My Diabetes Inklings

Healthcare During COVID19

Part of my research interests revolves around mobile health and integrating that into mainstream healthcare system. Mobile health can include things like online peer support, online platforms used to deliver health services and telehealth. For years, there has been advocacy for telehealth subsidises and its integration into metropolitan hospitals. And for years, it’s been “too difficult” or “there isn’t a need for it”. Cue COVID19 and within a few weeks, majority of our health appointments are done via telehealth or videoconferencing.

At the same time, I find myself in a sea of appointments. I had several endo appointments trying to sort out my thyroid, my educator appointment and a few GP appointments to coordinate other referrals. Not to mention frequent visits to the pathology lab.

I have to say that even though I really appreciated the quick phone call appointments with my endo, I missed going in to catch up. With my educator, we had used a videoconferencing platform. It was awesome to see my educator at the other end but I still missed our “hang out” time and long chats. Turns out I can be a really Chatty Cathy with my diabetes team. Then I had the horror realisation that I was one of those patients who doesn’t stop talking…Eep! Sorry!

Given that I usually travel a fair distance to see my endo and educator, the time saved by using telehealth was invaluable. If they were running late, I was able to continue working while waiting for their phone call or being in the virtual waiting room. I didn’t have to wrangle public transport or pay for parking. I did miss making these appointments a bit special without my usual cafe treat experiences, but that will come back soon.

Since I was a new patient at the GP clinic, I had to attend the first appointment in person. I was excited (and slightly anxious) to have a reason to leave the house and go for a walk! Thankfully the clinic was super organised and had strict entry screening and social distancing rules. It was also so nice to speak with others in person. I didn’t realise how much I had missed it.

As much as I love telehealth professionally and personally, I think that there will always be a place for face to face consultations. I’m still really excited that practitioners around Australia are adapting to telehealth options. COVID19 seems to be the push that the healthcare system needed to keep up with the times and technology the world has got to offer. Of course, we still have a way to go to integrate this into our healthcare system as usual practice. To this, I say, bring it on!

My Diabetes Inklings

Social Distancing with Diabetes

How the world has changed so quickly within a few days/weeks/months where we’re suddenly living out the Contagion movie. I didn’t think it would take me so long to adjust to isolation life; I was always keen on the idea of working from home anyway. It wasn’t until I saw a quote on twitter that nicely described my struggle:

Every time someone asks how I’m going, it’s impossible to be anything but positive. There are so many things I am grateful for and others in worse conditions that I really can’t complain about anything. It almost feels a little bit like survivor’s guilt. We’ve got a roof over our heads, food to eat, regular income, toilet paper to wipe our bums and the Internet to connect with friends and family.

At the same time, there’s no denying the tinge of stress and uncertainty that COVID19 has brought to our home. I am worried that when there won’t be insulin or my usual diabetes supplies when I go to the pharmacy (another reason not to panic buy!). I am scared of contracting the virus cos I know diabetes and viruses never play nice together. I am exhausted from the impact of stress sending my blood sugars into its own theme park with wild roller coasters.

You’d think that being in a routine at home would help with diabetes management. Yet I forget that stress likes to create surprises in blood glucose profiles. The only thing I’ve really enjoyed was the shift to using telehealth for my diabetes appointments, which has saved me so much time travelling and sitting in waiting rooms!

Even though everything is physically fine, my mental health has certainly been impacted. There are days where I am super productive and other days where I just can’t. Thankfully we’re still able to go for walks and I’m trying to incorporate this where I have a small break from work to get some sunshine in. I’ve made yoga a daily must-do to get my body moving and my boxing trainer has been running free online sessions everyday.

Isolation has really forced me to focus on myself more than ever. Now is as good of a time to remember that everyone processes stress differently. If you need to take a break from social media, do it. If you haven’t got the time to learn a new hobby or cook a scrumptious banquet everyday, don’t sweat it. I am, though, expecting a whole lot of handmade gifts and feasts in the near future from my crafty and foodie friends!

I’m surviving the days by counting my blessings, and prioritising things that really matter in my life. Treasure the things that make you smile and find things that make you belly laugh. The COVID19 pandemic is madness but it has also gifted us a rare moment of stillness in the world among its chaos.

My Diabetes Inklings

The Guilt of Privilege

I have access to subsidised (aka free) CGM and I feel guilty as heck for it. As my diabetes educator signed the forms, the wave of emotions hit me. I was excited, happy, relieved, angry and frustrated. It felt incredibly unfair that I was accessing CGM without cost while others were scraping every dollar to afford these.

CGM is precious. I remember trialing it when I started on my first insulin pump about six years ago now. It was life changing to be able to see what happened in between the finger pricks, to get alerts and see glucose level trends. I was armed with so much data that exercise didn’t seem so daunting anymore and the anxiety around hypos and highs were greatly reduced as well.

While the technology is awesome, the price wasn’t. Currently a Dexcom G5 transmitter is about $500 for three months, each sensor costs about $80 and lasts seven days. The Freestyle Libre sensor is $92.50 plus postage (don’t even get me started on having to pay for postage…). I’m not sure how much Medtronic sensors cost but I’d assume it’s comparable and the last time I checked, they were slightly more affordable on a subscription plan.

Of course, the diabetes community has come up with workarounds to get more bang for your buck with rebatteried CGM transmitters and extending sensors for as long as we can. For us, the benefit of having that continuous data outweighs the risk of infection that comes with extending the sensor.

While we make do with what we’ve got, many people are working in the background to to get CGM and Flash subsidy for everyone with type 1 diabetes (and hopefully for other people with diabetes who will benefit from it too down the track). We’ve come a long way since CGM first came to Australia and there’s still a long way to go.

Thank you to all the organisations and people behind the scenes who have made it possible for me to access subsidised CGM. I promise to pay it forward by donating expired transmitters to be rebatteried and doing what I can to keep advocating to achieve access for people with diabetes who will benefit from it. Out of pure habit I’m still extending my sensors for as long as possible (although the best I’ve done so far is just under three weeks). It’s the least I can do to ease this guilt and to make the most of what I am lucky to have.

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