What the Disability Advisory Committee Annual Report means to Canadians with diabetes

Disability Advisory Committee report Diabetes Advocacy

The Disability Advisory Committee (DAC)  was brought together to “provide advice to the Minister of National Revenue and the Commissioner of the Agency on the administration and interpretation of the laws and programs related to disability tax measures; ways in which the needs and expectations of the disability community can be better taken into consideration; current administrative practices and how to enhance the quality of services for persons with disabilities.”  In May of 2019, they released their first report.

The 107-page document was a very interesting read.  It had 42 recommendations in all.  For people living with insulin-dependent diabetes however, the most important issues to note were the following: 

Forms should be easier to access and to fill.

Many individuals, groups and physicians found the form T2201 confusing and difficult to fill out. Current wording left some doctors feeling that they were not qualified to fill out the forms. This left a rift between them and their patients that they felt should not exist.

The DAC recommended that the forms be much more streamlined and easy to use.  They also suggested that individuals should be able to apply for the disability tax credit online.  This change has been implemented by the Canada Revenue Agency this year.  You can now upload your application and supporting documents using your “My Account” access code.

More people should be aware of the credit.

awareness of the DTC Diabetes Advocacy

The Disability Advisory Committee felt that more individuals and their caregivers should be made aware of the disability tax credit.

They felt that a public awareness campaign on the credit and its eligibility criteria should be a high priority for Revenue Canada. They felt that physicians and individuals would benefit from videos and in-person sessions.

CRA staff should be uniformly trained.

Individuals, groups and doctors noted that it was very difficult to get assistance from Revenue Canada agents when they had questions.  If they did manage to get through to a person for help, the person was either no help or provided contrary advice to what was told to another taxpayer. It was felt that all agents should receive identical policy training and that a dedicated call center be created for questions related to the disability tax credit.

It was also felt that there should be a uniformity in the way applications were handled.  A more streamlined process would help both individual taxpayers and the staff involved in accessing applications.

Approval should be based on a diagnosis.

The DAC recommended that certain conditions should automatically be approved for the disability tax credit if they are using specific forms of life-sustaining therapy. 

It was felt that if a taxpayer was alive, they had to be successfully using life-sustaining therapy.  “These are therapies that are lifelong and continuous, requiring close medical supervision. Without them, the individual could not survive or would face serious life-threatening challenges… These therapies include but are not necessarily limited to: intensive insulin therapy for type 1 diabetes…”

The DTC should be a refundable tax credit.

access to financial assistance

Currently, the disability tax credit is a non-refundable tax credit. In a nutshell, this means that it reduces your taxable income.  If you are a low-income earner, this credit has very little financial value to you.  The DAC would like to see this credit turned into something that would offer greater benefit to those who have a lower income.

Registered Disability Savings Plan Access

The Disability Advisory Committee suggested that there should be another avenue of access for the Registered Disability Savings Plan. They felt that clawing back the RDSP when someone no longer qualified for the tax credit was inappropriate and punitive. Such a practice makes it impossible for many individuals and families to do solid financial planning.

While the Federal government has not yet created another way to access the RDSP, in their February 2019 budget they have announced they will no longer claw back money contributed if the DTC is lost.

Follow up letters should have more transparency.

Follow up letters are the bane of our existence. Some people get them. Some people don’t. If you get them, you tend to feel stress and pressure.

According to the report, in most cases, these letters are not even necessary.  The only thing it does is stall the process and make doctors feel that their credibility is being undermined.

To make things worse, the Canadian Revenue Agency does not always let individuals know that a follow-up letter has been sent to their doctor.  The DAC finds this unacceptable.

The committee feels that complete transparency on the part of CRA would “reduce the stress, time and cost involved in applying for the DTC. A more open and respectful process would also reduce the need to appeal CRA decisions regarding DTC eligibility.”

Easier access to appeal services and tax court.

disability tax credit

If a person is denied the disability tax credit, they often do not know that they can ask to have their application reviewed by another agent.  They don’t know that they can send in more supporting documents from their doctor before even starting a formal appeal

Many people who apply for the DTC are intimidated by the idea of taking on the federal government in court. They may lack the knowledge or the resources to take their case forward even if they would most likely win. The committee, therefore recommends that a straightforward, transparent and informed process should be created.

Applicants should have access to all relevant information (including the precise reason their application was denied) and documents (including copies of all information submitted by health providers that pertain to their application).

The Disability Advisory Committee feels that the CRA should create a document entitled “Your Rights When a Notice of Determination Denies a Claim for the DTC”.  It would explain the requirements, timelines and details for filing a review; a notice of objection with the Appeals Branch; and a notice of appeal with the Tax Court of Canada. It would further explain many more details required to launch a successful appeal.

What can we do with the Committee’s recommendations?

These recommendations echo much of what has been suggested by the Senate Review Committee.  The repetition of the same themes can only serve to strengthen our position…that the Disability Tax Credit should be fairly and equitably applied to all individuals with intensely monitored insulin-dependent diabetes.

Now that both groups have presented their reports, it is our job as advocates and people living with diabetes to share their message. We must ensure that our sitting Members of Parliament are aware of these recommendations and support them. 

It also falls on us to keep this issue relevant in the upcoming Federal Election. Make sure that those individuals seeking to be your next MP are also aware of the issues.  Help to educate them and share with them why these changes must be made by the Canada Revenue Agency.  Ask that the next Minister of Finance work to see these changes happen and allow people with insulin-dependent diabetes fair and equitable access to this credit.

What does this mean for Canadians with diabetes?

Currently, the findings in both reports remain suggestions.  Some suggestions like easier access to the DTC online, have been implemented by the Federal government but most have not. 

Until all of these recommendations are accepted by the Federal government and the Canadian Revenue Agency, access to the Disability Tax Credit remains the same. Unless you are under 18 years of age, you still must prove that you spend 14 hours per week on approved therapies.

Diabetes Advocacy has a short quiz that can help you to decide if you should apply for the tax credit based on your current insulin therapy regimen.  We also have a spreadsheet that can help you to track the time you spend on your diabetes care.

You can learn more about what is involved in applying for the Disability Tax Credit here or message us any time with your questions.

DAC May 2019 report infographic Diabetes Advocacy

YpsoPump® receives Health Canada Approval

ypsoPump Diabetes Advocacy

Ypsomed Diabetes Care recently announced that their insulin pump YpsoPump® has been approved for sale in Canada. We do not yet know when the pump will be available on the market or what its price point will be. Here are a few things that we do know.

Who is Ypsomed?

Ypsomed is a Swiss company with a long history of involvement in area of diabetes devices. twicediabetes.com states that they were behind the Disentronic insulin pumps that were available between the 1980s and early 2000s.

According to Ypsomed Diabetes Care “Ypsomed has set itself the goal of making medical self-treatment a matter of routine for people with diabetes. This is why the development team of the YpsoPump had your needs in mind. The result is an insulin pump which focuses on the essential functions and is easy to handle. It features the best of 30 years Swiss medical device engineering.”

How big is the YpsoPump®?

According to the Ypsomed Diabetes Care website, the YpsoPump® measures 7.8 cm × 4.6 cm × 1.6 cm and weighs 83 g (including battery and filled cartridge).

In comparison, the Medtronic ® 670G measures 5.3cm x 9.6cm x 2.4cm and weighs 85g.  The Tandem t:slimX2® is 7.95 cm x 5.08 cm x 1.52 cm and weighs 112g.  The OmniPod system includes the OmniPod is  4cm x 6cm x 1.8cm and weighs 34 g with a filled pod.  The PDM is 6.35cm x 11.4cm x 2.2cm and weighs 125g.

What are some of the key features of the YpsoPump®?

The YpsoPump® is marketed as an “easy to learn” insulin pump offering the “essential features”. 

The features that we have seen include:

  • 4.1 × 1.6 cm, OLED touch screen that uses icons to help you navigate the insulin pump options
  • Pre-filled, 1.6mL (160 unit) glass cartridges that will last for 7 days in the insulin pump or up to 30 days if filled and kept in the refrigerator
  • Waterproof rating of IPX8 (immersion to a depth of 1 m for up to 60 minutes)
  • Bolus delivery in increments of 0.1, 0.5, 1 or 2 units
  • 2 custom basal patterns set in increments of .01 units by the hour
  • Temporary basal patterns that can be set at 0%-200% for 15 min to up 24 hours.  They must be set in 10% increments.
  • Uses one AAA alkaline battery that lasts for 30 days
  • Mylife mobile app for smartphones that sync with the YpsoPump® via Bluetooth® technology.

Does it have a Continuous Glucose Monitor?

At the moment, the YpsoPump® does not work with any CGM or flash technology.  It has been suggested that Ypsomed Diabetes Care is in talks with the key players and plan to add this technology in the future.

What does it mean for people with diabetes?

four insulin pump choices Diabetes Advocacy

Choosing an insulin pump is personal.  The pump must fit your lifestyle and your needs.  The fact that there is now a fourth option for people with insulin-dependent diabetes is wonderful. 

If you are considering insulin pump therapy or are wondering if you should change from your current insulin pump, remember to shop around. Meet with all of the insulin pump reps and find the best fit for you.  Our ebook on choosing an insulin pump can help you to figure out which features are important to you and give you ideas of questions to ask the representatives that you speak to.

Mothers Day Ideas for Diabetes moms

It is May once again and that means Mothers Day will soon be here!

Finding the perfect Mothers Day gift can be a huge challenge. I often struggle to come up with the perfect idea for my mom and have an even harder time when my kids ask me to come up with ideas for their diabetes mom. 

This year I thought I would give you a few gift ideas that I think mothers with diabetes and mothers of children with diabetes might truly enjoy.  Whether you have a lot to spend or nothing at all, here are things that Mom is sure to love!

Myabetic

Myabetic bag

Myabetic has incredible bags and accessories for people living with diabetes.  You can scroll through many amazing styles and designs.  One is bound to be just perfect for your special diabetes mom!

Tah Handcrafted Jewelry

Tah ring

I love this place.  Years ago I purchased an awareness ring and the customer service was fantastic.  A quick scroll through their Facebook page shows that they are still producing gorgeous items that will definitely appeal to your mom.

Sugardrop Sweetwear

sweat shirt

Sugardrop is a great clothing line started by an inspirational young woman with diabetes. Get Mom a fun hoodie or tshirt that she will love! This one is on my wishlist!

Spa Day for your diabetes mom

spa day

Whether you send Mom for a day of pampering or create one yourself, Mothers Day is the perfect time to remind Mom to take time for herself. 

Tea or Wine Time

give wine

Find Mom that perfect mug or glass and allow her to fill it with the beverage of her choice.  Whether she is a tea drinker, a coffee lover, or enjoys a lovely glass of wine at the end of the day, pick up a special treat for her and allow her the time to truly unwind with it.

Book Lovers Heaven

diabetes books

If Mom is like me, you can never go wrong with a book. Find her a great new read (we have some awesome ones here) or give her a gift card and allow her to choose one of her own. Once again, make sure that you also help your diabetes mom to have some private time so she can enjoy her new book and recharge herself.

Coupons are a great gift for the diabetes mom in your life.

coupons are a great gift for diabetes moms

Give Mom coupons for things like a night of uninterrupted sleep when someone else will handle the diabetes care.  Give her a coupon for a lunch made just for her by you. Think of other tasks that Mom could use a little help with and add them in as well.  Allow her to redeem the coupons on days when she just needs a little break.

Time with you is the best gift for any mom.

time together with your diabetes mom is the best gift

This honestly is the absolute best gift of all.  Plan a day with Mom or even just a few hours.  Make it all about both of you! Schedule a walk in the park, take in a movie or meet for a coffee.  Time for just the two of you to make memories will be the best gift you can give.

What is your favourite Mothers Day memory? Which gift stands out in your mind? We’d love to know!

Talking to Political Candidates about Diabetes

talking to candidates about diabetes

Alberta and Prince Edward Island have both just elected new provincial governments. Residents of Newfoundland and Labrador will soon be going to the polls as well.  In the fall of 2019, all Canadians will be asked to elect members to the House of Commons to represent them at the federal level of government.

But how do you decide who to vote for? How do you decide who will best represent your interests while they are in government? That is for you to decide but thankfully we have a few tools that will help you to make an informed decision.

In Canada, as in many other countries of the Northern Hemisphere, we are free to evaluate candidates and elect those we judge to be most in line with our own values.  For people living with diabetes, this often means searching out candidates who are willing to invest in research; who will help to reduce the cost of diabetes supplies; and who will help everyone living with diabetes to have equal access to devices, supplies, and programs

How can you find out what their opinions are on issues that surround people with diabetes? How can you figure out if they know anything about diabetes? Here are a few things that you can do.

Ask them when they come to your door

Often candidates will tour neighbourhoods asking for your support.  When a candidate comes to your door, ask them directly how they feel about lowering the cost of diabetes care? Will they consider expanding the current insulin pump program to include CGMs or include people of all ages who require insulin? Ask them if they support increased funding for research and development.  Find out where they stand on the issues that matter to you.

Question them when they call you

Candidates and their supporters also will reach out to potential voters over the phone. Again, this is your chance to ask them one-on-one what they think and how they will support people living with diabetes if they are elected (or re-elected).

Reach out through social media

Many candidates nowadays have a strong social media presence as part of their campaign.  Reach out to the candidates in your riding or contact the parties who are running candidates in your area and ask them for their position.  Have they included diabetes-related issues in their platform? Are they planning on it? These are just some of the questions that you can ask on Facebook or Twitter pages for example.

You can also look for your local political hashtag like #nlpoli or #peipoli to call out all candidates in your province.  Posing a question and using a political hashtag or tagging candidates can generate some great interactions both from those in office and those looking to be elected.

Attend town hall meetings

townhall meeting

Contact party offices to see if their candidates will be hosting any town hall meetings.  These are forums that allow constituents to stand up and ask for opinions on issues that are important to them.  You may only have a short amount of time, but it can allow you to get those questions out there. You can also enlist friends and family to attend. Your larger presence can show the candidates how important this issue is.

Submit questions to news program debates

debating

Often leaders of political parties will take part in live debates.  News programs will usually reach out to the general public to ensure that they have a broad variety of questions to present to candidates.  Send in your questions and again, allow your voice to be heard.

To make it easier to keep track of what each candidate has to say and to ensure that you are clear on what you want to know, we have created a great single-page, fillable download. With this page, you can clarify your ask as well as take notes on the information provided to you by the various candidates.

35 Candy-free Easter Basket Ideas

Candy free Easter

It is almost that time of year again. Time for Easter treats, Easter hunts, the Easter bunny and memorable time with family.  Our house was never really big on a lot of chocolate at Easter.  There was the occasional trail of jelly beans for them to follow but for the most part, my children loved to search for hidden treats like small cars, new colouring books and a new movie to watch. 

Parents of children with diabetes know that it is possible to cover treats with insulin.  If you are multiple daily injections or an insulin pump, you can simply inject or bolus insulin to cover the treat based on your carb to insulin ratio.  Despite that fact, many parents of children with diabetes or not, don’t want to give their children a lot of sugar and are looking for alternatives. For those who are trying to control the amount of “junk food” that their children eat, it can be a challenge to come up with candy-free alternatives. 

Here is a quick list of 35 items we came up with to fill Easter baskets that don’t include candy.

  • Stickers
  • Finger puppets
  • Lip gloss
  • Magic grow toys
  • Bounce balls
  • Magic grow capsules
  • Glitter glue
  • Hair ties
  • Earrings
  • Wind-up toys
  • Slime
  • Play dough
  • Silly putty
  • Temporary tattoos
  • Toy cars
  • Bubbles
  • Nail polish
  • Colouring books
  • Crayons
  • Toy cars
  • Books
  • Movie passes
  • Lego
  • Sidewalk chalk
  • Bath toys
  • Ear phones
  • Body wash
  • Bath bombs
  • Silly string
  • Sunglasses
  • Gift cards
  • Plush toys
  • Tooth brush
  • Socks
  • Body spray

If you are still struggling to fill your child’s basket? Check out these great ideas…

For One-year-olds

easter for one year olds

Baby O and I has fun suggestions including PlayDough packs and rubber boots! Read all of their suggestions here.

For Toddlers

candy free for toddlers

Mommy Takes 5 shows you everything that you need for a toddlers basket from the basket itself to great things to put in it right here!

For all ages

candy free easter

The Teal Bandit has another 35 ides perfect for kids of all ages here.

Heather, over at Finding Our Green Life shares healthy treats as well as more great basket ideas here!

What is your favourite Easter basket idea? Let us know in the comments!

5 tips for eating out abroad when you have diabetes

Having just returned from a trip away, I know how important it can be to plan ahead when eating. Here are some great tips from our guest blogger Patrice Lewis.

Planning a holiday when you have medical conditions can be tricky. There’s packing the right medications, concerns like eating out and finding an insurance package which will actually cover your condition. For those with diabetes, there’s no need for it to be a barrier to enjoying your overseas holiday. Here are five tips for helping you enjoy the cuisines of other countries:

1. Research the restaurants at your destination location

do your research

Just like eating out at home there’s no real way to know the exact ingredients of every dish placed before you when you’re on holiday. However, it’s possible to use the internet to have a browse of the local eateries before you travel. This allows you to get a sense of what food will be on offer, before you commit to your holiday plans. If the destination only has high carb, and high sugar offerings, it might not be the best place to eat out every night. There will nearly always be somewhere, though, where you can find food to complement your diet.

2. Use forums, blogs, and ask questions

Websites and blogs like the one you’re currently reading and others have a wealth of information for those with diabetes. Search for diabetes forums and you’ll probably find that plenty of people have already asked the questions you need the answers to. If not, there’s normally a friendly community you can join to ask about eating out at your preferred destination. Use the experience of others, and when you return from holiday, you’ll be able to share your own experiences and advice.

3. Consider how much exercise you’ve had that day

exercise

You might have a pretty strict diet at home, and be completely on top of managing your blood sugar levels. It’s worth remembering, though, that when you’re on holiday you might exercise a lot more than on a standard day at home. Swimming, hiking, walking on the beach and even souvenir shopping can all cause your blood sugar to drop to lower levels than you might be used to. Glucose tablets can be a real help with this, as detailed in this blog entry about eating out when on cruise ships. Consider your level of activity when thinking about how often you need to be sitting down to eat, and what sort of food you should be eating.

4. Plan your day out to include plenty of food stops

If you are out and about all day, have a think about how often you’ll need to stop and refuel to keep your blood sugar levels where they need to be. If you’re planning a whole day out in the back of beyond, you might struggle unless you carry loads of provisions. Check what restaurants and cafes there are along your route, and take advantage of them accordingly.

5. Mention your condition to restaurant staff

Don’t be afraid to tell the staff that you have diabetes. What looks like something very savoury might actually be full of hidden sugars that you will want to properly cover with insulin. Discussing this with staff could stop you from getting a very nasty surprise indeed!

To learn more about making your vacation memorable, see more tips on our travel page.

Pros and Cons of using an Insulin Pump

I love insulin pump therapy.  I think that it is the best way of delivering insulin BUT it is not the only way AND it is not for everyone.  There, I said it. Insulin pump therapy is not for everyone. Some people really don’t like using an insulin pump and still have fabulous success in managing their diabetes care. Check out Ginger Vieira and Christel Oerum for great examples.

Whether you get your insulin through a pump or a pen or a syringe, it is important that you weigh out the pros and cons.  You must find the insulin delivery method that best suits your lifestyle.  

Here are a few of the pros and cons that we have come across when it comes to using an insulin pump.

The Pros of using an insulin pump

1.  Less Jabs

infusion sets

Infusion sets for insulin pumps only need to be changed every 2-4 days depending on the type of set used. While you may still require emergency site changes or an injection to bring down a stubborn high, you will still only use one or two injections vs multiple daily injections.

2. Flexibility with food

food

When using an insulin pump, you only use rapid-acting insulin.  This means that you don’t have to have snacks or meals at specific times.  Ideally, you don’t have to feed your insulin when using an insulin pump. You eat what you want, when you want to.

3.  Flexibility to exercise

exercise while pumping

You can adjust your background insulin to increase or decrease based on your anticipated activity level.  Some sensor augmented insulin pumps will even suspend your insulin delivery if your blood glucose levels are dropping too low or too rapidly.

4. Can be integrated with your CGM

cgm and pump

There is currently a category of insulin pumps that are “sensor augmented”.  This means that they can receive information from specific continuous glucose monitors.  This information is then used by the pump to help you make dosing and basal decisions.

5.  Micro-manage your blood sugars

An insulin pump allows you to make small corrections to your blood sugars.  The ability to dose fractions of a unit of insulin without injections gives you the flexibility of great control with greater ease. It allows you to tailor your insulin needs to your lifestyle rather than the other way around.

6.  Reduced episodes of severe hypoglycemia

Insulin pumps deliver small amounts of rapid insulin on a constant basis.  There is less variance in absorption rates and ultimately a reduced incidence of extreme hypoglycemia.

7. No peaks to chase

Again, because insulin pumps only use rapid acting insulin, there are no peaks of insulin that need to chased with food. 

8.  Built in dose calculator

You don’t have to do the math.  Your insulin pump will help you to figure out how much insulin you have left in your system and how much more insulin you will need to cover a meal or bring down a high bg level.

The Cons of using an insulin pump

1.  You are attached to something 24/7

insulin pump

Whether you are tethered to an insulin pump directly or just having to have a PDM nearby, you and your pump are attached…always.  There is no taking it off or leaving it behind unless you have gone back to at least some form of injection therapy.

2.  You can’t tell if the insulin has been delivered properly or not

Infusion sets can kink inside the body.  You can’t tell until your blood sugar levels start to spike for no apparent reason. 

3.  They cost a lot of money

RDSP

Not everyone has great insurance coverage.  Not every region offers public programs that pay for insulin pumps.  If you must pay for an insulin pump and then the supplies out of your own pocket, it can be a costly venture.

4.  Changing an infusion set takes more effort than an injection

To change an infusion set, you must prep the site, fill the tubing with insulin, inject the infusion set into the body, connect it to the tubing and fill the cannula, that is now under the skin, with insulin.

5.  Increased risk of DKA

An insulin pump uses only rapid acting insulin. This means that there is no background insulin in the body if there is a pump failure.  Without the background insulin, there is a greater risk of DKA.  A person using an insulin pump should be monitoring their blood glucose levels more closely and checking for blood ketones when readings begin to climb.

6.  Increased risk of infection

Because an infusion set stays in the skin for a period of 2-4 days, there can be an increased risk of infection to the sites.  Therefore, site rotation and proper skin prep is vital when using an insulin pump.

Make an educated choice

talk to an expert

 Choosing to inject or use an insulin pump should be a choice that you make based on your needs and comfort level.  Before you decide, spend time speaking with your diabetes team and take time to educate yourself.

If you decide to use an insulin pump, again, choose the insulin pump that is right for your lifestyle. To help you decide what is right for you, download our eBook. It has a checklist of features that will help you decide what is important to you.  It also has a list of questions that you can ask your pump reps before making your choice. 

Remember that all pumps come with some sort of guarantee. Ask your pump rep what their return policy is before you purchase.  Your insulin pump is a 4-5-year investment.  You don’t want to have buyers’ remorse.

10 Tips for Cruising with Type 1 Diabetes

cruising with diabetes

I am getting ready to head off for my first ever cruise so I was super excited when Rebekah Svensson of Awkwardyethealthy.com agreed to share tips on cruising with type 1 diabetes!

I have Type 1 Diabetes (and I have for the past 18 years) and I have been on exactly ONE cruise. A Disney cruise to be exact. Therefore, I declare myself an expert! Well, not really, but I do have some useful tips for my fellow Type 1’s who are looking to go on a cruise!

Type 1 Diabetes is no joke, and as we all know, things can go from just fine to really bad in the blink of an eye. And being on a ship in the middle of nowhere is probably not the best place for that to happen. Whether it’s you, your spouse, your child, or another member of your traveling party Diabetes can be a huge storm cloud. So how do we keep that nasty rain away?

1. Pack double the supplies. And then pack some more.

luggage to pack

This is one area I do not skimp on in any circumstances. Personally, I am a pump user, so I pack enough ‘hardware’ to get me through twice the length of my trip. And then I usually pack a few more just in case.

If you’re a pumper you know that sometimes infusion sites don’t work right, or reservoirs get all wonky. I choose not to stress about it by bringing plenty. This includes batteries too. Oddly, on our family cruise, I didn’t have an extra battery and Guest Service’s came to my rescues. I did NOT enjoy being in that situation. Also, it’s a good reminder that there are no REAL stores on board.

2. Bring extra insulin when cruising with type 1 diabetes

Bring an extra vial if you can. I broke a vial of Lantus once while overseas. Thankfully I had another even though I technically wouldn’t have needed it based on the length of the trip. It can be a huge hassle, but you’ll feel a million times better knowing it’s there if you need it. Because on a ship in the middle of the ocean it’s going to be hard to come by.

3. Carry Glucose Tablets

One thing everyone told me about before our cruise was there is SO. MUCH. FOOD. But the thing is, the food is not ALWAYS available. Or room service might not be quick enough. There’s also the issue of the dining schedule not necessarily being YOUR schedule, which can mean unpredictable sugars. My solution? Always, always, always, carry glucose tablets. Carrying a small purse or backpack is a small price to pay. Throw some glucagon in there too for good measure.

4. Ask to see the menu in advance

food

At least in my experience (I also have Celiac Disease), the waitstaff has access to the next day’s menu at dinner time. Ask to see it! Also, don’t hesitate to ask for substitutions! We all know how hard it can be when you don’t prepare the food yourself, it makes carb counting nearly impossible. The best way to combat that? Knowledge.

Ask for all the information you can possibly have. Tell your waitstaff you have dietary restrictions (Yes, you do. No disagreements here. You need to know what’s in your food. You are NOT bothering anyone!). You can also request that there be something brought to you immediately or waiting at your table, like a glass of juice, just in case. If highs are more your problem, ask them to skip the bread course or give you half portions of certain things. Whatever you do, don’t just eat blindly. I think we all know how bad that can turn out.

5. Plan your day

I know, I know, it’s VACATION! Why should you have to plan!? But hear me out. Think about your meals. If you know that night’s dinner is carb heavy PLAN FOR IT. If you know you want the sugary margarita or you Type 1 kiddo wants ice cream, build it into your day.

Some of us diabetics are a lot stricter than others, so for the stricter folks this won’t seem so bad. For the rest of us who tend to wing it, this can suck. But you know what sucks more? A reading of 400mg/dl (22.2mmol) and getting sick hundreds of miles away from proper medical care. It just isn’t worth it.

If you know you have a physically demanding excursion plan your margarita that day. Lounging on the pool deck all day? Might not be the best time for that 100g carb dessert. It doesn’t have to be down to the minute, but just try and match your carb intake to your cruise activities at the very least.

This is true for ANY vacation, but even more important on a cruise. Simply because you will have access to ALL. THE. TREATS but you might not have a chance to get off the ship for pleasure or medical care.

6. Take a note from your doctor

You will most likely be going in and out of different countries, on and off the ship through security, and traveling on a plane at some point. So have a note from a physician handy. Most security folks nowadays are familiar with Diabetes and the plethora of stuff that comes with it, but just in case it’s good to have a note explaining that you NEED it.

Traveling with needles, vials of medicine, and weird looking medical supplies can make some people uneasy, so this is a just-in-case that will pay off in the rare chance someone tries to take away your supplies. And ALL your supplies should be carry-on by the way. Always. Whether it’s on the plane or getting on the ship, keep them in your personal bag that stays with you.

7. Medical Alert ID: WEAR IT!

I am so guilty of this. I never wear mine, I loathe the thing. But a cruise is a very important place for a Type 1 Diabetic to be properly identified. If anything happens to you and you are not with an adult member of you party this will be what is used to treat you. If you are incoherent this is what will tell the ship’s doctor that you are not just drunk but might be in DKA. Accept the hideous tan line and wear it. While there are doctors on board, this will not be a full-blown hospital. So, if the worst is to happen it’s better to have the information on you and ready to go.

8. Set timers for blood sugar checks

set alarms

It may seem like overkill but set a timer for every 4ish hours during the day to check your sugar. I wear a Continuous Glucose Monitor, but I still checked more often while cruising because the swings could be so dramatic.

With today’s glucometers they are super-fast and super small, so throw it in with your glucose tablets and just take the time to check every so often. I found that we would be away from our room for very long spans of time, so it was easier to carry it with me in my ‘go bag’ rather than return to the room just for a BG check.

9. Talk about it

I know it annoys the crap out of my family and friends when I mention that I have Type 1 in conversations with strangers or servers. But guess what? The more people that know the more people that can help you. Unfortunately, this disease is not as rare as it should be and sometimes you run into a fellow Type 1 (or family member) and they have some good information for you. Or it’s a chance to educate someone. Or it helps remind YOU of what you need to be doing. If you talk about it, you can’t ignore it!

10. Loosen the reigns a bit and have fun!

If it’s you that it Type 1 diabetes, you are probably fine with this. If it is your spouse or your child, you are likely not ok with this. But, for the sake of your sanity, broaden your range of acceptable sugars a bit. Not to the point of getting sick but expect some lows and just know that there will be more highs than you’d like.

Even with planning your days a bit, taking all the precautions, and counting the carbs to the best of your ability there will still be unexplainable swings. If you are prepared, they will be nothing more than a minor speedbump. But if you are cruising with type 1 diabetes and expecting perfection, you will be miserable. Type 1 Diabetes is not a disease to be taken lightly, but it should also not rule your life. Make sure you have fun and ENJOY IT!

have fun

Those are some of my thoughts! Of course, there’s always the drink water, eat your fruits and veggies, and get plenty of exercise that all Diabetics are hammered with every day. It still applies on a cruise y’all. Just do it. I know life isn’t fair, but we can handle it, we’re tough.

My personal experience on a cruise with type 1 diabetes was that I had more frequent highs and occasional lows that weren’t very predictable. There was a ton to indulge in, and I did. Maybe too much. But the waitstaff was wonderful at being helpful and informative, the crew was very understanding and always willing to go above and beyond to help in any way, and while I did not have any experience with the medical staff on board, knowing they were there provided peace of mind. Cruising with Type 1 Diabetes is definitely worth it. With a little foresight and flexibility, it can be a truly great vacation!

If you’d like to learn more about me, Rebekah Svensson, feel free to visit my blog Awkwardyethealthy.com!

Happy Cruising!

To make your next vacation with diabetes a little easier, why not download our complete guide to traveling with diabetes. It has packing checklists as well as a list of things to do before you go.

10 things you need to know before shopping for an insulin pump

buying a pump

Insulin pump shopping for the first time can be exciting and daunting.  Whether you have been using insulin for years or are newly diagnosed, you have most likely heard all sorts of good…and bad things about insulin pumps.  As you begin your research to find the best insulin pump for you, you quickly find yourself in wading in a foreign language.  Let us translate some of the things you need to know when shopping for an insulin pump.

What is a basal rate?

One of the first terms that you hear is “basal rate”.  This is your background insulin.  It will replace the long-lasting insulin that you are currently using.  On injections, you inject a set amount of insulin into your body once or twice per day. 

With an insulin pump, you will set basal rates that will deliver that insulin in tiny amounts throughout the day.  These amounts can be extremely small or they can be larger depending on age, insulin sensitivity, and other factors that your diabetes team will help you with.

To give you a rough idea of what your basal needs will be, total up all of the long-acting insulin that you use in a 24-hour period.  Take that amount and divide it by 24.  This will give you a base idea of what you will require. 

A child who is only using 12 units of background insulin would need basal rates of at least .5 units per hour (and perhaps smaller).  An adult who is currently injecting 36 units per day would not be as concerned about small basal rates. Again, your exact rates will be set with the help of your diabetes team but this will help you to understand if you need to be concerned about smaller or larger rates.

What does it mean to bolus?

Another thing that you will often hear is the term “bolus”. That is the amount of insulin that is used to cover meals and correct high blood sugars.  If you have been on multiple injection therapy, this is the amount of rapid-acting insulin that you have been using.

For children, there is often a need for very small bolus amounts.  They might require .05 of a unit or less so small bolus rates are vital. In the case of teens, there can be a need for much larger bolus dosing.

Can you change the bolus delivery rate?

Large bolus dosing leads us to our next term–rate of delivery or delivery speed.  If you require larger amounts of insulin at one sitting (think pizza or pasta meal), you may prefer an insulin pump that will deliver the bolus to you at a slower speed rather than all at once.  Some people experience discomfort with large bolus amounts. 

Remember that your diabetes may vary so what is important for one person may not be a concern for another. Choice is important!

Do you want to be attached to your insulin pump 24/7?

insulin pump

Some people are okay with a tubed insulin pump.  They may even feel comforted by its presence.  Other people hate being attached to something.  You have to decide which you prefer—infusion sets and tubing or a patch insulin pump and PDM. 

How much insulin will you use over three days?

Insulin pumps require that you fill your pod/cartridge/reservoir with insulin on a regular basis. Pods currently hold 200 units of insulin. The Medtronic 670G and the Tandem t:slimX2 both hold 300 units.

Some people are okay with changing cartridges and infusion sets at different times, others want to do it at the same time. Either way, if you are using larger amounts of insulin, you may want to consider a larger insulin container.

Will you be using a continuous glucose monitor?

A Continuous Glucose Monitor or CGM is a device that constantly monitors your blood sugar levels.  If you are already using a system, you may want to know if it works with an insulin pump. Stand alone devices can be used in conjunction with the insulin pump of your choice but only specific brands “speak” to specific pumps at this time. Right now, the t:slim™X2 works with a Dexcom® system.  The 670G works with the Medtronic® Elite system.  If you are using the Libre™ Flash Monitoring system, there is currently no insulin pump that links directly to this device.

What is your body type?

infusion sets

Are you thin or do you have a bit of extra body fat? Are you athletic or pregnant? All of these questions are important when deciding on the best infusion set to use with your new insulin pump. 

Each pump company has their own names for the various infusion sets but infusion sets basically fall into three categories.  There are sites that go straight in (90-degree sites).  There are infusion sets that can be placed on an angle up to 30 degrees. Finally, there are 90-degree steel infusion sets.  Each infusion set works best with a specific body type. Make sure to discuss these options with your diabetes educator or pump trainer.

It is important to consider if you will need a certain type of infusion set before you purchase an insulin pump. Not all pumps currently allow you access to all types of infusion sets.  Because you will be wearing your site 24/7, you want to make sure that you have the most comfortable fit for your body type and lifestyle.

Are you visually impaired in any way?

The lighting of the screen and its font size can be something to consider when choosing the right insulin pump.  They can have a touch screen, a touch bolus or physical buttons that have to be pressed to deliver insulin and change settings.  It is important for you to feel comfortable with which ever option your insulin pump has.  You want to be able to view it in all lighting situations including when responding to those 3 am alarms.

Do you need to lock your pump?

Will the insulin pump be used on a small child? If so, you may want to ensure that you can lock them out of the insulin pump settings.  Buttons and touch screens are often relatively easy to use but you don’t want small children to be able to easily access their touch bolus and accidentally deliver insulin unsupervised.

What are the payment options?

If you don’t have private or public insurance coverage for your insulin pump, you will want to discuss payment options with your rep.  Do they have a payment plan? How does the plan work?

If you have insurance, will they work with your insurance company on your behalf or will you have to be the go-between?

diabetes costs

Purchasing an insulin pump is a huge decision. It is important that you understand the key feature before you begin your search. 

Diabetes Advocacy has helped to make this a little easier for you by creating a 20-page ebook with all of the above questions and more.  This downloadable document gives you things to think about before you purchase your insulin pump as well as prompts to ask your pump rep at your first meeting.

pump book

An insulin pump is a long-term commitment. You will be with your pump 24/7 for the next 4-5 years. It is important that it fits your needs and your lifestyle.

Take me to the insulin pump ebook.

It is NOT an artificial pancreas

My rant…

The media has been shouting for a while now about the new “artificial pancreas” on the market.  This is driving me crazy.  It is not an artificial pancreas. It is a new insulin pump.  This new pump has some automated features but it does not completely replace a pancreas that is not producing insulin. It does not bolus for food on its own.  It is not a cure. What this new device is is a new device! It is another tool to help people living with diabetes live a better life.  That is it!

Medtronic® does not call their latest insulin pump an artificial pancreas. They simply refer to it as “The world’s first self-adjusting insulin pump system for people with type 1 diabetes” (over 7 years of age).  That is fair.

In auto-mode, this new pump will make adjustments and suspend itself.  It uses information from the continuous glucose monitor (CGM) to predict rises and falls in blood glucose levels. The 670G (this self-adjusting insulin pump) will get your background insulin (your basal rate) under control for you.  In turn, “the sensor must be calibrated at a minimum of every 12 hours throughout the life of the sensor. For better sensor performance, it is recommended that you calibrate your sensor three or four times each day.” (page 216 of users manual).  The manual also notes that “the Auto Mode feature still requires your input for meals, calibrations, and times when you need the target value raised.” (page 231).  Again, making this is not a true “artificial pancreas” but a new tool for people with insulin-dependent diabetes.

not an artificial pancreas
It’s just a new tool!

This is great! I am seriously all for better tools.  I am also all for choice as you can read here and here.  I even have developed a tool to help you make your own choices when it comes to purchasing an insulin pump here.

Choice is vital because everyone’s diabetes is different. Children have different needs from teens. Teens have different needs from adults. One adult requires different things from an insulin pump than another does. The good news though is that more choice is coming…or in some countries it is already here.

insulin pumps

In the US, besides the Medtronic® 670G, you have the option to use the t:slim X2™ with Basal IQ™ (this option is available in countries where the t:slim X2™ is sold and the Dexcom® G6 is approved for use). This pump also has a great automated feature. 

It predicts low blood glucose levels ahead of time and stops insulin delivery.  The Basal IQ™ technology will allow the insulin pump to turn insulin delivery on and off as often as every 5 minutes.  As I noted, this system works with the Dexcom® G6 Continuous Glucose Monitor which is currently the only CGM approved for use without the need for fingerstick calibration.  

These systems have been approved for use in the US and other countries. There are other projects that are still being tested like the iLet® project out of the University of Boston.  Bigfoot Biomedical® is working on some exciting projects and patients are creating their own closed loop in the #WeAreNotWaiting projects.

The world of diabetes management tools is once again expanding at a fascinating rate. It is an exciting time.

We are not however at a time when diabetes is cured with an artificial pancreas.  No system counts carbs—although the ILet potentially will allow the pump to learn how. Every system requires you to change out infusion sets that can kink or come out of the body.  All of these systems require learning on the part of the user and the machine. 

Perhaps in another 20 years, we will see a true artificial pancreas.  Maybe in another 30 years, it will be available to everyone who needs one.  In the meantime, people with diabetes must continue to educate themselves on the various features of insulin pumps and choose the pump that best fits their lifestyle.

Download our ebook to help you find the right insulin pump for you.