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Are you an adult (aged 18 – 75 years) with type 1 or type 2 diabetes living in Australia or the UK?
No? Avert your eyes and go back to looking at pictures of of cats on the internet.
Yes? Stop right there…. You can go back to looking at pictures of cats later, ‘cause right now, you have better things to do.
Like THIS:
YourSay (Self-management And You): Quality of Life Study needs people just like you to have your say about the impact of living with, and managing diabetes on your quality of life.
You only have until the end of the month to participate, so now is definitely the time to do it.
And to say thank you, I baked these and am virtually sending you a couple:

You’re welcome!
Our kid has always enjoyed drawing. I’m someone who struggles to draw a stick figure, so I am frequently impressed by her ability to sketch and paint things that are actually quite good, and I’m able to easily identify.
The other day, I was tidying up the kitchen table when I came across one of her sketches. I picked it up and looked at it. ‘This is gorgeous, darling,’ I said to her as she sat at the table doing her homework. And then I stopped. ‘Wait…why are you drawing a woman pole dancing?’

Exhibit A
She looked at me with that expression that only a teenager-in-training can, and then started laughing. ‘Mum!’ She exclaimed, taking the drawing from my hands. She turned the paper ninety degrees, and held it up to me. ‘It’s a witch on a broomstick!’
Ah, perspective!
On Friday last week, I spoke at the first Australasian Diabetes Advancements and Technologies Summit (#ADATS) in Sydney. My talk was ‘The consumer perspective on new technologies’. So, as usual, I crowd sourced some ideas from Facebook friends. I do this for two reasons… one: it gives me the opportunity to share the thoughts of other PWD so that my voice is not the only one heard. And two: I’m lazy.
I centred my talk around the love/hate relationship I have with diabetes technology and asked others to give me a couple of dot points on what they love, and what they don’t really love (or hate) about diabetes tech.

In many cases, the things people love are also the things they hate, and that makes so much sense to me!
Our perspective of our diabetes devices can change all the time. Some days, I am so appreciative for all the information my diabetes technology offers; other days I want to ignore it as it just makes me want to cry. Sometimes I love the devices and I can’t imagine being without them; other days I long for my body to be free of them. Some days, I love the alerts and alarms, and respond to them promptly; other days, the noise is unbearable and I switch off everything I can so I don’t need aural reminders of just how hopeless I am at diabetes.
My perspective can spin on a coin, and often it takes very little for me to move from loving every piece of technology to wanting to bin it all.
The point of my talk was not to bitch and moan about the technology I know I am so fortunate and privileged to be able to afford and use. It was to try to explain that the bells and whistles, and data and information can truly be wonderful. But our feelings about the tech will change (often several times in the space of a day) and this does affect how we feel about our diabetes.
Disclosures
My travel costs were covered by the National Association of Diabetes Centres, the organisers of ADATS. I was on the ADATS organising committee.
Last night, I attended an event at Parliament House in Canberra, acknowledging and celebrating two milestones: 60 years of Diabetes Australia and 30 years of the National Diabetes Services Scheme (NDSS).
I spent the night chasing down people who were instrumental in the establishment of the NDSS to thank them for their efforts and try to explain just how significant the Scheme has been in my diabetes life for the last (almost) 20 years.
I never knew diabetes before the NDSS. On the day following my diagnosis, after spending the morning seeing my new best friends (endo, CDE, dietitian…actually, the dietitian and I never hit it off), I took a couple of freshly-filled-in forms to 100 Collins Street in the city and took a creaky elevator to the third floor. It was there I was introduced to the NDSS. I handed over the registration form and then the order form. Box after box was piled onto the counter in front of me and I looked at the unfamiliar words on unfamiliar boxes wondering where I was going to put it all and how much it was going to cost.
A few boxes of needle tips for insulin pens and a few boxes of glucose strips and a box or two of urine strips. It was tallied up and I was surprised that it wasn’t a lot more expensive. I was given a card and told to bring it in any time I needed further supplies.
As I came to learn about diabetes in other countries, I realised just how unique the NDSS is and how fortunate we are in Australia to have it.
I proudly speak about the NDSS to diabetes friends from all over the world. Often, these friends are astounded that the NDSS is free to join and available to everyone with diabetes. They are astonished that the price of diabetes supplies is the same for everyone and not reliant on insurance. Often they can’t get their head around the idea that we can choose which strips to use for which meter we prefer, with no interference from an insurance provider. And they simply cannot believe that while there are some limitations to the quantities that we can purchase, the amount we can access is actually quite significant, and there are allowances and exemptions for people who need more than the limits determined by the government.
The NDSS is more than a diabetes supplies program. It is intrinsically linked with Diabetes Australia who was instrumental in the establishment and implementation of the NDSS back in 1987. Diabetes Australia continues to administer the NDSS and runs all the services associated with the Scheme – from diabetes camps, information events, information resources and support services.
But more than that, Diabetes Australia continues to lobby the government to extend the NDSS. More than five years of consistent lobbying resulted in the CGM initiative being announced and launched, and Diabetes Australia is actively urging the broadening of initiative to include other groups of people with diabetes who benefit from CGM (as outlined in the original joint submission from Diabetes Australia, JDRF, ADS, ADEA and APEG). Back in 2004, following a similarly consistent campaign, pump consumables were added to the Scheme. Recently, Diabetes Australia’s responded to the stakeholder engagement regarding the listing of Freestyle Libre on the NDSS with this submission. From the initial lobbying for the introduction of the NDSS to today, the link between Diabetes Australia and the NDSS has resulted in supporting people living with diabetes and making our lives easier.
The NDSS remains the only scheme of its kind in the world. It has enjoyed bipartisan support from consecutive governments.
Of course, our health system is not perfect here in Australia. I believe that there should be more funding and more subsidies on the NDSS. I don’t believe in restricting access to glucose strips for people with type 2 diabetes not using insulin. I know that a lot of people still find the cost of diabetes prohibitive and there is still a divide between those who can afford the latest technologies and those who cannot.
But the NDSS does go a long way towards lessening the burden in some ways and I certainly am glad – and proud – that we have it.
Disclosure
I have been an employee of Diabetes Australia (and Diabetes Victoria) since 2001. I cover all costs for all NDSS products I use.
I’ve now been looping now for a couple of months. During that time, I’ve come to understand that I know far less about diabetes – my diabetes – than I actually realised. I’ve come to realise that diabetes is far more complex and difficult than I ever thought. I’ve come to see that the tools we have been using are so incapable of managing with the constant changes of diabetes. And I’ve come to realise that using tech off label is the only way to go anyway towards overcoming these challenges.
After my first couple of weeks of looping, I honestly thought that the whole thing was somehow tricking me. What was this ridiculousness of waking every single morning with numbers firmly between 5mmol/l and 5.5mmol/l? I’d look at my Loop app suspiciously, switching to my Dex app only to have the number confirmed, and a straight and steady glucose trace showing that I’d been there all night. How did THAT happen? I’d ask myself every. The Loop app had all the answers.
The automation is where the magic is. Prior to looping, I had about fourteen different basal rates sets for a 24-hour period. I had gone through times of extreme basal checking to try to tighten up those rates as much as possible, tweaking them here and there, and I thought that I had it pretty right. And insofar as basal rate settings on a pump, I suppose I did have it right.
But loop has taught me that while the overall shape of my basal rates was pretty spot on, there is only so much a pump can do with set, static rates programmed into a pump. There is nothing my pump could do to respond in real time if I needed more basal insulin unless I manually inserted a temporary basal rate.
On an average night for me now, my basal rates are automatically being adjusted dozens and dozens of times. Remember, this is during the night, when there is no need to contend with food or most other factors that affect glucose levels.
You know those mornings where you wake up, see a number in the double figures and wonder if it is at all possible that you sleep walked to the kitchen, sleep baked a pavlova and then sleep-ate the whole thing? Loop’s automation addresses that.
One morning I woke up to see that my basal rates over night had been more than double the set rate for three hours. I’d gone to sleep with a glucose level of 5mmol/l, but for some reason at about 1am, I had started climbing. Instead of waking high, the significant increase in basal insulin took care of it and I woke up in range.
Is looping the solution to all diabetes problems? Of course not and I’d be naïve to think that there was a silver bullet. But it is certainly a useful tool in my diabetes treatment arsenal, especially when combined with eating mostly lower carb. And thanks to the automation, it certainly does lift some of the burden. It also helps beautifully when I am ovulating or my period is about to start, when all bets are off and I just resigned myself to a couple of days of mayhem.
Undoubtedly it is not THE solution – in fact, if anything, it has made me despair more about what we are lacking in diabetes technology, because the increased understanding of diabetes that has come with using Loop makes me more desperate and impatient for tools that actually can manage more and more of the complexity of diabetes. I have a new found respect for that complexity.

Real time; Loop and iPhone app.
I really tried to switch off from the external diabetes world during my recent holiday. (I would have liked to have switched off from my own diabetes too, but apparently this diabetes gig doesn’t work that way.)
But now, I’m back and playing catch up on all the things I book-marked and planned to read later. Join me!
PLAID
Do you read PLAID Journal? It’s a truly terrific open access peer-reviewed research journal full of interesting articles and research news.
The latest edition is out now, and it includes a little piece I wrote about day to day diabetes.
PROPORTIONAL
My friend Hope Warsaw alerted me to this graph which was tweeted during the recent MedX conference. I like-y very much!

WORDS AND MUSIC
Gee I have some talented friends! Melissa Lee, (there are truly not enough adjectives to describe her aweseomess), has been recording D-Parodies for a number of years now. In recent efforts to raise money for Bigfoot Biomedical’s recent JDRF walk team, she enticed people to donate with promises of new tunes. And boy did she deliver. You can see all of her parodies via her YouTube channel.
But start here for a gorgeous diabetes-themed rendition of Fleetwood Mac’s Landslide – obviously renamed ‘Lancet…’
COVERAGE ON ANIMAS
There has been A LOT written about the recent Animas announcement that they will be ceasing business in the USA and Canada.
If you’re looking to catch up, here are some things I’ve found to be particularly useful:
This comprehensive update from Diabetes Mine.
This great piece from Georgie Peters reminding us how personal these devices are to those of us wearing them.
This piece from Diabetes Wookiee, David Burren, urging Roche to step up with their pump which is still available in Australia despite no longer being in the US market.)
And just a reminder of the situation in Australia: Animas is not going anywhere yet, with disruptor AMSL’s update that it’s ‘business as usual’. Unlike our US and Canadian friends who need to make a decision quickly about changing pumps, there is no suggestions that we need to do the same. Animas is still in the Australian pump market – along with Medtronic’s offerings, the Roche Accucheck Spirit Combo pump and (from 1 November) Cellnovo.
HAVE ANOTHER COFFEE
Presented at EASD – the results of a ten-year study that showed people who drink coffee regularly are less likely to die of diabetes. Another latte, please.
How’s this? A free 5-day diabetes summit that anyone can attend. The online Diabetes Empowerment Summit is the brainchild of Danielle Hargenrader.
Read all about it and get your ticket here.
YOGA FOR DIABETES
More from talented friends! Rachel Zinman is currently on a book tour in the US promoting her new book – Yoga for Diabetes: How to manage your health with Yoga and Ayurveda.
THROW OUT THE FAX!
I was delighted when Scott Johnson included this slide in his presentation about MySugr at the recent Roche Blogger MeetUp at EASD:

Clearly I’m not alone in my frustration at the insistence of some HCPs to continue to champion (and only use) fax machines!
PEER SUPPORT SESSION WRAP UP
I wrote about the peer support session at ADS-ADEA, and my talk in the symposium. Here’s the wrap up from the ACBRD – the organisers of the symposium.
ALSO FROM THE ACBRD…
If you live in Australia or the UK, please take part in the yourSAY quality of life study. Have your say about the impact living with diabetes has on your life.
Click here to take the survey.
BINGO!
I couldn’t help but laugh when Melinda Seed developed this neat little bingo chart to be used at diabetes conferences. She tweeted it out at the beginning of EASD, just as I was lamenting that questionable language being used by presenters at the conference.

Unfortunately, I couldn’t play during talks. I would have spent far too much time shouting Bingo at inappropriate moments. Come on, people; do better!
My blog break was completely unplanned, but once EASD was over and my family joined me in Lisbon, I knew that our next three weeks together would be completely dedicated to chasing the sun, relaxing, eating, wandering through art galleries, napping in the afternoons. And not writing.
I thought the best way to get my writing chops back would be to share some pictures. Because pictures tell a thousand words, which means I won’t have to write many!
So, here are some photos. With tenuous links to diabetes…
Fab event (as usual) by diaTribe at EASD. And this slide is just so damn on point and why I keep harping on about time in range rather than A1c:

We’ll title this photo ‘As if’. Or ‘Pffft”:

Wandering the streets of Lisbon, I found a shop that I wish was a real pharmacy:

Smart advice found in Lisbon. In my hands is the best chocolate cake I have ever eaten:

Also in Lisbon, this #LanguageMatters gem printed on the window of a water-side restaurant:

All day, every day. With thanks to Finn:

This is what happens when the sun is bright, all day is spent wandering around. And a Dexcom is firmly affixed to my upper arm….

It appears that Loop has broken my diabetes:

It’s important to visit family when visiting other countries. Thanks to CEO Chris Askew for the great catch up:

We visited Cheddar, went to an ice-creamery and discovered their ice cream has diabetes:

And finally: tribe.

DISCLOSURES
My flights and accommodation costs to attend EASD2017 have been covered by Roche Diabetes Care (Global). Yesterday I attended the Roche #DiabetesMeetup (more on that to come). Roche also provided me with press registration to attend ATTD. My agreement to attend their blogger day did not include any commitment from me, or expectation from them, to write about the day or their products.
Our holiday following EASD was funded by my family’s dwindling bank balance.
In my jet lagged stupor (HI! I’m back!) I reached for my phone in the middle of the night, and as I scrolled through my social media feeds, I was promptly alerted to the fact that Animas Corporation, a Johnson & Johnson Diabetes Care company, was out of business. Effective immediately, Animas pumps would no longer be supplied in the US or Canada
My initial thought: ‘No surprises here.’
My second thought: ‘What a mess.’
(My third thought: ‘Jet lag sucks.’)
So, what does this mean for Australia? Australian Medical and Scientific Limited (AMSL), the Australian distributors of the Animas pump, have today stated that the overnight announcement does not affect Australia. Supply of Animas pumps, pump consumables and technical support will continue.
So, business as usual?
Well yes. It is. And that’s great for people who are using Animas here in Australia. Unlike our friends in the US, we are not suddenly being forced to make an urgent decision about which pump will be changing to.
But can we say business as usual when we know not that there will be no upgraded, updated or new technology from Animas in the future? I don’t really think so. One of the important factors of diabetes tech is the element of ‘what’s next?’ There is no ‘what’s next?’ from this company.
The pump market seems to keep getting smaller. Deltec Cozmo and now Animas are all out of the game in Australia leaving us with less and less choice. (Cellnovo has delayed their 1 October launch for another month.)
My fear is that we will end up with no choice at all. I am very much turned to the US right now with my eyes are firmly planted on Bigfoot Biomedical and Beta Bionics as I watch the developments of their automated delivery device systems. And, of course, I have particular interest in how they are going to supply markets outside the US. Are they even going to supply markets like Australia?
This is not a good day for people with diabetes.

Happier days with my Animas Vibe pump.
It’s both exciting and slightly demoralising walking around the exhibition hall at a truly international diabetes conference. Exciting because it’s often where new things are launched. And it’s a good place to find coffee. Demoralising because a lot of the exciting things will never make their way to Australian shores. And the coffee can be really shit (the Lilly coffee stand was staffed by Aussie baristas, so it because my favourite!).
On day one, I wandered around the Expo Hall at EASD, doing the circuit a number of times. I seemed to find myself repeatedly drawn to stands showcasing insulin pumps. Maybe it was subconscious. Maybe it was just that their stands were the brightest!
Interestingly, Medtronic was not at EASD. Their absence was conspicuous – especially in a week of another product recall – and one that really is significant. I did see several talks that mentioned the 670G however, so it was disappointing that they were not here to answer the questions that many people seemed to have. (Although, given that I spent most of my time with European advocates, those questions would have all been variations of ‘When are we getting it?’…)
Animas was tucked away in the corner of the J&J stand, with no news on offer about where things are with the long-promised, and long-awaited Vibe Plus which is integrated with Dexcom G5. Rumour on the street (but it is just rumour) is that it’s not happening any time soon.
There was little mention of the Roche pump offering on their stand, although there were images and sales staff to answer questions. But there is nothing new coming in this space from them at the moment with most of their energies being dedicated to MySugr, GoCarb and the Senseonics implantable sensor.
I said hi to the European Cellnovo staff (all of whom somewhat disconcertingly knew who I was). They are super excited about launching in Australia. There is nothing new from them at this stage (but you can read my initial thoughts on the pump here, and Frank Sita’s here.)
No stranger to the Australian market, DANA had a pretty damn big and glossy stand here at EASD, proudly branded with their somewhat odd tag line is ‘Ubiquitous insulin pump’. DANA in Australia (distributed via a third party) has had some issues in Australia recently – mostly to do with the availability of their infusion sets.

The most exciting news from DANA was their big EASD announcement of their new pump – the DANA RS. You can read Mike Hoskins’, from Diabetes Mine, scoop about it here, but the essence is that the pump is ‘Android OpenAPS-able’ without the need for an additional piece of hardware. This is a very big step in the very right direction for integration of pumps with the whole #WeAreNotWaiting philosophy and congrats to the team for embracing it.
What I’m far less enthusiastic about is that DANA has persisted with using a proprietary battery. I find this really, really appalling and utterly non-user-centric. This was the case with the previous DANA R pump, and to replace the battery, users needed to place an order for cartridges.
No idea when the new DANA will be in Australia… I guess it’s just a wait and see, but absolute credit to DANA for making it possible for people to use Android OpenAPS with a new pump.
Ypsomed (‘Ipso-med’) had their nifty Ypsopump (‘Ipso-pump’) on show and I had a little play. It’s fun – I like the look of it and it is super-easy to use. I’ve been told that they are heading down under, so please do watch this space!

And finally, the bright and shiny team from Kaleido were brightly and shinily showing off their pump again. It still is beautiful. It still is fun. It also still is not on the market. I really, really would like to see them actually get to launch stage. And soon.

Okay, so the pump wash-up in relation to Australia is this: it looks like we might actually start to have some real choice on the pump market in the (hopefully) not-too-distant future. I remain frustrated with the current situation, dismayed that if I wanted a new pump this very minute (which I am entitled to) my choice is a pump that is just too large and clunky with features that just don’t work for me, or exactly the same pump as I’ve been using for the last four and a half years. Come 1 October Cellnovo will be ready to go with consumables on the NDSS, and there is the first hint of improved choice for people with diabetes.
And that can only be a bloody good thing!













