As of the end of 2011, insulin pumps have been moved to the new Section C of the Australian Government Prostheses List, guaranteeing its permanent place on the list. Section C is designed to include non-surgically implanted devices like insulin pumps that have an internal part which is essential to its effectiveness.

These changes recognise the value of insulin pump therapy, and increase pump accessibility through private health insurance. However, it is still important to confirm your eligibility for insulin pump benefits with your health fund.

The Rules require that a private hospital policy which includes a listed Prostheses must pay a benefit for an insulin pump on the Prostheses List when:

• The pump is provided during a professional service for which a Medicare benefit is payable;
• The service is professional attendance by a consultant health care professional;
• The professional service during which the pump is provided is a certified Type C procedure for which the admitting health care professional certifies that the hospitalisation was necessary because of the patient’s medical condition and/or other special circumstances

For more information about private health insurance and to compare prices and benefits of all private health insurance policies available, visit the Private Health Insurance Ombudsman’s website.

If you are interested in an insulin pump, JDRF’s Insulin Pump Program provides government-funded subsidies for insulin pumps for children under 18 who are not covered by private health insurance. For more information and to request an estimate of the subsidy you may be eligible for, please see the JDRF website.

The study looked at 27 teens and their parents, and analyzed their internalizing behaviours, or anxiety and depression, as well as externalizing behaviours, which relate to conduct problems and hyperactivity.

The study suggested that ‘greater lifestyle freedom and flexibility … may impact positively on children and adolescents,’ which echoes what many people in the type 1 diabetes community are saying about insulin pumps.

JDRF CEO Mike Wilson said has that “Children with type 1 diabetes face a huge strain juggling the management of diabetes with the demands of daily life. We know that insulin pumps can make this daily and lifesaving management much easier.”

The study was supported in part by a restricted research grant and provision of equipment from Medtronic Australasia. Medtronic had no involvement in study design, conduct, data analysis or preparation and submission of the manuscript.

 Diabetic Medicine 2011; doi: 10.1111/j.1464-5491.2011.03322.x

The Australian Civil Aviation Safety Authority (CASA) has changed its regulations to allow people with type 1 diabetes to pilot planes in some circumstances.

So what’s the catch? The license that is initially available is a Class 2 certificate, which allows piloting of private and recreational planes only. Additionally, flying with a safety pilot will be mandatory for 15 incident-free flights.

CASA will require that two ‘recording devices’ (BGMs) are used during flight, with a preference for continuous blood glucose monitoring over traditional methods.  Patients must not have any significant diabetes complications, including retinopathy.

The Medical Journal of Australia (MJA) stated that the relationship between ‘diabetes and aviation has been emotive and controversial, with a perception of conflict between individual rights and the need for aviation safety.’

This means that the regulations are navigating a complex path between the rights of a person with type 1 diabetes and acknowledgement that a blip in diabetes management could lead to harm for the pilot, their passengers and people on the ground.

In the normal course of life, those with type 1 diabetes are the best ones to judge their health and their ability to conduct challenging tasks. This is more possible now than ever before, with help like improved control and management practices, technology like insulin pumps, the latest BGMs and continuous blood glucose monitoring around the corner. Yet regulatory challenges remain for high risk career paths like flying.

The new regulations mean that main challenge facing those who want to pilot planes is control. Applicants will need to prove that they have not had a hypo in the previous year that required the assistance of another person, and that their last 3 HbA1c results over 6 months have been less than 7.5%.

So what’s happening overseas? In the US, private pilots can fly without a safety pilot, as long as they keep their BGM in the range of 5.5 – 16.0 mmol/L. Those levels would be considered ‘running high’ by most people. The MJA noted that this creates an perplexing ethical issue by effectively forcing pilots with type 1 diabetes to risk complications by keeping their BGL relatively high.

For year nine student Brendan, the change in Australian regulations is a promising sign.

Brendan’s dream is to be an Air Force pilot but having had type 1 diabetes for nearly 10 years, this dream is currently out of reach. It is diabetes not airplanes that he thinks of when he first wakes up in the morning and last thing at night.

Brendan is carving out his own air force path. He participates in camps to learn to make model airplanes, as well as other activities like aircraft recognition and survival. He says these activities have been ‘a great way for me to learn more about myself and living well with type 1 diabetes.’

Brendan’s life is full and he says ‘I am having a lot of fun but I believe things must get better as we continue to change the type 1 world we live in.’

‘To make my dream a reality we need to find a different outcome for people living with type 1 diabetes.’

Whilst it has long been known that insulin pump therapy can provide both a physical and psychological benefit to users, results from the recent Sensor-Augmented Pump Therapy for A1C Reduction trial (otherwise known as STAR 3) have shown that using an insulin pump in combination with a continuous glucose monitor can significantly reduce blood sugar fluctuations.

Published in the New England Journal of Medicine, results showed that all patients using the sensor-augmented system demonstrated a reduction in mean A1C levels that was four times greater than patients using insulin injections alone. This lower A1C result was sustained throughout the year of the trial.

An important additional result highlighted by the researchers was that the reduction in average blood glucose levels was not associated with an increased incidence of hypoglycemia.

One of the key steps to the development of an effective ‘artificial pancreas’ is the successful pairing of insulin delivery with blood glucose measurement. This research, in combination with the exciting results being obtained by the JDRF Artificial Pancreas Consortium, show that using a combination system enables users to better manage their glucose levels, even when eating, exercising or sleeping. Ultimately this will result in reduction of long-term complications and hypoglycemia and an increase in quality of life.

The Sensor-Augmented Pump Therapy for A1C Reduction trial was sponsored by Medtronic and involved JDRF-funded researchers across the US.

To date, the closed-loop systems tested have combined an insulin pump with glucose monitoring and complex computer programs designed to predict and activate insulin release as required. Whilst results of these trials have been overwhelmingly positive, researchers have found it to be more difficult than first anticipated to finely tune blood glucose levels – particularly when protecting patients against potentially dangerous hypoglycemia caused by too much insulin.

Dr Edward Damiano

This research program, led by Dr Edward Damiano in Boston USA, looked to the healthy pancreas for inspiration and came up with the idea of adding glucagon into the system.

Glucagon is a hormone produced naturally by the healthy pancreas to oppose the effect of insulin – finely tuning glucose levels by releasing the right amount of insulin or glucagon depending on how much glucose is required for the body to function. As most people with type 1 diabetes will know, glucagon is also used in hospitals to remedy hypoglycemic emergencies.

In this trial, the researchers developed a predictive computer program and pump technology that allowed for minute amounts of both insulin and glucagon to be released in response to fluctuating blood glucose. They combined this with intravenous glucose monitoring and tested the system on 11 hospital-based patients with type 1 diabetes.

Whilst the system did require some tweaking to account for unexpected differences in insulin absorption rates, the final results showed that all 11 patients maintained blood glucose levels within the target healthy range throughout the duration of the trial, even after eating high-carbohydrate meals.

Future trials are now planned to investigate the potential for introducing a commercially available continuous glucose monitor and to test the success of the system in patients experiencing realistic life situations such as exercising or illness.

Find out more about the JDRF Artificial Pancreas Project.

Cooper is a bright, active, “beautiful” seven year old boy who has had type 1 diabetes since he was three. Back then, while visiting a sick brother in hospital, Cooper picked up a virus. Leah says he never really recovered.

After a high temperature, Cooper started wetting the bed and consuming litres of water every night. He was quickly diagnosed with type 1 diabetes and spent a week in hospital on the general ward, while he recovered and his parents learnt about their new life of needles, fingerpricks and hypos.

The hypos are a worryingly frequent event in little Cooper’s life. Leah says sadly that his control is not very good. “Cooper is very sensitive to insulin. He’ll run really high and the doctor will increase his dose by just one unit to bring it down, but then we run into a spiral of hypos. There is no happy medium.”

As a result of the challenges with his insulin sensitivity, Cooper is currently having two or three hypos every day. Leah counts herself lucky that he has only ever had two overnight hypos, but luck has had little to do with it. She is vigilant at night with her son.

“I check him every three hours through the night because I’m so worried about hypos. I managed to combine it with feeding the baby so I was able to squeeze in a little bit of sleep!”

Cooper’s life with type 1 diabetes is about to change dramatically. The Australian Government has announced a big increase in the subsidy available for insulin pumps, which will make the technology much more affordable for families like Cooper’s.

The Type 1 Diabetes Insulin Pump Program was launched in 2008 and provides a means-tested subsidy towards the purchase of an insulin pump for children under 18. In Australia insulin pumps can cost up to $8,000, making it a medically desirable but unaffordable option for many without private health insurance.

Children under 18 with type 1 diabetes will now be eligible, on the recommendation of a health professional, for a significantly increased subsidy of up to 80% of the cost of an insulin pump, up to a maximum of $6,400. The subsidy will be means-tested and based on a sliding scale reflecting family income.

Research shows that insulin pumps can help in the management of type 1 diabetes by minimising the dangerous fluctuations in blood glucose levels that lead to complications.

Insulin pumps also alleviate the intrusive daily regime of management and injections.

Cooper’s need for supervision of his diabetes is ’round the clock’, so it is clear that an insulin pump is going to change the family’s life.

Leah has always made excuses for him to avoid birthday parties, and Cooper has never stayed overnight with grandparents or friends. Leah says “It is understandable that most other people don’t feel comfortable giving him needles and it’s a big responsibility to hand over.”

Cooper will still have type 1 diabetes after he gets an insulin pump and he may still experience hypos. But his diabetes management will get a lot easier. Insulin adjustments on pumps can be made in 0.05 unit increments.

Cooper is excited but nervous. Currently he has all his needles in his bottom, because he is very small and with no fat on his tummy, it quickly gets lumpy when he has injections there. The doctor has reassured him that he can have his pump site on his bottom too, minimising the pain of the site change.

For the next few weeks, he will watch Leah’s friend who has type 1 diabetes do a bolus dose on her insulin pump for her coffee and cake, and imagine all the things he will be able to do for the first time when his insulin pump arrives.

The program was first launched in 2008 and provides a means-tested subsidy towards the purchase of an insulin pump for children under 18 who do not have access to private health insurance.

In Australia insulin pumps can cost up to $8,000, making them a medically desirable but unaffordable option for many without private health rebates.

Children under 18 with type 1 diabetes will now be eligible, on the recommendation of a health professional, for a subsidy of up to 80% of the cost of an insulin pump, to a maximum of $6,400 and a minimum of $500.

The subsidy will be means-tested and based on a sliding scale reflecting gross family income.

This program will potentially impact around 500 Australian children with type 1 diabetes who would benefit from moving from multiple daily insulin injections of insulin pump therapy.

JDRF CEO Mike Wilson said increased access to insulin pumps had the potential to dramatically change many hundreds of lives.

“Children with type 1 diabetes face a huge strain juggling the management diabetes with the demands of daily life. We know that insulin pumps can make this daily and lifesaving management much easier.”

“More importantly, pumps are the best way for many patients to improve their chances of a healthy future, making this subsidy a win-win for people with type 1 diabetes and Australia’s health system.”

The Type 1 Diabetes Insulin Pump Program is a collaboration between the Juvenile Diabetes Research Foundation and the Department of Health and Ageing.

For more information for patients about the Type 1 Diabetes Insulin Pump Program, please contact Chanelle Stowers on 02 9966 0400 ext 223 or cstowers@jdrf.org.au.

Alternatively, visit our website for more information and the online subsidy estimator.

Show your support for the insulin pump subsidy

Send a thank you message to the Hon Nicola Roxon MP for increasing the government subsidy.

The Juvenile Diabetes Research Foundation has today announced an innovative partnership to develop an automated system to help people with type 1 diabetes better control their disease – the first step on the path to what would be among the most revolutionary advancements in treating type 1 diabetes: the development of an artificial pancreas, a fully automated system to dispense insulin to patients based on real-time changes in blood sugar levels.

JDRF has formed a partnership with Animas, a Johnson & Johnson company and a leading manufacturer and distributor of insulin delivery and glucose management systems.

The objectives of the partnership, a major industry initiative within the JDRF Artificial Pancreas Project, are to not only produce the automated system but to conduct extensive clinical trials for safety and efficacy and submit the product to the regulatory authorities for approval and subsidy.

“If successful, the development of this first-generation system would begin the process of automating how people with diabetes manage their blood sugar,” said Mike Wilson Chief Executive Officer of JDRF Australia.

“Ultimately, an artificial pancreas will deliver insulin as needed, minute-by-minute, throughout the day to maintain blood sugars within a target range.  But even this early system could bring dramatic changes in the quality of life for the 140,000 Australians living with type 1 diabetes, beginning to free kids and adults from testing, calculating and treating themselves throughout the day.”

Dr. Alan Lewis, CEO and President of JDRF International noted that “JDRF will provide $US8 million in funding over the next three years for this project, with a target of having a first-generation system ready within four years.”

Currently, type 1 diabetes is managed with insulin injected from a needle or an insulin pump and regular fingerprick blood tests. Unfortunately, blood glucose levels can change rapidly in response to hundreds of different triggers making it extremely difficult to accurately predict the amount of insulin required.

This first-generation system will be partially automated, utilising an insulin pump connected wirelessly with a continuous glucose monitor (CGM). The CGM continuously reads glucose levels through a sensor with a hair-thin sensor wire inserted just below the skin, typically on the abdomen.  The sensor would transmit those readings to the insulin pump, which delivers insulin through a small tube or patch on the body.  The pump would house a sophisticated computer program that will address safety concerns during the day and night, by helping prevent hypoglycemia and extreme hyperglycemia.  It would slow or stop insulin delivery if it detected blood sugar was going too low and would increase insulin delivery if blood sugar was too high.

For example, the system would automatically discontinue insulin delivery to help prevent hypoglycemia, and then automatically resume insulin delivery based on a specific time interval (i.e., 2 hours) and/or glucose concentration.  It will also automatically increase insulin delivery to reduce the amount of time spent in the hyperglycemic range and return to a pre-set basal rate once glucose concentrations have returned to acceptable levels.

In this early version of an automated diabetes management system, the patient would still need to manually instruct the pump to deliver insulin at times, (i.e. around meals).  But this “hypoglycemia-hyperglycemia minimiser” system would represent a significant step forward in diabetes management, and could provide immediate benefits in terms of blood sugar control, by minimising dangerous highs and lows.

The Artificial Pancreas Project was established by JDRF in 2005. You can find out more at www.jdrf.org/artificialpancreas.

You can help speed up the process of bringing the Artificial Pancreas to reality. Support the Artificial Pancreas Project by giving to JDRF. Every dollar will help bring research to reality.

There is extensive research to show that tight blood glucose control is the best way to prevent the onset of type 1 diabetes complications such as kidney failure, retinopathy and heart disease. According to results from the Diabetes Complications and Control Trial, every one point reduction in HbA1C reduces the risk of long-term complications by approximately 40%.

Unfortunately, research has also shown that one of the hurdles to tight blood sugar control is the risk of hypoglycemia – both real and perceived.

Over the past 15 years the use of different insulin analogs as well as improvements in insulin pumps and blood glucose monitoring has had a positive impact on the ability of people to achieve blood sugar control targets. The rates of severe hypoglycemia, however, remain high and occurrence of such events is often followed by a decline of glycemic control due to fears of further hypoglycemic episodes.

In two multi-centre clinical trials – the first concentrating on people with bad glycemic control and the second on people who intensively manage their blood sugars – JDRF researchers have now demonstrated that an excellent solution to this problem is the use of a continuous glucose monitor, or CGM.

According to these trials, people using CGM spent two hours more time per day in the target blood sugar range of 3.9 to 10.0 mmol/l compared with people using fingerprick testing alone. They also found that CGM subjects had a significant overall improvement in HbA1C over time without an increased number of hypoglycemic attacks.

CGM devices are worn in a similar fashion to an insulin pump and provide both a real-time snapshot of glucose levels as well as trend information on whether glucose is moving up or down. They can also provide a warning when glucose is becoming too high or too low.

The continuous glucose monitor is a key component of the JDRF international Artificial Pancreas Program and these results take researchers one step closer to making the artificial pancreas a reality.

Diabetes Care published online 25th May 2009