DSMA Blog Carnival – My top five for 2012.

So with a few days left before Christmas, I’ve decided to join the DSMA Blog Carnival for December, 2012, which asks bloggers to write a 2012 in Review Post. If you’d like to participate too, you can get all of the information over here.

Bloggers were asked to:

Take a moment to reflect on diabetes in 2012 – on a personal level, on a community level, on a technological level, anything you can think of. What things stand out to you the most? What did 2012 and Diabetes mean to you? You can even take the challenge one step further, and post a collage of your Year in Diabetes!

Well, a collage is possibly beyond my bounds of creativity, but I have narrowed my list of personal diabetes milestones in 2012 down to five. It’s been a huge year for me diabetes-wise, so this was tough exercise.

In no particular order…

1. Pumped up
In May 2012, I got my Medtronic insulin pump. Yay! In hindsight, I don’t know what I did not do this sooner. The pump has given me flexibility, freedom and perhaps most importantly, a stronger sense of ownership in regards to living with diabetes. Sure, I still have ups and downs, but I can now play a game of squash without crashing to a vicious low afterwards; I can happily fall asleep at 4.6 without waking up at 2.9 an hour later; and I can even eat a plate full of dumplings and still land a BSL at around 7.2 two hours later. These were things I just could not master on MDI.

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The pump. Hasn’t quite got a name yet.

This has been a massive accomplishment for 2012 – one that I initially started planning this time in 2011. I’m still learning the ropes, but I feel more in “control” of my diabetes today than ever before, so two thumbs up there. I’ve also had the good fortune of wearing a sensor a handful of times this year, which I found to be a really rewarding experience. Hopefully I will be talking about these being more accessible financially in my 2013 review post…fingers crossed.

2. The rise, rise and rise of the Australian Diabetes Online Community
It’s a cold, drizzly night in Melbourne…well, I’ll let Renza tell you the rest. But what I will say is that over the past six or seven months the Australian Diabetes Online Community has really become something remarkable and more connected. The number of Australians tweeting about their diabetes continues to grow, the #OzDoc chats held on Tuesday nights are providing a place for people with diabetes to tweet together at a downunder-friendly time, and Diabetes Australia – Victoria held the inaugural Diabetes Social Media Summit on World Diabetes Day. Kerri from Six Until Me was the keynote at this event, and I’m confident we are on the right track here below the equator. I have met some great people through this, ranging from fellow Melburnians, other Australians and even Rhode Islanders. Further to that, the Australian Diabetes Online Community gave me the gentle nudge I needed to start this blog. Huzzah!

3. Involvement in the Type 1 Diabetes Network
Over the past 8 or 9 months, I have started volunteering with the Type 1 Diabetes Network (T1DN). The T1DN is most well-known for the Reality Check forum, which really guided my move to a pump, but is also involved in a range of other activities to support and inform people living with type 1 in Australia, plus a range of other stuff. I had the opportunity to attend a strategic planning event for T1DN earlier this year and was blown away by the passion that people had towards both the direction of the organisation, and type 1 diabetes within Australia. Mind you, I got so used to being around folk with insulin pumps and blood glucose monitors that when I got to the airport, going back to being around people with functioning pancreases was a bit of an adjustment. In November I decided to nominate to join the Management Committee for T1DN. I’m very much looking forward to contributing to the network, particularly in regards to building upon past successes of consumer advocacy and ensuring people with type 1 have a voice in regards to decisions that influence them.

4. Verio IQ = my new best mate
I’ll say up front that I am a bit of a diabetes gadget geek. I tend to get meters when they are on those free deals at pharmacies “just in case”. I also don’t seem to throw meters away, even those that don’t work, or those that I’d rather see the back off (hello Accu-Chek Active). When I was first diagnosed in 1996, my first blood glucose meter was the Accu-Chek Advantage. Not the coolish blue and white one, the bland grey and white one that needed a heap of blood, took 15 seconds to deliver a result, required coding and needed two of those cell circle batteries.

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My first BGM …

Things have changed a lot since then, but in all this time, I’ve never quite found a meter that I was happy with. There was quite a lot of buzz about the OneTouch Verio IQ around the diabetes blog scene earlier this year. After seeing good reviews from both Kim, That Diabetic Girl – and Kerri – and then seeing Kerri’s meter up close on her Melbourne trip, I knew this was one super cool piece of gadgetry that I needed to add to my collection.

It just feels to me like the folk behind the IQ have taken note of what people with diabetes want from their meter. Accuracy, a colour screen (you don’t realise how much you value a colour screen until you go back to another meter), a strip port that lights up for tests in the dark, trend pattern alerts and also it doesn’t look or feel like a blood glucose meter. I have a drawer full of diabetes gadgets that look like diabetes gadgets. I am kind of stoked to have one that looks like a music player that I could listen to The Lucksmiths on.

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Verio IQ ftw.

It’s not perfect, but it is probably my favourite meter. Ever. It doesn’t send results to my pump like the Bayer Contour Link did (the Contour USB is not yet available in Australia), but the Contour Link unfortunately is closer to the Accu-Chek Advantage than the OneTouch Verio IQ.

I can be rather fickle with regards to meters, but at the moment it is Verio IQ ftw.

[Disclosure: I received this meter for free at Diabetes Australia – Victoria’s Diabetes Plus Technology Expo, with 10 strips. I was not asked to write about the meter, nor was I the only person to receive a free meter at this event].

5. Safety first.
I finaaaalllllly got a MedicAlert bracelet.

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The inscription. It’s not quite Lord of the Rings, is it?

It only took me about 16 years, but one day I woke up, I went online and purchased one, all within about 5 minutes. I can’t quite put my finger on why, but I think it was driven by the fact that after all this time, I’m in a good position of acceptance regarding this diabetes stuff. We all like to think we are invincible and we have this diabetes stuff sorted out, but I certainly don’t. I like to think that I’m pretty good at it, but I can’t guarantee that invincibility and consequently it’s a matter of safety first. I therefore consider my MedicAlert bracelet as an bit of an extra safety net – better safe than sorry, as they say. Getting this was a bit of a big thing for me in accepting that one day, I could have a hypo that goes that tad (!) pear-shaped, and I want to make sure I’m prepared for that situation.

6. Oh and…
Merry Christmas all!

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The intangible value of CGM

A month or two before I got my insulin pump, I was lucky enough to see the fantastic Gary Scheiner MS, CDE, author of Think Like a Pancreas present at a Diabetes Australia – Victoria event. One of the things that stood in my mind was when Gary remarked that he finds Continuous Glucose Monitoring as useful as insulin pumps – possibly even more useful.

Since that time, I’ve got my insulin pump, and on to my 5th or 6th sensor (trying to average one every 4-6 weeks due to cost – see below) and the value of these sensors to diabetes management is becoming glaringly obvious.

Over recent weeks, I’ve been having real issues managing meal spikes, particularly around breakfast, and have been going through a fairly arduous process of refining basal rates, tinkering with carb ratios, reviewing insulin sensitivity numbers and also changing my standard breakfast fare. Muesli and I are not talking at the minute, and don’t even get me started on Weetbix.

The usual diabetes fun and games.

The CGM has been fundamental to putting the finishing touches to this campaign, allowing me to review the trends forensically over the past 4 or so days and confirming to me that I’m that close to getting these settings pretty spot on. For the moment anyway.

Yesterday afternoon I had a look at my 12-hour trend graph to see the following:

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Huzzah!

People often talk about the value of CGM being alarms, low glucose suspend features and ability to see the direction of BSL’s. These are all unquestionably useful, but the real value for me is something more intrinsic and intangible – validation and reinforcement presented on a nice little graph. I believe one of the overarching aims of any diabetes technology should be enabling people with the condition to feel confident about their decision making.

The cost of CGM is evidently still an issue. I purchased the recent Medtronic CGM offer of a receiver and 5 sensors for $375.00, but I’m now down to my last sensor. Will I buy another box? In time, most certainly. But due to the cost I’ll be sticking with my sensor per 4-6 weeks rule. The cost (~$4,500 per year if you really wanted to go nuts over the year) is still problematic for a significant portion of the diabetes community, particularly given the other extensive costs involved of living with type 1.

I think Mr. Scheiner is pretty spot on. Whether it’s Medtronic or Animas, Enlite or Dexcom, CGM technology is a world of awesome and I’m holding out hope that accessibility of these products will increase across Australia. Whilst I’m sure diabetes technology companies are pushing to increase access, I think the responsibility will largely fall to the diabetes community to mount the case. It is easy for decision-makers to ignore companies making a profit from diabetes technology. It is harder for them to ignore the people that live with diabetes due to the pure value it offers for diabetes management. As Renza has pointed out, CGM is certainly the next “battle line“ for diabetes advocacy.

That value for me yesterday, was an peek at a 12 hour graph after lunch in sunny Melbourne that provided a bit of validation and reinforcement in the daily grind of T1.