Can an insulin pump kill you?

August 26, 2009

DeathFor me, and insulin pump is the best thing that could happen to me since becoming a diabetic. It has allowed be a level of flexibility and control that has never been possible before. With the pump I’ve been able to get as normal a life as a type 1 diabetic can have and I’ve been able to achieve nearly normal glucose levels with a fraction of the effort that it would take otherwise.

I wear a Medtronic Paradigm 522, and trust it with my life. Is exactly for that reason that recent news published in the canadian newspaper The Windsor Star where someone got killed by their pump.

Steven Krueger used an insulin pump for four years after nine years of daily injections, and according to his parents “it allowed him to accomplish things he otherwise would not have been able to do as a diabetic. He received his scuba diving certificate, completed the Red Cross Lifeguard Program and earned his recreational pilot’s licence.

Steven’s pump failed by giving him a lethal dose of insulin and he died in his sleep three years ago at the age of 27, while living in British Columbia. The cause of death was confirmed by the B.C. coroner’s office. Dr. Phillip Neufeld at the Health Canada lab in Ottawa tested the pump and confirmed the failure and cited some additional interesting facts regarding the Medtronic Minimed Paradigm infusion pump, model MMT-511 that Steven used.”

Other deaths by lethal insulin doses have been recorded in the past, but the pumps have never been tested and therefore, a solid link can not be established. I must admit, however, that the thought of my pump having the potential of killing me makes me nervous.

I can only hope that Medtronics newer pumps have corrected any potential issues…

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Australian environment linked to type 1

August 21, 2009

diabetes-environmental-factors-insulinAccording to an article published today by the Herald Sun, the number of  Australian children developing Type 1 diabetes is growing by around four per cent each year, putting the country in the top 10 countries in the world in terms of the number of new cases. Figures released today show there were 987 new cases of insulin-dependent diabetes in children aged under 14 in 2007, compared with 758 in 2000.

This trend may be also replicated in Europe wherescientifics estimate that the total number of children under age 15 with type 1 diabetes will rise 70 percent to 160,000 by 2020, up from 94,000 now. To predict the future burden of type 1 diabetes,  Dr. Chris Patterson of Queen’s University in Belfast, Gyula Soltesz of Pecs University in Hungary and colleagues analyzed data from 17 European countries on 29,311 cases of type 1 diabetes during 1989 to 2003.

“These findings suggest that the incidence of type 1 diabetes is increasing even faster than before, pointing toward harmful changes in the environment in which contemporary children live,” Dr. Dana Dabelea of the University of Colorado in Denver wrote in a commentary.

For a while, there has been speculation about the causes of Type 1 diabetes, and in particular, whether genetic makeup or the environment are the triggers. Now there seems to be more evidence that the environment is playing a bigger role. Associate Professor Maria Craig, a paediatrician who specialises in diabetes at the University of NSW, says the rapid rise in Type 1 cases “means it’s got to be something in the environment because genes can’t change that quickly”.

In my personal conversations with various diabetes professionals the view seems to be that we simply may be getting better at diagnosing these cases, and not that there are more of them. There is also the question that now people with Type 1 diabetes can have children, which may inevitably spread whatever genetic factors are involved.

We obviously still have a lort or research to do before we can come any close to understanding what is causing type 1 diabetes.

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More accurate meters on its way

August 17, 2009

accuracy

7.5mmol/l (or 135 mg/dl)… that was my first blood test result today… but how accurate is really my meter… can I really trust that number?

In a study performed by the Department of Health of the UK, One-hundred-and-two patients with type 1 and 2 diabetes were observed performing a capillary blood glucose test. Immediately afterwards, a venous sample was taken for glucose and the two values compared. Only 47% of patients’ results were accurate to within 10% of their corresponding laboratory value.

After reading this you may feel, like I did, that your meter is completely useless and that you may as well toss a coin or throw a dice before chosing your next insulin dose. It is important, however, to understand the current regulations for glucose meter accuracy. According to the American Diabetes Association, a test result from a home blood glucose meter is considered accurate if it falls within ±20% of a lab test.  Comparing a meter’s test result with a lab test is the only valid method of determining whether or not your glucose meter is really accurate.

On the other hand, it does not seem like everything is lost. In a report published in the New York times a few weeks ago, the commissioner of the US Food and Drug Administration (FDA) indicates that there is a move to lobby the International Standards Organization into revising the international standard to mandate higher meter accuracy. Furthermore, according to a letter from the FDA, if the international standard is not revised, the agency may recognize the new requirement on its own, effectively making it mandatory for approval into the US market.

While this is not yet a done deal, it definitely looks promising.


Is this the end of Diabetes Australia?

August 10, 2009

DART LogoDiabetes Australia is a national non for profit organization that deals with all types of Diabetes. You could think of it as the equivalent (although unrelated) to the American Diabetes Association here in Australia. More importantly for people with D, this organisation is in charge of administering the National Diabetes Services Scheme (NDSS) that provides subsidized testing strips and other consumables.

Like many of its international counterparts, Diabetes Australia is organized in chapters or member organizations, usually one per every state. An interesting tension has always existed amongst different member organizations over issues such as branding and spending priorities. It seems now the issue has become too big and half the state branches have now split.

Accoording to a report published in the Brisbane Times, “the national organisation has been plunged into disarray with a walkout by the NSW, South Australia and Northern Territory branches and the resignation of the national president, Gary Deed, and the chief executive, Matt O’Brien, in recent days.”

The three organisations have said that “they would welcome the establishment of a new body to replace the national organisation.”

So, is this the end of Diabetes Australia? How will Australians with D be able to maintain access to the NDSS which provides $750million of funding over the next 3 years? How will the lack of a national representing body affect the care and advocacy of Diabetes in Australia?


Review: Accuchek Performa

August 6, 2009

accu_check_performa_monitor_1.jpgWith the near release of the Accu-chek nano here In Australia, I thought I would publish here a review of the Accu-chek performat I conducted for Reality Check a few months ago.

The performa is the international version very similar to the Aviva sold in the US. It boasts 5 second result and one of the best lancet devices on the market

Advantages:

This meter is meant to give results in 5 seconds and use 0.6microliters of blood, but these numbers don’t show the real picture. For some reason, it requires a lot less blood than my Optium Xceed which on paper requires the same amount of blood. It also uses better suction technology in the strip so the filling is super fast, much faster than any other meter I’ve tried.

The strips come in a canister with a hinge which make it very convenient as there is no need to fiddle with foils or lids. The meter also comes with the highly regarded Softclix, by far the best lancet device around these days.

Disadvantages:

No backlight, not that I really use it that much, but is the only thing I could really miss. The meter and case are also a little big bigger than the Xceed, but still very manageable.

Verdict:

I was very happy with my Optium Xceed before getting this one, but now that I have used the Performa, I’m completely hooked to it.

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How to survive the Ski season with Diabetes

August 3, 2009

overhead_view_of_mt_buller_gallerylargeMany of my readers already know I live in Australia, and some may know that here the seasons are reversed, which means that instead of the middle of summer, we are about half way through our winter season.

A couple of weeks ago I spent a weekend skiing in the Australian alps, and decided to share some of the tips that others gave me and that made this incredible fun experience possible.

I’m on a pump, and that made a lot of difference. Skiing is quite a strenuous spot, so I initially set my basal at 50% of normal rate.  I still ended up going lowish (not quite hypo but lower than I wanted) so I lowered to 20% and that worked better for me.  (note, this is me so no guarantee it would work for anyone else).

Australian ski resorts are a bit warmer than those in Europe or the US, but still go subzero regularly. Skiing on these conditions means that extra measures have to be taken to prevent insulin from freezing. In my case, I decided to keep my pump on the inside of my jacket, in one of the pockets (mine has a ipod pocket, which is perfect). Having the pump in my jacket meant I could also feel the vibrations, which is easier than trying to listen to alarms while in a loud chairlift.

On one of the other pockets, I had a few muesli bars.  I aslo carried my Freestyle lite meter, which behaved well in the cold. Also, beware you may test more than usual as sometimes being cold can be confused with the symptoms of hypo. I actually ran out of strips so beware.

Overall I had a great time in the snow, and will hopefully come back later in the season, hopefully better prepared.

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