When cannulas turn evil.....

Diabetes isn't generally a gory disease.  There are needles, blood tests and occasional HbA1c check that lower the tone but, unlike some diseases, diabetes doesn't usually result in fountains of spouting blood or leaking body fluids.  In fact, in the 3 years since I've been on the insulin pump I have been amazed at the lack of bruises at the cannula site, unlike my former previous dappled blue and purple-covered arms: a reminder of the constant needle-sticks.

After an overnight bonanza of elevated blood sugars I decided this morning that a cannula change was in order.  Because it stays in place for 3 days at a time there can be occasions when a cannula gets irritated, bumped, knocked or just doesn't like where it is, and a swift swap-out can be just the ticket to resolve a mystery high blood sugar.  

Cannula changes, a once timely affair involving much fumbling and shaking as I nervously tried not to slip and get it wrong somehow, are now a swift 30-second job, having changed around 370 of them over the years.  This morning's was no different: I opened a cannula fresh from the pack, loaded into the automatic inserter, placed it on the skin where I wanted it and 'clicked' the inserter buttons.  I made my way to the kitchen to collect a fresh bottle of insulin and change my reservoir at the same time, just in case an old bottle of insulin had contributed to the blood sugar mayhem.

As I disconnected  my tubing ready to connect it to the new reservoir, I discovered this little crime scene:

That's right folks: my cannula, in what I can only describe as a scene from 'ER', tried to kill me.

So readers, watch out for your own cannulas - some of them may are working to their own agenda!

Pumps, selling points and counting down

Three years ago on 25th January 2010, I hooked up to my insulin pump for the very first time. How time flies when you are having fun. I have barely looked back since, save for the occasional pump break or frustrated tubing-catching-on-door incident. Better blood sugar levels, results comparable to the effort I put in and a complete halt to progressing retinopathy issues were among the earliest benefits I saw when I started the pump.

That said, as I enter the last year of my four-year pump warranty, a time when I need to consider what pump I might like when I renew, thoughts of the last 3 years and the pros and cons of my particular pump begin to feature more and more often. I love Medtronic and have found their customer service second to none. This is no secret. I have also always been clear that for me, how 'sexy' the pump appears is far less important than the company behind it; if the pump fails to work at 4am, its va-va-voom will seem worthless when you are trying to reach a company who operate a 9-5pm 'daytime only' customer service line.

But there are elements to my pump that I would look to improve on:

1. Waterproof. My husband and I got together because of a surfing holiday in Cornwall; a holiday we treasure so much that when we got married we took 70 of our dear friends and family there with us. When I went onto an insulin pump surfing became a lot harder because unlike many of the other pumps my Medtronic Paradigm VEO is not waterproof.  In fact it seems barely water resistent when you mention water and the pump in the same sentence to a Medtronic rep, actually. Following my weekend at Loughborough University last year, I have given a lot of thought to how much I would love to swim, but am unable to for more than 30 minutes or so. I also find myself questioning whether that post-gym spike is down to the fact that I have been showering and changing after an intense workout, when every last bit of insulin is key. So I have reached the decision I need a pump with some guts to get wet.

2. Tubing. It has been 3 years since I was able to sleep pyjama-less. This may not seem like a big deal, but having tried it once in 42 degree heat in Thailand, almost completely tieing myself up overnight like a cartoon baddy, being tubing free and able to sleep 'al fresco' again, would be devine. The stares at the gym I can deal with but the tubing, as I've said before, is something of a growing bug-bear.

3. Continuous Glucose Monitoring (CGM) capability. In the next four years it is very likely that J-Dizzle and I will be wanting to start a family. At the ripe old age of 30 babies, family and future take up every available waking moment. While I am not funded for CGM and am unlikely to be, Jamie and I have reached the decision that this is a key part of the pregnancy control puzzle we won't do without and will be funding it ourselves. Because of this, pumps with integrated CGM, Dexcom in my case, are of much greater interest.

As Medtronic are not yet rocking a waterproof version and are only able to have their own Enlite CGM sensors integrated, I feel I am almost certainly approaching end of my Medtronic journey.   Instead, my eyes now wander regularly to one of two pumps in particular:

1. Animas Vibe. Fully waterproof with the capability of integrated Dexcom technology, it is a clear leader for me. I have met a number of people from the Animas team and have been very impressed by their customer service and dedication to their 'clients'. Having also chatted in secret with other Animas users (after all, it is we the person wearing the pump who can offer the most real experiences), I am also sure that as a pump, it manages very nicely. I would feel confident that the customer service issue, as well as the sexy pump, would be no problem for the folks at Animas. The one problem, it still has tubing.

2. The Omnipod. What it lacks in integrated CGM (although according to other blogs, this may be on the cusp of change), it makes up for by being both waterproof and completely tubing free. Having only arrived in the UK around 3 years ago, I could have been one of the first people using it in the UK. After an unfortunate false start however, I decided that until the company were more established in the UK and could demonstrate the customer support I rely on so greatly, it wasn't meant to be. Since then, my post about the problems I experienced has brought a lot of feedback. Mostly, I'm glad to say, from very positive Omnipod users who are as adamant about the Omnipod as I have been about the VEO. 

So there it is, my current thinking about which pumps I will be pursuing in the next year. It's a tough one and if I'm honest my dislike of tubing outweighs my preference to have integrated CGM, seeing as carrying around a million and one things is a well-practiced hobby of every diabetic.  Over the next year I will be exploring these further and chatting with both companies to see which, if any, of these pumps most suits my lifestyle and diabetes care needs.

The gift of sight

The list of the complications available for a person with diabetes to choose from is certainly a lengthy one.  Like any normal person, I have times when my BGs are an afterthought and the rest of my life takes over.  But for the other 95% of the time I bolus 20 mins before my food, eat meals I know agree with me and exercise - sometimes reluctantly - all with the aim of avoiding complications.



Nevertheless, if complications do happen and I had to choose which I would want least (weirdest. list. ever.), blindness would be right up there. High glucose levels, something every diabetic can struggle with, are the root cause of a great number of eye problems leading to blindess that diabetics can suffer from, including macular oedema.


In 2011, NICE deemed a sight-saving drug called Lucentis 'too expensive' to prescribe to people with diabetes at risk of losing their sight due to Macular Oedema.  However, thanks to the manufacturers dropping their prices, the decision has been re-considered and a review of the guidance has now deemed it favourable. Very NICE indeed.


This drug however, is injected straight into they eye - something you might want to consider if you were planning to take your eyes off your diabetes game for just a minute.


For the full report, click here, and keep up the stirling work, folks.

Animas 'Sports day' event. Do it.

Last year I had the pleasure of attending the Animas Sports Day event held at Loughborough University, to blog on behalf of Shoot Up or Put Up, who were busy doing other less exercisey things.  Bonus.  The event is for those over 18 and sporting (no pun intended) a pain in the backside disease called Type 1 Diabetes. 

Exercise can be one of the most challenging elements of type 1 diabetes.  For some, it makes their blood sugars skyrocket, while others are left plummeting to the depths of a nasty hypo before even having left the gym.    We all know exercise is fantastic for everyone, everywhere.  You have to have lived under a rock to think otherwise. But the challenge is especially great for people with diabetes.  On top of all the benefits like improved blood sugar control, increased insulin sensitivity and circulation benefits, it is also an excellent way to keep your weight in check, something I have struggled with for years.  But managing blood sugars during exercise is no simple task, which is where Animas come in.

Well guess what, even though you may feel the blood sugars you have during exercise are totally random, they aren't.  Not even close.  There is science behind all of it and this weekend tells you all about that, without needing your own Degree in Physiology and Endocrinology.  This weekend gave me the footing I needed to grab diabetes by the horns (yes, it is cow-shaped) and give it a right good seeing to.

Oh, and the weekend is freakin' fun.

As someone who has managed to overcome many of my exercise (and weight) demons by taking part in this weekend, I urge you to go.  And I don't just mean those who love their sport and are already super-svelte and exercising regularly; this weekend would also benefit those who struggle with weight, managing blood sugars and are lacking in confidence about where the heck to start.  In fact in my opinion, we are the ones who need the biggest 'leg up'.

The time has come to register, so contact sportsday@its.jnj.com for more details and to reserve your space.  If all goes to plan, I will even be there myself talking about the challenges of weight loss and diabetes which, thanks to this weekend, are now a lot less challenging.

The best news is that newcomers are also being treated with priority which is great news as the spaces are normally filled by those who have come to learn what a superb weekend it is.  So take them up on it! If you are free on the 10th, 11th and 12th of May 2013, come and join in! 

If you fancy seeing how last year's event went, check it out below:

AP (off for a speed jog, because I can)

Tamagotchi fanciers

In December my brother celebrated his birthay and as part of the celebrations came over for dinner with 'the fam', bringing with him a friend from work. Chris, my brother, had decided that to celebrate his birthday he really wanted my mother's legendary 'mac and cheese'. It's a corker, let me tell you. It is also a diabetic's best friend, because thanks to the high fat content of the cheese, any carbs in the 'mac' are slowed down from entering the system at their usual lightning speed. So no 20 minute window to adhere to for me. Awesome.

As we all sat down to dinner I started to fiddle with the bolus wizard on the pump, letting out numerous beeps, squeaks and near-inaudible crunching sounds (as the plunger delivers the insulin from the resevoir) as I went.  My brothers friend looked over, knowingly.  "Tamagotchi?" he asked.

This might be fun.

"Yes, it is", I teased.

"Cool."

Before I knew it he was relaying the story of the time he accidentally killed his sister's beloved Tamagotchi.  Apparently, he considered it normal for a 30 year-old woman to be petting her Tamagotchi (that sounds a little, wrong) as we sat down to dinner. It didn't seem to even register that this would be about the weidest thing for those noises to have been.  Even weirder than a battery-powered robotic external fake sort-of pancreas.

"Um, actually, it's an insulin pump. I'm diabetic."

As we giggled about Tamagotchi-gate and the fact that he was too polite to point out how weird a hobby that would have been, I smiled and thought to myself: perhaps there really are stranger things in this world than wearing an insulin pump full-time.

Thirty year old Tamagotchi fanciers, for a start.