The cost of peace of mind

A number of times now I have come across people asking how much does it cost to be on a pump and a CGM system. Don't worry I am not going to lie it is another cost in this extremely expensive world but when I look at the benefits it is 100% worth every cent.

I will go into more detail but here is the basic details -

• Insulin - With being on a pump you only need 1 type of insulin so to fill the script, here in Aus, will be under $40 for around 2 months (longer depending on your intake).

• Pump - This is obviously an expensive piece of the pie however what a lot of people don't realize is that 100% of the cost is covered if you have basic hospital cover with your Private Health Insurer. Yes that means that even though it may be a pre-existing condition the only thing you have to do is wait for a 12 month waiting period before you can claim for the pump. One great thing that Medtronic are doing about this is that while your waiting to get through the 12 month waiting period your able to access what is called a Bridge the Gap pump. This will give you a loan pump to get you up and running and then once the PHI kicks in you get your very own buddy that sits on your hip.

• Pump Consumables - This is the reservoirs and the canular lines that you need to replace every 2-3 days. Seeing as we are all Type 1 Diabetics we are lucky that 90% of the cost of these is covered by the government run NDSS (National Diabetes Services Scheme) program. If you not registered then get registered. On average 1 box of 10 reservoirs and a box of 10 canular lines will cost around $30. This means around $30 per month to run your pump.

• CGM - this part is where people really get scared and run away and I don't blame you. That is until you break it down to smaller periods of time and smaller periods of money. The best way to really look at things, I find, is to put it into perspective. A large part of the population these days take it upon themselves and have a few freshly brewed coffees a day and to get a decent coffee we are at least looking at $4 - $5 per coffee (Lets not get into the specialized coffee). So lets say you have 2 coffee's a day at $5, you are in fact spending $3,650 per year on something that may make you feel slightly more awake but in the long run isn't making too much of a difference. A CGM can cost as little as $8 per day and that sensor will make a big difference to both you and your child if your a parent of a T1D as I am. So what this really means is you are a couple that drinks coffee then you could make a difference by just giving up one coffee a day each. Medtronic have also come to the party as they understand that cost is a big part of making the decision around getting a CGM. They have created a subscription service which breaks up what originally was a large purchase and when you sign up for a 12 month subscription which would deliver a box of 5 sensors to your door every month but you would also get the transmitter for free. Now this is a saving of around $700. This is but one option that Medtronic offer as they really do understand that somtimes it isn't in the budget.

Yes this all adds to the budget and being a father to 3 girls and 1 of which has T1D as well as myself it is difficult however the peace of mind that we receive by stopping hypo's and just knowing what is happening at any given day or night is peace of mind I never want to give up.

Don't be afraid to look at the options because there are just that options to try and suit the majority of budgets.

3 Days in the Snow with T1D

• Hitting the slopes with ski's strapped to your feet,
• Darting left and right as you slide trying to reach the balance between speed and stability,
• Watching for pot holes, rocks, and even people is sometimes just the fun of it all.
• Doing  this between 9am and 4pm can be seen as extensive but doing it for 3 days straight gets your heart racing and your muscles working overtime.
• Pushing yourself to go on the runs that take you out of the comfort zone is also a part of the joy.

All of the above plus I am sure a lot more are the components that run through the heads of probably everyone going to the snow to ski or board now what if exercise has a major effect on your blood sugar control and how do you cope with T1D.

Thinking too much about it and thinking it could be scary is easy to do but in practise I found it to be amazingly simple.

One of the gray things about ski jackets is that there are a lot of pockets. I say this because we all know we always carry a lot of stuff each and every day.

• I start the day the same as everyone checking my BSL and having a decent breakfast.
• I then head to get set for the day. In my pockets I pack a pack of quick acting glucose, my tester, wallet, glucagon, phone and keys. Yes there are that many pockets.
• I then make sure my CGM sensor is still reaching the pump under the layers of the ski clothes and that all of my tubing is nice and tucked into my clothes so that I don't run the risk of it freezing in the sub zero temperatures I am about to go into.
• I then collect my gear and head for the beautifully groomed snow fields in Queensrown, New Zealand.
• After going through the standard awkwardness of putting my ski boots on I step onto the snow and place my skii's down getting ready to head straight to the top of the mountain.
• Before I do however I take my pump out from its warm and protected home and check my BGL on the CGM. 
• I am currently sitting at around 9.0 BGL keeping in mind I have just had breakfast and insulin is still on board. At this point I also start a temporary basal of 50%. So in simple terms I am only going to be having half of what I usually do because of the strenuous excercise that I will be doing.
• I then tuck the pump safely away and step into my ski's and push off to the lifts.

My day then went as anyone else's would, fast skiing, dodging and pushing myself to an uncomfortable level. Through my 3 days of following this process I did not have a simple hypo. I would start at the beginning of the session and terminate the temp rate as soon as I finished and was leaving the mountain for the day. Each of the days, depending on how hard I pushed my BGL stayed between 9.5 and 5.4. Even after each of the sessions and making sure I had wholesome meals and making sure the CGM and Smartguard was active I didn't even have any susequent hypo's.

To me this also proves that this was a successful trip and also shows that with the technology we have there is no reason why anything is out of reach if you just manage the best ways possible.

The Cost of Life

It is 2016 and in Australia there is 125,000 type 1 diabetics. There are millions world wide and we progress everyday towards easier management however in some countries it would be still believed that type 1 diabetes is a certain death sentence. This isn't because the life saving hormone, Insulin, isn't available but more to do with the fact that it is not affordable for a family to get what they desperately need for life.

I admit here and now that here in Australia we are lucky. Lucky to be born in a country that realises that health is important and that a suitable health care system is in place to make sure the drugs and devices are available when needed.

After reading stories on line from people saying that they needed to ration out their insulin to make sure they can make it through to when they could afford more (due to either the health care system or the insurance company rules) it shocked me to think that big business and governments are playing with lives of people who should be able to lead long and normal lives as long as they have the small drops of insulin in their system to stop the rapid rise of dangerous blood sugars which if left untreated will cause organ failure and ultimately death.

Anyway after reading these stories I came across data that looked at the true cost of what we need when held up to the average wage in each country. We all complain that this disease is expensive but I bet the following will shock at least some of you.

• In Australia the cost of insulin and diabetic consumables equates on average to 1% of a yearly family income who sit in the lowest 20% income group for the country.
• In India the cost of insulin and diabetic consumables equates on average 148% of a yearly family income who sit in the lowest 20% income group for the country.

Right now I bet your thinking well if I had to try and find a way to live with what I have and put the insulin into my body but it will cost me more that I can earn "What the hell would I do?". I know I am. But they s isn't even the scariest part of the story.

• In Malawi and the Central African Republic the cost of insulin and diabetic consumables for the lowest 20% income bracket is 1160% and 1438% of the yearly income.

Imagine being that person knowing that the drugs that you need and the equipment that can help save your life is just simply out of reach.

We live in an era where we go online and purchase this and that from all over the world never thinking of the people who can't get what they need to live, to stay alive even at a basic level. This isn't just for people with T1D this a problem with a lot of diseases in developing nations however T1D hits home for me and as a father of a T1DD it makes me think what if I couldn't get what she needed. Her life would not be as it is.

Further investigation into this I came across Insulin for Life (IFL). A non for profit organisation in place to collect and distribute insulin and diabetic supplies that would be otherwise be disregarded and thrown out and sending them to developing nations to help just some of those that don't have access to what they desperately need. IFL is located globally so if you have insulin that is getting close to use by date or equipment that you have upgraded or your moving from MDI to being on a pump and you no longer need large stores of long acting insulin then open your mind to those that don't have the access you and I do and save a life. Even if your reading this and a loved one is the one with T1D then you can also help with donations. 

We live in a time of global awareness and I believe that we all have the right to live now that we have the technology and medical advancements to change a death sentence into life.