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10 Tips for Cruising with Type 1 Diabetes

cruising with diabetes

by Rebekah Svensson

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, but I did NOT enjoy being in that situation. Also, it’s a good reminder that there’s no REAL stores on board.

2. Bring extra insulin

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 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, 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 go on your cruise 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 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 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 toolkit for 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 a pump

buying a pump

Deciding to use an insulin pump 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.

Takeaways from the Senate Committee Report on DTC

This article was originally created for insulinpumps.ca and published on June 19, 2019

Some background

senate review

During the summer of 2017, many Canadian diabetes groups were made aware of an increased number of rejected applications for the Disability Tax Credit (DTC) by people living with diabetes. A public letter was sent to both the media and finance department asking why the Canada Revenue Agency seemed to be implementing a policy change when there had been no change in legislation.

By December of 2017, the Senate Committee on Social Affairs, Science and Technology convened to discuss this issue. They met with various groups in February of 2018.

What the committee was told

The committee heard from a variety of groups and individuals including key players from the Juvenile Diabetes Research Foundation (JDRF) and Diabetes Canada. They were told that both the DTC and the (Registered Disability Savings Plan)RDSP are underutilized despite the potential to offer great assistance to qualifying individuals. The current DTC is only of financial benefit to those who have an income because it is a non-refundable tax credit. Individuals with little or no income are not applying and therefore are not eligible for any further assistance in the form of grants available from the RDSP.

They were told that currently the CRA (Canada Revenue Agency) employees are being given the power to overrule the certification of a medical doctor. This suggests that the employees somehow have greater knowledge of a person’s medical condition and restrictions than that of a physician.

JDRF and Diabetes Canada also requested that the 14 hour minimum for life sustaining therapy be removed. They noted that similar health burdens and financial challenges occur for all people with type one diabetes regardless of the time spent. They all require the same activity restrictions and higher costs associated with administering insulin regardless of whether it takes 10 hours or 14 hours per week.

It was further noted that “these rules can often mean that young adults cease to qualify for the DTC when they turn 18 simply because their parent’s time is no longer included in the amount of time spent administering a therapy. In reality the only thing that has changed is that the person has turned 18. “

Finally, the committee was advised that people with life-long conditions, like diabetes, are being forced to reapply for the disability tax credit. This is a waste of time and resources.

The Recommendations:

On June 27th, 2018 the Senate Committee on Social Affairs, Science and Technology released its recommendation on the Disability Tax Credit and the Registered Disability Savings Program. These are the ones that apply to people living with diabetes.

  • implement legislation that would limit the fees disability services providers can charge to complete the Disability Tax Credit application (this has been tabled but not brought into force yet)
  • Re-examine the arbitrary 14 hours required for life sustaining therapy
  • Eliminate the need to reapply for life long conditions
  • Improved transparency for those who have to appeal their DTC denial
  • Allow people to keep all contributions made to their Registered Disability Savings Plans for periods in which they qualified for the Disability Tax Credit.
  • Work with all levels of government to ensure that all people with qualifying disabilities over the age of 18 can access the Registered Disability Savings Plan program.
  • Change the 10 year wait to access RDSP funds and grants
  • Make this a refundable credit so that it also helps those with lower or no incomes
Senate committee recommendations

Everything you need to know about RDSPs

RDSP

If you have successfully applied for the Disability Tax Credit, the savings do not end with your tax return. You are also eligible for FREE money from the government! I know that sounds too good to be true! That is why I asked Jane Buchanan, District Leader, Representative of Primerica Financial Services, to explain exactly how easy it is to get FREE money!

What is the Registered Disability Savings Plans (RDSPs)?

People with disabilities and their loved ones face a distinct set of financial challenges throughout their lives. To help address these challenges, the Government of Canada introduced the Registered Disability Savings Plan (RDSP) in 2008. Designed to help build long-term financial security for disabled persons, the RDSP makes it easier to accumulate funds by providing assisted savings and tax-deferred investment growth.

 Who is eligible for an RDSP?

To qualify for an RDSP a beneficiary must:

• Be eligible for the Disability Tax Credit

• Be a resident of Canada

• Be less than 60 years of age

• Have a valid Social Insurance Number

The Disability Tax Credit is available to individuals who have mental or physical impairments that markedly restrict their ability to perform one or more of the basic activities of living, such as speaking, hearing or walking. The credit is also available to those who spend more than 14 hours per week on life-sustaining therapy.

The impairment must be expected to last longer than one year, and a physician must certify the extent of the disability. There can only be one RDSP account per beneficiary, and only one beneficiary per plan.

Click here to see if you might qualify.

What are the key benefits of an RDSP?

RDSP
  • Money contributed grows tax free.
  • Anyone can contribute to an RDSP with the written consent of the account holder.
  • Contributions can be matched, based on family income, with up to $3,500 a year in Canada Disability Savings Grants (CDSG) and up to $1,000 a year in Canada Disability Savings Bonds (CDSB).
  • Carry forward on CDSG and CDSB is available back 10 years or to date of diagnosis.
  • The total lifetime contribution for each beneficiary is $200,000, with no annual contribution limits.
  • If a parent or grandparent passes away and has a financially dependent child or grandchild, they can transfer up to $200,000 of their RRSP/RRIF or RPP to the dependent’s RDSP on a tax-deferred basis.

Who can qualify to be the beneficiary of an RDSP?

To qualify to be the beneficiary of an RDSP, an individual must:

  • Be eligible for the Disability Tax Credit
  • Be a resident of Canada
  • Be less than 60 years of age
  • Have a valid Social Insurance Number (SIN)

How do you maximize your savings?

  • Start saving early. Make it automatic by enrolling in a pre-authorized chequing program.
  • Take advantage of government grants and bonds and contribute every year to get the maximum annual Canada Disability Savings Grant and Canada Disability Savings Bond.
  • Plan withdrawals to avoid federal grant and bond repayments.

What is the Canada Disability Savings Grant (CDSG) and the Canada Disability Savings Bond (CDSB)?

The Canada Disability Savings Grant (CDSG) and the Canada Disability Savings Bond (CDSB) are federal programs that provide payments to RDSPs to encourage long-term savings through an RDSP.

Grants and bonds are available to beneficiaries up until December 31st in the year they reach age 49. Contributions can be matched, based on family income, with up to $70,000 in Canada Disability Savings Grants and up to $20,000 in Canada Disability Savings Bonds.

RDSP with drawls are also known as disability assistance payments. There are two types of payments from an RDSP lifetime disability assistance payments and disability assistance payments.

How do you contribute to an RDSP?

 Once an RDSP is set up there are five ways to put money in:

  1. contributions by the account holder.
  2. contributions by people the account holder has authorized.
  3. federal grants and bonds.
  4. transfers from a qualified or RRSP, RRIF or RPP.
  5. transfers of the accumulated income from a registered education savings plan on which the beneficiary is on both RESP and RDSP.

How do to get money out of an RDSP?

RDSP withdrawls are known as disability assistance payments. There are two types of payments from a RDSP. 

Lifetime disability assistance payments are recurring annual payments that one started must be paid until the plan is terminated where the beneficiary has died. These may begin at any age that must start by the end of the year in which the beneficiary turns 60. 

The other type of payments are disability assistance payments which are lump sum payments made to the beneficiary or the beneficiary’s estate.

When withdrawing funds from the RDSP, it is important to be aware of the 10 year rule. If a person withdraws amounts that were contributed in the ten-year period prior, grants and the bonds from the government must be repaid to them. The repayment is three dollars for every one dollar withdrawn (aka the Holdback amount).

The purpose of the holdback amount is to ensure that RDSPs are used for long-term savings, and it also ensures the government funds contributed are not withdrawn and used otherwise.

Have more questions?

Contact Jane Buchanan, District Leader, Representative of Primerica Financial Services Call: (506) 863-4425 Email: [email protected]

To see if you might qualify for the Disability Tax Credit, try our short quiz. If you have been putting off filling out your application form, get our easy to follow step-by-step guidebook.

Choosing an insulin pump is personal

chosing an insulin pump

Choosing an insulin pump is a very personal experience. Anyone who tells you otherwise is basically lying to you. To pump or not to pump, to go with tubing or no tubing, it is all a matter of personal preference.

When we first began looking for an insulin pump for my son it was 2002 and he was 4 years old. The only requirement he had was that it could NOT be the blue pump. Everyone he saw seemed to have a blue insulin pump and he wanted to be different. As a parent, I knew that there were other things to consider. At first, however, I wasn’t quite sure what they were.

I read books like Pumping Insulin. I reached out to the parent email list on the Children with Diabetes website. Finally, I consulted with friends and began to compile my own list of features that our insulin pump had to have.

Get our insulin pump shopping list ebook.

It was important for this to be the most up-to-date insulin pump. I was paying for this pump out of my own pocket and would have it for the next four years. I wanted the best technology for my money.

My son was only four so it had to be able to deliver very small amounts of insulin. Because we were new to pumping, certain alerts were also going to make our journey a little easier.

I didn’t order the blue pump. I didn’t order from the rep who became a lifelong friend. The other rep whom I met for coffee and answered every question I had, also did not get our business. I felt horrible not purchasing from either of these amazing people but pumping is personal. I had to go with the pump that fit us. They understood.

wearing an insulin pump

I chose a brand new insulin pump. It had everything that we wanted in a pump. It had features that he would need in the coming four years and features that were perfect for our life at that time. This was an insulin pump that was ideal for our family.

Let me repeat that…it was ideal for our family. It was not ideal for everyone’s family. This was a pump that was not ideal for every person with diabetes. That is the thing with insulin pumps and with diabetes in general…everyone is different. Everyone’s needs, wants, and budgets are different. The technology has to fit the person.

If you are looking at an insulin pump for the very first time, here are five things to consider…

insulin pumps

1. Do you want tubing or not?

For some people, being attached to something 24/7 can be overwhelming. This might mean that an insulin pump is not for them. It may also mean that they might be better suited to a pump that has no tubing like the Omnipod. Other people find that having a pump at the end of their tubing allows them to know where their “pancreas” is at all times and gives them peace of mind.

2. Is a Continuous Glucose Monitor important to you?

Do you need a continuous glucose monitor with your insulin pump? Are you already using one? Do you want a pump that “talks” to your CGM? Do you prefer the Flash Meter system?

There are some insulin pumps with CGMs built into them. This can be a pro or a con depending on how you look at it. It is great to not have to be concerned about carrying or dealing with another device but technology is changing so rapidly that it can be nice to have a stand-alone device that is more updated than the one integrated into your pump.

3. Does it update itself?

As I said, for me it was vital to have to most uptodate technology. My thinking was that if I was spending that kind of money, why did I want a Kia when I could get a Cadillac for the same price?

Insulin pumps are constantly changing. New models are being brought to the FDA and Health Canada on a regular basis for approval. Some people, like me, want the most advanced technology for their money. Other people are okay with any insulin pump as long as it delivers insulin. Again, an insulin pump is a personal choice.

Currently, in the Canadian and US markets, there is only one insulin pump company that offers upgrades without having to purchase a new insulin pump. A Tandem insulin pump has the capability to remotely update its software without the need to purchase an entirely new device.

4. How much insulin do you need?

The reservoir or insulin cartridge is what will hold the insulin in your pump. Depending on your age and needs, size can make a huge difference.

Teens for example, tend to go through a lot of insulin. An insulin pump with a 2mL(200 unit) cartridge will not last them nearly as long as a 3mL (300 unit) cartridge. Changing the reservoir takes time out of your day and that can be annoying to some. If you hate changing out your insulin reservoir, this might be something that you have to think about.

Also, depending on your age and lifestyle, basal rates and bolus amounts are important. The basal rate is the amount of background insulin that your pump is delivering to you every hour. Each pump delivers that background insulin differently and has different maximum and minimum amounts.

To get a rough idea of how much background insulin you might need, look at the amount of long-acting insulin you are currently using and divide it by 24. This is a very rough guess and will change with an insulin pump but it will tell you if you need smaller or larger basal rates.

Bolus amounts are the amount of insulin that you will inject (or bolus) to cover your meals. If you are a big eater or you have a high carbohydrate to insulin ratio, you are going to want a pump that can handle that. If you are someone who is very sensitive to insulin, then small, precise bolus amounts will be very important to you.

5. What sort of alerts will you need?

Will you remember when to do an infusion set change? Do you need a reminder to let you know if you forgot to take insulin to cover a meal? Is it important to you to have an alert that lets you know if you are dropping low or spiking during the day?

These are just some of the alerts that are found on some of the insulin pumps currently on the North American market. When searching for an insulin pump, take a look at the alerts and see which ones you will use and which ones you can do without.

Choosing an insulin pump can be overwhelming. Make a list of what you require in an insulin pump. Think about the five key things I mentioned above. Add your own features that you feel are important like screen size and temporary basal patterns.

Once you have your list (we have a great checklist of features here), contact your local insulin pump reps. Contact all of them, not just the one from the pump company that you know the most about or the one that you are leaning towards. Get to know them. Get a feel for how they treat you. Learn about their payment plans and customer service. Will they let you try out the pump?

Get our questions to ask your pump rep.

Make sure that you choose the pump that is the right fit for you. You are the one who will have to deal with it 24/7 for the next 4-5 years, no one else.

If you are unsure where to start when looking for an insulin pump, our insulin pump workbook can help.

10 Things to do When Life with Diabetes Becomes Too Much

stress

We know that diabetes is stressful and can be overwhelming at times. The day in and day out grind of carb counting, injecting insulin, and checking on blood sugar levels can wear a person down. That is why it is so important to look after your mental health as well as your physical health. Here are a few things that myself and others have done over the years.

Cry, scream or yell in the shower

cry

Whether you are the person living with diabetes or you are helping someone you love, there are those days when you have had it. You want to kick and scream. You just don’t want to “diabetes” anymore.

Guess what? That is okay! In fact, it is pretty darn healthy! It isn’t healthy to keep those feelings and frustrations bottled up, however.

When you are completely overwhelmed and want to throw in the towel…do it! Find a private spot, like the shower, and just let out all of that pent up emotion. Allow yourself to cry. Go ahead and scream at the universe. Yell at diabetes itself. Simply vent and then…let go. I promise you that while it won’t fix everything, you will feel a little better.

Go for a walk

walk

We all know that we are supposed to exercise. Did you also know that it really can be good for your mental health?

Take some time to join a gym, sign up for a yoga class or just take the dog for a walk. Do something to get moving and get out of your head for a bit. Shake off the cobwebs as you stretch or lift. Allow all of that stress to hit the pavement as you go for a walk. Taking in some fresh air and taking some time for you will help you to improve your overall health.

Go out on a date

date

Go out for a lunch date with a friend. Meet your significant other for a lovely meal. Take one of your children out for a playdate that involves just the two of you. Simply get out and put diabetes on the backburner.

If you are living with diabetes, you will sadly still have to bring it along but, for just an hour, make it sit at another table. Don’t complain about it. Don’t worry about it. Just focus on the person you are with and leave the rest behind for 20 minutes, an hour, whatever you can spare. Recharge yourself with someone you care about.

Grab a glass of wine

At the end of the day, allow yourself to unwind with a glass of wine, a shot of rum or simply a great cup of tea. If you enjoy essential oils, make sure you have your favourite blend diffusing. Light a candle. Just breathe and relax. Let your mind go blank for a bit and simply unwind. It is okay. You need it. You deserve it.

Enjoy a book

Take a few minutes to unwind with a good book. Put on a Netflix show. Turn on your favourite music and let it flow through you. Dance a little if you like or allow the music to put you to sleep! Do something that requires minimal thought and maximum relaxation.

Live life 4 hours at a time

4 hours

This is advice that truly kept me sane through toddlerhood, preteen years and the teens. Live life 4 hours at a time.

When living with diabetes, there can be highs and lows that appear out of nowhere. There can be highs and lows that show up because you got a bit of air in your tubing, you injected into a different site, or you counted the carbs in a meal wrong. There are more reasons for highs and lows than the average person can imagine. Obsessing over them can drive you completely insane.

My advice is simply to deal with them in short blocks. Rapid-acting insulin has a life of 4 hours (on average). Take your day and break it up into those four-hour sections. When you get up and check your blood sugar, that is the start of your first four hours. If that reading is perfect, do a happy dance and get some breakfast. Savor the victory over the diabetes gods.

If you find that you are running a bit high or low, you treat with food or insulin and move forward. By lunch time, you will either have everything under control or you won’t but that is a four hour time period that is behind you. It is something to look at later and see what you could have done differently. It is not something to dwell on. You have another 4 hours to deal with.

In those next four hours, you can celebrate in range readings. You can ponder out of range numbers but know that there will be another four hours for you to look at and you will get through.

Give diabetes away for the day

share

Seriously, give diabetes away for the day. Have someone else think about the blood checks and carb counting. Take the day off.

If you are a parent of a child with diabetes, have your partner or a family member do your child’s care for the day. Remember that they will do things differently. That is okay. As long as your child is okay and you can rest, it will be okay.

If you have diabetes yourself, ask your partner, good friend or even parent to deal with everything for a day. Okay, maybe you won’t be able to handle an entire day but let them scan your sensor. Have them push the buttons on your pump. Let someone else do your site change. Give your brain a break for an hour, an afternoon, a full day if you can!

Join a support group

No matter what, there is nothing like talking to people who get it. If you are on Facebook, join one of the many online groups that are there. Most are private or secret so that what you say in the group will stay there.

If you are a Twitter person, look for the hashtag #DOC or #DSMA and join in diabetes chats. It is a great way to share and meet other people who live the same life as you.

Some people prefer to meet in real life. Check with your diabetes clinic for support groups or diabetes-related events in your area. There are many conferences and camps for both adults and youth that are worth checking out.

Journal

It can be very therapeutic to simply write out your feelings. Start a journal online or in your favourite notebook. Write about your victories and your frustrations. Get your feelings down on paper so that you can better handle them in your daily life.

Seek help

Finally, if you are still finding diabetes too much to handle, please look to finding the help of a professional. There are mentor programs for teens. You can connect with diabetes educators in other areas who will help you tackle getting blood sugars in a more manageable range. You can also connect with therapists who will assist you in person or via remote networks. Some of them like Virtue Bajurny and Joe Solowiejczyk are not only therapists but live with type 1 diabetes themselves.

No matter what you decide to do. Remember that you never have to do it alone. If you are struggling, please reach out to someone or contact us. We will try to help you to find someone in your area who may be able to help.

Diabetes Advocacy Keeps Growing!

Its a new year. A lot of people make resolutions to do things like lose weight, check their blood sugars more often, or to get a bit more active. Another option is to choose a word to live by for the year. This is a word that inspires you and encourages you. A word that resonates with you and helps you move towards your goals. My word for this year is growth.

If you have been following Diabetes Advocacy for any length of time, you have seen a lot of changes.

We started out as a place for people to share information about the Disability Tax Credit. We grew to help families who were struggling with their children with diabetes in schools. Diabetes Advocacy became a hub for insulin pump program advocacy and so much more. Over the years, we added a blog to document our lives, review books and products, and share information.

Diabetes Advocacy has also undergone some cosmetic changes. The website is now completely mobile friendly. We can be found on Instagram, Twitter, and Facebook. We have a monthly newsletter once again that shares tips and information.

Do you see how perfectly the word fits? Diabetes Advocacy is growing! This year I will continue to update the site and provide great content and more products. There will be more downloads and tools to make your life easier! There will be more of the great content you have come to love over the past 16 years.

What would you like to see added to the Diabetes Advocacy site? What topic would you like to see us tackle?

All of our downloads can now be found in our new digital store! We will continue to add more products on a monthly basis so be sure to take advantage of our growth!!

Did you make a resolution this year? Do you have a word that will inspire you? Let us know!

Tax Tips for People with Diabetes

Tax tips for people with diabetes

If you are like me, you aren’t overly excited by tax time. The thought of paying in more money is so depressing that you are probably digging through every receipt trying to figure out how you can write off that last Ice-cap from Tim Hortons as a diabetes-related expense. Here are a few tax tips that you may have overlooked.

Diabetes supplies

Keep all of the receipts for your diabetes supplies such as:

  • insulin
  • syringes
  • test strips
  • ketone strips
  • alcohol wipes
  • medical tape
  • Glucagon kit
  • pump supplies including the insulin pump, tape, infusion sets, reservoirs, batteries, and mastisol 
  • Continuous Glucose Monitor, transmitters, and batteries

If you have paid out of pocket for these items or a co-pay after insurance, make sure that you have a prescription for them.

Travel

You can claim the cost of travel to medical appointments.

In Canada you must travel at least 40 km one way to get to your appointment. Make sure that you have a signed letter from the office before you leave stating that you have been there. You will then be able to deduct the cost of public transportation or vehicle expenses.

If you must travel over 80 km one way, you will also be able to claim the cost of meals. You are allowed up to $17 per meal up to a maximum of $51 per day. You can learn more here.

Finally, you can also claim your accommodations and parking fees for travel over 80km. Again, make sure that you have a letter stating that you have traveled for medical appointments.

In the US, you can deduct 23 cents per mile in lieu of gas and oil, plus any parking fees and tolls for travel to medical appointments. If you take a taxi, bus, train, airplane or ambulance you can deduct the actual expense. You can deduct the cost of any accomodations, but unlike Canada, you cannot deduct the cost of meals.

In the US, these expenses must exceed 7.5% of your gross annual income. The amount will rise to 10% in the 2019 tax year. For those living in Canada, medical expenses must be above the lesser of $2,208 or 3 percent of your net income.

HSA/FSA

If you live in the USA, you can also save by contributing to a Health Savings Account (HSA) or a Flexible Spending Account (FSA).

These accounts are managed by financial institutions and accessed in the same way as you access your chequing account.

Both a Health Savings Account and a Flexible Spending Account are made up of tax-deductible contributions with pre-set contribution limits. Contributions can be set up through your employer. Both accounts also share the same list of “qualified expenses”.

The difference, however, is in who is eligible. Anyone can contribute to an FSA but only those with a high deductible ($1,350 or more for an individual or $2,700 or more for a family in 2018) health plan are eligible for the Health Savings Accounts. 

The maximum contribution to an HSA is $3,450 for an individual and $6,900 for families.  The maximum contribution into an FSA is $2,650. (at the time of this writing)

Disability Tax Credit

In Canada, we do not have Health Savings Accounts. We do however have a Registered Disability Savings Plan. To access this plan and the associated government grants, you must first apply for and be approved for the Disability Tax Credit (DTC).

The DTC is a non-refundable tax credit that reduces your taxable income. To qualify, you must be insulin-dependent and spend over 14 hours per week on your care.

See if you might qualify for the DTC here.

To make sure that you have all of the receipts you need, download our checklist before you start your tax return this year!

19 years later and the guilt remains

I found this photo the other night. It was tucked away in an album I had created for my son when he was just a baby. There were sweet memories and even a bit about the time he spent in the hospital after his diagnosis with type 1 diabetes.  When I saw this photo however I wanted to cry.

It has been nineteen years since this photo was taken.  My son is now a  strong young man living on his own.  The years have brought both of my children many challenges in their short lives and the way they have handled them makes me proud. Looking at this photo, however, cuts me to the core. How did I not see?

When I posted this photo to social media someone commented that the boys looked happy.  Another person commented on how cute they were.  I was struck by how thin my youngest was.  His little face was hollow looking.  His eyes seemed to be sunken in his small head. How did I miss that?

My youngest was always the slimmer of the two boys. He was born a pound lighter than his older brother.  Throughout his life, he has always managed to remain slim. Looking at this photo though, he was beyond slim.  As some would say, he looks poorly.  He has a sickly pallor behind the glimmer in his eye. Why didn’t I see that then?

I now know that his body was eating itself to survive. He was just making enough insulin to keep himself out of the hospital. I know that holiday treats and Christmas dinner must have been hard on his small body.  His blood sugars would have been skyrocketing out of control.  No one was stopping them.  No one was helping his tiny little body to work properly. What sort of parent was I?

I made sure that my children ate very few preservatives.  I attempted to keep my them safe from toxins.  While I thought I took good care of them, this picture suggests otherwise. Somehow I missed this. I didn’t see him fading before my eyes.

19 years ago this picture was taken.  I thought that I was long past the feelings of guilt and sadness. It would appear I was wrong.  An image of two sweet, small faces smiling from under a Christmas tree brought it all rushing back.  This picture of innocence has unleashed a flood of reprimands for my former self.

This is why parents of children with diabetes don’t need society to blame us for our child’s diagnosis.  Years later, we can still berate ourselves for what we didn’t do.  We can still cry over the fact that we failed to protect our children from their own bodies…even when it really isn’t our fault. We still feel carry that guilt.

Make sure that you know the signs of type 1 diabetes.