The New York Times has a short article (registration required) on the thrills of wearing the Minimed CGMS. It's written by a journalist who has had diabetes for 30 years.
I don't know, maybe it's because it's the NYT, but it does make me think that the Minimed device isn't quite for me yet. This despite my endo and others already telling me the same thing.
My ideal CGMS? One that requires minimal calibration, with readings that are within 5% of my meter and that has an alarm that can be switched off for short periods.
Call me crazy for the last feature request, but so many folks I've read or talked with have tales of being kept awake at night because the device is repeatedly warning them of lows (which may be wrong because of the 15%+ variability between the device and their meter). It sounds like a nightmare to me. (Thanks to Caro for correcting me about this last point. There are ways to have less alarms go off!)
I wonder how long it will be before someone is offering a CGMS bag that muffles the noise for sound sleeping? :-)
I have a Minimed 512 pump which I've owned for just over 3 years this week. That means that my insurance will cover me for a new pump in about 12 months time.
Or...I can go for the Minimed upgrade program. Except for what I recently found out about this program.
Now please bear in mind that I'm already a little ticked off with Minimed because before I had the 512 for a year, they released the 515 model. And the 515 is a much better pump.
For one thing you can decide on the insulin duration based on what you've found. In the 512 that insulin action curve is fixed. For another thing the 512 treats blood sugar readings that you enter differently to readings that it gets from the (cough lousy cough) BD monitor. At that stage there was no reasonably priced upgrade option, so I've been stuck with this pump ever since then.
So here's what I found out. For $400 I can upgrade to a 'reconditioned' 522 pump. However the warranty that I get with this newer pump only lasts for the duration of the pump I already own. So if the new pump breaks down in 12 months or more it would no longer be under warranty.
What I can't understand (and maybe you can help me here) is why Minimed would expect anyone to spend their own money on something with such a short warranty. Also, why would a 512 user spend $400 for a 1-year warranty when a 515 user only has to spend $300 for a 2-3 year warranty? Does that make any sense to anyone who doesn't work for Minimed?
Have you used the upgrade program? What's your experience when the warranty runs out?
When I saw my endo recently we talked about the use of Symlin. She looked at my after dinner readings and agreed that Symlin would help there (range of 200-300 mg/dL). So she gave me a dosing information sheet for Type I's and a sample vial. By the way, there is a reimbursement assistance program for folks using Symlin.
The information given to patients tells you exactly what to do, but not a lot of the why. The prescribing information sheet (PDF) that comes inside the box is a good deal more informative, but of course it's written with a good deal of doctorese.
I started taking Symlin last Saturday, and right now I'm only taking it for dinner. I did experience the nausea for the first two days. It comes on about 10 minutes after the shot. More interesting for me was the experience of feeling full. This is something that I really haven't felt in many years and it really does reduce my inclination to over eat.
Right now I'm on the Symlin 15 µg dose (2.5u on a normal insulin syringe). It stings slightly when injected. Within 10 minutes I get the full feeling (or very mild nausea). I've started dosing it about 15 minutes before I eat so I tend to eat less. I'm currently reducing my insulin dosage by 40% and taking that just before I eat. (Note: the Symlin folks want you to stabilize your Symlin dosage before adjusting your insulin too much beyond the 50% reduction.)
The net results. For the most part I've seen much better after meal levels. One evening the values never went above 180-186 mg/dL, which was great.
Tomorrow I'll start using the 30 µg dose and see how that goes. I'm also tracking a good deal more information using a spreadsheet, including: blood glucose; carb count; Symlin dosage; pump-suggested insulin amount; bolus amount taken; dual wave bolus amount taken. Right now this much information is not too informative, but later it may prove valuable.
My advice? I think this is an important tool in your diabetes toolkit. The many warnings about hypos means that I'm being very careful about usage, and you probably should too.
The biggest benefit? The feeling of being full, I really missed that and it's nice to have it back for at least one meal a day (for now).
My life is more than full of things to do. And like most (all?) of you, I have trouble keeping track of the important things and ensuring that they are given the attention they deserve.
So I've been reading things on 43 Folders and trying to get into the whole GTD (Getting Things Done) mindset.
Recently I started using a great Outlook add-on called ClearContext. While it makes Outlook startup a little slower, it does a great job of helping me to categorize my e-mails and assignment them priorities. (If you know of the David Allen GTD Outlook Add-in, I've tried that. I couldn't get it working successfully with the Outlook setup at work.)
Bear in mind that it does take effort and time to get used to the ClearContext way. After a month of use I think that now I get about 40% of its capabilities, and that's giving me enough benefits that I'll be continuing to use it.
I purchased a full copy a few weeks back, and I just received an e-mail about passing the message about ClearContext on to friends and colleagues. You get a $15 discount on the purchase price, and I get a free upgrade to the latest version of ClearContext, which is due out shortly.
So if you download it, try it, and decide you can't live without it, use the following coupon code CC15-15874 and you should be all set.
I saw this posting about some folks who are working on wireless technology for linking glucometers and insulin pumps.
The reason I'm commenting on it is because there's a picture in the posting that doesn't look like any device that I'm currently aware of. It's certainly not a Minimed device.
So my question is, who else is working on these things?
I was cleaning out some shelves from the top of my closet this evening. In the process, I found some oooold diabetes bits and pieces. Now in their day, these were most useful to me. But now, they're just gathering dust.
So, if you would like one of these drop me an e-mail and let me know. I'm not looking for anything in return, I'd just hate to send them to a landfill.
NovoPen 1.5 Silver. Made by Novo Nordisk. New in box.
NovoPen 1.5 Silver. Made by Novo Nordisk. Used. With directions.
Autopen. AN 3100. Made by Owens Mumford. New in box.
Accu-chek Complete meter. Used. With lancet, carrying case and instructional video.
Thanks to Gabrielle over at Insulin Pump Demystified I just ordered some Groovy Patches for my infusion sets. Here's a sneak peek of some of the designs.
These look like serious fun, so I've ordered extras for the three women pumpers that I know well. I want to spread the joy!
I know that some of you might be uncomfortable with calling attention to that thing which looks like a spare navel (my opinion). But this way you have some choice in how it looks. And hopefully Dina Klavon will add more designs as time goes on.
Now my wife knows how much of a sentimental fool I am, so she won't be surprised to hear that I was teary-eyed as I listened to what Dr. Faustman has already accomplished and what the next steps are.
The Bike the Miles for Human Trials folks have a ride to support Dr. Faustman on September 10th. It's starts and ends close to the MGH research labs in Charlestown, MA. You can learn all about the ride on their web site. And Dr. Faustman will be talking a little after it's all over.
Anyone else want to sign up for this one? If we had another 10 riders and each raised $1,000 that's probably enough for a month or two of research work and a few steps closer to curing Type 1 diabetes.
Tomorrow morning I'm meeting with my endo and a lot has changed since I saw her a few months ago.
First of all, she's working at a new place which is a lot closer to work for me. That alone is exciting, especially when you're getting faster bloods drawn!
Secondly, since I last saw her the new 522 insulin pump was announced by Minimed. So I'll be taking along the Minimed coverage letter (PDF) that may help me to get coverage for the 'real-time' meter that works with the 522.
I also want to chat with her about the pros and cons of Symlin as a way to reduce those postprandial highs after meals.
You can call me hopelessly optimistic (you wouldn't be the first), but I know they're closing in on a cure. If I can raise money that pays for a few months of research that might mean thirty times where I don't have to change my infusion set. Now that's a dream I'd pay for any day of the year.
I'll check in later and let you know what I find out about the 522 and Symlin.
I'm working on getting my laptop configured so that it's both a useful home machine and office machine. That's such a pain because I've so many essential tools that I need to get across.
One of these is ActiveWords. I'll bet you've never heard of it.
What ActiveWords does is allow you to turn almost anything you type (in a document, browser window, spreadsheet, or via an ActiveWords toolbar) into a short command. So you're writing a document and you want to put your name in, type: name and the text name will be magically replaced with your name.
Filling out an online form that wants your phone number? Just setup the word fon so that ActiveWords replaces it with the right digits and you're all set!
Install a few free add-ons from the supportive folks at ActiveWords, and you can initiate a Yahoo search on any word, open a web site with a few keystrokes, or pretty much anything you want to do.
At work I have the word twoon setup to enable my second desktop monitor via ActiveWords scripting.
Sorry to go on about it, but this is a great tool, and I'm just a very satisfied customer. I bought a personal copy for myself at work and it's one of a key number of tools that make me look like a really smart person (at least some of the time).
Don't believe me? Try the free download and see what you can with it.
My notes from a pump club meeting about the Minimed 522/722
I was at a pump club meeting in mid-June when some information was presented about the new Minimed pump with realtime glucose monitoring. I realized that I should post this here, for those who are just gathering as much information as they can about the Minimed 522 and 722 pumps.
It turns out that about 10 patients in the Boston area have received insurance coverage for the pump and associated 'real-time' sensor. The Minimed rep sent me a template of a letter that Minimed is suggesting could be used to get coverage from insurance. E-mail me if you want a copy of it.
I joked that maybe all we need to do in order to get coverage is to have a few ambulance rides! It does turn out that problems with A1C level control or hospitalizations due to reactions or DKA are all likely to persuade an insurer to cover the sensor.
The sales rep mentioned that Minimed is actively talking with major insurers, including Aetna, about getting full coverage. Minimed will have some studies out in the fall that will provide more evidence of the benefits for using this type of system.
The sensor is a complete unit including power source. It needs to be returned to Minimed every year or so for a replacement. I don't know if there's a cost associated with that.
Even though Minimed says that the sensor needs to be changed every 3 days, it seems that it will work for up to 6 days (or more) in most people. Because it's just lying in the skin, and not delivering insulin, there seems to be less skin reaction problems with it. They do provide a spring loaded insertion device for the sensors.
The computer software to download the data is provided with the pump. I assume they also provide something to collect the data (don't know if that's wireless or some wired connection to the pump).
A woman from Minimed who attended the meeting was wearing the sensor and pump. She said that she normally just lets the transmitter dangle. The transmitter is fully waterproof. So if you removed your pump to go swimming, you could leave the sensor/transmitter in place.
In that case it continues to collect data for the first 45 minutes after it's not 'connected' to the pump, and will upload that data to the pump once reconnected. It seems very likely that the sensor size will be reduced as Minimed refines it.
It appears that it takes about 21 days to get used to the new information available and learn how to take best advantage of it. There may still be a significant benefit in just using the sensor from time to time (wear it for a month and then not for a month) - which would certainly save money for people who don't have insurance coverage.
It also seems that it provides much tighter control because it allows you to see a high coming and take earlier action to reduce it. Ditto with a low.
Other things that I learnt: Minimed has a program where they will lend you a pump if you're going overseas on vacation and want to have a backup with you. There may be a minimal cost (? $50) associated with this. Some students who go overseas for an entire semester take advantage of this.
The next version of the pump will provide predictions about where your blood sugar will be in 30 minutes. It's not clear when that would come out. My guess is not before the fall of 2007.
The version after the next one will probably be a closed loop system. This really helps with your basals. You'll still have to work boluses and dealing with illness/exercise separately. Since I see this as a much more significant change in the overall system, my bet would be that we don't see it before early 2009. It would be interesting to attend the FDA approval hearings about that one!
I can't vouch for the accuracy of any of this info, it's a mental set of notes that I sent to some diabetic friends the next day. I hope it's useful to someone out there.
Picture how and when your food affects your blood sugar
Amy Tenderich has posted a really useful picture that shows hows different types of food affect your blood sugar.
Now this is all based on the Glycemic Index of different food types. I know that this index is often used as a way to help people diet, and there's some controversy about whether or not it's effective for that purpose. But ignoring the dietary issues, I do find the curves in Amy's picture really look like what I expect to see when I eat food.
Has anyone found an effective way for dealing with that long tail for fat? My CDE gave me an algorithm that she has found works. If anyone is interested I can try and write up a post about it.
Microsoft has posted a list of common support issues that arise when folks try to install IE 7.
I really like how Microsoft is handling this. After all it's hard for IT to lock down all machines to ensure that no-one installs IE 7 before IT can support it.
At least this way, IT folks can read this knowledge base posting and already have answers to some of the problems their users may encounter.
I just listened to an interesting 13 minute podcast, where the first 7 minutes are an interview with a scientist from a Northern Ireland company called Diabetica.
Diabetica signed a licensing deal with Amylin in March of 2006 for a product that is part of Diabetica research on a molecule called Glucose-dependent insulinotropic polypeptide (GIP). I don't pretend to understand the science, but it does seem like these are smart folks working on some different ways to treat diabetes.
Now I've not yet tried Symlin, which was at least co-developed by Amylin, which sounds like a most interesting treatment option. I'm going to keep my eye on what Diabetica is up to, those Irish guys are smart.
(Disclosure: I emigrated to the US about 20 years ago, but I was a teenager living in Dublin , Ireland when I was diagnosed with diabetes in 1972.)
Diabetes: technology, devices, software, and other stuff.
About Me
Name: Bernard Farrell
Location: Massachusetts, United States
I was born in Ireland and now live in the US.
I have had Type 1 diabetes for over 35 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 CGM to track my blood glucose levels. I also take Symlin to help control my post-meal blood sugars.
I'm blessed by God, and every day brings the possibility of a cure.
