20 years ago today, my mum picked me up from my university dorm room and brought me to the ER where I was diagnosed with type 1 diabetes. I spent a couple of nights in the intensive care unit, then 3 days learning the basics of diabetes management. Then I was sent out into the real world to learn what it was really like to live day to day with my newfound life mate.

During the last 2 decades (or 240 months or 1044 weeks or 7305 days, but who’s counting?!), I have been:

•    checking my blood glucose levels,
•    injecting or infusing insulin,
•    counting carbs,
•    trouble shooting basal rates,
•    treating lows,
•    riding the blood sugar roller coaster,
•    dealing with burnout,
•    sticking medical devices on (and in) my skin,
•    filling insulin pump reservoirs,
•    scrambling to get sugar into my mouth,
•    battling high glucose levels that won’t come down,
•    being part robot,
•    planning my meals,
•    thinking like a pancreas,
•    feeling overwhelmed at times,
•    waiting for doctor and hospital appointments,
•    trying not to feel judged by the number on my glucose meter,
•    calculating insulin doses,
•    reassuring my family – and myself,
•    making sure I don’t run out of diabetes supplies,
•    having my eyes, heart and feet checked,
•    choosing my clothes carefully,
•    sewing pockets to house diabetes devices,
•    avoiding door knobs,
•    lacking sleep,
•    eating candy as medicine,
•    toting around a ridiculously heavy hand bag to store all my diabetes crap,
•    nursing bruises from injections and pump sites,
•    dealing with discrimination,
•    silencing the beeps,
•    finding the right diabetes technology to fit my life,
•    improving my math skills,
•    wearing blue,
•    sticking up for myself,
•    participating in clinical trials,
•    reading scientific papers,
•    finding my tribe,
•    being inspired by so many others living with diabetes,
•    running a marathon,
•    engaging in advocacy,
•    volunteering for my local diabetes association,
•    organizing diabetes peer support initiatives,
•    using skills learned from living with diabetes in my professional life
•    learning from other people’s stories,
•    becoming an expert,
•    sharing my experiences,
•    teaching medical students about patient perspectives,
•    attending and talking at medical conferences,
•    kicking diabetes’ butt,

Oh, and also generally getting on with the rest of my life.

Sorry, that got a little out of hand, but once I started typing, the list kind of grabbed a life of its own. There is no question that diabetes is a full time job and this list only scratches the surface of the mental gymnastics that living with D involves. I guess the point is that diabetes has added a lot to my life, some of it downright horrible, some of it tedious and time consuming, some of it stressful and emotionally difficult, and some of it utterly amazing. I could not have gotten this far without the ongoing support I have from my family and friends and of course, the amazing people with diabetes I have met along the way, in person or in the DOC.

And as a little diaversary gift, my diabetes gave me this today:

It doesn’t happen all the time, so it’s worth celebrating !

This years’ World Diabetes Day events and celebrations were entirely smothered by the horrible violence that erupted in Paris last night. I live quite close to several of the shootings took place and I spent my evening and well into the night listening to sirens and hearing a few loud noises that sounded like explosions. I refused to turn on the TV but was watching  live feed on some news websites as well as my twitter and Facebook feeds until 2am in absolute disbelief.

That shock continued this morning as I tuned back into social media for updates on the tragedy that had unfolded, and to find news of close friends who had had to take detours on their way home or had been actually unable to get home because of police barricades in the streets. One who did not get home until noon today to her husband and 10 month old, breastfed baby.

How could something like this happen? And why here? Why so close to home? What kind of human can execute another innocent human?

And yet, as these questions pound my head, I am very aware that in many many countries, these types of events are common occurrences. So common and yet not reported in news feeds I am familiar with. I had heard nothing of the bombing earlier this week in Beirut until late last night in the midst of all the news on what was going on in my neighbourhood. I realise how privileged I am to live in a place were I can walk the streets without fearing for my safety, or my life or for the lives of my children. I realise how privileged and loved I am to have received so many messages from family and friends all over the world to check in and make sure my family and I are safe.

That privilege, of course, also extends to being able to live well with diabetes. I have access to insulin, blood testing supplies, insulin pumps, education and peer support. None of this, down the the batteries in my insulin pump, have any direct cost for me. Such is the privilege of living in a country with a socialised health care system. And while I can be heard raising my voice to talk about the need for public funding of new diabetes technology like CGMs, I know that there are many, many countries in the world where there isn’t access even to lifesaving insulin or syringes to administer it, let alone refrigeration to make sure it stays potent.

T1 International is an organisation who believes in a world where everyone with type 1 diabetes – no matter where they live – has everything they need to survive and achieve their dreams. They work towards adequate access to insulin, diabetes supplies, medical care and education for all people living with type 1 diabetes. This year’s T1 international’s World Diabetes Day campaign, “We are the world in WDD” is about showing everyone who we are: a global force standing together to push for access to diabetes supplies, care and treatment for all.

It is my hope that we not only stand together for this, but that the global force of humanity can stand together for peace and love in all nations around the globe.

With all these #showmeyourpump pictures filling up the internets, I thought I’d share some of my thoughts around my pump choices.

I first started pumping in 2000 with a minimed 508. I loved that pump because it was what gave me my first taste of the freedom of different basal rates throughout the day and to be able to take a meal bolus with the touch of a button. I still have my old 508 along with a set of batteries and a couple of reservoirs – just in case. When minimed’s (or was it already Medtronic by then?) first paradigm pump came out – the 511 – it was the natural “next pump”. However, if I remember correctly, the 511’s features were about the same as it’s predesessor; it was mostly the outer physical aspect of the pump that was upgrated at that point. I didn’t stick with it for long.

Cozmo was the first “smart pump” on the market and I was lucky enough that France was the second country in the world where it was available. It came out in the US in late 2002 and Smiths Medical decided to use the World Diabetes Congress in August 2003 in Paris to launch the pump to the rest of the world.  I got my first Cozmo about a week before the WDC.

Any time I have needed to switch pumps since then (for warranty or malfunction issues), I have always chosen to stick with the Cozmo despite the fact that all pump manufactuerers have come out with several newer pumps over the last decade and despite the fact that the Cozmo itself has no longer been available since 2009.

In France, all insulin pumps and pump supplies are ordered through specialised medical supply companies. They buy the pumps and supplies from the manufacturers and patients “rent” the pump and buy supplies from these third party suppliers (covered, thankfully, by French social security – the famous “Sécu”). So, lucky me, even though Smiths Medical took their pump off the market, my supplier still has some in stock and it is still avalable to me – at least until they run out of reservoirs.

After 11 years, I still love my Cozmo with its personalisable menus and features. I choose to use an insulin pump partly because it makes it easier to adapt my diabetes to my lifestyle and I love that I can adapt my Cozmo to my own habits and needs in terms of diabetes management.

That said, after 5 years now with no updates, I figure it is worth looking at what else is out there.  I’ll spare you the full details of my pump comparison but one negative aspect of this process for me was that there are only 3 pump options here in France :

• Roche Accu-Check Spirit Combo
• Animas Vibe
• Metdtronic Veo 554 (which I think is equivalent to the  MiniMed 530G system in the US)

When you look at some of the unique features of the T:slim, the Omnipod or the Snap pumps, it is disappointing that those are not at least options here.

With the choices available to me and my own preferences in terms of features that are important to me in a pump, I chose to weigh the pros and cons of staying with my Cozmo or switching to an Animas Vibe.

To get to know the Vibe a bit better I talked with a nurse educator at my pump supplier and she showed me some of the main features. I talked to people using the Vibe locally and on social media to get their impressions. I posted detailed questions on diabetes forums asking which of features I love on my Cozmo might also be available on the Vibe. Finally, still unsatisfied that I didn’t get the nitty gritty of the comarison that I was looking for, the geek in me decided to download the user manual, which I read cover to cover.

The Vibe looks like a great pump and I know many people who use it and are very happy with it. It has certain features that I would like to have on a pump and don’t have today, like showing my dexcom graph, or different insulin sensitivity factors at different times of day. I would trust it’s waterproofness more than my current 4+ year old Cozmo and I could use software like Diasend to compile a majority of my diabetes data. These would be definite advantages of switching.

However… after much thought, there are still too many features on my Cozmo that I use daily or weekly that are not available in the Vibe (or any other pumps available to me) that have made me decide to stick to my status quo.

Just to name a few:

• size, shape and light weight (though I’d be happier if the Cozmo was slightly less thick)
• user set site change reminders (even though most often change my sites every 2 days, I have a hard time remembering when the last change was)
• the ability to save temp basal rates that I use often
• detailed history feature including daily carb intake, %of basal insulin and averages
• fewer button presses to complete any action
• the intutive nature of the screens (right and left buttons make navigation easier)
• very personaliseable reminders & alarms (although there is one more that I would like to add)
• can give a quick bolus using unit of insulin or grams of carbs
• a battery change only involves changing the battery (no re-priming of reservoir or losing stored data)
• a low reservoir alarm at a only 5u left (rather than a minimum of 10)

All these years later, I am still disappointed that Smiths Medical decided to leave the diabetes business. They had a great product and I will continue to use it as long as I still have access to replacements and pump supplies.

If you use an insulin pump, I’d love to know what features were deciding factors for you in chosing your particular pump.

I’ve been wondering for a while about when will be the right time for me to switch insulin pumps because the pump I currently wear is no longer on the market and well past its warranty date by now. One of the main reasons I’m still wearing my Cozmo is that I’m a little picky when it comes to insulin pump features. I’ll write more about my my pump comarisons and decision process at another time but for now I want to throw out a question to the diabetes online community:

Does any pump on the market today automatically switch from a weekend to weekday basal profile on monday morning and back again on friday night? Even better, at a user specified day and time? I’d even accept a user-set reminder to do it manually.

Let me explain. All last week I was able to observe a very specific pattern emerge in my glucose levels. Every evening right around the time I was picking my kids up from school and getting home to put dinner on, my blood sugar tanked. So yesterday, being the beginning of a new work week, I was determined to be prepared. My BG was coasting at about 120 during the afternoon and about 45 minutes before I left work I ate 10g of carb in the form of dark chocolate figuring that the fat in the chocolate will keep me from spiking but that amount of carb should hold off the expected low.

The result? An hour later my BG had slowly and steadily risen to 182mg/dl. My first reaction was the typical frustration at diabetes for never acting how you would expect. Then I realised my own mistake. It was monday and I had left my basal profile on “weekend”. (So perhaps the real surprise was that my blood sugar hadn’t been higher all day with a lower basal rate than I usually have while sitting at my desk. I sense some more basal testing in my future!)

This is not surprisingly not the first time I had noted a need for a reminder to switch basal profiles. I don’t work wednesdays (a very common thing for mums in France as traditionally there is no school on wednesdays) so I switch back and forth between my weekend and weekday basal profiles twice a week. And I definitely forget from time to time.

Spending my monday with a weekend profile didn’t result in anything too dramatic. I corrected that 182 with a fraction of a unit of insulin, switched to the weekday profile and went on with my evening. For me, forgetting to activate the weekend profile can have more notable consequences with some pretty major lows on wednesday or saturday mornings. So an automatic switch or an integrated reminder would make a real difference to me in terms of having one less diabetes-related detail to think about 4 times per week.

While I’m at it, why don’t other pumps have a site change reminder feature?