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Tax Credits, Registered Disability Savings Plans and Grants in Canada

Tuesday, February 14, 2017 2:49:25 PM America/New_York

by Barbara Wagstaff of http://www.diabetesadvocacy.com

Diabetes is a costly disease in so many ways. Trying to fight complications can be a financial burden that often is too much to carry. Sadly it is the poorest in our world who stand the highest chance of experiencing complications. Some  provinces and states in North America offer  help  to cover the costs of such items. That is still not enough. There are those of us in Canada who are and will continue to lobby various government agencies so that one day there is no longer this gap and everyone living with diabetes will have equal access to the best methods of care.

Disability Tax Credit

What is the Disability Tax Credit?

The Disability Tax Credit is a credit offered by Revenue Canada to those of who have a severe mental or physical impairment which markedly restricts the basic activities of daily living and/or need and dedicate time for Life Sustaining Therapy (Therapy that must occur at least 3 times per week for more than 14 hours per week). They further require that the person eligible have an impairment that has lasted or is expected to last for a period of 12 continuous months. Further Revenue Canada notes "For the purposes of the disability amount, Life Sustaining Therapy is any treatment for a disease or a disorder that, if withheld would prevent the functioning on one or a group of vital organs to sustain human life."

There are some who do not wish to be labelled as "disabled" or have their child carry such a label. I respect that but for myself and others, any financial relief provided by the Federal government is accepted and desired.

Who Can Apply?

The Disability Tax Credit is available to those who have a taxable income and who are markedly restricted in the Basic Acts of Daily Living OR require 14 or more hours per week to administer Life Sustaining Therapy.

My child or I have Type 1 Diabetes. Do either of us qualify?

Yes! If you or your child use an intensive insulin management system, you will qualify for the Disability Tax Credit because you require Life Sustaining Therapy.  You require an insulin regime to keep you and/or your child alive.

But what is an Intensive Insulin Management System?

This means that you are taking more than 1 or 2 injections of insulin per day,  you are monitoring your blood glucose levels 6 or more times per day, you are monitoring your carbohydrate income to match your insulin needs, and you are keeping detailed data on trends and patterns for your diabetes care.

I'm on a pump so I automatically qualify right?

WRONG.  As of the 2004 tax year, the method of insulin delivery no longer matters.  What matters is the time you spend on Life Sustaining Therapy.  In previous years, the amount of time spent injecting insulin was the criteria for acceptance.  Insulin pumps inject 24/7.  With the changes, activities must take away from routine daily living.

Please note that if you are using an insulin pump, you can ask to be reassessed for the years 2000-2004 based on pump use.  This will not help you after 2004 BUT you will be given the credit based on the 2000 guidelines for those in between years. Those people who used injections during that time will not qualify.

What if I have no taxable income?

People with low incomes may still find some relief but the credit is designed to assist in reducing your taxable income.  IF you have a child with Type 1 diabetes, there is an added benefit to being approved for the DTC regardless of your income level.  If you are receiving a Child Tax Benefit AND you have a child with Type 1 diabetes, you will be entitled to an added Disabled Child Benefit each month.

But I already filed my taxes for this year. Do I have to wait until next year?

NO.  You can fill out the T2201 at any time.  When you are ready to submit it, you simply request that CRA reassess your taxes for the applicable years (2004 and 2005 for example)

Where do I start?

You will first need to obtain a T2201.  This can be ordered from CRA or found online by clicking on the following link http://www.ccra-adrc.gc.ca/E/pbg/tf/t2201/

This form must then be filled out by the applicant and by an attending physician.  For details on what may be included in this form, please see our Tips section.

The T2201 is sent in with your income tax return. You will fill out your income tax return as if you have ALREADY been approved for the credit and will fill out line 316 (or line 318 to transfer from a  dependent).

What do I need to tell my doctor to have the form signed?

It is important that physicians understand what they are signing. If you have a child with Type 1 diabetes, make sure that your doctor understands that by signing the T2201, they are certifying ONLY that the child has a diagnosis of Type 1 Diabetes.  They are NOT being asked to specify how much time the child or family spends on diabetes related care.  CRA assumes, based on previous Tax Court cases, that to look after a child (presently defined as someone under 18 years of age) with Type 1 diabetes requires more than 14 hours dedicated to Life Sustaining Therapy on the part of the parent and the child.

For adults and older children, the doctor must understand that they WILL be asked to fill out a supplementary form.  Provide your doctor with as many details of what you do over a week as possible.  They must understand how you spend your time so that they can accurately fill out the supplementary form.  Again, our tips page lists what activities are currently recognized as being part of Life Sustaining Therapy for Type 1 Diabetes. The more information you and your doctor can provide in the original T2201, the less room for error.

Make sure that your doctor indicates that this condition is PERMANENT.  It may effect the amount of time you are given the credit for.

How long will I get the DTC for?

The length of time you qualify for the DTC is subject to CRA's internal policies.  They can grant the credit for one year time frames, and you will have to reapply each year, or they can grant it for specific lengths of time (i.e. 5 years), or they may grant it permanently.  The last scenario is unlikely unless there are other underlying conditions that would warrant it.

When you receive your Notice of Assessment stating that you qualify for the DTC, there should be a further statement of exactly how long you have before you need to reapply.

I received the DTC already as a pumper. Will I be disqualified under the new guidelines?

You will not be disqualified, but you may receive a letter stating that the criteria has changed.  This does NOT mean that you don't qualify. It simply means that you need to reapply under the new rules.  If you were given the credit for 5 years for example, you should not receive any letters but will have to reapply under the new rules when your 5 year period ends.

How do I fill out the form?

Go to the above CRA site and download the form.

On the "Self-Assessment page" check off "yes" to question 3 Do you require life sustaining therapy?

Fill out Part A, page one of the Disability Tax Certificate.

Part B is to be filled out by your doctor. The only issue of importance for most people is "life sustaining therapy".

Your doctor will check off the box "yes" when asked "Does your patient meet the conditions for life sustaining therapy as described above?"

In the section of "year" he/she will put the diagnosis year.

Details would be insulin dependent Type 1 diabetes and then the method of insulin delivery (please remember that method of deliver does NOT change your eligibility for the DTC)

Effects of impairment is the reliance on an external source of insulin to sustain life.

Duration is annoying for those living with diabetes but you must remember that this form is for other diseases/conditions as well. Please note that "yes" the impairment will last for more than 12 months and no there will be no marked improvement thanks to therapy (there will be no cure).

The physician signs off on the form and you submit it with your tax return.

What do I do if I am sent a second form asking about time spent?

The easy answer is of course to simply tell them all the time it takes you to fill cartridges, adjust basals, and do all of those things that you have probably forgotten take time out out your day. If you sit for one day and every time you do something because you have diabetes, you will quickly be amazed how time adds up.

Here are examples:

For injections: Establish the insulin required based on time of day, caloric intake, activity level and wellness; clean the area with alcohol; make sure alcohol is dried; clean insulin vial with alcohol; remove cap on needle; draw up correct amount of insulin; pinch skin; insert needle; inject insulin; relax hold on skin; place swab over injection site and maintain pressure for a few seconds; replace protective cap on needle; and properly dispose of needle. This takes approximately 6 minutes multiplied by the number of injections per day. For a person who uses a long acting and injects for meals you would count a minimum of 5 needles per day (without corrections) totalling 30 minutes per day, and 210 minutes per week (3.5 hours)

For insulin pumps: Establish the insulin required based on time of day, caloric intake, activity level and wellness (2 minutes six times per day for 84 minutes per week), change pump tubing and insulin cartridge (7.5 minutes every other day totalling 70 minutes per week); adjusting pump programming to accommodate for temporary basal rates, exercise, changing bolus ratios or altering basal rates (10 minutes daily, 70 minutes per week), site change and rotation (10 minutes every other day, 35 minutes per week), emergency site changes due to sites falling out or failing (17.5 minutes twice per week, 35 minutes), establishing correction doses (1 minute twelve times per day, 84 minutes per week), changing pump battery (2 minutes every other week, Logging: I know not everyone logs but reality says that you must look at trends and see if you need adjustments for your exercise routine, pizza supper, or that extra shift at work.  All of these things are tasks that a person with a functioning pancreas would not have to do. This is something you do think about. It would total a minimum of 30 minutes per day, equating to three and a half hours per week.

Analyzing trends and making adjustments: every three days, 20 minutes equals one hour per week Checking meter: this includes coding, using control solution, changing lancet for approximately fifteen minute procedure

Repeating Blood Glucose Test when meter error occurs:  two minutes of your time approximately five times per week (10 minutes)

Treating lows: CDA guidelines state a low is anything under 4. How many lows are normal? This is individual but if you maintain tight control it is more likely to occur. Fourteen lows per week and 5 minutes to treat equals 70 minutes per week.  CRA states in their legislation that recovery time from lows does not count in the calculation of time spent on Life Sustaining Therapy(an extra 15 minutes per low). It has been argued that this is part of therapy and privately they agree but unfortunately there does not seem to be legal precedents backing us at the moment.

Dealing with highs: Again, not to be taken lightly. You need to establish a correction factor. Some people are more insulin resistant at higher bg levels. If you are pumping, you want to check the tubing and the site. If you are on injections you may wish to look at the insulin and the injected area for hypertrophy. You will need to inject to correct and finally you may also need to test for ketones (three minutes every other week, or 1.5 minutes per week). The amount of time this takes would be approximately 6 minutes and as most people tend to run high more times than low. We found 21 highs per week I would say three highs per day totalling 18 minutes per day, or 2 hour 8 minutes per week

Testing: Testing becomes routine but it still must be done. On average one hopes that there is at least 6-12 tests per day. To test you must wash the area to be tested, ensure that the meter is coded properly, insert the test strip, lance the area, apply the blood, record the reading. 8 times per day at 3 minutes per test is 24 minutes per day or 3 hours per week .

For people using a CGM:  You would most likely have slightly less testing time (6 times per day or 2.1 hours per week) but will have other tasks that must be added into your calculations such as:
Rotating CGM Sensor sites:  10 minutes once per week
Analyzing your CGM Trends:  30 minutes once per week
Emergency Sensor site changes:  10 minutes every other week or 5 minutes per week.
CGM Calibration:  1 minute four times per day or 28 minutes per week)For a total time spent dealing with the CGMS part of your diabetes care being 73 minutes per week.

So what are the totals?

For someone on injections:
Injecting: 4.5 hours (this includes the time required when you are high and need to calculate a correction dose.)
Logging: 3.5 hour
Analyzing trends and making adjustments: 1.5 hour
Checking meter, coding, changing lancets, etc.: 15 minutes
Testing: 4.5 hours (this included the extra time for retesting during lows)
Total: 14.25 hours per week

For pumpers:
Dealing with pump: 6.3 hours
Logging: 3.5 hour
Analyzing trends and making adjustments: 1 hour
Checking meter, coding, changing lancets, etc.: 15 minutes
Treating lows: 1 hour 15 minutes (or more)
Dealing with highs: 2 hours 30 minutes
Testing: 4 hours (pumpers usually test closer to the 10-12x per day mark)

Total: 18.8 hours per week If using a CGM:  add .5 hr.  Time devoted to the CGM part of therapy is approximately 73 minutes but there is usually less time spent testing blood glucose levels which would negate the total or increase it only slightly.

Still not sure?

Diabetes Advocacy offers assistance in filling out the T2201.  We will print off the T2201 as well as any requests for reassessment years, fill in the forms and indicate where you and your doctor need to sign, as well as provide you with a detailed letter stating why people with diabetes now qualify for the DTC.  We are not tax accountants but are well versed regarding the Disability Tax Credit and those with diabetes.  Please make sure that your doctor will support your claim.  This fee is for filling out the appropriate forms for you only. We do not guarantee your success but will assist you with any further issues you may have.

 

Registered Disability Savings Plan

What is the Registered Disability Savings Plan?

RDSP - ITS NOT A MYTH! THERES NO CATCH; AND YES - ITS SO REAL IT WILL CHANGE YOUR LIFE. A Registered Disability Savings Plan (RDSP) was designed to provide long-term financial security for a person with a disability. Tax-deferred investment growth, along with generous government grants and bonds make the RDSP a powerful investment tool. "There must be a catch," is a familiar comment advocates often hear so it comes as a surprise when disabled people learn they can often get thousands and tens of thousands of dollars. Perhaps the most attractive reason to open up an RDSP is to get access to the annual Canada Disability Saving Grants (CDSGs) which can provide 100%, 200% or 300% matching grants, depending both on the beneficiary’s family income and the amount contributed, up to a lifetime maximum CDSG limit of $70,000*

Who Can Apply?

In order to qualify for an RDSP, you must have also qualified for the Disability Tax Credit.

When can I  begin taking money back out?

Money put into a RDSP can be withdrawn at any time but in order to receive the full amount of your grant money, funds must be left in the account for 10 years.  (Grant money received in 2013 are not eligible for use until 2023).

How do I get started?

Contributions for RDSPs can be made through your local financial institution and invested in a way that best suits you and your goals.

The above information has been contributed by Avi Yoffe, a mother of a child with Type 1 diabetes.  She has had the pleasure of educating families with disabled people (adults and children), on how to receive the maximum amount of disability tax credit as well as RDSP Grants and Bonds.  You may contact her with your questions at avi @ rdspforyou.com

How much money will I get from the government?

CRA provides a wonderful breakdown of grant amounts on their website.

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Posted in Living With Diabetes Guides By Tino Montopoli

HOW DO YOU CARRY YOUR PUMP AND SUPPLIES?

Friday, May 6, 2016 3:13:43 PM America/New_York

Kamor Belt with 5 Pockets

Made of polyester/spandex fabric for moisture wicking, quick drying, stretch, softness against your skin, and machine washable. 3M™ reflective strip in the front of belt make your more visible during night.

  • Easily pull this over your head or up your legs and position it on your waist or hips, fitting nice and snug, without uncomfortable chafing. Turn over for double protection.
  • One large pocket, space continuous around the belt, which can hold a lot of personal belongings, another small separate pocket can take your cash, ID, cards more securely. An inner keychain to hook your key tightly plus a zippered pocket for extra security.

https://www.diabetesdepot.org/diabetes/catalogsearch/result?q=kamor

 

Universal Zipper Pump Pouch

This unbelievably small pouch will expand to accommodate more than just an insulin pump, epi pen, asthma inhaler, cell phone, keys, pocket camera, children's snacks, money, identification... or a combination of any other small items that you may want to carry with you on a daily basis, or as you travel.

The built in belt will adjust to comfortably fit waist measurements from approximately 28" to 42".

Assorted colours. https://www.diabetesdepot.org/diabetes/universal-zipper-pump-pouch.html

 

 

Universal Velcro Pump Pouch

Velcro Insulin Pump Pouch is universal for all pumps. Our elastic belts are adjustable to accommodate growing children and to allow the stretch required in active children's lives- 20-38". Assorted colours. https://www.diabetesdepot.org/diabetes/universal-velcro-pump-pouch.html

Clip-N-Go Pump Case

You can clip your insulin pump to your waistband so you can decide where the pump is most comfortable. The interlocking clip holds the pump securely in place. Made of water resistant nylon with a soft cotton lining. Fits all Animas Pumps. 

https://www.diabetesdepot.org/diabetes/clip-n-go-for-case.html

Belter Case

Belter™ for all insulin pumps.

The Belter™ holds your insulin pump on your belt. Just slip your belt through the back of the Belter and you can wear your pump in a horizontal position. The Belter accommodates belts up to 1.5" wide. Appropriate for business attire too.

https://www.diabetesdepot.org/diabetes/belter-case.html

Waist Pouch on Elastic Belt

Wear the pump around your waist for the ultimate in comfort. The soft, adjustable belt and case feel good under your clothing or pajama available in black or beige

https://www.diabetesdepot.org/diabetes/waist-pouch-on-elastic-belt-black.html black

https://www.diabetesdepot.org/diabetes/waist-pouch-on-elastic-belt-white.html beige

 

Bra Pouches in Black or Beige

BRA POUCH, Velcro is sewn onto bra and the pouch adheres to it. Pouch is made of soft Lycra.

https://www.diabetesdepot.org/diabetes/bra-pouch-black.html

FRIO Insulin Cooling Wallets

Travel wallet for insulin. No more messy ice bags. No more worry about refrigeration. Simply activate it with water and it keeps insulin cool for up to 48 hours. Re-usable. Available in a variety of sizes to accommodate insulin vials, pens and insulin pumps. https://www.diabetesdepot.org/diabetes/catalogsearch/result?q=frio

On Thigh or Leg

The Thigh Thing https://www.diabetesdepot.org/diabetes/thigh-thing.html (above the knee) and the Leg Thing (below the knee) https://www.diabetesdepot.org/diabetes/leg-thing.html allows you to wear any insulin pump under dresses, shorts, or pants. It is a discreet alternative to wearing a pump on your bra, belt or underwear. It is a sleeve with a pocket made of nylon/spandex so it won't lose its shape.

LEG POUCH on ELASTIC BELT can be worn discreetly under clothing. Wraps around the thigh or calf with a special pocket for the pump. The Vel Stretch nylon elasticized straps come in thigh width and can be altered to wear alternatively below the knee. Secure Velcro prevents slippage.

Available in black https://www.diabetesdepot.org/diabetes/leg-pouch-for-medtronic-universal.html
and beige https://www.diabetesdepot.org/diabetes/leg-pouch-for-medtronic-universal.html

GirlyGoGarter

 

https://www.diabetesdepot.org/diabetes/girlygogarter.html

This new product is the most talked about accessory at the Oscars.The GirlyGoGarter® is a sexy, lacey garter with pockets that adheres to your upper thigh with patented GentleFlex™ Grippers.  There are two types of pockets on the GirlyGoGarter®: easy-access (on the outside, just within the lace) and lock-flap (on the inside, against your thigh). Both types of pockets keep your insulin pump, BG meter, glucose tablets, money, I.D., lip gloss, mobile phone, keys, passport and all of your essentials safe, secure and right at your fingertips. Available in small (fits 0-6), medium (fits 8-12 and large (fits 14-18). Unsure of size? Go smaller rather than larger. Colours - Black, Nude, Red, Hot Pink, Wedding Blue. Check it out on Youtube http://www.youtube.com/watch?v=DgwQig0qNTQ

Clips, Cases and Holsters for Pumps

Clips, Cases and Holsters for Pumps

phone us with make and model of your pump for recommendations

Multi-Fit Case

Multi-Fit Case

The stylish Multi-fit Case carries everything that the Ezy-fit Case carries plus much more. This new design is suitable for both Type 1 and Type 2 diabetics. The outer case is made of a tough, easy to clean material with a lanyard loop handle, while Velcro and elastic features are used to hold equipment into place.

The top compartment carries a BG Meter, 2 x pen needles, foil or canister test strips, a lancet device, insulin vials, Test-wipes, a Record Book, a Card Sized Personalized Management Plan, a biro, a needle and lancet tips, as well as a rubbish bin. The compartment underneath can carry Insulin Pump Consumables, a Glucagon kit, jelly beans or food for hypo treatments, spare batteries, Test-wipes, test strips, other medications or even money and credit cards.

Finally, everything can truly be stored in the one place. https://www.diabetesdepot.org/diabetes/multi-fit-case.html

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Posted in Living With Diabetes Products By Tino Montopoli

Diabetes Depot’s Diabetes Resolutions for the New Year

Tuesday, January 5, 2016 2:52:29 PM America/New_York

New Years is a time to come up with resolutions to better your life for the future.  Why not use your resolution this year to set goals to better your diabetes management overall health?

Your diabetes management goals for the New Year should be specific, measurable, action-oriented, realistic and time-limited. 

Annual Goals

  • See your physician 2 to 4 times a year.
  • Follow your schedule for checking blood glucose levels.
  • Follow exact instructions for every diabetes medications you take.
  • Know and keep these numbers in check: A1C, blood pressure and cholesterol level
  • get a renal function test and microalbumin test each year.
  • Get moving.  Any form of physical activity is a step in the right direction. Here’s a great video on benefits of physical activity see youtube video called ‘23 ½ hours’ by Dr Mike Evans
  • Create a well-balanced meals plan with your diabetes educator.
  • Have a yearly eye exam.
  • See your dentist twice a year.
  • Get a flu shot in the fall.
  • Always be prepared for a low or high blood glucose reaction - know the warning signs.

Daily Goals

  • Check blood glucose X times a day (depending on what your physician suggests).
  • Take all diabetes-related medications.
  • Examine your feet daily and follow recommended guidelines by CDA or Diabetes Educator.
  • Bathe with mild soap and lukewarm water.
  • Brush and floss your teeth.

New Years is a time to come up with resolutions to better your life for the future.  Why not use your resolution this year to set goals to better your diabetes management overall health?

 

Your diabetes management goals for the New Year should be specific, measurable, action-oriented, realistic and time-limited. 

Annual Goals

  • See your physician 2 to 4 times a year.

  • Follow your schedule for checking blood glucose levels.

  • Follow exact instructions for every diabetes medications you take.

  • Know and keep these numbers in check: A1C, blood pressure and cholesterol level

  • get a renal function test and microalbumin test each year.

  • Get moving.  Any form of physical activity is a step in the right direction. Here’s a great video on benefits of physical activity see youtube video called ‘23 ½ hours’ by Dr Mike Evans

  • Create a well-balanced meals plan with your diabetes educator.

  • Have a yearly eye exam.

  • See your dentist twice a year.

  • Get a flu shot in the fall.

  • Always be prepared for a low or high blood glucose reaction - know the warning signs.

 

Daily Goals

  • Check blood glucose X times a day (depending on what your physician suggests).

  • Take all diabetes-related medications.

  • Examine your feet daily and follow recommended guidelines by CDA or Diabetes Educator.

  • Bathe with mild soap and lukewarm water.

  • Brush and floss your teeth.

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Posted in Living With Diabetes By Tino Montopoli

Tell Us Your Storey: Shae Forrester

Thursday, October 22, 2015 11:26:53 AM America/New_York

Not only do I have I child with this life threatening illness of Type 1 Diabetes, but also my other child  continues to suffer with the symptoms of heart disease called Tetralogy of Fallot.  As a mother, I love and protect my children including the food that they eat and to see that both of my children are consistently fighting for their lives, leaves me with a heavy burden each day.  They are both now also living with depression as a result.  I seem to have to kiis the doctors asses and nurses to sign my son" ADP form for funding.  They keep passing it aroung while my son's life slips into danger zone.  

They say that although my son is using and benefitting from the insulin pump, and that he has depression, ADHD, speech language delay, that he is not testing the 4 times per days as the form indicates.  My phone call to ADP supervisor, Chris Vactora confirms to me that my son medical team can simply write a letter and attach it to the form that my son is still on the insulin pump and that he is benefitting from it.

To date they have not responded to any of my request and my son have to continue to reuse the instruments to last him from month to month. While I struggle with all this and to help him navigate due to his speech, depression, frustration, he is at risk as he had 2 near death experiences in the past due to all this.  This is a Canadian crying out for HELP and no one listening..

My daughter has a colourful stretch of medical dilemas that is throwing my emoting to a new level and so I will stop here.

Thank you for this opportunity to talk for my son Ty and my daughter T

Shae

Posted in Tell Us Your Story By Tino Montopoli

Insulin Absorption and Infusion site Health

Wednesday, August 26, 2015 12:21:39 PM America/New_York

Considering that insulin pumps are new to more than a third of the population with type 1 diabetes in Canada, we continue to learn new positives as well as challenges in use of the therapy. An emerging challenge is long term infusion site health as it relates to absorption of insulin. In my experience, about one in four pump users have insulin absorption issues which ultimately affect overall Diabetes control (A1c).

Signs and observations:

  • increase in total daily dose of insulin over past year or more >/= 25%.
  • increasing A1c
  • new onset insulin resistance diagnosis or medications (applies to those without significant weight gain)

In other words, if you have been on a pump for a while, and have noticed it takes more insulin to bring your glucose down then it used to and your A1c is not in range, this issue may apply.

What are the contributing factors? 

Compared to injecting, placing an infusion set is tricky. Site rotation becomes limited to what you can reach with both hands. Usually, you need to see what you are doing clearly. This means pump users likely use half of 'injection-approved' site areas. (injection approved like the back of arms, lower back or side of upper thigh.)

Add to this the demand on the tissue for 3 days worth of absorption and the challenge emerges:

  • most adult pump users alternate between sides of the abdomen.
  • the abdomen has the most consistent absorption and therefore is the most used whether injections or infusion sites.
  • the cost of replacing an infusion set means sets can be left in too long.

All of the above set the groundwork for the development of scar tissue which ultimately affects the absorption of insulin.

Assessment

During a self-assessment of your infusion sites, you may notice:

  • differences in one side of the abdomen from the other when gently pinching up along your infusion areas.
  • you have more than 2 past sites still trying to heal.
  • your infusion set gets damp or seems to leak as it gets closer to day 3. 
  • the recommended cannula prime amount is not enough- usually have to take a non- food bolus to get the insulin absorption of your site "going".
  • more than one site infection requiring a course of antibiotics.

Treatment

As with injecting, areas of scar tissue are to be left alone / avoided. A challenge when using a pump! Development and frequency of site infections can also relate to the individual's immune defences. Leaving in painful , red looking infusion sets in beyond the 3 days increases the risk o site infection- leading case of scar tissue.

If you wish to try new areas for infusion placement, be aware you may need to lower your insulin amounts as much as 25% to prevent hypoglycaemia. You could try a temporary basal rate lowering with the usual meal bolus for simplicity until you are satisfied your usual rates apply in the new site area. More frequent glucose checks may be required while monitoring this change.

Routine use of a topical antiseptic ointment can help limit the risk of site infection beyond the basics of good hand washing and clean process of set placement. Expand the areas of use in your site rotation plan. Monitor your glucose response when using 'fresh' infusion areas. Talk to your diabetes team for tips or treatments to help you.

Hair removal may be used to find new ‘fresh’ infusion areas on hairy men.

Some hair removed on belly

Some Hair Removed

Hair removed on entire belly with Veet wax strips

All Hair Removed

Jill Milliken RN, is a Diabetes Nurse Educator in private practice who has been developing educational programs for people using insulin pumps since 1999. Ms. Milliken contributor to Pumping Insulin (Walsh) and Diabetes for Dummies for Canadians.

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Posted in Living With Diabetes Products By Jill Milliken RN, CDE

Pumping Insulin during Water Activities and more

Tuesday, August 4, 2015 12:03:35 PM America/New_York

Pumping Insulin during Water Activities and more

Insulin pumps are designed to be able to comfortably withstand temporary exposure to water. This means that if you get splashed or your insulin pump drops into the sink when washing, it shouldn’t malfunction if it’s dried quickly with a towel. Some pumps have been designed specifically with greater waterproof protection in mind and have been tested to confirm their waterproof capabilities.

If you are planning to go for a short swim, you may simply disconnect your pump and enjoy the water. Doing so is the best way to avoid risk of any water damage to your pump. You may make up the basal insulin you normally would get as a bolus when you reconnect your pump. For example, if you are disconnected for 1 hour and your basal rate during that hour is 1U per hour, simply give yourself 1 U as a bolus. However, if you are fairly active during the hour you disconnected, you likely don’t need to make up that basal dose- in fact you may need a snack to compensate for the activity. It's recommended to test your blood glucose before and after your activity. Speak to your diabetes healthcare provider for further instructions.

Which insulin pumps are waterproof?

Insulin pumps need to be waterproof to some degree but some have been shown to be more waterproof than others.

Animas Pumps are waterproof for up to 24 hours at 3.6 meters however battery caps should be changed every 6 months. If you are a frequent swimmer or work in a dusty environment, you should change your battery cap every 3 months.

Animas Battery Cap

Animas Battery Cap

SKU: A100-158-01 https://www.diabetesdepot.org/diabetes/animas-battery-cap.html

Accu-Chek Combo Insulin Pumps are rated as water tight so they are protected against the effects of temporary immersion in water for up to 60 minutes at a depth of 8 feet. It is very important to replace the battery cap every 2 months to prevent water leakage.
https://www.diabetesdepot.org/diabetes/accu-chek-spirit-battery-cover-kit.html

Medtronic Paradigm Insulin Pumps are NOT waterproof and must be protected from water damage. For more information about the water resistant rating of Medtronic Pumps see
http://www.medtronic-diabetes-me.com/8784.html

Aquapac Insulin Pump Case may be used to protect any insulin pump from water damage.
https://www.diabetesdepot.org/diabetes/aquapac-insulin-pump-case.html

Delicate Insulin Pumps and water don't often mix well, so this case allows the user to bathe, go boating or enjoy water sports with peace of mind.

Protected against temporary immersion - The case will withstand immersion for up to 5 seconds to a depth of 3 feet/1 metre.

Refer to Aquapac's manufacturer site:
http://store.aquapac.net/waterproof-rating.html

Aquapac Insulin Pump Case

Features:

Protects from dust, dirt and sand
Supplied with a belt, or feed your own belt through the case
It will float if you drop it in the water
The seams are high-frequency welded to form a super-strong bond
The Aquaclip® (a patented, ultra-secure, rustproof, injection-molded plastic seal) opens and closes with a simple twist of two levers, and everything stays in one piece even when open
The case comes with an adjustable belt & works with the majority of Insulin Pumps.

Sharps while travelling

Wondering how to handle your sharps while travelling? Save your empty test strip containers and use them as a temporary sharps container. When you get home just transfer them into your regular sharps container. In a pinch you can use an empty can of soda pop with tape over the opening.

FRIO Insulin Cooling Wallets

Black FRIO Insulin Cooling Wallet Blue FRIO Insulin Cooling Wallet 

https://www.diabetesdepot.org/diabetes/catalogsearch/result?q=Frio

No more messy ice bags. No more worries about refrigeration. Simply activate it with water and it keeps insulin cool for up to 48 hours. Re-usable and available in a variety of sizes to accommodate insulin vials, pens and insulin pumps.

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Posted in Living With Diabetes Products By Tino Montopoli

Infusion Site Sticking Problems

Wednesday, June 3, 2015 10:04:26 AM America/New_York

Infusion Site Sticking Problems

As we know, infusion sites are "prime real estate" and care is required to maintain a good number of effectively absorbing areas. Absorption of insulin becomes very limited in the presence of swelling due to infection and or scar tissue. People with frequent site issues may be infusing more insulin than they need. Glucose levels may increase initially due to lack of absorption and then as a result of inflammation and eventually, scar tissue. 


For those who have been using a pump long term adhesion may be less of an issue but site rotation can become more limited as a result of using these preferred sites. Our aim in this discussion is to share some tips which have helped solve infusion site issues.

So let's talk about infusion sites! Some of the variables which relate to whether your site will last 3 days or 3 hours include:

  1. location of the site is best in areas which are as protected as possible from being dislodged by moving alone. The sides of the body are more vulnerable to site dislodgement from movement and being caught on things than sites closer to your core.
  2. Body hair can affect the longevity of an infusion site. If you can , use areas with the least amount of hair. Use products to remove hair instead of a razor to avoid later itch at the site. Apply hair removal product to the area a few days before placing the infusion site to decrease the likelihood of skin irritation under the new site. 
  3. Skin preparation process and adherence products (Skin Prep and Liquid Spray Bandage). To maintain a site for 3 days, the site area should be clean and air dried with the use of site preparation products unless you have sensitivities to these products. About one in 5 people seem to have skin sensitivities. If you have signs of skin sensitivity such as red itchy marked area where the tape was, or angry raised looking areas, speak to your diabetes care provider. Use the process of elimination to evaluate which compound is causing the problem if more than one product is being used. Sensitivity to one product does not translate to sensitivity to all. Some pump manufacturers provide samples of various site prep products.

    Skin Prep MMT-175

    Skin Prep MMT-175
    Spray Liquid Bandage MED 070487

    Spray Liquid Bandage MED 070487
     
  4. Site change routines. Many people stretch their dollars worth out of a good infusion site. In general, the older the person and the longer duration of diabetes can extend their infusion sites longer than 3 days where children cannot. This is likely due to the blunting of the immune response to the cannula in adults than in children who's sites usually start failing after 48 hrs as their body actively rejects the cannula. In all ages and stages, when a site becomes painful or uncomfortable to touch it's better to change it out. The pain means infection or irritability which result in the development of scar tissue. 
  5. Technique. There are many kinds of infusion sets in optional lengths and angles. It may be that there is some trial and error needed to find a product right for you. For example, some brands have stickier backing than others! 

For some people the backing of their infusion set alone will carry them through to day 3. Success is often based on the site prep product used. Allow to dry to at least "tacky" before applying the site. Use anti - perspirant spray if needed on the area a few hours before the site prep pad is used is one trick which helps improve adhesion in the summer.

An occlusive dressing such as IV 3000 ( looks like plastic wrap) can be used against the skin and does help anchor the infusion set which is inserted directly through the dressing or a small hole in the centre. This "sandwiching" technique helps hold the cannula securely. It will also prevent "set migration' when the site stretches over time and can cause a kinked cannula. 

iv3000

In the case of tape, more is not better. The added tape means the whole site becomes more vulnerable to dislodgement. Some people use a site prep pad to circle the perimeter of their infusion set occasionally to encourage the edges to stay down. Always go by your blood sugar no matter how beautiful or ugly and beat up your site looks! 

Rarely, allergies to the cannula itself occur. The process to get to this point in troubleshooting is long painful and frustrating usually because it isn't the top of mind reason. The way to rule this out is to try a steel needle-based infusion set. This solution has been miraculous to those who were considering coming off of their pump due to this issue.

If the preceding techniques or products have failed, there are a couple of other products that may help secure the infusion set in place.

Skin Tac Adhesive Wipes

Skin Tac  Adhesive Wipes

Mastisol-01

Mastisol-01

written by Jill Milliken


Jill Milliken RN is a Diabetes Nurse Educator in private practice who has been developing educational programs for people using insulin pumps since 1999. Ms. Milliken contributor to Pumping Insulin (Walsh) and Diabetes for Dummies for Canadians.

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Posted in Living With Diabetes Products By Tino Montopoli

Diabetes Depot's Blog on Infusion Set Site Problems

Monday, January 19, 2015 11:55:09 AM America/New_York

When To Change The Infusion Set

The infusion set and site should be changed frequently and regularly. A general rule of thumb is that a metal needle should be changed at least every two days (though some users successfully use them for longer), while a Teflon set should be changed at least every three days. However, your doctor or educator may recommend a different schedule based on your particular situation. For example, many doctors recommend more frequent set changes during pregnancy. Make sure you know and follow your team's advice about frequency of set changes. Do not change the infusion set before bed as you will need to be awake to know if the set is performing properly.

Your set and site should also be changed whenever you notice any irritation or discomfort at the infusion site and always when you have two unexplained high blood glucose readings in a row. Also, leaving the set in for too long may promote hardening of the skin tissue leading to poor absorption of insulin. This is often referred to as losing your site.

Pump users and health care professionals alike stress the fact that "if it's noticeable, something is wrong." Check or change your site at the first sign of irritation or discomfort. Irritation, discomfort or pain may be the first sign of a developing infection. Taking action immediately will keep little problems from turning into big ones.

Skin Irritation

Skin Irritation at the the infusion set site is much more common than infections. This may be caused by sensitivity to the tape being used or by sensitivity to the metal needle or plastic parts of the infusion set. If the irritation appears around the edges of your tape or dressing, try lifting the edges slightly all around the dressing. This creates a new contact edge and often alleviates the problem.

If the irritation appears wherever the tape touches the skin, you may be sensitive to the tape's adhesive or material. There are a couple of products which may prevent this kind of skin irritation.

Skin Prep (SKU MMT-175) is available in boxes of 50 pads/wipes. The wipes are applied to the skin like an alcohol wipe and allowed to dry. This will disinfect, cleanse and leave a protective film on the skin thus preventing direct contact of the adhesive from the infusion set to the skin. Skin Prep will also enhance adhesion.

Skin Prep

 

3M's Nexcare Spray Liquid Bandage (SKU MED 070482) is another very effective product which leaves a protective film on the skin. Simply point and spray then wait for it to dry and then apply the infusion set to the sprayed area.

Nexcare Spray

 

Another way to protect the skin from irritation caused by the infusion set adhesive or plastic part of infusion set housing is to apply a transparent dressing like IV 3000 or Tegaderm to the skin first and then insert the infusion set through the dressing.

IV 3000tegaderm

 

Metal sensitivity is another possible cause of irritation. If you experience irritation in areas that come in contact with a metal needle, try an infusion set with a Teflon cannula.

Treatment of Skin Irritations

First and foremost it is important to remove whatever is causing the irritation (infusion site, adhesive tape, dressing, etc). Relocate the infusion set to another location taking care to protect the skin as discussed previously. If there is no sign of infection, the skin may be treated with hydrocortisone cream 0.5% twice daily. This may be purchased at any pharmacy without a prescription. An infected site may be treated with a topical antibiotic ointment like Polysporin or Bacitracin applied 2-3 times daily.

IN UP COMING BLOG, I WILL DISCUSS STICKING PROBLEMS

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Posted in Products By Tino Montopoli

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