Tag Archives: insulin pump

Choice

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I have been watching and reading as the United Healthcare / Medtronic story has unfolded in the US this past week. While I am following from the relative safety of a European health care system where deals like this cannot happen, I realise that all people with diabetes are potentially impacted by this deal.

This is not the first time I have witnessed Medtronic muscle its way into losing less market share. I remember the shock of Smith Medical’s announcement in March 2009 that they were withdrawing the Cozmo pump from the market and leaving the insulin pump business altogether. It made no sense to me that the most advanced and most “personalizable” pump on the market was disappearing. That is, until the story came out that Medtronic had essentially sued them out of business for patent infringement.

The details of the law suit are unknown to me but I do know that competition from smaller companies improves everyone’s products. The people who should benefit from advancements in these devices are first and foremost the users, not just company shareholders. If an insurance company or medical device company’s first priority isn’t improving patients’ health and quality of life, they are doing it wrong!!

I was lucky enough to have the choice to stick with my Cozmo long after it was pulled from the market because of the way pumps are provided to patients in France. And stick with it I did, because the other pumps I could choose from did not meet my needs in the same way that Cozmo did. For many years there have only been 3 pumps on the market in France but suddenly (as of last month) there are 3 new ones to choose from. In order to choose a pump that actually fits my needs, I have chosen, with the support and encouragement of my endocrinologist, to try out all three of them.

As I have said, I am privileged to live in a country where I have choice in the devices I use to manage my diabetes. That choice should not be dictated by deals that inflate bottom lines for payers and manufacturers. It should be (and for me, thankfully, is) between me and my health care provider.

There are some really exciting developments in diabetes devices that should be hitting the market over the next few years. Most of these are from smaller, as of yet non-profitable companies. If the 800 pound gorilla comes and squashes the smaller, more nimble initiatives, it’s people with diabetes globally who lose out, not only those unlucky enough to have an insurance company who doesn’t believe in providing their customers with a range products to fit their individual needs.

#mypumpmychoice

#diabetesaccessmatters

Le Conte de trois pompes (préambule)

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Je suis sur le point de m’embarquer dans une nouvelle aventure : au cours des 3 prochains mois je vais tester 3 pompes à insuline différentes. Ma diabétologue était d’accord avec moi sur le principe que choisir une pompe à insuline sur description papier était difficile – même quand on a eu la possibilité de les manipuler un peu. Pour être sûre que mon choix portait sur la pompe qui allait me convenir le mieux, je lui ai demandé si je pouvais essayer chacune pendant un mois. Elle m’a fait les 3 ordonnances nécessaires.

Pour comprendre à quel point ça représente une rupture dans mon traitement du diabète au quotidien, il faut savoir que je porte la même marque et le même modèle de pompe à insuline depuis bientôt 13 ans.

Vous pourriez penser que je n’aime pas le changement ou que j’ai peur des nouveautés. Au contraire. Je suis plutôt une “early adopteur” en ce qui concerne la technologie. D’ailleurs, j’ai eu ma pompe Cozmo, première “Smart Pump” sur le marché, le premier mois de sa disponibilité en France, en août 2003. J’étais une des premières personnes en France à l’avoir et je suis une des dernières à la garder. Elle à été retiré du marché en 2009 après que Smiths Medical ait perdu le jeu des brevets contre Medtronic.

Si j’ai gardé cette pompe 7 années après sa disparition du marché c’est surtout à cause du fait qu’aucune pompe disponible depuis ne m’intéresse autant que celle que je porte déjà. Mais, enfin, il y a du changement dans l’air. Trois nouvelles pompes sont apparues en France tout récemment. Chacune a des points très intéressants qui les mettent un peu à l’écart des pompes disponibles jusque là.

Elles sont : CellNovo, Omnipod et Accu-Chek Insight

CellNovo
CellNovo
Omnipod (Ypsomed)
Omnipod (Ypsomed)
Insight (Accu-Chek)
Insight (Accu-Chek)

 

Une pompe patch avec une toute petite tubulure et tournée déjà vers les études de pancréas artificiel, une pompe patch sans tubulure du tout et bien apprécié dans d’autres pays depuis des années et une pompe plus classique qui a une cartouche pré-rempli facilitant grandement le changement de réservoir ! Elles sont toutes les trois étanches et toutes les trois télécommandées ou télécommandables donc pas besoin de manipuler la pompe directement au moment du repas. Ces éléments sont que le début des nouveautés et des points forts de ces pompes.

Cela dit, les points forts mis en avant par chacun des fabricants sur leurs sites web ne parlent pas de la vie réelle avec la pompe et l’utilisation de ses fonctions au quotidien. Sur papier, je sais déjà que certaines fonctions vont me manquer par rapport à ma pompe actuelle. D’autres fonctionnalités vont me plaire moyennement tels que le changement de bandelettes d’analyse glycémique, le gaspillage d’insuline, la tablette de pilotage de pompe lourd et encombrant…

De plus, de nombreuses questions restent encore en suspend comme l’analyse des données historiques disponibles sur la tablette de pilotage ou sur logiciel compatible, la facilité d’utilisation au quotidien, ou même le niveau de confort de porter chaque pompe. Ne parlons même pas de la place nécessaire sur ma table de chevet pour brancher et recharger les parties que le nécessite !

Mon but est de voir la pompe qui convient le mieux à mes besoins et à mes préférences. Et si aucune des 3 fait l’affaire pour moi, ma Cozmo restera au fond de mon tiroir en attente ! Suivez moi au cours des prochains mois pour mieux connaître ces pompes nouvellement disponibles en France et pour voir si j’arrive à me détacher de ma chère Cozmo.

3Cozmos

Diabetes and security

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Yesterday, after attending the IDEA Summit in Strasbourg where I moderated a panel discussion about empowering patients to become more involved in diabetes research initiatives (more about that in another post), I was waiting for my train back to Paris.

The train was a little delayed – apparently for technical issues and not security ones – and while I waited on the platform, I glanced a few times at my dexcom and watched my post-dinner blood glucose levels slowly rise. Given the timing and amount of my dinnertime bolus, I knew it was headed in the wrong direction. So I did what you do when you need to correct a slightly high blood sugar… I reached up under my winter jacket to where my pump was in a flipbelt on my waist.

Then I pulled out this little plastic box attached to what
looks like a wire that went back up under my clothes.

As I quickly pressed a few buttons on my pump, it suddenly occurred to me how this could look from the perspective of bystanders, not to mention the police teams that were patrolling the station. I glanced around and thankfully, nobody seemed to have noticed.

A few weeks ago, I wouldn’t have thought twice about pulling out my pump to take a bolus. But as you can imagine, security measures in France have been taken to a new level in the past few weeks and pulling out an electronic box that is concealed under clothing is definitely something that can cause suspicion. I don’t like to feel like I have to hide my diabetes. I’m definitely not ashamed of it but I also realise that there is a time and a place for diabetes pride.

In a surreal sort of way, daily life hasn’t really changed much since the attacks on Paris in November. And yet, the signs keep popping up that show how the events have affected us all.

So I’ll leave you with an image of hope and of light. This is the 4 storey tall tree at the Strasbourg Christmas market that I had the pleasure of looking at while eating my dinner before catching my train.

ChristmasTreeStrasbourg

#dblogweek 2015 – Cleaning it out

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Already behind on my #dblogweek posts… Wednesday’s topic is (was!) “Cleaning it out”.

I live in a small apartment with my husband and 2 kids. I don’t have the luxury of taking up too much space with diabetes supplies.

One thing that helps me keep on top of the stash is that I pick up my insulin and test strips monthly from the pharmacy, so those are never over-flowing. Glucagon is only on my prescription about every 18 months and once replaced, my husband uses the expired one to show me that he remembers how. My pump supplies come by mail every 3 months. When I get my shipment, it’s a bit of a puzzle to store everything at first but changing my infusion set every other day at the moment means that they get used up quickly.

But I must purge somewhat regularly to be able to contain my D-supply stash to the plastic storage box beneath my bed. So I have taken this topic very literally as it has prompted me to clean it out. I threw out a full box of  manuals for meters I don’t use anymore and I threw out the box that my original Cozmo came in (back in 2003). I threw out bizarre free samples I had received over the years and kept just in case one day I’d have use for them. And I threw out some lancets that had been hanging around for more than a decade.

Dsupplieswm

I kept only essentials – well, essentials plus a dozen back up meters (for which I have no strips), a stupid number of old meter cases pump clips, pretty much every log book I have ever written in (which, considering 18 years of diabetes, is relatively few) and a healthy stash of Cozmo reservoirs since when those run out I may actually need to consider changing pumps!!

I’m glad to have things tidied up – so thanks for this topic suggestion!

#dblogweek 2015 – I can

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I wasn’t sure about participating in this year’s #dblogweek. I started my blog almost a year ago (after many years of considering it) and started after #dblogweek because I thought it would be too much pressure to start my blog with 7 posts in a week. A year later, I still think it’s a lot of pressure, but we’ll see how it goes!


To start, for more info on #dblog week and to discover the blogs of those participating go here:
Sixth annual diabetes blog week.

The first topic is “I can…”. I’ve written recently about some of the things that I can do and have done while living with diabetes for the last 18 years. So today, my post is going to be simple. I’m appreciating the fact that I live in a country where I have access to diabetes technologies and that most of my diabetes supplies are covered 100% by the French social security system (including the batteries for my pump and meter, but excluding all continuous glucose monitoring or flash glucose monitoring equipment).

This is not the case in so much of the world so I don’t take for granted that I can choose which meter I use to monitor my glucose levels and how I administer my insulin (pump vs. MDI). I am currently taking advantage of this choice in that I have been having issues with reactions to my infusion site tape, so I’ve been trying out new sets. I feel lucky that “I can” do this with just a phone call to my pump supply company.

Skin rashes aside, I rarely have occlusion problems with my angled infusion sets. Unfortunately almost every time I have tried a 90° set, this happens:

ElbowedSetwm…with the obvious consequences! But since my skin issues persist, I am still on the hunt for solutions. This week I’m trying out some Orbit sets for the first time. I don’t have full conclusions yet as to whether these 90° sets might work for me, but so far so good. I like the fact that the tape is totally different than most sets and so far, after 36 hours I haven’t had any redness or itchiness. And so far, no elbowed cannulas or crazy high blood glucose levels. I also love the fact that the set can swivel 360° on itself so I can move the tubing if it gets in the way of my clothing, or sleeping.

https://vine.co/v/emxJbe1vA30/embed/simple

Of couse, if you play too much with the 360° swivel, this happens:

OrbitTwistedTubingwm

(Please pay no attention to the infusion site scars that dot my belly!)
(But go ahead and notice how the blue tubing matches my blue pump!)

Diabetes isn’t always easy to live with and presents different types of problems at different times but I’m glad I have a choice in how to deal with each issue and I’m confident that I can find a solution to these pump site rashes. Perhaps with Orbit. But if not, I’ll try another set or some kind of barrier.

(Canadian!) Insulin pump in the (Parisian) wild

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It was warm and sunny this afternoon in Paris. After the kids’ music classes, we scooted to a nearby park to take advantage of the spring weather. There was climbing, sliding, jumping, balancing and running. And snacks – well, they had snacks, I had glucose tablets just to keep up with their energy level.

Then, just as I watched my younger daughter run around from the bottom of a slide to go back up the climbing wall, a woman walked up to me a said Hi, in English. This isn’t all that surprising for the neighbourhood, but I’m always happy to meet other anglophones around town. But she didn’t stop there – she continued with a “I’m sorry but I couldn’t help but notice…” and then she pointed to my pump on the waistband of my jeans and then pointed to her own pocket, where I saw a purple Medtronic pump poking out.

The conversation took off right away. She’s had type 1 for 40+ years and been on a pump for 3. She said her only regret is not getting on a pump earlier. When we had talked diabetes for a couple minutes, we switched to life stories. Each picking up on our respective North-American-but-not-quite-American accents, we had a second “wow, cool” moment realising we are both Canadian, me from Toronto and her from Nova Scotia. Beyond the visible pump tubing we also both had Mountain Equipment Co-op (MEC) backpacks. Secret Diabetes flags and secret Canadian flags.

Since we were both running after children (Mummy, come play tag – you’re IT!), we didn’t get to chat for long, but how fun it was to be able to say “Me too!” with a total stranger. She’s only in Paris for a few months and neither of us were at our regular local parks so I don’t know if we’ll meet again. But it was nice to make a connection with a fellow Canadian with diabetes.

Running with diabetes

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As I got ready to go for a run the other day, I got a little disgruntled at the number of steps I had to take to get out the door. Indeed, I sometimes resent the fact that others can simply lace up their shoes and go for a run without having to take into account dozens of factors that could turn their hour of exercise into a potentially dangerous experience.

Here is the list of questions I ask myself before a run (and some of them in the hour(s) leading up to said run):

  • What is my blood glucose level?
  • How stable is it and how stable has it been over the last few hours?
  • When did I last eat and what was my last bolus?
  • Do I have any active insulin on board?
  • Based on last dose of insulin and current basal rate what is blood glucose level expected to do over the next hour?
  • How long am I planning to run for?
  • Do I need to drop my basal rate before and/or during my run? By how much?
  • Do I need to consume some carbs before setting out?

And here are a list of actions I do to get ready for a run:

Pump Pocket in Running Jacket

Pump Pocket in Running Jacket

  • Fill up glucose tab tube, put in pocket of running tights.
  • Put pump in pocket of running jacket and feed infusion set through the button hole inside the pocket (and don’t forget to click the infusion set back into place!!).
  • Put in-case-of-emergency card and phone in arm band.
  • Do a last blood sugar check and compare to dexcom (since the Dex comes with me while the meter sits at home).
  • Put dexcom receiver in spibelt around waist.
  • Lace up shoes.
  • Put Moov coach around ankle.
  • Try not to get earphones tangled around arm/jacket
    Connected run

    Connected run

    hood/ponytail…

  • Start Runkeeper.
  • Take first step.

Without diabetes, None of those questions are of any consequence other than perhaps about my previous meal and how long I’m going to run for. As for the To-Do list, only the last 5 items are not diabetes related and that part takes a total of about 3 minutes.

And yet, I am so thankful that I can run and do other forms of exercise despite diabetes. In fact, I know that my diabetes diagnosis almost 18 years ago changed my views on physical activity in general and motivated me to be more serious about running in particular. In turn, wanting to manage my running well was an additional motivator for managing my diabetes well. I switched to an insulin pump because I knew I would have more control over both timing and amounts of insulin doses and therefore could minimise exercise-induced lows. More recently, using a CGM has given me new insight as to what is going on with my blood sugar during my runs and I have made changes to both my running and diabetes management habits because of it.

All of those questions and steps had become second nature to me years ago when I was in peak form and I was marathon training. At that time, there was just me and my diabetes to think about. Now with young kids at home and many more demands on my time, all the organisation it takes to get out the door really is a challenge. But it is worth it for how it makes me feel, both in terms of physical fitness and in terms of empowerment for living well with diabetes.

New pump but keeping the Cozmo!

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A month ago, my insulin pump started giving me more frequent alarms. Most of them have been “dead battery” alarms, when I know there has been a brand new battery in there. One day it told me pump was without power (ie – dead battery) in the middle of each meal bolus of the day. I really can’t complain. This little piece of amazing technology has been on my hip for close to 5 years now. It has been bumped on door frames and dropped on tile floors more times than I can count. It’s well past its warranty and I’ve never had any major problem with it. But when it was clear where my pump was heading, I made sure that I had all my current basal and alarm settings written down.

One morning a couple of weeks ago, as I did a routine cartridge change, the pump simply couldn’t recognise there was a cartridge there. I must have tried to rewind a dozen times but eventually, there was a single, unending BEEEEEEEEEEEEEEEEEEEEEEP and a “Your-pump-is-dead-please-call-your-doctor-or-pump-rep.” message.

My backup plan in the event of pump failure is that I have a second pump at home. This is possible because I still wear a Cozmo and since there are only a few of us Cozmo users left on the planet, my pump supply company was willing to give me an extra one on “permanent loan”. This one is also almost 5 years old, but never been used so it felt brand new as I punched in all my personalised settings.

This event of course gave me another chance to ponder pump choices, but they haven’t changed since my post in July so I’m still sticking to the status quo. And the extra good news in all of this is that my pump supply company managed to get me a brand new black Cozmo. I couldn’t believe they still had one in stock! So I am set to go for another few years – either until they run out of Cozmo reservoirs or until a more interesting pump comes out on the French market. 2015 should see the release of the Accu-Chek Insight,
 The Medtronic Minimed 640g, minimed640g

And the Ypsopump. YpsoPump2

Just so you don’t think I’m too set in my ways (is 11+ years with the same insulin pump too much?), I’m excited to see some new options in pumping coming to the European market and I will be looking carefully at my possibilities to modernise! In the meantime, I programmed my blue Cozmo replacement pump while waiting for the new black one to arrive and I the colour grew on me. Plus my 4 and 6 year old daughters think it is SO much prettier and would be mad if I went back to the black one. Blue Cozmo it is then! I always have the new black one to fall back on.

(The old black one has now gone back to my pump supplier but I was amused to have 3 for a short time!)

3Cozmos