Sometimes I'm a bit of a perfectionist. I demand a lot of myself and expect it from others. I'm telling you this because maybe I just have unrealistic expectations.
In September my current insulin pump (Minimed 512) will be 4 years old. At that stage it will be out of warranty and I can get a new pump and expect that insurance will cover most of it.
Insulin pumps are truly a marvel of technology. This is a small pager-sized device that I will wear 24 hours a day, 365 days a year. It helps me to keep my blood glucose levels close to normal and it's something that I'll probably actually use and interact with at least eight times a day, every day.
So why are pump companies making it so hard to try one out for a short while? Yes, I can read the instruction manual and get some feeling for how the pump will behave and feel. But that's not the same as wearing the thing and using it for a week or so.
My original plan was to contact a few pump makers and ask them for a one or two week loaner. I'd fill it with a saline solution and wear it together with my old pump for that period. That way I could gauge its accuracy and usability and see if it was right for me.
So far I've contacted three different companies. One (Cozmo) has told me they don't have a loaner program. And the other two claim to be working on it, but I'm not holding my breath.
Pump companies (Minimed, Animas, Cozmo, and others) - WAKE UP. These are complex devices that are essentially extension of our bodies and our brains. There is no way I'm going to purchase a new one without trying it out first.
I don't want a 30-day money-back guarantee. I want to be able to try out the pump, with its software for a week or two. I want to know how it will work for me.
Will I be able to use it when I'm exercising? What are the insulin on board calculations like? How easy is it to bolus? What do I need to do to set a temporary basal? Can I easily calculate meal requirements? What kind of extended bolus options are there, and can I use them?
Maybe I'm crazy. Maybe I should just look at the glossy brochures with pictures of happy people and just pick one at random?
Yesterday was such a lovely day that I decided to dust my bike off and start training in earnest for my fund-raising bike ride. Which explains the title of my post.
Like many of us with Type 1, I feel that I'm in charge of my control and my destiny with this disease. I can get help from my healthcare team, and from my great friends online at TuDiabetes.com or the Diabetes OC community. But I'm the one who lives with the disease 24 hours a day.
I've walked and ridden many times over the last 10 years to help push this disease back. Last year I was able to raise about $7,500 to fund the important research being done by Dr. Denise Faustman. She really seems to be close to figuring out some important parts of the puzzle that is a diabetes cure.
This year I really want to raise $10,000, which is an impossibly large amount. I've been e-mailing and talking with friends and family, but that amount of money doesn't come easily. So if you feel like supporting me, do it now. Just drop by my fund-raising page and give as much as you can afford.
Yesterday I was on my bike for about an hour and managed to cycle for 11 miles. I practiced a lot on getting up hills without dropping my speed too much and without having to get out of the saddle. I need to get my average speed up to 15 miles per hour, so I can complete a 50 mile ride in a little over 3 hours in the saddle. So I've got a ways to go. And now I'll need to start getting up really early so I can get in a 40 minute ride before work.
It's hard work. But what pushes me forward is this thought.
What if the money that I raise (with your help) hires the researcher. You know, the person who figures out a key part of the cure. Wouldn't that be something?
I've been wearing both Dexcom CGM systems for about 24 hours now. It amazes me how closely they track one another, though yesterday the old one was always about 10 points below the new one. Today I'm seeing about the same difference. You can also see there are some gaps in readings for the Dexcom 7. I think the receiver is a bit fussier about rejecting possibly bogus readings. I wonder how that will look when I'm more than seven days into the Dexcom 7 sensor.
I came across a 19-page HSBC Global Research report(PDF) comparing Minimed and Dexcom based on the ADA conference and a survey that HSBC took. The report estimates there will be about 140,000 CGMS users by the end of 2009 versus about 15,000 today (and 6,000 at the end of 2006). That's a huge growth rate, and you know it will impact insurance coverage. I think it will also drive the demand for software to help healthcare teams interpret the huge amount of numbers they'll see in place of log books.
I hope this quote will come about
We would view any such collaboration between DexCom and any of the leading insulin pump manufacturers – Johnson & Johnson (Animas), Roche (Disetronic), Smiths Group (Deltec), or Insulet – as a positive for both parties, as both companies would better com
Personally, I think that CGM will become the standard for testing for anyone with Type 1 diabetes. Read the report, I think you'll find it interesting.
I'll post some pictures from the Dexcom 7 software later in the week. I did try the new software with my old data values and it worked just fine. So I've much more interesting statistical views of my readings available back to March.
Note: I currently own some shares in Dexcom, I work not to let this influence what I say about the company or its products.
Finally here's a picture from last weekend of some of the lovely flowers in my sister-in-law's place in Rhode Island. What a lovely weekend we had there.
When I got home last night a surprise was waiting for me. No, not the Harry Potter book -- that was earlier in the weekend.
A box from Dexcom was sitting on my porch, the new Dexcom 7 CGMS had arrived. The box contained an updated Receiver, a transmitter, and the new software box including download cable. I didn't get a new recharger, and unfortunately they didn't provide a shorter cable to connect the Dexcom 7 receiver with my OneTouch Ultra meter for synchronizing.
So I read the instruction manual while eating my dinner. Then I plugged the receiver in for a few hours to charge it up. I decided to insert the new sensor around bedtime. And wow that was a lot easier for me. That small change they've made in the sensor needle gauge made the insertion pain feel a lot less for me.
The Dexcom SEVEN transmitter design changed slightly. It now has two small extensions on the back to lock it into the sensor. This much be part of making the system waterproof. This did make it a lot harder to actually lock the transmitter into the sensor. The little piece of plastic left after sensor insertion really just didn't work.
Luckily I have such wonderful stomach muscles (hah!) that I was able to just push the transmitter into place. It was really tough! It'll be interesting to try and remove it in when the sensor is all used up.
I waited until this morning to tell the Dexcom 7 receiver about the new sensor. A lot of people have reported better results if you wait more than 2 hours after insertion of the sensor.
Dexcom has made several small changes to the screen between the Dexcom 3 and the Dexcom 7. All of these improve it greatly. They've replaced the time range on the Dexcom 3 (9:30 AM to 10:30 AM) with just the current time (10:30 AM) in a larger font and 1 Hr in an even larger font. Net result, it's much easier to figure out which screen you're looking at.
They've also changed the screens you use when telling the receiver that a new sensor is available. I think this will mean less confusion between the sensor insertion and sensor removal screens.
I've posted a short (and slightly fuzzy, sorry) video on YouTube that shows some of the differences between the screens. I'll try and most more about differences between the Dexcom 3 and the Dexcom SEVEN tomorrow.
Note: I currently own some shares in Dexcom, I work not to let this influence what I say about the company or its products.
Between Diabetes, Asthma and general coughs and colds, I'd say that I'm in a doctor's office at least 10 times each year. And one thing that's always bothered me is when I visit a doctor that I don't see visibly wash their hands before starting to talk with me.
Now they may have washed their hands before coming into the room. But what are the chances?
Today on the editorial page of the Wall Street Journal, I saw an advertisement placed by RID, the Committee to Reduce Infectious Deaths. And guess what they have listed as the first of 15 steps you can take to reduce your risk of getting a hospital infection?
That's right Ask that hospital staff clean their hands before treating you.
I'm going to clip the advert and give a copy to all my doctors at my next visit.
Today it's been a year since I started posting on this blog.
This is my 137th post since then. I want to use it to let you know what I'm trying to do with my blog.
If you're a regular reader you can hopefully tell that I care a lot about technology and user experience. I'm blessed that my regular job is as a software architect. On the job I get to look at tools and techniques that can help improve the user experience in software.
On this blog I look at software and technology for diabetes, what it's like and how it might be improved. Along the way I hope to influence device and software makers so they think about user experience in the early stages of design and development for new diabetes technology.
In the last year I've learned a lot from your comments and suggestions. I appreciate these more than I can say. I plan to be blogging actively a year from now. If I'm doing a lousy job, let me know.
And thanks for support and friendship to my many diabetes friends from TuDiabetes and the Diabetes OC.
According to the page the Dexcom SEVEN was approved on May 31st, and a pointer to the approval letter(PDF) is provided. So Dexcom really didn't delay at all before telling us about it.
It's interesting to see the history of the Dexcom filing with the FDA
Filed: June 9, 2006 Amended: July 11, August 4, November 21, November 24, and November 28, 2006, and February 9, April 20, and April 23, 2007
I don't think this amount of filing is unusual, but it gives some insight into the amount of work needed for FDA approval.
Two points in the background notice jump out for me. The first I already knew and the second is a little vague:
Use of acetaminophen-containing medication when the STS-7 sensor is inserted may affect the performance of the device.
The Dexcom STS-7 System must be removed prior to MRI
Does this mean that I need to remove the sensor and the transmitter before an MRI, or that I just need to remove the transmitter? I'll have to clarify that one with Dexcom. Update: I exchanged emails with Dexcom customer support. When having an MRI I need to remove the transmitter and sensor and leave the entire system in another room.
If the FDA only points out issues with acetaminophen, then it appears that use of other drugs doesn't cause issues. That's good, because I've already seen the impact of acetaminophen on the Dexcom STS that I'm wearing and it's not good.
I'm still waiting on my Dexcom SEVEN. I hope to see it in a week or so.
Note: I currently own some shares in Dexcom, I work not to let this ownership influence what I say about the company or its products.
This morning I attended a pump club meeting in Woburn, just north of Boston. This is the second meeting that I've been too. About 18 people of various ages and backgrounds. This time there were four people who had diabetes for over 50 years. That's an unbelievable achievement, especially given how primitive things where even 20 years ago.
But that's not the point of my posting here. We spent a lot of time just chatting about diabetes: technology; balancing it; complications; victories. In the two+ hours I was there I don't remember seeing a frowning face. In fact there was a lot of laughing, applause, encouragement, and generally positive feeling.
But wait, isn't this diabetes. That chronic disease that's such a pain to live with?
The disease that all these frowning-faced people are affected by? (Photos of some members on TuDiabetes.com)
I know there are days when I struggle with this disease. But most days I just get up in the morning and deal with it until bedtime. Could things be better? Absolutely. What helps me? Sometimes a little pick-me-up like a Groovy Patch for my insulin pump.
Right now, I'm thinking the best fix I could have is a good diabetes T-shirt. Someone at this mornings meeting showed me a picture where a woman was wearing a T-shirt that read "Insulin-powered Engine". I liked that, but I wanted even more. A shirt with attitude.
Then I came across a post from Amy T. in 2005 looking for T-shirt slogans. She pointed to Gina at DiabetesTalkFest, but that page is gone! Thanks to the magic of the Wayback Machine, I was able to find the page from 2005 and the slogans are awesome! Some are listed below.
Wouldn't you feel better wearing a shirt that had one of the following?
Diabetics are sweeter
Diabetic: Gimme sugar and no one gets hurt!
Diabetes - it's a blood sport!
I’m not Diabetic, I’m sugar-challenged
Insulin-powered Diabetic
Diabetes, the thinking person's disease (a t-shirt I have)
So here's my suggestion. Comment with your best slogans. I'll put together a survey and see which one gets the vote for the most popular slogan. I'll post the results on TuDiabetes.com and on this blog.
If enough people are interested in owning one, I'll arrange to get the #1 slogan printed on a T-shirt and offer them for sale at cost. I already know a few people who'll buy one.
The MedApps system is designed to transmit glucose readings to a central server by way of your cellphone. It's now been approved for over-the-counter use.
The illustration from MedApps all show a OneTouch Ultra meter, but their information claims 'the BluePAL technology wirelessly transmits data from 20 of the most popular glucose devices from 4 of the leading manufacturers'.
They provide a device (Polymap Polytel) that connects to the meter and sends the data via Bluetooth to your cell phone. The cell phone transmits the data to a MedApps central server. The system can be setup to send alerts to healthcare providers based on per-patient thresholds.
It all sounds interesting, but there's a lot of steps from meter to software. Now if all the meter makers agreed on a single data standard, this would all be a little easier.
I've spent a good deal of time over the last week on the phone with the local sales rep from Dexcom. I was trying to negotiate either a loan of the Dexcom SEVEN, or a deal where I could purchase it and return it if I wasn't satisfied with the new features promised.
I was disappointed before by a promise made by the previous Dexcom representative and I really didn't want this to happen again. But thanks to the great posts on the Dexcom SEVEN by Clemma, I'm now more confident that I'll really like the new features, and I can live without an improved display for now.
The big outstanding question is how long the new Dexcom SEVEN sensors will last for. I'm on day 11 of a current 3-day Dexcom sensor. So to get the equivalent performance from a 7-day sensor, I'd need to be able to wear it for about 25 days. I don't see this happening. So I'm going to work my insurance hard about reimbursement.
It looks like the new software is much better. The representative tells me that you can export the Dexcom data to an Excel spreadsheet - he'd better be right. The waterproofing will be nice and the reduced gauge needle.
What else should I tell you about? Oh yes, the upgrade price. Officially the entire new system (receiver, transmitter, cable, software, One Touch meter) is $800. They currently have a special upgrade offer for July. Over the last week, I got three versions of the upgrade price.
Last week Dexcom sales told me it was $350. Yesterday the Dexcom representative told me it was $450. But late yesterday when I called Dexcom sales to order the system, I was told the price was $150!! So that was what I paid. I also ordered 4 sensors at the special price of $175 (instead of $240). So for about $343 plus tax I'll get the new sensor, receiver, and software. I'll have to return the old ones.
Other minor piece of new is that they're all out of upgrade kits. So right now I need to wait for about 2 weeks to receive it. Once I do, I'll be sure to let you know what I think of it.
Note: I currently own some shares in Dexcom, I work not to let this ownership influence what I say about the company or its products.
I had my first meeting (by phone) with him last week. Today was a great day, and I think some of that was due to the suggestions that he made about changing some pump settings. Here's the proof, thanks to my Dexcom STS.
I'm hoping to get a few more days like this from here on out. I'll let you know how it goes.
Tom and Ray Magliozzi, those crazy Car Talk guys, were kind enough to send me a photo wishing me good luck in my diabetes bike ride.
I'm trying to raise $10,000 for this important research on a cure for Type 1 diabetes. Right now I'm 25% of the way there, and with your help I can reach my goal.
Why not do it now, before you forget about it? And thanks, it really does help.
I've been using Symlin since late 2006 to reduce the blood glucose peaks that I get after eating.
Symlin works by slowing down food processing so that your sugar levels rise more slowly after you've eaten. Typically you need to reduce your insulin dosage and, if you're using an insulin pump, take the bolus over an extended duration so that you don't have a low. It takes time to get used to Symlin and figure out how much Symlin to take and how to properly take whatever insulin you need to cover the meal.
When I started using Symlin I had a lot more lows. They were hard to fix because the Symlin slowed down the absorption of the juice or Gatorade that I took to get my blood glucose levels up.
I finally figured out this tip for fixing low blood sugars that are caused by Symlin. I chew one dex tablet at a time, holding the chewed up mess in my mouth for as long as I can. That way some of the dextrose is absorbed through my mouth What does get into my stomach is easier for my digestive system to work on. After 2-3 tablets I wait for 15 minutes and see how things are going.
This works much better than drinking a lot of juice and then having to deal with the super highs later. The juice absorption is slowed enough by the Symlin that it takes more time than usual to work.
If you're using a pump, don't forget to cancel any bolus in progress otherwise you may have a recurring low shortly after fixing the first one.
During this week I've read more about the new Dexcom SEVEN continuous glucose monitor that was approved back in May.
I see some traffic on various mailing groups and I've spoken with Dexcom service/sales about the new device. So I now have a little additional information that I wanted to share (because there's so little out there in webland).
The new system appears to be available now. The person at Dexcom that I spoke with was ready to take my order on Friday.
The upgrade price for the system is $350. This includes new receiver, transmitter and software. You'll need to mail in the old transmitter and receiver. You'll receive a reconditioned receiver.
Warranty on the upgraded system is one year.
The price for a box (four) of new sensors is $175 when ordered with the upgrade. Future boxes are the full price. I think this is still $240 for a box of four.
The software is much improved. It can read data from the current Dexcom system as well as the Dexcom SEVEN. It includes statistics that can give you an hourly breakdown. I don't know whether it supports data export yet.
The receiver has not changed much. It still shows a graph of readings from 50 to 400 mg/dL. Major change is that it now shows you how long until the sensor expires.
I don't know how long the new sensors last beyond the official 7-day life span.
That's all the details that I have right now.
I hope to get the new system to try out for two weeks before purchasing. The software is the current Dexcom system was such a disappointment that I won't upgrade without trying the entire system out first (including software).
In the meantime, if you're already using the Dexcom SEVEN why not let us know what you think about it? Maybe you could post about it on the CGM Users group on TuDiabetes?
I came across a report from the BBC about work on an artificial pancreas in Cambridge, England.
Apparently trials are currently being done on 12 children aged from 5 to 18. The work involves a continuous glucose monitor that's fitted under the skin, though it's not clear who makes this.
The research is led by Dr. Roman Hovorka, and it seems as if they're making real progress. I also came across slides and audio for a presentation that he gave.
This is all part of the artificial pancreas project being led by JDRF. Sounds like this project will lead to some interesting treatment options.
I'm saying this because Google makes most of its money from advertising.
I first noticed Google's interest in health-related issues when I blogged about Adam Bosworth's keynote speech at the AMIA congress. And more recently, Google listed the members of their health advisory council. I guess I had my head in the sand, because Google has been looking at the health industry for some time now.
So how can I tell that Google is getting serious about the health industry? Because as of mid-June Google has a Health Advertising Blog.
I figure anytime Google gets interested in a new area, it's worth watching them. So I'll be watching that blog in the future.
The Diabetes Technology Blog is focused on using technology to live life to the full with diabetes. I review new diabetes technology including: blood glucose monitors; continuous glucose monitors; blood sugar meters; diabetes software and living with diabetes.
I was born in Ireland and now live in the US.
I have had Type 1 diabetes for over 36 years. I struggle with my blood sugar, the same as most people with diabetes.
I wear a Cozmo 1800 insulin pump and a Dexcom SEVEN Plus CGM to track my blood glucose levels.
I'm blessed by God, and every day brings the possibility of a cure.
