Tuesday, 31 March 2015

Episode 6: 64 days on MiniMed 640G: Running with SmartGuard

Hello there!

Thanks for coming to visit the latest instalment on tales from the land of Minimed 640G.

For the observant ones amongst you you'll notice we've gone from Episode 4 to Episode 6 without number 5. Well 5 was a video blog only about CGM basics and can be found here. Worth watching, even if I do say so myself. 

This week I made a second attempt at going for a run whilst on video and this time I managed to not turn the cleverest bit of the pump off. So it worked. I was very fortunate that James from Open Adventure came along too and helped to keep me going and also do his Jeremy Paxman impression.

So watch the video and then come back for some more thoughts.

That was an example of me using the pump in a way that's not ideal but proving to the extreme what the SmartGuard could do. For me running normally would involve a suspension of insulin before starting, some carbohydrates pre-run, a few sweets along the way and then some careful monitoring afterwards. The difference the 640G has made to my exercise is mostly in the post-run time. Previously I'd be concerned about a later drop in blood glucose level and this meant lots of extra testing and treatment. Now I'm more confident to leave the pump to do it's stuff as it will protect from the lows. 

From the exercise point of view I'm off to a Diabetes Sports Weekend in May when I hope to learn more about how to handle the pre and post run highs and lows.

Hopefully you're enjoying my blog pieces on this piece of kit and I've been getting some very nice comments which I'm very grateful for. This week I hope to grab some photos of maybe even some video of the 640G in action while I'm attached to a thin wire on the side of a cliff. Follow this link to see what I mean. And yes, we are doing the extreme version. Why did I think this would be a good thing? I've no idea!

And then next up I want to have a look at what the 640G offers when you strip away the CGM elements. As I've mentioned before full-time use won't be that common in the UK until it gets NICE approval and even then, will probably only be needs based. And I'm fairly certain I won't meet that criteria so it's time to open the wallet. Which in turn means if/when I get the 640G permanently I probably won't have 365/24/7 CGM usage. So how does it compare to the Veo and also to other pumps out there? As I've only used the Veo before I may need some assistance with the comparison. All volunteers with assistance are welcome!

If you've got anything you want me to cover then either leave me a comment here, on the videos or via Twitter.

Finally here's some more links to other great vlogs I've watched recently.
Firstly there's John's tales of drunken adventures and occasional shirt removal. Shameless!
Next up we have Laura answering questions from other people with diabetes about her 640G whilst simultaneously juggling degus!
And lastly pop over to have a watch of Emma's fantastic video on her CGM kit bag. The obvious things are the best ones and I can't believe I'd never thought of using velcro. Genius! Well done Emma and it's a great video.

Have a great week and see you soon!


PS As a quick final note this blog's picture comes courtesy of my 24 hour CGM profile that is recording a maximum of 10.2 mmol/L (183 mg/dl) and a minimum of 4.1 mmol/L (73.8 mg/dl). This was almost identical to yesterday and they both rank up there with my best ever CGM 24hrs!

Wednesday, 18 March 2015

Carpe Diem and All That For Local Diabetes Care

So these pages recently have been all about pumping and more specifically the 640G. Whilst I know this interests many, I’m keen to keep a more general feel to the blog now and again and a few hours last night gives me the perfect chance to do this.

The event I attended at my local hospital was about a proposed new diabetes centre for the surrounding area. The ‘Patient Conversation’ was billed as an opportunity for patients to put across what the team currently do well and what can be improved upon. Along with a few others from a local diabetes group I attend, I went along to really try and make a difference. This should be an opportunity for local diabetes care to step back and look at everything they do to see what they do well, what they do badly and what they don’t do at all.

Being the good boy scout that I am I made a few notes beforehand and went along to see what was being proposed.

We were grouped into tables of roughly five to eight and together we put our thoughts down on to paper and answered the four questions of the night.  The questioning was good and open about what we’d like to see from the centre and also what can be improved with current treatment.

Overall a common theme was coming through the evening as we answered the questions and fed back table by table. The healthcare professionals we meet with at every appointment are fantastic (except Barney obviously!) and their hard work and dedication will be what makes any new centre work even better. On the flip of this process and organization needs improving along with taking this opportunity to make some relatively simple changes to improve the lives of people with diabetes locally.

A simple example of what works well and what doesn’t is getting to speak to the people you need to. On appointment day it’s not unusual for me to see the consultant and also squeeze in a meeting with the diabetes support nurse (DSN) and dietician at the same time. However contacting someone when away from the hospital means leaving an answer-phone message with the DSNs that will be listened to the same day (if Monday to Friday 9am to 5pm) and you normally get a call back the same day or the next. But when leaving the message you’ve no idea if or when you will get responded too. Likewise email responses are, what’s the word, ah yes, intermittent. And out of hours; you’re flying solo matey.

Obviously as this is the local NHS, resource is always a constant issue and we were reminded during the night that people are being stretched as far as they can. I fed back that I understood this but this has to seen from the other direction. Whilst the HCP is running around saying “I’m busy, I’m busy” I’m sat there waiting for an hour, looking at my watch thinking of the work building up back at my office and watching the emails come in that I need to deal with urgently but can’t because I’m sat on an uncomfortable chair and don’t have a decent phone signal. Being a person with diabetes takes time as I’ve touched on before and if I had a choice of hobby, this wouldn’t be it!

Through the night some fantastic yet simple ideas were coming out. For example, move the consultants desk to break down that ‘headtecher’ style barrier to communication, put up a noticeboard with posters of local support groups to enable peer to peer support, text alerts for appointments, same day HbA1c tests where currently it takes a few, remote appointments such as via Skype for those who find it hard to travel, a coffee machine in the waiting area with diabetes literature (Balance etc) to generate conversation etc.

I kept bringing up again and again the subject of social media and peer support. It’s hard to judge but I got the feeling the heads were being nodded but the historical fear of ‘nutters on the net’ still exists. The presentations given at the recent Diabetes Professionals Conference show that online support is a significant aid and encouragement to better self-management and to ignore or dismiss it at the stage would be foolish. I really do hope I’m wrong on how I think this will go. There were enough people with diabetes in the room that were there because of meeting others that showed if you can encourage it you will get a much higher involvement and therefore far less ‘did not attends’ on the appointment list. Paired with this I’m sure people in the room (including me) would be also willing to help provide some simple pointers (such as Kev’s great leaflet) for people to connect with other local, national and international people who understand what they are feeling too. On a local level we NEED to engage with those better. Some people don’t want to tweet, Facebook or blog. That’s fine. But they must at least know that these avenues exist.

Throughout the meeting we were asked to write our thoughts down and these would be taken away and fed into the decision making process. This must be applauded as connecting at any level can only help to make the proposed centre more successful going forward. Indeed some of the ideas already on the slides pre-prepared for a summary at the end matched the feedback we gave last night. This shows that the thinking is going in the right direction. Great!

The key question now is what is going to happen next? I have a very real fear that last night was an exercise in ticking boxes and if the decision makers were asked in the future if they had consulted they can say yes.

Some of things discussed don’t need a new centre building; they just need the process tweaking. And by tweaking this process it may help to ease the burden on the wonderful DSNs rather than adding to it.

I hope with a passion that this is just the start of the consultative process and as well as looking locally at what’s desired they can look nationally at other diabetes centres to find best practice and excellence in each strand of the diabetes journey.

This is the chance to redefine local diabetes care for a generation. Let’s do it! Let’s do it together!

Tuesday, 17 March 2015

Episode 4: 64 days on MiniMed 640G: Failed Experiment

Hello there!

Now it's week three of my 64 day trial of the Medtronic Minimed 640G insulin pump system I really wanted to see how useful it can be in terms of exercise.

You can see my 'success' by clicking through to the video below followed by some handy hints from my assistant.

Episode 4: 64 days on MiniMed 640G: Failed Experiment

For the Saturday you can see from the graph below it's wasn't one of my most successful 'being the perfect person with diabetes days'!

Thanks for reading and watching. And questions or comments please add them below or to the YouTube channel.


Sunday, 8 March 2015

Episode 3: 64 days on MiniMed 640G: Smart Guard

Welcome back. 

Following last week's introduction to my 640G system that you can read and watch about here, this week saw me getting more used to it.

The big selling point for this new pump system is the Smart Guard insulin control function. You'll find more about it in the video below but in summary the pump predicts when you are going low and cuts the insulin supply and then restores it when you start to come back up again. It sounds pretty cool and for me it's been working really well in my first two weeks of usage.

The second part of the video blog (or vlog as the kids call it) looks at the pricing of the Enlite sensors. Obviously this is entirely based on your location. So for me I'm considering the UK only where CGM use is normally not paid for by the NHS and therefore for continued use with a compatible pump I would need to buy the sensors. And yes, I did drag in a little helper as I needed some help with the maths :)

As promised here's a link to the facts behind SmartGuard

Hope you enjoy the video and please come back next week when I plan to have a good look at the bolusing now on offer and how this has changed in the new pump!

Before you go also have a look at Laura who gives her spin on the SmartGuard. And also John who's preparing to get drunk!

Have a good week!