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Posts from the ‘Diabetes Products’ Category

Even Small Medical Advances Can Mean Big Jumps in Quality of Life.

I came home after two days away to a flurry of discussion about Sunday’s New York Times article, “Even Small Medical Advances Can Mean Big Jumps in Bills.”

My knee-jerk response was to be thrilled that type 1 diabetes received above-the-fold coverage in the New York Times.  Reading the profile of and quotes from Catherine Hayley felt like a fair assessment of life with type 1 diabetes, and painted Catherine not as someone who suffered from anything, but who worked hard to power through a whole lot.  I wished the columnist had been more focused in her discussion (Is this article about health system economics?  The cost of treating type 1 diabetes?  The complications associated with diabetes as a whole?) but I am not the best person to discuss a lack of focus because … (shiny thing)

That said, the quote that really bothered me was right at the beginning:

“But as diabetics live longer, healthier lives and worries fade about dreaded complications like heart attacks, kidney failure, amputations and blindness, they have been replaced by another preoccupation: soaring treatment costs.”

Really?  It’s that simple?  I wish I was being dramatic, but every, single night before I go to sleep, I think about whether or not I’ll wake up in the morning.  It’s not a thought I belabor, and at this point, I sometimes debate the possibility almost pragmatically, calculating insulin on board and exercise I’ve done recently, thinking about my last A1C or EKG, thinking about how 27+ years of type 1 diabetes has affected my body.

I wish financial worries were replacing others, but instead, I worry about diabetes-related complications in addition to cost of treatment.  However, the trick is that these advanced treatments will allow me to worry about diabetes into proper old age, because I will live longer, and better, with access to this technology.

Devices like an insulin pump, which can precision dose my insulin and help efficiently calculate and track insulin use throughout the day, help me fall asleep with more peace of mind.  Wearing a Dexcom, which alarms when my blood sugars falls out of my pre-established comfort zone, helps me fall asleep with more peace of mind.  Peace of mind, when living with a complicated chronic illness, matters.  These are not devices I wear because they’re “cool” or “fun.”  I don’t care what colors they come in or whether or not they resemble an iAnything – I want it to work and work well.  I turn to technology to help best manage my diabetes because my pancreas stopped making insulin almost three decades ago, and these advances in treatment have improved my quality of life immeasurably in some ways (emotional health) and very measurably in others (better blood sugar control).

One other quote was particularly frustrating, not because it was the study that was referenced, but because the study itself is over 20 years old:

“But that all changed after a landmark study in 1992 showed that patients did better if they maintained very tight control — keeping their blood sugar within a nearly normal range by checking it frequently and taking multiple insulin shots a day.”

Where is today’s modern DCCT?  Where is the study that’s looking at the influence of insulin pumps, CGM, and insulin analogs on patient outcomes?  (Please tell me this study exists – I hope it does!)  We’re talking about modern-day diabetes treatments and lining these discussions with studies involving somewhat out-dated treatments.  I’ve seen the benefits of pumping and CGM use on my personal diabetes management, and I can only hope that the overall PWD population sees positive outcomes in their management when given access to these technologies.

The discussion I’ve seen across the DOC and the web at-large has been enlightening, and I’m really glad to see and hear people talking about diabetes with such excitement and passion.  Diverse opinions should be shared, and heard.  Progress is important.  Innovation matters.  And in my opinion, modern-day diabetes should be treated with modern-day technologies.

 


 

[hi, there are my disclosures]

 

 

Excited About Exercise … Again?

I’m climbing up on a new bandwagon.

Oh hell yes I am, and I needed one.  Over the last few weeks, I’ve completely fallen off in terms of exercise.  I could blame the endless winter weather, or work, or the endless fuzzy hairballs that are Loopy and Siah, but the truth is, I just got lazy.  Laziness turned into apathy, and apathy turned into a bad habit of not exercising much at all.

Not cool, because my blood sugars/weight/emotions fare best when I’m active.  Sounds trite, but it’s true.

I’ve taken up with a new fitness tracker, and one that motivates me less because it’s tracking activity and more because it’s connecting me with some folks to engage in some friendly “account-a-tition” (accountability + competitiveness).  And that’s the theme of this month’s Animas column:

“… so now I had a way of tracking what I was doing, exercise-wise, and a group of people to help keep me accountable.  THIS was exactly the boost I needed to pull me out of the exercise doldrums.  Now, instead of relying on my sometimes-hard-to-find motivation, I could turn to the DOC to help motivate me.  The application, much like other fitness tracker applications, allows people to cheer one another on, and share daily workout stats.  Were my fellow PWDs logging nine, ten, … thirteen thousand steps per day?  Were they finding ways to eek out a little more exercise?  I was inspired to follow suit. “

Click over to Animas for a read, and since I needed to keep the type of tracker brand-agnostic for purposes of that column, I’ll say here that I’m using a FitBit, and if you’d like to connect, let’s do it!

Inset/Outset.

Most of the time (read: every other time except this one), the cannula is laced through the insertion needle on the insets for my insulin pump infusion sets.  But this infusion set was attacked by diabetes gremlins, because the cannula made a run for it before I even opened the spaceship pod:

Insulin pump inset ... er, outset.

Insulin pump inset … er, outset.

Scott, on Facebook, quipped it best:  “It appears that instead of an Inset, they gave you an Outset.”

UPDATED:  I opened the set this morning.  No tubing, either.  Gremlins!!

My Diabetes App Wishlist.

After a long day of diabetes rule-following and making an attempt to log all of my actions [insert laugh track here], I started drumming up another diabetes application wishlist.  Because I’m beyond tired of having five different devices that speak entirely different languages/require different charging cords/can’t work on the operating system I use/hate the idea of integration.

I’m in wicked curmudgeon mode today.  But stay on my lawn for a few more minutes, because I have a list, a la Veruca Salt.

I want a diabetes application:

    • … that auto-magically siphons the results from my glucose meter and logs them in a lovely, color-coded graph and logbook on my phone and on my computer.
    • Yes, I want my data on my phone and my computer, because while my phone is with me constantly and is good for everyday spot-checking, I like having the bulk of my data stored on my computer so I can see a week at a glance, a month at a glance, and a clue as to what my A1C might be at a glance.
    • I want to be able to email all of this data as a PDF (because Excel and I have a less than harmonious relationship) to my healthcare professional and whoever else I choose.  Or I can print it and put it into a blood sugar binder that I do not currently have but would have if my logbooks were this easy to compile.
    • And then, the data from my pump should just as easily be pulled off and graphed neatly alongside the data of my glucose meter.  Insulin doses plotted alongside blood sugar checks, with the option to add a smiley face when I fucking well feel like it because some days deserve a big, fat smiley face.
    • (Frowny faces and other emoticons would be a nice bonus, to add in accordance with my whims, as emoticons are sometimes the only recourse I have against a day that’s been truly and mind-bogglingly ridiculous in those ways only diabetes can be.)
    • It should go without saying, but I’ll say it:  the data from my Dexcom should follow the same sharing and integration platform, living in logbook and pie chart harmony with my glucose meter and insulin pump.  And all of that data should be visible on all operating systems EVEN A MAC HOW ‘BOUT THAT?!
    • I want to be able to look at this data in several different ways: at-a-glance, where I can see how my day is going (similar to the One Touch Reveal app); how a week looks, where I can see data broken into high-level pie charts, detailed logbooks, and a bunch of in-between options; and what I’d call an A1C level-glance, which would give me data (detailed and high-level) about how all of my numbers have tracked over the course of three months.
    • All of this data should move from my devices to the application without needing to cobble together proprietary cables.  Bluetooth is fine.  Cloud is fine.  Bluetooth cloud with a side of hazelnut iced coffee would be ideal.
    • Hey, wouldn’t it be cool if the application also synced up with my FitBit (or Shine or whatever other fitness tracker is the thing in use these days) so that I could see how exercise plots against blood sugar checks or insulin doses?  Yes, yes it would.
    • Another excellent detail would be if the application, upon access the diabetes devices, would confirm that each device is synced up with the right time zone.  So when I travel and the clock on my phone is updated, so are my devices.
    • And lastly, NO DONGLES.  I can’t handle that word. It’s too silly.

I know this kind of application isn’t flashy enough, and doesn’t benefit each respective company enough to actually work together and create something cohesive and workable, with an easy data flow and an even easier user interface, but whatever.  A girl can dream, right?

Guest Post: A Do-It-Yourself Pancreas System.

Necessity is the mother of invention, and in some cases, that necessity comes with a side of love. My dear friend Dana Lewis (who threatens to wash my mouth out with soap every time I curse) and her amazing boyfriend, Scott Leibrand, have created a “Do It Yourself Pancreas System” that is revolutionizing not only Dana’s diabetes confidence, but potentially changing the landscape of diabetes management for us all.  Does that seem like too-big of a statement?  Read for yourself and see what patient-led innovation can really accomplish.

*   *   *

I took a deep breath, intentionally pulled out my pump, and bolused. He asked if it was a pager and we continued our conversation.

That was our first date, and his first introduction to my diabetes. It wasn’t the big deal that I thought it would be.

On our second date, I hated to drink the toddler sized juicy juice from my coat pocket when walking on the beach before dinner, but that wasn’t a big deal, either. He only asked if it was for low blood sugar.

On our fourth date, when he opened his trunk to grab roller blades, I noticed a Costco-sized box of juice boxes. “I thought they might be good to keep in the car in case you run out of them in your purse,” he said.

The next few months were filled with other surprising moments as Scott started learning about diabetes, not only from me, but also from the DOC. I loved when he started following some of my d-friends on Twitter and saw other perspectives on life with diabetes.

I wasn’t sure what to think about all of this, though – especially because I was falling in love with someone for the first time, and it was with someone who was not only interested in understanding diabetes, but also in helping me find ways to make it easier. 

I joke about using Twitter partially so my family knows I’m alive, but it’s actually pretty true. I had shared with Scott what it was like living by myself and dealing with diabetes at night. I will sleep through any type of CGM alarm, even if I place it in a glass to amplify the audio of the alerts. I talked about wanting someone to be able to look remotely and see if I was alive based on CGM numbers. Scott and I started talking about other things we’d like to do, if only we could get the data off of my CGM in real time.

Then late last year, I stumbled across John Costik on Twitter. He was talking about viewing his son’s CGM data remotely. I emailed Scott saying we should talk to John and build upon what he was doing … and Scott tweeted John before he even responded to my email!

Thanks to John, we were able to upload my CGM data in real time. We created a system that would trigger custom CGM alerts to send to both me and Scott. If I wasn’t responding to CGM alarms and “snoozing” them in the system, Scott could see what my BG was and decide if he needed to call and check on me. If I was responding to alarms, he didn’t need to do anything except send e-hugs for lows.

We added a feature to the system to plug in how much insulin was in my body and how many carbs I had eaten. This enables me to track my BGs after a meal more accurately, and project if I am likely to go high or low. When my BGs come in higher or lower than estimated (for any reason), it shows me how far out of range I am projected to go and what I need to do to fix it (with an additional bolus for a projected high or using temp basals or carbs for an impending low). It also tell me how long I have before I drop below 80, to figure out if I have time to do a temp basal or if carbs are the best option to prevent a low.

We started calling it the “do it yourself pancreas system”, or #DIYPS.

Before #DIYPS, it took more guessing to try to prevent or fix a low without causing a rebound. #DIYPS’s calculations help me reduce the extra carbs I use for lows by allowing me to more precisely use temp basals. It’s also brought my average blood sugar down and reduced total time spent high or low. You can see the difference from before I started using the system, and after, by looking at my 30-day trailing estimated average glucose (eAG).

#DIYPS is especially helpful during those “oh no” (or something that involves soaping your mouth afterward) moments – like when you put in a new pump site and two hours later you get a “no delivery” alarm. I had this happen last week; my BGs were rising suddenly, I supposedly had insulin on board, but in reality my pump hadn’t been able to deliver my basal insulin for the last two hours, and the corrections hadn’t really gone into my body either. I didn’t know if any of the insulin had gone in or how high I was going to rise.

Previously, I would have guessed and hoped for the best. With #DIYPS, I was able to use the system’s constant re-calculation of my data to safely give a big correction bolus to replace the un-delivered basals & boluses from the past two hours, and use it to come down to a safe level. In this case, I managed to level off flat in the mid-90s for the next few hours. Of course, this all had happened after midnight – so the other great benefit of #DIYPS in this situation was feeling like I could go to sleep safely. Even with a lot of insulin on board to correct this who-knows-how-high BG, I could trust #DIYPS to alarm and wake me up if I was projected to go out of range.

You can read more about how #DIYPS works here (and why it’s not an artificial pancreas), and Scott’s perspective on it here. We’re not done, and we’re hoping to partner with folks who are interested in helping us build on the system. But we are not waiting until an artificial pancreas is out on the market to make the quality of life with diabetes better. Right now, the #DIYPS user interface is pretty simple. But, my biased opinion is that it’s incredible – how can it not be when it gives me the peace of mind of being able to sleep safely at night?

#DIYPS – and Scott – have also taught me that just because I can do something myself, doesn’t mean I have to. Yes, I can do all the calculations #DIYPS does, but I don’t have to spend as much time thinking about it now over the course of the day (although I do validate any action I take with my own assessment of my CGM data or BG reading). Reducing the cognitive load of diabetes means I have more time and energy to spend living my life. That’s something else to fall in love with.

*   *   *

Following Dana and Scott’s journey on Twitter via the #DIYPS hashtag, or through Scott’s blog.  (Because Dana does not blog.  She changes the world via Twitter. Although she can be gently asked to guest post, which is why I’m so happy she bit the blogging bullet and shared her story here today.  Thanks, Dana!!  And look – I didn’t curse at ALL through this whole write-up!)

Guest Post: Timesulin, Innovation, and the Sniff Test.

People with diabetes know what people with diabetes want, and John Sjölund is no exception to this rule.  Diagnosed with type 1 diabetes just before he turned four, he has created a simple, streamlined solution to make multiple daily injections easier to manage:  Timesulin. I’ve used his product, and thought of it as “informed MDI’ing.”  Recently, he kicked off an Indiegogo campaign to raise funds to help bring Timesulin to the US market, and today, he’s sharing the how and why of that effort.

*   *   *

If we haven’t yet had the opportunity to meet, you won’t know that diabetes doesn’t define me. Diabetes has, however, given me a platform to speak to amazing people, to ensure I live healthier than most of my non-D friends and it’s put me on a path to try to make life for all of us around the world with diabetes a little easier. In fact, I have made this my mission!

I have lived with type 1 for 28 years, first diagnosed a couple of days before my fourth birthday. I really have never known a different life to one that consists of 6-10 finger pricks a day, 4-6 insulin injections and constantly checking in with my body to check whether my blood glucose levels are high…or that dreaded low. That said, diabetes has never held me back from leading a life that is full, high-paced and filled with excitement! Kickboxing, triathlons, sky diving or traveling off the beaten path (horseback riding in Lesotho??) …I decide what I want to do and then make adjustments to allow me to do whatever I set my mind to, despite my faulty pancreas.

With this life, however, few things are as routine as taking my four daily insulin shots – one before each meal and a slow-acting injection at bedtime. And maybe it’s because I usually have a thousand things on the go, but over the years I have often caught myself feeling unsure of whether or not I had taken my shot. Do you know that feeling? I would step out of the shower, ready to get to bed and then have that sinking feeling, ‘Ugh…Did I take it, or not?’ or sit down for dinner and then have that niggling worry hit me.

Not having a way of knowing for sure was driving me nuts! The best method I had was to ask my then-girlfriend, Susan (now my wife and pregnant with our twin boys, due any day now!) if she had seen me take my insulin. Too often, we had to resort to the Sniff Test.

The ‘Sniff Test?’ Indeed.

Susan has a keen sense of smell and would sniff my belly, legs or arms to see if the smell of insulin was present around the injection site, which was the sign that I had already taken it. After a shower, however, the method was less reliable as the smell of body wash would mask the pungent smell of insulin. The sniff test just wasn’t a fail safe method to see if I had taken my insulin or not, something that 77% of physicians estimate happens as many as six times a month for those of us with diabetes, according to a study done by Novo Nordisk. Also, I tend to take my long-acting insulin in the backside … and Susan often exerted her right to not have to sniff that region in the name of healthy living!

Frustrated with the existing solutions that were available to me from large pharmaceutical brands, I gathered a team, which included my brother Andreas, one of the creators of Skype, to create Timesulin – a smart replacement cap for your existing insulin pen to simply show how much time had passed since the last shot. By having this basic information you can make decisions that will help you avoid an accidental missed or double dose of insulin – which can have very serious effects. Very importantly, we didn’t want Timesulin to incorporate wi-fi, bluetooth or USB plugs or any other mumbo-jumbo that I felt complicated life with diabetes (it’s worth noting that I am a tech junky, know html and CSS, can program, but when it comes to diabetes I believe in the idea of ‘Keeping it simple’). I’m proud to say that we created a product that encompassed all of this – and is today being sold in forty countries around the globe – two years after launching to consumers in February 2012!

As proud as I am on a personal level that our simple solution has helped so many people, I am super frustrated that we haven’t been successful in getting our product to the United States. Why you may ask?

  • Requirements for U.S. regulatory registration (which function well, we are supporters of keeping people safe) on medical devices are lengthy and more expensive than in Europe. It is a big undertaking for my team both in cost, time and resources to get it done, with no 100% guarantee that it will be worthwhile
  • The sheer size of the U.S., which makes distribution and logistics a challenge.
  • The costs of marketing a new brand in a market cluttered with medical advertising from big pharmaceutical brands with enormous budgets.

Most importantly, I realized that patients in the United States are not given the same choices about which devices will help them live their best possible life with diabetes. I want to change this.

We just launched a crowdfunding campaign on Indiegogo to help us raise the funds necessary to file for approval from the FDA and help us get Timesulin approved for distribution in the U.S. I am particularly excited about this as it truly lets those of us living with diabetes the ability to vote and decide for ourselves what tools we need. Is Timesulin going to solve everybody’s challenges with diabetes? Of course not, but it can play one small yet important part in allowing people to not be afraid of taking a double dose. Since I couldn’t find a solution that worked for me, I decided to start Timesulin. I have been super frustrated at not being able to empower other people to make that same decision for themselves, and I think that crowdfunding may just have the potential to help us.

This is just the start, we have lots of other ideas that we want to launch, which may not be blockbusters that cure diabetes, but can go a long way, until a cure is reached, in making life with diabetes a little simpler, less complicated and perhaps less scary.

We need your help to get there, and without the support of other people with diabetes, it will be impossible for us to keep innovating.

I know it has made things much easier for myself – and for Susan! – and importantly, we no longer have any of those awkward restaurant moments when it’s a toss up between pulling my shirt up to have her ‘Sniff Test’ my belly and taking the risk of an accidental double dose when I simply feel unsure of whether or not I had already administered my insulin dose. These days I just glance at Timesulin and know.

And now, so can you! Please help us succeed with this campaign and help everyone who’s ever needed a “Sniffer.”

*   *   *

You can follow the Timesulin efforts through their Twitter account, learn more about the product on their website, and you can help support the campaign by visiting their Indiegogo page.  And if your significant other has ever sniffed your skin for insulin, show them this post; they are not alone.

Bloody Cannula. (A Grost.)

This one’s a gross [read: gross post], so viewer beware:

Blood sugars inexplicably in the high 200′s?  Burning sensation when I bolus?  Site uncomfortable to lay on?

Shoulda known.  Sneaky little vampire cannula.

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