New Year, New Adventures, and a Request

I don’t usually do New Year’s resolutions; I’ve found that I am more successful at making changes in my life when I initially realize something needs to change, rather than waiting for an arbitrarily later time.  Plus, this year, I need to contain most of my resolve for a potential major life change.  For M and I, it is becoming increasingly likely that we’ll need to make a move to Germany in 2014.

You see, 5 years ago I fell in love with a German.  M and I moved together from Indiana to Boston and it’s always been understood that when M’s work visa expires, we’d move to Germany for awhile. (Or forever… Don’t tell my mother…)  That time is coming in September.  Since neither of us is fully ready to move right now (I like my job, moving is expensive and my school loans are barely paid off, our current proximity to Joslin is ideal while we contemplate our future family, etc), we’re working on obtaining a new visa or a green card for M but we’re planning for what is probably the inevitable.

I’ve made some effort to learn German but am still have an underwhelming grasp of the German language.  M has decided that the remedy for this is for him to speak to me only in German from now on. This should be interesting.

More importantly (or maybe just equally important), I’ve been reading up on life in Germany for an American expat with diabetes.  Unfortunately, that info is not altogether easy to come by.  I can rely on M for info about the German social health care system, and the internet has plenty of resources for both diabetics and expats, but what it seems to be lacking is a mixing of the two.

What I’ve learned is that an insulin pump is not the standard of care in Germany and insurance coverage for one needs to be fought for on an individual basis.  CGMs are basically never covered and would certainly need to be paid for out of pocket.  My poor German language skills are certainly going to make it tricky to find a job (luckily English is widely spoken in science so I might be in luck…) so we are unlikely to be able to afford such extravagant things initially and I haven’t been on MDI in 12 years!  This is a slightly terrifying prospect and some first-hand info would be greatly appreciated. (Please help!!)

Clearly diabetes in Germany can’t be all bad.  There’s the MySugr app (Ok, it’s from Austria but they speak German so I’m counting it), Mein Diabetes Blog, many, manydiabetes online resources, etc.

Which brings me to the request.  I’m asking you, the DOC, to please comment below with your links, advice, first-hand accounts dealing with insurance in Germany, or any information at all about being a diabetic expat in any EU country; we are willing to move anywhere where we can find jobs and D covered.  I’m looking for things like insurance for foreigners, any policies regarding diabetics and driving,  access to  and cost  of insulin pumps and CGMS, etc.  I plan to do the same and turn this page into a hub full of info for any diabetic looking to make a move to the EU.

Thanks for your help!

T:slim – first impressions

It’s Thanksgiving and today I’m thankful for life-sustaining medical technology that’s also nice to look at and easy to use. My new touch screen pancreas t:slim insulin pump arrived on Tuesday and after 24 hours of patience, I ran out. So I opened the box, unwrapped my new toy durable medical equipment and began my d-life again without the hassle of dialing in carbs and BG values. It’s been a measly 18 hours since I first plugged her in (name pending) but I’ve already identified a few pros and cons about the newest member if my diabetes team. Since today’s a holiday I’m leaving this post in bullets but I assure you I’ll do my best to update this post as my experience with the t:slim evolves.

• Touch screen!!! Hello 21st century.
• Back button and Home button
• Bolus calculator – as in “I had 10+6+32+1+7g of carbs, bolus please!”
• Pretty, shines, modern, relatively small
• Copy/paste basal program – build a new basal program without having to start from scratch.
• Basal program includes ISF, I:C, and target BG
• I:C can be entered in half grams
• IOB on home screen
• 75 xtra units – see cons for explanation.
• Great history menu includes entered BGs, blouses split by type and if the calculated dose was overridden.

Cons Less awesome things:
• Touch screen less responsive than I expected
• 9 button key pad, as in three letters per button. But you only need this for naming basal programs so who really cares?
• Very slow priming and insulin delivery. Ugh!
• Only corrects for low blood sugars under 60 so I need to be a bit more conscious when dosing food with lower BGs
• Clip is a bit poorly placed on the case – only slightly north of center so the pump hangs forward while clipped to my pocket.
• Leur lock connector in awkward position and I can’t seem to hide it.
• Uses close to 50u to ready cartridge and prime 23in tube ( as opposed to about 25 for the ping) so the xtra 100 units I fill are really only and extra 75.

• Wall charger – I was directly connected to the grid for about 10 min this morning
• Multiple confirmation screens before bolus initiates.

And that’s all I got for now.

Switching to the t:slim’s been nearly 9 months since I last posted anything on this blog.  Either this post will the turning over of a new leaf or maybe I’ll neglect the blog for another 9 months.  Only time will tell.

Until then, I’m here to tell the world that I’m making the change over to Tandem and should receive my new t:slim within a couple weeks.  I’ve been using an Aimas pump for nearly 12 years.  I stated on their IR1000 model (a brick with a cord), switched to the IR1250 (for the carbsmart calculator and the free iPod mini that came with it), then my beloved Ping.  As far as I’ve always been concerned, no other brand was even worth looking at – Animas is and always has been fully water proof (I’ve worn it under waterfalls, and in lakes and pools), has easy (enough) to navigate menus, and great customer service. (Although it was better back in the day when everyone else was on minimed and I was Animas’ only customer.  Not really, but that’s how it often seemed.)  I remember fighting my doctor to subscribe Animas over minimed.  I knew it was the pump for me and I couldn’t be convinced otherwise.  And to this day I have always had great experiences with my Animas pumps.

Then one day there was Tandem.  The t:slim is smaller, holds more insulin, is rechargeable (no more expensive lithium batteries insurance would never pay for), has a touch screen which allows carbs and BGs and boluses to be typed in instead of dialed, and the ever ellusive back button.  I was instantly twitterpated; it’s like Tandem knew all the things I wanted out of a pump and poof there it was!

Yet I remained reluctant.   Tandem does not offer pump trials; the t:slim is not water proof (merely water resistant); and perhaps most importantly is a start up company just breaking into the market with a first generation product.

And then my Ping’s warranty expired.   Do I sign up for 4 more years of Animas or do I take a risk and give this new company a try?  They have a 30 day return policy (from start-up day) and the only way they make to the next generation is by having customers willing to give them a chance.  Plus they’re teamed up with both Dexcom (integration, please!) and the dual-chamber-bihormonal-closed-loop-pump people at Mass General so they have a bright looking future.

I got word of my approval today and I’m pumped (excuse the pun).  Let’s hope it’s worth the gamble.

Evolution of Insulin Delivery

In the Beginning, there was Regular and NPH delivered via disposable ultra-fine hypodermic syringes, circa1992.

Sometimes with the “help” of funny little contraptions designed to “hide” the needle, or speed up insertion.

Then came insulin pens.  At first, they were made to look like any other pen with all of the Rx info printed only on the disposable cartridge inside the pen.  I switched to these pens around 2000.

At some point, pens became entire disposable units.  Luckily, I never used these…

…because I began pumping in 2002.  I chose Animas because, at the time, they were the only waterproof pump on the market.  Despite pull from my doctors to choose MiniMed, I insisted.  My IR1000 pump was a brick, but I loved it.

I didn’t so much love the infusion site insertion.  Equipped with a 2 inch needle that needed to be inserted manually, I was still grateful to not to have to take 4+ shots per day.

Then, in 2006, Animas came out with the new IR1250 which had a built in food database for carb counting, smaller dosing incriments, and a sleek new design.  Goodbye brick, hello future!  (It also helped that the new pump came with a free iPod nano.)

The new pump also came with a new way to infuse.  Automatic insertion quickly became my new best friend.

Ping became a part of my life in 2010 (I always managed to get an entirely new pump system whenever my warranty for the old pump expired.)  With the remote in hand, Ping and I get along swimmingly to this day.

In 2011, I added Dex to my D-care team and I am now patiently awaiting the release of Dex and Ping’s child, Vibe, which will hopefully take place soon! (Ping’s warranty is up in 2014, hint, hint!)

It feel like the only thing left to wait for is a completely integrated, closed loop system,

Or maybe just a new one of these:

Isn’t he cute?

Taking Diabetes to Work

I started my new job at Company X last week. I have my very own cubical equipped with my very own computer, phone, and stapler; my very own fume hood equipped with a fancy new Schlenk line, vacuum pump, and shiny stir plates and lab jacks (I am a R&D chemist, btw); a slew of friendly and helpful coworkers; and a comfortable paycheck and benefits package (can you say “Yay! for dental insurance!”). Needless to say I am happy.

However, with a new job comes the need to introduce my diabetes to a new environment and new people. Something that I’m never sure exactly how to approach. Do I let people find out organically and not tell anyone unless it “comes up” or do I “disclose” my diabetes to my boss and few select coworkers as I get to know people? And how will my diabetes react to my new schedule?

The latter has turned out to be the easy part. Relatively speaking. During my first 3 days of work I was low constantly so I reduced just about every rate and ratio by about 10%. Sine then D has been behaving and I think that over time I will have to stepwise adjust my rates back to pseudo pre-job numbers as I develop a routine and begin to settle in.

The tricky part is figuring out how to introduce D to new people. In the past I have tended toward the organic option, making more effort to keep my diabetes under wraps than developing an at-work D-support system. But, I also have never been as conscientious about my diabetes as I am now. But I still don’t feel completely comfortable beginning the disclosure conversation.

My immediate supervisor, JK, already knows – it came out as we were heading off to lunch on Day 1 and he was telling me about his recent vegan conversion (since D is also a bit a bout food choices, it fit right in). His response was typical. “Oh, that’s interesting. My [insert distant relative here] died just last week from diabetes. She didn’t even know she had it before she was rushed to the hospital with a blood sugar of 900.” Yeah, mine isn’t like that. I explained to him that I have type one, had it since I was six. I wear an insulin pump and am otherwise completely healthy. That his distant relative is the exception, not the rule.

Then he stepped into the role of supervisor and asked me if there was anything he needed to know. I told him that I keep my diabetes well monitored but I could let him know the signs of low blood sugars and the appropriate emergency response, but really all I need is that he’s aware so that in case of an unrelated emergency he can make inform anyone else who needs to know. There. D-introduction done. Right?

The next day, the was training me on some piece of equipment when my BG began to trend low and Dex felt the need to inform me. Loudly. So I pulle doff my glove, reached into my pocket to silence Dex and put on a new glove. When I looked up, JK looked concerned and asked if everything is ok. I blushed and simply said “yep – everything’s fine” and the training continued.

Now I think that maybe I need to sit him down and give a breif tutorial about my different bionic parts, the noises they make, and the implications of those noises. The last thing I want is to be sitting in a meeting, have Dex go off, and have everyone think that I’m reaching in my pocket to return a text or something. I’d rather the explanation be preemptive.

But I don’t know how to begin that conversation. Despite my new found comfort with D, I’m still uncomfortable talking about it with people unfamiliar with D.

Then there’s the conversation I had with another coworker who was interested in seeing pictures of my hedgehog, which I have on my phone. She pointed to my pocket and said, “Do you have your phone with you?” As if she thought that even though I said I left my phone at my desk, I had something clearly cell-phone like in my pocket so I must’ve been mistaken. I told her that I did not in fact have my phone with me but would definitely show her later. I could have said a million other things. I could have told her what was in my pocket, showed her even. I could have brought her into the loop but I choked. And D remains under wraps.

I’m thinking of being really bold and beginning to wear my pump and Dex outside of my pockets at work. The idea behind this is two-fold. First, it would make life in the lab a bit easier. I would have better access to these devices and would be less likely to accidentally contaminate something by having to reach into my pocket to see them. Second, although people still wouldn’t necessarily know what they are, it would be more obvious what they aren’t and maybe these conversations would come more organically.

I’d be very interested in hearing how other people have approached introducing D at work. Please comment if you have any stories or insight.