Ontario Government rejects covering Continuous Glucose Monitor / Flash Glucose Monitor

Last Thursday, May 13^th, 2021 in the province of Ontario, coverage for ContinuousGlucose Monitors and Flash Glucose Monitor ( CGM / FGM ) for Type 1 Diabetics was sadly defeated.  We diabetics in this province are very fortunate that tax payers of Ontario currently fund our insulin pumps and some of our supplies through the Assistive Devices Program ( ADP ).  I am one of those working stiffs, that pays their taxes diligently to support important programs like this and feel like I've been slapped in the face hard.

32 Nahs / 14 Ayes

For many of us who advocate for the use of CGM / FGM, especially ones that do not have work/private/provincial assistance to purchase this life saving piece of technology this is a pretty hard hit!  Compiling the list of the “Nahs” list and seeing the faces of the Ministers and how they represent us, started to make my blood boil up (stress is not good for anyone, but with diabetes, it can cause blood sugars to rise … and the CGM will show it off with rising arrows and alarms).

If you were 1 of the just over 2,000 people that signed to push this bill through, fantastic!  Many of us reposted the petition asking fellow Canadians to sign, because if this had gone through, other provinces would hopefully follow suit.

John Whitehead stated to the public on his Facebook page that reflects in a nutshell my thoughts - 

    “So yesterday in Ontario, CGM for all was defeated. Who should we be mad at? Of course the current in power government with the voting power to defeat it is one.

    But who else is part of this defeat? You are not going to like this answer. Go to a mirror look at it, if you signed the petition give a high 5, if you didn't sign the answer is staring you in the face.

    Just over 2000 people signed to push this bill. Other organizations or causes get 20,000 signatures in a week.

    If you sat in the government which causes would you focus on? The more noise the more focus and attention given to it.”

OVERALL A BAD DAY FOR ONTARIO

That last statement above in BOLD RED, pretty well sums it up for me as an advocate trying to make living with T1D less complicated for ALL so we can live our lives to the fullest.  To not be a burden on our medical system that even with the current Pandemic, has been flailing with budget cuts to make corporations happy (the joys of a Conservative government ... NOT).  I would love to put those 32 members into our shoes for even 24-48 hours or spend time with us, to see how diabetes affects each one of us differently, even if we do the same thing every day in our workplace / private lives.  Would they perhaps have voted differently? 

Thank you if you’ve taken the time to read this far, are living in Ontario (or even if you’re not), consider sending an email to the MPP’s listed below who had signed Nah (what a horrible word to use for No) … let us be heard.  I know that even though I don’t notice my MPP’s name on the list, I’ll be writing to each and every one of those listed below, so that they hopefully understand how important these devices are and how the initial cost factor to the province/tax payers will reap benefits with having healthy Ontarian’s living in their province.

If you need further information such as snail mail address, etc.  you can find the details easily using the link for the Legislative Office at the following Ontario Legislative website -  

Deepak Anand (Mississauga—Malton) - deepak.anand@pc.ola.org 

Aris Babikian (Scarborough—Agincourt) - aris.babikian@pc.ola.org

Robert Bailey (Sarnia—Lambton) - bob.bailey@pc.ola.org

Hon. Paul Calandra (Markham—Stouffville) - paul.calandra@pc.ola.org

Stan Cho (Willowdale) - stan.cho@pc.ola.org

Lorne Coe (Whitby) - lorne.coe@pc.ola.org

Rudy Cuzzetto (Mississauga—Lakeshore) - rudy.cuzzetto@pc.ola.org

Hon. Doug Downey (Barrie—Springwater—Oro-Medonte) - doug.downey@pc.ola.org

Hon. Jill Dunlop (Simcoe North) - jill.dunlop@pc.ola.org

Hon. Christine Elliott (Newmarket—Aurora) - christine.elliott@pc.ola.org

Goldie Ghamari (Carleton) - goldie.ghamari@pc.ola.org

Mike Harris (Kitchener—Conestoga) - mike.harris@pc.ola.org

Christine Hogarth (Etobicoke—Lakeshore) - christine.hogarth@pc.ola.org

Hon. Sylvia Jones (Dufferin—Caledon) - sylvia.jones@pc.ola.org

Andrea Khanjin (Barrie—Innisfil) - andrea.khanjin@pc.ola.org

Daryl Kramp (Hastings—Lennox and Addington) - daryl.kramp@pc.ola.org

Hon. Stephen Lecce (King—Vaughan) - stephen.lecce@pc.ola.org

Hon. Monte McNaughton (Lambton—Kent—Middlesex) - monte.mcnaughtonco@pc.ola.org

Norman Miller (Parry Sound—Muskoka) -norm.miller@pc.ola.org

Sam Oosterhoff (Niagara West) - sam.oosterhoff@pc.ola.org

Randy Pettapiece (Perth—Wellington) - randy.pettapiece@pc.ola.org

David Piccini (Northumberland—Peterborough South) - david.piccini@pc.ola.org

Jeremy Roberts (Ottawa West—Nepean) - jeremy.roberts@pc.ola.org

Hon. Laurie Scott (Haliburton—Kawartha Lakes—Brock) - laurie.scott@pc.ola.org

Donna Skelly (Flamborough—Glanbrook) - donna.skelly@pc.ola.org

Hon. Todd Smith (Bay of Quinte) - todd.smithco@pc.ola.org

Dave Smith (Peterborough—Kawartha) - dave.smith@pc.ola.org

Hon. Kinga Surma (Etobicoke Centre) - kinga.surma@pc.ola.org

Vijay Thanigasalam (Scarborough—Rouge Park) - vijay.thanigasalam@pc.ola.org

Hon. Lisa M. Thompson (Huron—Bruce) - lisa.thompson@pc.ola.org

Hon. Bill Walker (Bruce—Grey—Owen Sound) - bill.walker@pc.ola.org

Hon. John Yakabuski (Renfrew—Nipissing—Pembroke) - john.yakabuski@pc.ola.org

Life as a Podder Chapter Deux

Well, with the approach of  the New Year I decided to go back to my Animas Vibe after having  issues with the Omnipod in my leg as well as dislike of the PDM (more on that at end).  My legs are an occasional place that I put my infusion sets in but I never had blood sugar results like I was having with the pod … high high high (my meaning of a “high” is anything above 12 mmol/l  or 324 mg/dl ).  Compared to where I had placed the Pod in other areas of my body over the month … it rarely went over except when I didn’t either bolus properly for food, etc.  So obviously, my legs with the plastic cannula … just do not work.  As you can see by the assorted pics below, with the 2^nd pod placement … with what looks like watered down blood … maybe the infusion set wasn’t placed quite right, but the window that you can view the placement of the infusion set, is pretty well impossible to see if things are okay. 

I guess my other thing with going back to the Vibe, is the simplicity of changing the suggested amount of insulin, either with using a different ISF or I:C ratio in the calculations that Animas programming allows you to do (see photos below when I'd decided enough is enough with the Omnipod).  The Omnipod PDM doesn't allow you to do this, along with extra steps to see what IOB you have onboard, tick tock tick tock ... my time is precious.  On the Animas below you can change the suggested amount to bolus based on the calculations of the “set” ISF and/or I:C ration.  To give Omnipod at least a run for it's money, I tried and tried with both user manual and forum groups to figure it this was possible … but nope – not doable.  I have a feeling the Omnipod PDM programming is abit on the “basic” side, and more for the person who perhaps doesn’t want to go outside of what the program in the PDM allows you to do.  Probably for the safety of the user, but not all of us follow the rules.  This has been my way of controlling my diabetes over the past 40+ years since leaving the next of home as a teenager.

 I was finding too that when I was really high with the Omnipod … like really high … DKA possibility … that correcting with an insulin injection, based on my calculations (this is what I do when I’m on MDI … using either my noggin’ and or calculator to determine amount of insulin to inject) … would bring me down much faster.  Otherwise, putting that large glob of insulin via the Pod was almost like putting water into me.  Even with doing a split shot of the amount over ½ hour … it just didn’t work well.

Plus, again, that friggin’ huge PDM (yes the clip pouch I was given, more bulkier than a tubed pump IMHO).  I found in the beginning of the months trial as a Podder, that when I was needing to bolus quickly, I often was going to my waistband, where I usually keep my Animas.  

One thing that I did do by accident during the trial run, near the end ... due to how itchy the pod was on my skin, and that was only at the end of Day 1 (this was the only time I had irritation with the pod) . Because I didn't want to lose the insulin left in the pod (would Omnipod have replaced the pod because of that???) ... I stuck it out.  By the time came to remove it, by accident, when placing a new pod in place, without thinking ... I REMOVED A NEWLY INSTALLED SENSOR FOR MY DEXCOM!!!  I broke down at that point, and my hubby gently reminded me it was not the end of the world removing the CGM by accident.  Because I pay out of pocket for the Dexcom, it meant I went for 6 days without the CGMS.  And even now, as I write this, I'm taking a break from the Dexcom so I'm not out of pocket ... but I do miss the CGM the most for staying in the right range I like of blood sugars.

What has me abit miffed, and not just with Omnipod, but also Medtronic.  That the devices they are offering Animas users sort of like “old stock” to be able to make a profit I expect (in Medtronics case they are offering us the MiniMed 630g ( see this link  https://www.medtronicdiabetes.ca/minimed-630g ) .  I recently came across an article about the Omnipod Dash System (read more at these links https://diatribe.org/insulet-omnipod-dash-system-to-add-touchscreen-and-bluetooth and https://forum.fudiabetes.org/t/omnipod-q3-earnings-call-dash-pdm-update/2576 ).  The Dash was expected out in the 2017, but it’s set to launch sometime in 2018.  So, for any Animas users that are getting the “free” PDM offer (which is what I went for) … you’d probably want to upgrade to that, but at what COST is my big question.  I just know that my fingers got split with pushing those darn buttons on the PDM (doesn't help with the cold weather we've been experiencing that's not normal at this time of the year and lack of humidity).  I found it easier to use if I  kept some of my finger nails longer, in order to ease up on bloody thumbs/fingers.  It was abit annoying since I like to keep my claws clipped.

So, that’s it in a nutshell.  I’ll be heading out on holidays for almost 3 weeks, and bringing along both insulin pump systems (yes, have carry on – you can travel with all your medical crap <lol>).  I’ll also be bringing my pen needles, using Fiasp and Levemir as my insulins of choice for control.  Last time I went on a 3 week trip, all I used was MDI, sans CGM (I’m on fence post right now with bringing CGM for this holiday due to the space it takes up for souvenirs <lol>).

See you sometime in February and thanks Boss’s for letting me off the hook for abit of much needed down time from work!

NB:  Remember, my trial with the Omnipod may vary from yours.  So while I may not like it, doesn't necessarily mean you won't.  I've heard through the grapevine that Omnipod is offering the deal up to March now, rather than the end of December.  If you've ever wanted to know what it is like to pump insulin without any tubes, I'd say give it a try.  Perhaps your experience will be much better than mine has been.

Cranky one eyed cat

Yuppers, that's been me pretty well since my cataract surgery (see the original post HERE) - that has left one eye slightly buggered up for seeing properly. 

I am hoping I am doing the right thing here, since tomorrow, I am going back under the knife - to remove the original lens ... and have a new one put in place (with or without stitches - it all depends according to my surgeon Dr. Tarkek Youssef ... and yes ... I'm bloody scared!!! 

Like all of us with diabetes, our fear is always having diabetic complications with our eyes.  So far, touch wood, I've been blessed, but since the surgery back in July, it's been non stop problems that have left me drained emotionally, since I depend highly on my eyesight for the work I do.  I have finally, after 4 months, learned to accept my limited vision which varies daily, but it's put a lot of stress on everyone around me, since I can get a wee bit impatient sometimes!

I think my biggest fear tomorrow is ... the surgeon is performing surgery at the local hospital here in Cornwall rather than in his office (where my original surgery was done privately).  In the past (see my post of how my blood sugars over a 6 hour surgery caused DKA HERE), staff do not have much knowledge of Type 1 diabetics or the devices we use to stay healthy and out of overcrowded ER's!  It'll be interesting to see how things go with my wearing the Omnipod, and whether the PDM device also will be allowed in the OR ... along with the Dexcom CGMS.  If I was able to have my DH in the OR, or someone who has knowledge of what to do incase of alarms ... I would be more at ease. 

So, hopefully the next time you see a blog post or post on Facebook ...  I'll be more perky ... and I'll be able to perform my job that has been sadly sacrificed due to limited vision (my work requires good eyesight).  Though if I have to only have vision in one eye - I'm sure I'd be rocking a eyepatch that is out of sight!

Handmade eye patch from https://www.etsy.com/ca/shop/iPatching

Life as a Podder

Okay – well at least for a month – I’m being a Podder … and for those of you who are wondering … WTF is she talking about ??? ....   I’m using what is referred to as a “tubeless pump” for pumping insulin through my body 24/7 called the Omnipod.  A plastic mini-me type of insulin pump is replaced every 3 days on your skin (if you’re lucky enough to not have it fail as you’ll see below).  

I’m now approaching my 2^nd week as a Podder and the notes I’ve made up so far on how it has been going will hopefully help any Canadian on the fence post as to which of the 2 current pump manufacturers we have as an option with Animas exiting the pump market (NB – you can still use your current Animas pump – get supplies well into 2019 – so do not think you have to jump ship just yet – it’s just you’ll be buying your supplies from Medtronic eventually once Animas closes up shop – sigh).

As far as purchasing Omnipod supplies, especially if you are one of the Canadian provinces that have a pump program, the price tag of $300/month for the pods will go over and beyond what you might be paying for a tubing pump.  For some, that can be a deal breaker, especially if you do NOT have private insurance/work insurance.  In Canada, you also have to buy the pods directly from Diabetes Express .

My first few pods I used before the meet up with the rep from Omnipod were from a former Podder who for one reason or another, decided to go with a tube pump.  The funny thing, was the pods I used from them are newer, but they are the ones that I had problems with.  The 1^st one alarmed with “OCCLUSION” about 2 hours before the Pod would shut down for a new one to be installed.  The 2^nd pod, after 1 ½ days, just “FAILED”.  I went through the steps to get it to work again, and after a few futile attempts, had to remove the pod, losing about 50 units of NovoRapid.  I was NOT to happy with that since I have no insurance anymore, but I just told myself, this is an EXPERIMENT.

After that, I started to use the pods that the Omnipod rep had given me (and these are older manufactured ones than what my friend had donated to me).  So far, with only filling the pods up with the minimum amount of insulin ... NO PROBLEMS to report to date!!! 

Now for my beefs (isn't that a cute cow or what?) with the Omnipod so far, is the PDM (Personal Diabetic Manager) – which serves as your blood meter as well as for bolusing for meals and/or corrections … and setting up the programming for your pod on your body.  It’s abit dated due to not touch screen and it’s so bloody big!!!  I still keep on occasionally reaching for my waistline where I used to clip my Animas Vibe, to  bolus, etc. – then having to remember where I left the PDM (I now have a system - which works most of the time - yes - you can teach a cat new tricks)!   I also find it takes longer to punch in everything into the PDM to get my juice of life infused into me for a meal and/or correction (though I'm getting faster now - but I find more thinking is required than my Animas Vibe).  If you do misplace the PDM, the pod will continue to disperse basal insulin, nothing else, but f the pod starts to alarm, and you don’t have your PDM on you, you have no idea what it’s alarming for.  NB Rep did give me a belt clip case for the PDM, but it’s kind of useless since you still require the test strip container and finger pricker – and there’s no room for either of these.  So I am designing a little wristlet to fit everything in (yes .. I am such a Fashionista).

Always, always have a spare pod, insulin, gunk remover, alcohol etc. on hand.  I know people who inject, or use tube pumps are always ... ALWAYS ... supposed to have those with them every time they leave the house.  In the case of the Omnipod, if it starts screaming, and it can't be resolved with following instructions on PDM, you will have to remove and put a new pod in place (tip - always have an opened paper clip to mute the bloody thing - been there done that - and it is all in the very detailed instruction manual supplied with the PDM).  So, with an tube insulin pump, if you're a 15 minute drive away, and haven't got supplies, it's abit less stressful and not go bonky with a screaming pod. 

One of my other concerns originally with Omnipod was the large amount of adhesive along with the 60 degree 6.5 mm cannula.  I’ve not had much luck with plastic cannulas over the last 8 years of pumping with Animas, so stainless steel 90 degree sets are what I’ve always used, and when removing the sets, you would never know I had been infusing insulin, along with no skin irritation from the adhesive.  So my other beef is, where my insulin has infused the cannula … there’s a hard small lump underneath the skin.  I never had this with the Animas sets, so have been closely watching how the area heals (so far it seems it may take 2 weeks for the lumps to go away).  I was wondering how people who are insulin resistant – and take more than my normal 2-4 units each time for a bolus or correction  - if they experience this - and how long it takes to heal.

Now for bonuses of being on the Omnipod !  I feel quite free without any tubing (oohhh cannot wait for a romantic weekend with the hubby).  Oh, and last weekend I went thrift shopping, and usually when trying on clothing, it takes forever with unclipping pump, etc.  With no pump clipped on me, or bulk of pump … badda bing badda boom … I feel like a fashionista again … though … damn … where did some of those extra rolls of fat come from ? <lol>

There is less waste of insulin, that's if the pod doesn’t fail!  Usually with tube pumps, we have to fill our tubing, which we can’t reuse again (some do, but I wouldn’t recommend it).  So, on average, I’d lose about 10 units of insulin.  With the pod, filling it up to exactly to 3 days worth of insulin, I’m seeing about 2-6 units wasted.  NB:  I have been using Fiasp a few times for last minute meals via MDI, or a correction over 12 mmol/l (very rare these days) – so in reality – I might have run out of insulin before the 3 days is up.

One caveat is the Eco-pod Disposal Kit available free of charge from Diabetes Express.  I hate the amount of garbage that our gadgets we use for health creates on our big blue marble.  According to my rep, some items can be recycled.  I hope so!

The other great bonus though?  It uses FreeStyle test strips – yippee – small droplet of blood – more accuracy!  I sadly am almost out of the strips I was given, so back  to use my One Touch since I have lots of those test strips.  

So, that’s about it in a nutshell - I'll carry on testing it out until the last pod is used up, and decide from there ... should I stay or should I go ... back to Animas or just MDI.  If you’ve not caught my posts on Instagram and/or Facebook you’ll be able to see some extra pictures and discussions.

I've Got My Eyes On You

Before I go on ... all I can say is #prayersforlasvegas ... words cannot describe my feelings of what happened in Las Vegas Sunday night. 

Last Friday night, one of my neighbours commented that my inner eyeball looked red.  It felt abit hot and itchy (I'm still not sure if I maybe had scratched it earlier, but since being told women are the worst out of the sexes to have eye irritations due to rubbing their eyes, I now am vigilant to NOT rub) .  If you think this is all poppy cock ... go check out this link to learn how dangerous it can be!

When I was washing my face later at night as I prepared for zzzzz time I saw how the blood vessels had broken in the corner of my eye.  Pretty ugly to say the least, but it was when I opened my eye up wide, I discovered what looked like a clump of cottage cheese.  Of course, I freaked out, when after washing my hands carefully, I couldn't dislodge it.  When my DH eventually heard me, he tried with a Q-tip.  No luck.  So, off to ER at Cornwall Community Hospital (CCH) we went.

Three hours later ... it was mutually decided to not remove it (the on call doctor said he could but to me that's like having a dentist do plastic surgery).  My ophthalmologist luckily was on call that weekend so he would be contacted the next day.  Main thing, they determined it was nothing serious and to use lubricating drops every hour.  I felt abit stupid going to ER, but they've told me that I did the right thing, especially being a Type 1 diabetic.  The fear of losing my our sight is always in the back of our minds, or it is for me!

So fast forward to Monday, which is today.  Took a cool stroll into downtown, and discovered that what the white clump is all to do with is the "Dropless/No Drops Long Acting Meds" that you see in the bill below when I had double cataract surgery performed at the end of July.  It will dissolve in time, and as the surgeon said, it lasts a long time.  I went this route rather than drops due to already having enough to remember about with diabetes and other meds I take.  This way, bing ... it's done ... though as he explained ... he thinks he should now maybe warn his patients about what may occur.

If you notice below, in the bill ... I went private due to feeling unsure about how I'd be treated at the CCH as a Type 1 diabetic wearing an insulin pump and CGM.  Also, any laser correction required for follow up to lens implant, is covered with this charge (this is where I'm abit puzzled, if I'd gone public, then I'd be paying for this???).  Laser has been performed once to remove cloudiness on the implanted lenses, called posterior capsule opacification (PCO) and is often more common in younger cataract patients - so that must mean I'm not an old fart <lol>.  Laser will probably be performed again to hopefully correct my other eye that surgeon had difficulty placing lens into the vitreous so it's sitting more securely (that eye had the bigger cataract .. my buggered up eye in this blog had just a itsy bitsy one starting).  Today, he also talked of removing that lens and suturing a new one in place rather than compromising my thinning vitreous.  The things I learned today when he was open and honest with both myself and my husband.

From a personal point of view, which is why I haven't written in awhile ... I wish I had never had the cataract surgery and saved the $3K for something else (wine, holiday, yadda, yadda).  I also wish I had not gone with having BOTH eyes done.  I only had a small cataract starting in the other eye (the eye that you see here in this post) ... the other one was supposedly larger.  I miss my glasses (have been wearing them since Grade 5), and during this process of recovery, miss having good vision.  My vision was never that bad even with needing extra light once in awhile due to the larger cataract, plus I only wore glasses for driving since my eyesight had been improving over the years believe it or not.  Now, both distance and close up ... are buggered up - I have my good days of seeing semi-clear ... and bad days where I frustrate myself and my husband to no end when I'm trying to read a recipe or magazine (I do not read as much or watch TV now that often - which I miss so much).  Again, I keep on telling myself it's still early days as other cataract patients (thanks Dad) have told me as well as my surgeon.

The only thing I can leave you with, if you are like myself, having doubts about going for cataract surgery along with the promise from your ophthalmologist of having perfect vision (which most times does happen ... along with not wearing glasses if you dislike wearing them).  DO YOUR RESEARCH ... this is coming from someone who researches diligently when creating a blog like this and didn't for her own health. I sadly, did not, and only saw afterwards a statement at the RNIB (see below) that if your vision is NOT helped by changing your lenses, then having cataract surgery is probably your best option.

If you need more help in understanding about cataracts, I highly recommend the Royal Institute of Blind People based in the UK ... it has amazing information ... written in easy to understand terms ... you can find a downloadable .pdf file at this website link.  If you're wondering about complications like I've just had with this surgery, check out All About Vision at this website link.

NB: the wait time for cataract surgery varies from province to province in Canada.  I was told if I'd not gone private that it would not be performed until 6 months later.  If you're Canadian and reading this, you maybe able to find a similar link like this one for Ontario wait times. 

Update to blog 2023-10-21  - with another link  below to a post that was written a few months later - when surgeon removed lens that they'd had problems with - and my fear of hospitals that don't understand Type 1 Diabetic patients - entitled Cranky One Eyed Cat . 

Vampire testing on the fingertips

Okay, kidding aside ... as diabetics ... testing your blood sugar on your finger tips can be abit of a drag at times.  I've been doing this process since home testing was introduced back in the 1980's  (you can read more about the history of these blood sucking devices at David Mendosa's link HERE).  Even with wearing a CGMS (aka Bowie) which many people think means you won't have to do the old finger prick anymore, I still test on average about 6X a day, sometimes more, depending on what is going on in my life.

Recently, a family member of mine was diagnosed with Type 2 diabetes.  Luckily, with the help of their spouse, they're are diligently performing 4 tests a day in order to stay in a good blood sugar range to avoid any complications of high blood sugars.  The one thing they admitted to me the other day, was how much it hurt.  I discovered the "nurse" was pricking the fatty portion of the finger tip, where numerous nerves exist ... that beg <NOT> to be heard when they're mistreated.

Screaming Hands by http://lintza.deviantart.com/

I then slowly explained the best way to avoid the pain, by testing on their finger tips, which over the years I've shown nurses how to perform this task on their patients hands.  What better person to show them how to treat their patients, and not have them stop testing when they go back home to deal with diabetes on their own.

I even went as far as to post a few pictures on my Instagram account that you see below, since sometimes pictures are worth a thousand words!   If you've never tried testing on the sides of your finger tips, then give it a go next time, and be rewarded with no pain or scars.

Here's some of my tips to get the best results out of a pain free blood test:

• Always wash your hands before testing, simple soap and water are fine (alcohol dries out the skin).
• If your fingertips are cold, rub them gently to warm them up and get better blood circulation.
• Use your lancing device on the SIDE of your fingertip to get a drop of blood sufficient for test.
• Then hold the edge of the test strip to the drop of blood and wait for results 😀