List & Explanation of Devices, Products & Insulins.
INSULIN PUMPS
These are a battery operated electronic device that is a bit smaller than a phone that holds a syringe like reservoir of insulin inside of it. It has a fine tube (roughly 30-60cm long) that runs from the pump and has a fine steel needle (changed every 2 days to avoid infection) or a plastic flexible cannula (changed every 3 days). There are pros and cons to both types of cannulas and the choice of cannula is best made with guidance from a credentialed diabetes educator who can help you choose the right cannula for your kind of lifestyle, body size and skin type. It is inserted just under the skin and delivers rapid acting insulin only, which acts as both the basal (long acting) and bolus (rapid acting) insulin. The pump has various settings programmed into it that can be tweaked as often as needed depending on a myriad of factors so you're receiving insulin to suit the lifestyle you want to lead. Using a pump means you will not have to have daily injections of insulin (though you must still carry an insulin pen in your emergency kit in case of pump failure).
There are a few types of pumps available, you can purchase them outright (can be around $9000 and last about 4 years, but if you purchase a pump outright you won't have access to a warranty for the pump so if something goes wrong with the pump you'll have to pay upfront or do without), or most commonly you can take out health insurance so you can have access to a pump under warranty which is a good safety net, or you could speak with your credentialed diabetes educator as you may qualify for a subsidised pump through the JDRF Australia.
Two readily available pump-CGM combos currently in Australia are :
T:slim pump paired with the Dexcom G6 CGM: read more
Medtronic pump paired with the Guardian 2 Link CGM: read more
Note you can use pumps without CGMs. You may choose to use a pump and keep finger pricking. Your diabetes, your choice :)
YPSOPUMP
Insulin pump with a touchscreen that works with the mylife Unio Neva and mylife App.
Mylife Software receives and helps manage and integrate data from the mylife YpsoPump, mylife Unio Neva and the mylife App.
System Components of the mylife YpsoPump:
Mylife YpsoPump
Mylife YpsoPump Reservoir
Mylife YpsoPump Orbit infusion sets (More information on the different infusion sets available for this pump can be found here)
Mylife Orbit Inserter
Mylife Digital
Mylife Unio Neva blood glucose monitoring system
The mylife Unio Neva is a blood glucose monitor which can give suggested bolus by connecting to the mylife App.
The mylife Unio Neva has Bluetooth connectivity and is able to wirelessly send blood glucose data to the mylife App which can be loaded onto a phone. Data can also be transferred via micro-USB transfer.
More info on the mylife Unio Neva can be found here:
(https://www.mylife-diabetescare.com/en-AU/products/blood-glucose-monitoring-systems/mylife-unio-neva.html)
Mylife App – receives the data. The mylife App is downloaded onto a phone. It imports data from the mylife YpsoPump and mylife Unio Neva blood glucose meter via Bluetooth. This uploads into the mylife Cloud. It has an integrated bolus calculator which will also factor in insulin on board for bolusing.
Mylife Software is compatible with the mylife Unio Neva and mylife YpsoPump. This is the
mylife Cloud share solution for the pump user and their healthcare team allowing professionals to access the pump and blood glucose data once data has been uploaded:
Data from the mylife YpsoPump is uploaded on a computer or device into the mylife Software.
More information can be found here: https://www.mylife-diabetescare.com/en-AU/products/therapy-management/mylife-digital.html
OTHER INSULIN DELIVERY DEVICES (AKA TUBELESS PUMPS)
Omnipod
- Tubeless & wireless
- Delivers rapid acting insulin
- Each pod lasts for 3 days (up to 72 hours)
- Can hold 200 units of insulin
- Not funded by PHI or NDSS
- The POD is waterproof up to 7.6m for up to 60 minutes
- Connects to a PDM (Personal Diabetes Management)
- The PDM is NOT waterproof
- Want more info? See: https://www.omnipod.com/en-au
Accu-Chek Pump:
Tubeless pump – has a cannula patch that the pump “clips” into
Each pump “body” lasts 4 months
Can hold 200 units
Uses an Aviva Solo handset which has an integrated BG meter. Blood Glucose levels can also be entered into the handset from another meter or CGM
The pump is not waterproof and needs to be removed for swimming or showers. This leaves the cannula in place still.
9mm and 6mm Teflon cannulas and reservoirs are available through NDSS
Inserter device used for the infusion sets which is supplied with the pump
Not a closed loop system
More Info? https://www.accu-chek.com.au/solo-help
INSULIN DELIVERY DEVICES - SYRINGES & PENS (AKA ‘MULTIPLE DAILY INJECTIONS - MDI)
Other than insulin pump therapy, a person may choose to deliver their insulin via syringue or pen devices.
Injectable devices like syringues or pens use a vial of insulin and a needle to inject the required amount into the body.
Needle sizes can vary and it is important you discuss with your health team what is the best needle for you so your body absorbs the insulin to benefit your unique metabolism.
Needles and syringes are free and available through the NDSS. They should be disposed of safely in a sharps container and disposed of via the local council or pharmacy.
Needles for any injectable device are single use only and must be changed for every dose needing to be administered.
It is important to know how to prime a needle when delivering insulin doses.
Insulin pens are either disposable (pre-filled) or a cartridge (vial).
Have a collaborative discussion with your diabetes care team about what option will suit your lifestyle the best.
CGM - CONTINUOUS GLUCOSE MONITORS
Can be worn with an insulin pump or in conjunction with injections (MDI)
Consists of a transmitter, sensor and receiver device
The receiver device is usually a smartphone with the installed on the smartphone
Continuous Glucose Monitoring (CGM) detects glucose levels via the interstitial fluid (not via the blood).
Sensors are disposable and applied using an “applicator”. Sensors are worn for a certain period before they are replaced. This is set by the manufacturer. For example, a Dexcom G6 sensor can last up to 10 days before it will need to be replaced.*
Transmitters are inserted into the sensor and used for a certain amount of time before they must be replaced.
CGMs are useful for seeing glucose trends and patterns throughout the day and night, as well as before and after meals.
If the receiver/smartphone has network/wifi reception you will receive CGM results and data
This data is useful to:
See individual glucose levels
See by how much and how fast a glucose level is dropping or rising
Creates alerts/alarms when levels are above or below individual targets
Create alerts/alarms for how fast a glucose level may drop or rise
CGM systems in Australia currently include:
Dexcom G5 CGM : connects to a phone only
Dexcom G6 CGM : connects to a pump only
Guardian Connect CGM : connects to a phone only
Guardian 2 Link CGM : connects to a pump only
Guardian 3 CGM : connects to a pump only
LIBRE (AKA FLASH) - FLASH GLUCOSE MONITORS
Measures interstitial fluid glucose levels using sensor technology
A sensor is inserted using an applicator which is held in place by a small adhesive pad.
Sensors are scanned by a smartphone using the FreeStyle LibreLink app or the Freestyle Libre reader which also works as a meter that checks glucose and ketone levels
Sensors are about the size of a 20c coin and put on the back of the arm
Results can be seen on the app or on the reader and data can integrate with the FreeStyle Libre Software system, which can be shared with your credentialed diabetes educator who can help you tweak insulin doses
FreeStyle Libre and FreeStyle Libre 2 are the current flash glucose monitors available in Australia
Useful for detecting trends and patterns in glucose levels
Freestyle Libre 2 does have an alarm for highs and lows , but only when it goes past the number you have set for a high or low so you will have to set reminders to further monitor. With the alarm system it will only alarm on the device you first scan the new sensor with , phone or the reader. If upgrading from the Libre 1 to the Libre 2 you will require a new reader.
The Freestyle Libre readers can also be used to test for BGL and Ketones with the appropriate strips.
GLUCOSE METERS + STRIPS
A blood glucose meter or monitor measures the amount of glucose in the blood. There are many devices on the market in Australia and even if you use flash glucose monitoring or continuous glucose monitoring it is essential to a have blood glucose meter/monitor in your emergency kit. A finger pricker is used to draw a drop of blood which is then placed onto the strip that is inserted into the blood glucose meter/monitor. It will give a reading of how much glucose is currently in the blood. In Australia we use mmol/L (millimoles per litre of blood). You may sometimes read or see information which refers to BGL in mg/dl (milligrams per decilitre). Both mg/dl and mmol/L are a measure of the amount of the glucose in the blood. This is a useful conversion chart on the Danii foundation page if you want to see a visual comparison: https://danii.org.au/conversion-table-for-blood-glucose-monitoring/
KETONES METER + STRIPS
Blood ketones are measured using a blood ketone meter. It is always necessary to have a meter which can read blood ketone levels and to have spare ketone strips.
Note that chemists are often sold out of Ketone Strips , so always make sure you have at least half a box on hand and restock before you run out
RAPID ACTING INSULIN (BOLUS)
This is used for food/meals, for a correction or during sick day management when glucose levels are above your target range.
Rapid acting insulin will start working within 15 minutes of being injected/delivered. Examples of rapid acting insulin in Australia:
· Fiasp and NovoRapid® (insulin aspart)
· Humalog® (insulin lispro)
· Apidra® (insulin glulisine)
Short acting insulin will start working 30 minutes after injection. Examples of short acting insulin available in Australia is:
o Actrapid®
LONG ACTING INSULIN (BASAL)
This is also known as background insulin and is always in your system.
If you are using MDI you never ever want to withdraw your basal doses, not even when you're fasting or sick...you will just reduce the doses given.
If you using an insulin pump you will you have a number of basal rates set in your pump across a 24 hour period, which change automatically across each 24 hour period depending on how the basal rates have been set.
With the help of your diabetes care team, you can tweak basal doses and rates depending on a myriad of factors.
Some examples of long acting (basal) insulins* used in Australia for injections include:
Optiinsulin® (glargine insulin)
Toujeo (glargine insulin)
Levemir® (detemir insulin)
*There are a number of mixed insulins that are also now being used for T1 in kids and adults ie. mixtard, novomix, ryzodeg