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Posts from the ‘Diabetes Products’ Category

Guest Post: From Inside a D-Tech Startup

Marcus is cool.  I’m pretty certain about this because he has diabetes, thus making him part of a group of people I trust without justification outside of the whole “not making insulin, either” part.  (And he makes entertaining videos, but that’s a whole separate post.)  Over the next few weeks, I’ll be hosting some guest posts here and there, and today, Marcus is taking over SUM to talk about how his day job intersects with his all-the-time disease, and what kind of help he’s looking for from our diabetes community.

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Like most of you, I have plenty of thoughts on what device manufacturers for diabetes should be doing differently. Through my thirty-two years of being T1, I’ve used countless pumps, CGMs, and meters. Opinions? I’ve got plenty of them.

I suppose that’s why I jumped at the chance to get an insider’s view as Chief Marketing Officer for Aspire Universal, the venture company that supports Tempo Health. Tempo is a mobile health start-up focused on developing new personalized technologies for diabetes patients.  Think of it as the most the sophisticated bolus calculator you ever saw, but one that does the math for you, taking into account not just carbs and insulin, but heart rate, skin temperature, altitude and more.

Personalized diabetes also means dynamic diabetes. An app I’m testing this week actually has four different blood glucose models running constantly, and constantly updates itself to use the most accurate one with each calibration.

Before you run from this post thinking that Kerri sold this space to the highest bidder, relax.  [Editor’s note:  The bids weren’t that high.  Second note:  This is a joke; no money was exchanged for this post, nor would there ever be.]  I’ve got nothing to sell you, yet. But I can give you my view of what changing diabetes looks like from this side of the blank white board and what’s required to take an idea and turn it into a useful product for diabetes treatment.

Tempo Health has a mandate from our VC to apply machine learning and the Internet of Things (IoT) to find new solutions for diabetes management. Simply put, we pull data off of devices (like a Dexcom G5 or a FitBit) and run it through seriously crazy math to predict your future BG. The most important word there is “your.” Every T1 knows that everything changes our BG every day. Some days our bolus calculations are spot-on, but often they’re not.

Assuming we can achieve personalized diabetes management with machine learning, there are many ways we could deploy the solutions: better bolus calculators for insulin pumps, non-invasive CGMs, etc. As the IoT continues to grow, so will the data and so will the insights that come out of the data.

When I first heard about using machine learning this way, I was taken aback. Months later, I can tell you that it’s not the math that’s holding back diabetes innovation. Here are three immediate hurdles that come to mind (relax, FDA – I’m giving you a pass this time around):

  1. Data. Everyone operating in the space needs data. Data from trials. Data from partners. Data from you. But truth is, we need more. Last I counted, there were twenty-four obvious factors that affect blood glucose, but the most robust integrated databases today usually include only three: carbs, insulin and BG. We need more data, which means…
  2. Willingness to share data. Vendors need to work together and share data with each other in joint ventures to help solve the problem. If you keep your chocolate bar and I keep my peanut butter, we’ll never have my favorite way to treat a low.
  3. Quantifying the potential value of personalized solutions is complex. If approaches to diabetes management are unique to each person, be it with data or devices, the value proposition per person is also unique.

The most exciting part about those obstacles is that while these are the things we bang our heads against the wall about every day right now, they don’t for a moment strike me as insurmountable. In fact, when I look at what’s going on in the industry, I see overcoming them as inevitable. Better technological approaches to diabetes treatment are coming soon and if you’re interested, you can be part of the revolution.

On our website, we have a simple form where you can sign up to be a beta user for our products. Like all studies, criteria vary. Sometimes we want people local to our Lancaster, PA offices and sometimes we don’t. Sometimes we’re trying out apps for pump patients and other times we’re looking at pen users. So I can’t promise we’ll use you, but we’d love to have you sign up today. Just go to http://tempohealth.com

Marcus Grimm is CMO for Aspire Universal, serving as a startup storyteller for multiple ventures. He’s also the Running Coach for Diabetes Training Camp is on the Board of the Diabetes Sports Project and his local JDRF. Follow him on Twitter at @marcusgrimm.

Open the Door.

For several weeks, I was flipping open the charging port on my t:slim insulin pump and plugging it in while I was in the shower.  But then I noticed the charging port cover was looking a little worse for the wear, and I connected with a friend about best practices.  (“Best practices” standing in for “How the hell do you charge this thing without breaking the door off?”)

Turns out the door swivels.  And swiveling the door keeps it from ripping.

Swivel that door! #tslim

A photo posted by Kerri Sparling (@sixuntilme) on

Well I’ll be (… more careful, more aware, a swivel-er).

(Also, you tell me if “Open the door” as a post title immediately made you think “get on the floor … everybody walks the dinosaur.”

 

[Tandem disclosure]

 

Switching to the t:slim Insulin Pump.

This will not be a post about what insulin pump is better for YOU.  I’m not a soothsayer (though every time I say that word, the mental image of a knight slaying a dragon made entirely out of teeth is hard to shake), so keep in mind that this post doesn’t include as many facts as it does opinions.  Also, don’t take any of this as medical advice, because I’m not a doctor.  I can’t even drive a stick shift.  Consider your sources, please.

Securing my bias lens even further, please read my recent disclosure about my agreement with Tandem.

All that official throat-clearing out of the way, let’s do this.  Because I switched insulin pumps for the third time a few months ago, and it’s been a good change for me.  (If you want to read more about the how and why of switching this time, that’s in the disclosure post.)

Get Off My Lawn Stuff (Known Formally As “Cons”)

I did multiple daily injections to administer my insulin for seventeen years, and switching to a Medtronic insulin pump back in 2004 was jarring because it was a big change to my daily routine.  Going from carrying syringes to wearing a device 24/7 was a switch.  But even after adjusting to the Medtronic pump, every subsequent change to my hardware, however small, felt like a big deal.  Switching to the Animas pump was hard not because the pump was that different, but because the clip was different in the most infinitesimal ways. It drove me bananas making the adjustment.  It took a good month to adjust to how the Animas pump clipped to my clothes.  Big deal?  No.  Big difference?  Nope.  But big adjustment?  Hell yes.  Any insulin pump that I wear is with me all day long, in every imaginable situation, and every single human factor of anything must be taken into account.

When I tried out the t:slim a while back, just to see how I like it, four things struck me as annoying:  the process of filling/priming the pump, the luer lock/pig tail system, the assumed fragility of the pump, and the pump clip. The technology was new and exciting, but I kept hitting myself in the face with it … metaphorically.

Back when I tried the pump, you had to install an empty cartridge and then fill it once it was loaded into the pump, but updates have made it possible to pre-fill the pump cartridges, making the process slightly less annoying.  The time it takes to prime the tubing is longer than that of the other tubed pumps, but I usually change my pump out after a shower, so it’s not inconvenient to spend an extra minute at the bathroom counter while the tubing fills.  An odd quirk is the recommendation that the pump be tipped up with the tubing facing up and the tubing extended while it filled, but this made sense to me and I actually started doing it with my Animas pump when I filled it, too.  (Brings any air bubbles to the top of the cartridge and pushes them out.)  Overall, the prime/fill process is a little cumbersome and at first it drove me up a wall, but now I’ve adjusted.  Ish.

The luer lock is not new (Animas has a luer lock system) but the lock itself being two inches (or so) away from the pump itself has made for some awkward under-the-dress-or-shirt lumpy bits.  It’s not the biggest deal, but for the first week or two, this change was frustrating and I felt like my tubing had becoming a permanent, and migratory, third nipple.

But the pump seems a little more delicate than other pumps I’ve used before.  I’m not easy on technology, and many of my daily activities usually include interacting with my five year old daughter, traveling, and changing my clothes in a closet that is tiled and the tile in our new house is apparently impossibly hard.  (Using the 42″ tubing for my infusion sets makes my pumps into yo-yos.)  Every medical device I’ve ever owned has hit the floor multiple times either in the bathroom, the kitchen, the airport TSA lines, etc. I do not go gentle into … anything.  In my short time with the t:slim, I’ve scuffed the ever loving hell of of the edge of the pump.  For a few weeks, I thought this pump was more fragile than others I’ve had in the past, but it turns out (after inspecting my stash of medical devices) I’ve destroyed the edges of every pump, ever. So the fragility of the t:slim, in my case, is assumed.  And I remain a bull in a diabetes closet.

The last frustration I had with the t:slim when trying it out and then switching was the pump clip.  See the previous paragraph for my brutish behavior when it comes to devices, but I felt like the clip couldn’t stand up to my clumsiness and awkwardness. This was a deal-breaker for me when I tried the pump, as I need to be able to wear it effectively.  BUT WAIT!  This particular con turned into a pro, so I’ll lead with it for the next section, which is the PROS section of switching.

Stay On My Lawn Stuff (Known Formally As “PROS”)

So the clip – THE CLIP!  A solution was found, but not a medically blessed one, so don’t make any fast moves without consulting with your doctor, and your neighbor, and the post office lady, and god.  But there is a clip that I bought on Amazon that, when applied strategically to the back of my t:slim in such a way that does not cover up any pertinent medical information (like the phone number for Tandem Care, etc.), it fixes the pump clip conundrum for me completely.  It’s totally a “to each their own” sort of gig, but I love wearing the pump in a streamlined, secure manner like this, and the wearability is completely badass.

T:slim with clip

A photo posted by Kerri Sparling (@sixuntilme) on

Another thing I really like about the pump is how updated and streamlined it looks.  These things cost, what – $5,000? – and they should damn well look like they cost a pretty penny.  I like that my insulin pump looks like the sophisticated medical device it is supposed to look like.  Sure, looks don’t trump functionality, but it doesn’t hurt that this pump works well and also looks smart.  Call me superficial.  Go ahead.

With that sexy look comes functionality that I had been craving (which makes it sound like a delicious grilled cheese sandwich, in which case … hang on … brb).  I wanted a pump that did what I needed it to do without having to press 10,000 buttons along the way.  Like the temp basal feature.  Temp basaling (a verb, to be sure) is my favorite way to combat lazy, slow lows that don’t necessarily require a snack but do require some kind of gentle intervention.  For example, if I’m 70 mg/dL and trending flat with no IOB before bed, I may do a temp basal for 30 minutes in order to bring me back up into the 85 mg/dL range.  Setting up a temp basal on the t:slim is extremely easy and takes a matter of seconds.  I appreciate that.

The temp basal rate to gentle smash a low is my favorite. #diabetesgram

A photo posted by Kerri Sparling (@sixuntilme) on

Integration is a plus with this pump, although integration is a frustrating topic all on its own because companies never seem to be on the same page for long enough.  (Project Odyssey might help change that, allowing software updates to replace hardware ones, i.e. downloading updates from your computer to your pump,  and I’m excited to see that move forward.  More on that once there’s more on that.)  But as it stands now, the t:slim is integrated with Dexcom G4 technology.  I am pro-options and prefer that patients have access to what they want, so I tried out the integrated system to get a feel for how the technologies worked together.  Overall, the user interface for CGM is really nice and a huge upgrade from other systems I’ve seen (CGM results are on the home screen, trend arrows are there, too, and the X axis is more than an inch long).  The CGM alarms on the pump are loud enough to hear while I’m sleeping, and the hypo repeat option worked irritatingly well on the overnight (stupid lows).  The integration seems solid and streamlined.

CGMed. #slightlylatergram

A photo posted by Kerri Sparling (@sixuntilme) on

But … I like Dexcom Share.  And having Share as an option is essential for me, with my work and travel schedule, so I decided to bounce between the G4 and the G5 technology in whatever way fits best week-to-week.  In order to Share while using the t:slim as my primary CGM screen, I need to use my G4 receiver for cloud uploading.  That’s clunky (and also required me ordering a G4 receiver since I had already updated my previous G4 receiver to the G5 technology … see also:  regret) and the G4 receiver I ordered is borked, so I switched back to G5 for the time being in order to continue Share.  This is a long, kind of boring paragraph, the point being that the integration is great, but Share options suffer, so know what you’re getting into and also what you expect.

One other point re: the t:slim with G4:  When I decided to go back to G5, it took a full 24 hours for the home screen on my t:slim to stop showing the CGM graph.  I was confused as to where the option to “turn off CGM” was on the pump itself, but it turns out that the screen automagically reverts to regular t:slim mode once the 24 hour window is up.  Useful.  

Also (unrelated), the little “change sensor” icon on the screen looks like a bottle of champaign and a clock, making it seem like New Year’s Eve on your pump for 24 hours.

A photo posted by Kerri Sparling (@sixuntilme) on

I also like how quickly I can take a bolus.  The audio bolus is loud (and the disco boobs are in full effect for those sorts of moments, so turn that shit down if you’re feeling demure), and I’m a big fan of the audio bolus.  The bolus screen is different on the current iteration of the t:slim than the one I first tried out, allowing me to put in a number of units without forcing me to enter a BG or carb amount.  I know I should be taking advantage of all the options available to me on this technology, but sometimes I just want to take a unit of insulin and not jump through a dozen hoops en route to bolusing, so streamlining this process is a plus.

A photo posted by Kerri Sparling (@sixuntilme) on

These are just some first impressions, but there’s always a learning curve with new tech. As the weeks go by, I’ll have experience with the more advanced features and will have tinkered around extensively with the device, but at first glance and first few weeks, I’m deep into techno-joy once I stopped being scared of the change itself.

Kind of like this:

View post on imgur.com

It feels like a device company has taken my diabetes experience and given it an overhaul. One that was sorely needed after almost 30 years with type 1 diabetes.

Verio Sync: Unanticipated Glitch.

The Verio Sync meter and I have been happy friends for a few years now, starting back in late 2013.  (Here’s that first post, with disclosures aplenty. Second impressions are here.)  

I honestly can’t figure out why more people aren’t using this meter.  It’s fast, it’s accurate, and the Reveal app is awesome.  This meter has been the best fit for me in the last few years, which is a big statement because I historically revolt against excessive change when it comes to diabetes tech.

Bottom line:  I like this meter.  Quite a bit.

Footnote on bottom line:  Until last week, when I tried to upload my information to the app, which had been recently  updated on my phone, which meant the app needed all of my information again, only to realize that the PIN had worn off my meter and I couldn’t enter it into the app.

Holy run-on sentence, but the end result is no PIN?  No upload.  No upload?  No data access.

Pain in the ass, that is.  Had I known, I would not have updated the app on my phone.  Had I known, I would have written the PIN down on a piece of paper.

But wait a second … I was just at Joslin with my endocrinologist, and she was able to plug my meter into her computer and upload my data.  No PIN, no hassle.  She had some magical data system that siphoned my health data into their files.  How come my doctor can access my data but I can’t?

The guy who talked to me for ages on the One Touch customer service line was very nice, and very helpful, only ultimately couldn’t do anything other than offer to send me a new meter (which still has not arrived).

“You’ll receive a shipping label to return the old meter,”  he mentioned.

“Can I wait a few weeks to return it?  I want to see if my doctor can get the data off that meter before I send it back.  I want those numbers, if I can get them,” I asked.

“Sure thing.  Not a problem.”

So he was very nice.  But the underlying problem here is that the data on that meter is mine.  My glucose data, generated every morning, every time I eat, and every night before bed.  It’s the specifics of my diabetes day, dictating the content of my dinner plate and influencing the integrity of my CGM sensor.  That information is mine.  And yet my doctor has the key to open access but I do not.  She has a “pro” account but I’m managing my disease daily, and yet I can’t access my own data from my own machine.

This doesn’t make sense. It’s my data! This problem can be fixed once patients are given the tools to manage their condition, instead of information being held behind a wall of medical privilege. You know … once we’re viewed as “pros,” too.

UPDATE: Lifescan called me a few minutes ago. Here’s the rundown:

Pump Peelz Gift Card Winners!

Giveaways are fun, but the entries received on this Pump Peelz Superhero gift card giveaway were truly awesome.  From Sir Lancet-a-lot to Carbo-Man to Madame Betta, the superheroes created by insulin-infused imaginations are incredibly fun.  And now, on to the winners!

The superhero call:

To enter the giveaway, you need to leave a comment on this post that includes a fictional diabetes superhero name and that superhero’s special power.

Through a fastidious screening process that included (but is not limited to) which entries made everyone in my house giggle and which ones the cats sniffed the computer screen longest for (<– this part is not true … perhaps), the entries have been narrowed down to three winners.

THIRD PLACE:  “Agent Sticky”. Who happens to be able to scare any Dexcom sensor or infusion site into actually sticking on someone’s skin until they want it to come off, even if they go swimming. Or bump into doorways, as I’m prone to do when I cut a corner too hard. I’m picturing a cross between Agent K from MIB and Coulson from The Avengers.  — submitted by Morgan T

SECOND PLACE:  “My superhero is Queen Islets of Wonderhans, who can cross her arms and stomp her feet and create perfectly working cells that make insulin again.  Why not!?” – submitted by Lucia Maya

And … FIRST PLACE! “My super hero would be Master No-No Carb. His super power would be to remove all carbs in your favorite foods by using a super high powered vacuum to suck the carbs out all while leaving the sweet goodness behind.”  –  submitted by Andrea

Our first winner will receive a $25 gift card, the second place winner gets a $10 gift card, and third place wins a $5 gift card.  Winners, you’ll receive an email from me connecting you with Scott and Emily from Pump Peelz, and they’ll send along your gift cardCongratulations!! 

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