when we failed to ‘enforce’ the messages he believed needed to be sent), a small group of people felt we weren’t inclusive enough so they spent time criticising us online and sending nasty reviews of the website to publications, people visited the forum paid for from the personal funds of the founder and yelled their criticism and aired their minor grievances there.

All this to say a degree of anger/nastiness/personal attack is not new in the diabetes community.  What keeps me involved though is that for every person with whom I’ve had some sort of less than ideal experience online, there’s been 10 people from whom I’ve received empathy, validation, useful information and a warm fuzzy feeling. I would be so much the poorer, emotionally, intellectually and in physical and mental health  without the online diabetes community AND I want others to experience this too. I came to realise that many of those who behaved in what we perceived were less than ideal ways were most in need of the help offered by peer support and their depth of feeling was indicative of just how important the community was.

All communities are made up of flawed individuals and we can’t always be at our best. I cherish the authenticity of real interactions and sometimes these can be uncomfortable-but the community needs diversity and will be stronger if independent thinking is allowed and sometimes we have to agree to disagree.

There is nothing more prejudicial to community life than to mask tensions and pretend they do not exist, or to hide from them behind a polite facade and flee from reality and dialogue. Jean Vernier

Of course there’s often a tricky balance between critique and constructive disagreement versus negativity and point scoring that may degenerate to nastiness. When I look at the rest of Twitter, I am really encouraged by the #DOC, there are occasional less than ideal interactions but generally there is a civility and search for mutual understanding and a sense of fairness that far exceeds that of most other social media interactions. Jean Vernier has wonderful insights into community life, being the founder of the world wide L’Arche communities of people with and without intellectual and developmental disabilities, he says:

It is difficult to make people understand that the ideal community doesn’t exist and that the equilibrium and harmony they imagine possible are things that come only after years of struggle, and that even then come only as flashes of grace and peace.

Community is the place of forgiveness. There are always words that wound, self-promoting attitudes, situations where susceptibilities clash. That is why living together implies a certain cross, a constant effort and an acceptance that comes from daily and mutual forgiveness.

I’ll leave the last word to Cherise who was recently on the receiving end of criticism that was not based on fact, and upon which a bunch of people on either side (including me) weighed in without doing a fact check first. Her response is all class and shows commitment to the community that goes way beyond her individual interests and gives me something to aspire to!

When Language Causes Doctors to Behave Badly!

 

Melinda Seed

Language matters is not about being polite or swapping one word for another that conveys the same concept.

The reason why people with diabetes get upset and angry about words is that they betray flawed assumptions, presumptions and inaccuracies NOT because they’ve hurt out feelings. We may get upset about rudeness, incivility and being patronised too but that’s a different issue and one that many of us can solve by simply seeking health care providers with basic social skills.

Here’s a little story to illustrate what I mean.

Jack’s GP  referred him to an endocrinologist for his diabetes.  The referral said:

“… Jack is a type 2 diabetic of 1 years duration. He is not adhering to treatment recommendations, having failed to control blood sugars with oral meds and life style modification. His HBA1c has been steadily increasing over the last twelve months and as of d/m/y it was 12.2%. …”

The GP didn’t cause Jack emotional distress. The words were recorded in a communication between doctors, trying to convey ‘facts’. So there’s no problem here-right? I mean they’ve been polite even  used the word ‘adherence’ instead of ‘compliance’-gheez some people are just so sensitive?    The problem here is with lazy doctoring! Continue reading

Language Matters & Compliance Officers

Melinda Seed writes for Twice Diabetes

In the midst of  the launch of the UK’s statement about language and diabetes (good to see them catching up with the pioneering work of Australia on this) I’ve been thinking about the sort of communication that I’ve found most helpful around diabetes.  Here are some of the things that have stuck in my mind as being really helpful over the years. Continue reading

My D Team: Me, Myself and I

The only player on the D mgt court!

The other day somebody innocently tweeted that diabetes management was a team effort.That got me thinking and although it’s dangerous to push metaphors too far I don’t believe thinking of diabetes management in terms of a team is appropriate or helpful.

The team analogy implies that everyone has a role to play at all times and most importantly that everyone shares the joys of victory or the bitterness of defeat. This is simply not true. It is me and me alone who feels the hypos, the highs, the fear and reality of complications.  Every finger prick, every needle, every blood test, dilated pupil exam or pump site change is felt by me alone. It is me who savours the ‘victory’ of a straight line on the Libre after eating pasta or the relief of a ‘clear’ complication screening.  The closest I come to sharing this is the empathy  in the diabetes community when rejoicing or commiserating with those of us who know exactly what it’s like. Continue reading

A New Pump on the Aussie Block: Ypsomed!

A new pump is available in Australia, right now. The Ypsomed (pronounced ipsomed) has been TGA approved and will be reimbursed by your health fund and the consumables are on the NDSS.  I was invited to attend a soft launch of the product and provided with a loan pump to ‘test-drive’. Ypsomed covered my travel and accommodation expenses to attend this event and lent me a pump to test drive. I have not been paid or expected to  write about or comment on this or any other product.

 

Size comparison, Ypsomed at top, my current pump below.
My current pump (on left) alongside the Ypsomed.

The first thing I noticed about the Ypsomed is its size. It’s small and lightweight. I REALLY like that it is much smaller and much less bulky than my current pump (which is only a few months old and yet is the biggest pump I have ever owned).

 

 

It has a large, touch screen. Despite being small, almost the entire front of the pump is the screen, so it’s easy to read and use.

The pump is made in Switzerland (which has a reputation for quality in manufacturing) but 24/7 support is local rather than using an international call centre.

I was surprised to learn that Ypsomed has a long history of involvement in diabetes devices. They were, in fact, behind the Disetronic pumps available in the 80s through to the early 2000s. The current pump has been available in Europe since 2016.

 

The pump has a glass cartridge, which appeals to me as I feel the insulin may be less likely to degrade in glass and hope that at least there will be a tiny bit less plastic diabetes waste around as a result. Here’s hoping that Novo start bringing the pre-filled cartridges into Australia (they are currently available in Europe).

It is water proof (although I haven’t tested this…yet) and takes a AAA alkaline battery (the pump won’t accept lithium batteries).

A downside at the moment is that the pump doesn’t ‘talk’ to any of the CGMs, so blood sugar readings would need to be entered into the MYLife app manually in order to calculate correction doses. Ypsomed staff assured us that they are in talks with most of the CGM and Flash manufacturers

I understand that the Ypsomed blood glucose meter talks directly to the app for bolus calcs etc.

I haven’t actually attached the Ypsomed pump yet-I plan to in the next day or two (no sense wasting the full insulin reservoir in my current pump.  I shall update this review about usability and button pushes and also the use of the app once I’ve worn it for a while.

For a couple of other early reviews check out:

Bionic Wookee

Diabetogenic

I am excited about a pump that is smaller AND the fact that more players are entering the insulin pump market. I was worried with the withdrawal of J&J that we might end up with only one pump in Australia.  I’m sure that every pump has its own pros and cons but if you are looking for a pump or an upgrade make sure you check out all available options. Some educators or endos tend to push the pump that they’re most familiar with, I’m all for choice-so make sure you see a sample of ALL the pumps in the Aussie market before you commit.

 

Diet Wars, Again!

So the diet wars are hotting up again, I have a sense of deja vu… again.

I have had diabetes all my life and soon I will notch up 50 years. I’ve seen the advice chop and change over that time. Firstly it was eat loads of carbs at breakfast, morning tea, lunch, afternoon tea, dinner and supper. The distinction was made between starch and sugar. So it was thought that a piece of fruit would ‘burn up’ in your system more quickly than, say a slice of white bread.   Then there was eat a balanced diet, then there was the Glycemic Index diet, then there was the carb counting and insulin dose ratio approach. Now we are learning that protein impacts upon blood sugar, as does eating fats but only if consumed with carbohydrate-so those after tight control are counting and blousing for protein and fats as well as carbs.  Lately  very low carbohydrate diets have been gaining attention and some very zealous followers. Continue reading