This was a packed session that deserved to be in a much bigger room. Polita Paulus and Mahesh Prakriya covered the new dynamic data controls available in ASP.NET.
Essentially these controls make it much easier to add master-detail editing to a web site based on a database. Polita did a great presentation that showed using both C# and IronPython to extend the behavior of these dynamic controls.
Drop one of the controls on the page, and you get basic editing for almost no work. You can add a little code and the control will use UI widgets that you provide and can extend. And if you add a row to the database, it displays automatically when your rebuild and redeploy.
The demo included displaying pictures that are retrieved from the database, with no converter code required.
I've not done any ASP.NET programming in several years, but this stuff was impressive for the amount of UI you can create for almost no written code.
I just left the tail-end of the Ray Ozzie and Scott Guthrie keynote session at Mix07.
The session was jam-packed with folks standing at the back of the room (probably around 1,000 in attendance).
Ray was repurposing SaaS from Software as a Service to Software and a Service. It really sounds like they're embracing the approach that was first widely deployed with the iPod. Software running in the network cloud, and on the desktop (or in a browser), and on a mobile device. As Ozzie said, software 'embracing the value of the client'.
Most of the session was devoted to Silverlight and some new announcements around Silverlight design and development tools. Lots of cool demos from MLB.com, CBS, Netflix and others.
Lots of examples of rich content (especially live and streaming video) embedded in the web page. And they showed these running in IE7 and Firefox on Windows Vista and Firefox and Safari running on Mac. There also a nice demo showing a debugger running on Windows that was debugging a client session running on a Mac - that was impressive!
I also noticed an emphasis on the size of the download and the user experience in installing a Silverlight application. With broadband, it may seem that size no longer matters but remember there are still a large number of user environments (for example retail stores) that don't have a huge bandwidth connections to the client.
Scott Guthrie also pointed out several times how Silverlight is much faster for development and execution that JavaScript. He showed a simple chess program with a .NET chess player running against a JavaScript player. Silverlight 1.5 million move node calculation \versus JavaScript 500 node calculations for the same game. .NET wins. A little cheap but effective.
I'm in the big ballroom at the Venetian Hotel waiting for the start of the general session for Mix07. Microsoft has setup quite show with four huge screens (I'm guessing about 15 feet by 20 feet each) plus a central area where currently a three piece band is playing some interesting music.
There's quite a buzz in the crowd and the room is filling up (enough room for about 1,000 people I'm guessing).
I plan to blog some about the sessions that I attend and let you know what I think about each of them. So until Wednesday, most of the posts will be related to Microsoft and MS technology. More later.
The authors did a comparison between the FreeStyle (reading every 1 minute) and a system to measure venous blood glucose (reading every 15 minutes).
And the conclusion?
Measurements with the FreeStyle Navigator system were found to be consistent and accurate compared with venous measurements made using a laboratory reference method over 5 days of sensor wear (82.5% in the A zone on day 1 and 80.9% on day 5).
This article also contains pointers to two interesting FDA summary of safety and effectiveness documents. One for the Dexcom STS system(PDF), and one for the Medtronic Guardian RT system(PDF).
Has anyone out there used this system and can post about it? I'm especially interested in what the software does.
Update: They've finally received FDA approval for the Navigator. I've posted on my blog with the details.
Readers Challenge: Help me decode the Dexcom data format
I've been using a Dexcom STS continuous glucose monitor system for about a month now.
For day to day use, it's really wonderful. I can see highs before they happen and take the edge off them, and I can also watch much more easily for lows and reduce their impact.
But the software continues to be a major annoyance. Basically all it gives me is two very simplistic graphs of the blood glucose data collected by the Dexcom system.
The Glucose Trend graph shows up to one week of glucose readings from the system.
By choosing a smaller number of days, I can see the readings a little more spread out. For me, this makes it easier to look at the values.
However the software shows no summary statistics, and the only way I can actually see that values is by holding my mouse over them.
The other graph is the Modal Day one, which lets me see a number of days worth of data superimposed over a 24-hour period. This makes it a little easier to see patterns.
Again there is no summary data for the selected time period, and I can only look at one time segment at a time. So if I wanted to see what was happening for the last two weekends, I'd need to produce one report for each weekend and then look from one to the other.
OK. Now this is where I ask for your help. I've sent some e-mails to Dexcom asking for more information on how to get the data out of the system. So far, I've heard nothing back. Maybe one of you format hackers can help me in decoding the actual information itself.
Warning, it's fairly technical below this point. And I'm really hoping that someone can help with this problem.
Using some tools such as the wonderful FileMon from SysInternals, I've finally figured out where the receiver data is being stored on my PC. Trust me when I tell you that this is not easy.
For example, on my system, a lot of information is written by the software to various folders in this location: C:\Documents and Settings\Bernard Farrell\Local Settings\Apps\2.0\TO260ZDW.VE3\JGBRCCZA.X12
But the actual receiver data is written into a number of .R2Download files in this location: C:\Documents and Settings\All Users\Application Data\DexCom\DexCom DM - Consumer\ReceiverData\
For example one of them is named {2E6B7BE9-DA8F-42FA-8337-29404D84A829}.R2Download.
The files contain XML structured data, part of which is the readings themselves in some compressed form.
The data is contained in the DataBaseRecords object in this XML file. And from looking at the Signature object later in the file, it may be encoded using some sha1 approach.
I've uploaded the contents of one data file to my server. If you'd like to have a look at the file and see if you can figure out the data portion, then download the data file from here.
And if you can give me any suggestions as to how to decode this, I'd be thrilled.
I've been doing prototype development with Flex for about six weeks now, and it's really an awesome tool for putting together polished, rich demos and applications. I'm still climbing the learning curve, and really enjoying it.
I think this is going to be an interesting challenge to Microsoft's recent announcement about Silverlight. After all, I can't see them open sourcing Visual Studio or any part of their stack like this.
Sorry that I've not posted in a while. We all went to Washington DC for a week (school vacation week here in Massachusetts).
What a busy time it all was. The Dexcom continuous meter was especially useful on those days where we walked about 3 miles (and we had a few of those) and grabbed food on the run. The weather was terrible, but we all had a great time.
And thanks all for the responses to my poll. I'll try and summarize before the end of this week, if you have friends with diabetes please encourage them to answer the five simple questions.
On Sunday I fly to Las Vegas to attend Mix07, the Microsoft technical conference for web design and development. If you're likely to be there, e-mail me and let's see if we can connect.
And if you have a few dollars to spend on a great cause, please drop by my fund-raising page and support my bike ride coming up this September. I'm planning to raise at least $10,000 to directly support Dr. Faustman's research towards a cure for Type 1 diabetes - it's great research and really needs this independent support.
I've been wearing a Dexcom continuous glucose monitor for almost three weeks now. And you know what? I've now got this super power.
No, it's not X-ray vision.
Even better, it's a power that folks without diabetes don't have.
I can see my blood sugar readings. In fact, I can also predict them some. It's like I'm looking into my bloodstream at the molecular level.
And here's what it looks like as I'm writing this entry.
So what, I hear you say.
Well get this. If I'm about to get in my car and drive, I can simply take this out of my pocket and tell in a split second whether it's safe for me to drive.
If I'm running around with the kids, I can take a quick look and make sure that my numbers aren't dropping too quickly.
And if I've just eaten more than I should, I can keep an eye on this and correct before my numbers get way too high.
It's simply amazing to me. And I'm already seeing a benefit in my numbers. Less horrible highs and tighter control all round.
There are drawbacks. It's another gadget to carry around. And I don't yet know whether my insurance will cover it. But with the announcement from Medicare/Medicaid, I think it's only a matter of time.
In the meantime, I think I'm going to go jump over my house. After all, I do have super powers.
I'm curious about what you're using to manage your diabetes.
So here are my questions.
1. What type of diabetes do you have? 2. What blood glucose meter(s) do you use? 3. If you use an insulin pump, what is the make and model? 4. If you have a Continuous Glucose Monitor, what make? 5. If you have a computer(s) at home, is it Windows or Mac?
I'd like to get as many answers as possible. So please forward these to others if you can.
If you'd like to do a completely different poll, check out the questions that Curious Girl is asking. Update: I just realized I should answer my own questions. 1. Type 1, 34+ years. 2. OneTouch Ultra, recently OneTouch UltraSmart. 3. Minimed 512. Can't wait to change this in September. 4. Dexcom as of 3 weeks ago. 5. Several Windows XP desktops and laptops.
Warning for those of you who are faint-hearted. This is not good software. So this is a very critical review
After some pestering, I finally received the download software for my Dexcom CGM system. I paid for the system on March 30th, and received the software today April 10th. It wasn't worth waiting for.
In a nutshell, this is extremely poor software. According to the Dexcom Help About screen, this is version 9.0.2.18. Why they would use a complicated numbering scheme is just an indication of how little they're thinking of the user.
To me this feels like beta software. There was no attempt made to give the user any level of control.
You can only do three slightly useful things with the software. Download the readings from the Dexcom receiver, view up to seven days worth of readings at a time, and print a report showing the readings over an extended period, with seven days of readings summarized on each page.
The screen to view the readings is shown below. You can see strong correlation between the Dexcom readings (blue circles) and the Ultra meter readings (red X marks). If you hold the mouse over a symbol you can see the summary value in mg/dL.
Later in the review, I show an example of the Modal Day view for the data. This is valuable for doctors and, with some help, patients.
I believe that software like this is unusable for the average patient. It doesn't provide information that they can readily act on. At the end of this review I've outlined some areas for improvement.
The rest of this article is a screen by screen description of what I found in the Dexcom software.
Dexcom Software Details
When I loaded the CD that the software arrived on, it immediately started installing. I was given no installation choices about where to put the software. This was the only screen that I saw.
The whole feeling I got during thw install was the lack of control I was given. Notice how the screen above only has a Cancel button? And there's no option to indicate where to install the software.
The next screen below warned me to remove any attached Dexcom receivers. Now this is written all over the box that contains the software and cable, but I understand the need to be cautious.
So after pressing OK, the next screen tells me to connect the Dexcom receiver using the supplied cable.
I connect the cable to a USB port on my computer and to the Dexcom receiver. After pressing OK, I get the obligatory legalese screen.
Now I'm ready to download data from my Dexcom receiver....but the software isn't.
First I've got to fill in some details to get the download going. On the screen below, I click the New button (picture is after I filled in my details).
Then I fill out this form. You could leave it blank. But then if you exported the data, it wouldn't have your name. I added the minimal amount of information.
Then I press the Start button to get the transfer going. I had data from March 23rd to April 10th, about 18 days worth. While the data is transferring I see the following screen. It takes about four minutes to transfer all the data across.
After that I can finally see the data, up to seven days at a time. Apart from the Glucose Trend view (shown at the start of my review), there is also a Modal Day view that shows up to seven days worth of data superimposed over a single 24-hour time period.
I think this is the most valuable aspect of the Dexcom software. You can select for example three days worth of data and then use the arrows to see successive days. That gives me some idea of the trends.
Minor Points
The Dexcom software was almost hidden on my PC. I had to use a special tool to find it buried under the following area:
C:\Documents and Settings\Bernard Farrell\Local Settings\Apps\2.0
After a good deal of investigation, I could not figure out which file in this area is holding the data itself. So for a technical person like me, I couldn't figure out how to extract my own data from their software so I could look at it in more detail.
Areas for Improvement
I could write several pages here. Let me just make a few points.
First. Make two versions of the software. One for patients and one for doctors. An individual doesn't need to track patients. This same criticism is true for software from OneTouch and Minimed. I think they're using the same group of consultants!
Second. Let us get at our data. Better yet, make it available in a standard format. That way we can build software to combine this with data about food, insulin, and other useful information.
Finally. Add some basic statistics. How about the average (mean) blood glucose value for the displayed time period? Or the percentage of time between a range of values. This could really help.
Other stuff. I'd like to compare what happens over different time periods. Show me the trend for a 14-day period. Give me the modal view for a selected set of weekends. Allow me to mark a range of readings with additional data to indicate sickness, menses, etc.
Your Assignment
Have you any experience with diabetes-related software? Are there things that you like or don't like? How about providing some comments that might help in the development of the next version of this software.
Have you used the Minimed software for this CGM? How about posting a review somewhere for that.
The FDA has just launched a new page to track the status of patient studies on newly approved medical devices. This will contain information on studies ordered after a device has been in use for a while.
The page currently has information on studies ordered since January 1st, 2005.
The page will be updated on the 5th of every month. Currently there are 44 studies listed, and none of them are related to diabetes.
Codes for insurance coverage of Dexcom devices may be issued later this year.
According to this Forbes article, there will be a public hearing in May and the codes may be available before the end of the year.
I'm hoping that this means insurance companies will actually get a bit more flexible before final approval.
Dexcom shares have increased significantly as a result of this. I wonder if folks were just using it as a chance to cash out. Let's see what happens to the share price over the next few weeks. That'll indicate what the market really thinks about Dexcom and its future prospects.
In the batch of photos that I published earlier about the Dexcom, one of the photos shows a trace of the redness left after using a shower cover. Now this was after I'd worn the sensor for about 4 days. So I'd have at least 3 shower covers applied in the same place.
Here's that picture again. And if you jump to Flickr, you'll see where the red mark from the shower cover is visible.
I'd read somewhere (don't remember I'm afraid) that the Press n' Seal food wrap worked pretty well for shower covering. So I decided to invest in a box and try it out. Here's a picture of the results before a shower.
Overall it's worked pretty well for me, and I've tried this three times so far.
Now this isn't a perfect alternative to the Dexcom shower covers (about $0.60 each). First of all, you need to trim the wrap because it's too wide. And I've found that even with a sharp scissors this is difficult. Also it's hard to get a tight seal all around the edge. You'll probably get some amount of water in behind the wrap.
But it is much easier on my skin. The last time I used the shower cover it was really sore to take it off. I've heard that the Dexcom shower cover does seem to work in swimming pools, so that's a benefit for those.
I've also tried showering without any cover over the transmitter. After I'm done I've found that sometimes there's very little water behind it. Sometimes there's a lot. Immediately after the shower, I take the transmitter off the sensor and dry carefully both the transmitter and the sensor. Then I reattach the transmitter. I try to do this at some distance from the Dexcom receiver so that I don't send it strange readings that might throw it off. So far that's worked fairly well the 3-4 times I've tried it.
Can I point out another CGM benefit? My wife likes that she can see where things are by simply looking at the CGM. Sometimes when my blood sugar gets low I get very uncooperative. I think in situations like that it'll be nice to have something where she can quickly see what the number is right now and where it's been for the last hour or so.
The way I've described it to people that I meet (I love yakking about this thing) is that it gives me a much better feeling of control. I hope that my A1C will actually reflect that.
I'm meeting with my endo on Wednesday and I'm going to start the paperwork for the insurance reimbursement after that.
I have two minor issues with Dexcom support. First of all, I still haven't received the download software. It's been over a week since I paid for all this and I can't download readings and see what the software's like. That's really irritating.
Second, I tried to call the Dexcom support number on Friday morning to talk about getting an extended period of "---" results. I wanted to see if they had any suggestions for resolving this. I spoke to someone (after about 5 minutes on hold) who took my number and said that a support person would call me back shortly. In the end, I got the callback over 90 minutes later, when I wasn't there to talk with them. If the Dexcom sales take off substantially, how will they deal with the likely increase in support calls? I'm hoping this is a once-off issue.
Now on the first day of the week, very early in the morning, they, and certain other women with them, came to the tomb bringing the spices which they had prepared. But they found the stone rolled away from the tomb. Then they went in and did not find the body of the Lord Jesus. And it happened, as they were greatly perplexed about this, that behold, two men stood by them in shining garments. Then, as they were afraid and bowed their faces to the earth, they said to them, "Why do you seek the living among the dead? He is not here, but is risen! Remember how He spoke to you when He was still in Galilee, saying, "The Son of Man must be delivered into the hands of sinful men, and be crucified, and the third day rise again.'"
From noon until three in the afternoon darkness came over all the land. About three in the afternoon Jesus cried out in a loud voice, "Eli, Eli, lema sabachthani?" (which means "My God, my God, why have you forsaken me?").
When some of those standing there heard this, they said, "He's calling Elijah."
Immediately one of them ran and got a sponge. He filled it with wine vinegar, put it on a staff, and offered it to Jesus to drink. The rest said, "Now leave him alone. Let's see if Elijah comes to save him."
And when Jesus had cried out again in a loud voice, he gave up his spirit.
At that moment the curtain of the temple was torn in two from top to bottom. The earth shook, the rocks split and the tombs broke open. The bodies of many holy people who had died were raised to life. They came out of the tombs after Jesus' resurrection and went into the holy city and appeared to many people.
When the centurion and those with him who were guarding Jesus saw the earthquake and all that had happened, they were terrified, and exclaimed, "Surely he was the Son of God!"
I wanted to post on what it took to change the Dexcom sensor. This is a small amount of text and a lot of photos. You can click on any of them to see larger versions.
If you've any questions, let me know.
First of all, here's a picture of the old site.
And here's what the sensor looks like after it was removed. It's quite long, but not painful while it's in place.
After choosing a new location where there isn't scarring from insulin pump sets, I used an alcohol swab to clean the new site.
Then I positioned the new Dexcom sensor.
After making sure it's stuck in place, I remove the safety lock.
Then I can push the plunger to get the needle and sensor inserted. This is probably the worst part of the entire process, thought it's really only a small pinch.
Then I pull back on the collar, which remove the needle and leaves the sensor wire in place. Once I've had a little discomfort doing this.
I remove the applicator. The blue pad sometimes swings out a little. The first time I saw this I thought it was broken.
Finally I use the transmitter latch to lock the transmitter into place. This takes a little practice. You can also do it just by pressing with your fingers.
And here's the finished result. You can also see the trace of the old sensor location.
At the moment I'm working in a new team. We're investigating how to develop user interfaces on top of web services. I'm using Flex from Adobe to build UIs and experiment with different techniques for doing this quickly and easily.
I'm having a lot of fun, the Flex facilities are very cool. But the learning curve is significant. I've been at this for about a month and I'm finally understanding how to do things the "Flex way".
One resource that I just came across is FlexExtensions.com. They provide training videos for Flash and Flex. The tutorial videos are free and the ones that I looked at are very short and informative.
There are lots and lots of other Flex resources, including the just restyled Flex.org site.
If you get chance to play with Flex, I highly recommend it.
P.S. I also hear that there's a big shortage of Flex developers. So you might land a good job by learning Flex.
If you're a pump user and you've never had to do one of these, hands up.
Ok, the young man in the back. How have you managed to escape changing your set in the wee hours of the morning?
OK I see, your mom does it for you.
For the rest of you. I guess that at some stage of your pumping life you've had to change a set in the early hours. And this morning, it was my turn.
What a pain it is to have a CGM at a time like this. It looks like my readings had started to climb around midnight and when I woke up I had a high of 240 mg/dL according to the Dexcom. And a value of around 280 according to my meter.
But looking at the Dexcom readings for the previous 3 hours it seemed a set change was just a good idea. I'd corrected just before bed and my numbers just kept climbing from there.
Note to Dexcom engineering: Please add an additional alarm that will tell me if my blood glucose has been above a certain value for more than a set number of hours. It would have been nice if I'd done this set change at midnight instead of 2:30 AM.
I'm still wearing and using the Dexcom and for the most part really finding it useful.
This week I'm starting to gather supporting paperwork so can make a submission to my insurance company. I hoping that I'll get coverage and I'll post here to let you know how that goes.
I found this useful post on the JDRF website that outlines what you should do to get coverage for a CGM device. I call it the eight steps to getting a CGM. Because I'm not sure that I'd do the final two suggested steps: tell JDRF about what happens, and become a JDRF advocate.
I'm already working hard on advocacy, and JDRF has enough advocates of its own.
Let me point out a few things that I've noticed about wearing this device (and I'm sure the same is true for any CGM device.
First is that this gives you immediate feedback when your control is not good. So it's not like waiting 20+ years to see if you develop complications. It buzzes at you each time you cross the high threshold. If they'd just add a feature so it would shock you, then I might be motivated to reduce my highs!
Second is along the lines of a good news/bad news observation. The good news is that when my readings are behaving properly, it's nice to get the positive feedback. The bad news is when I have a night like last night where my readings were about 200 mg/dL from about 1 AM to 6:30 AM, I get to see that all displayed out as a high line. Yuk.
Despite its shortcomings, I still like the device. I'll try and post some more photos next time round.
The Diabetes Technology Blog is focused on using technology to life better with diabetes. I review: blood glucose monitors; continuous glucose monitor; blood sugar meters; diabetes software and living with diabetes.
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.
