I'm looking forward to a last bit of R&R before school starts for everyone.
On Monday I'm looking forward to lunch with Allison and Mel in Cambridge, MA. If any of you d-bloggers are local to Massachusetts drop me a line if you'd like to join the fun.
And next week I'll try and post some thoughts on the Cozmo insulin pump that I just returned today. Overall I liked it with a few reservations.
This is only partially diabetes-related, but I'm sure you'll forgive me.
My wife has just started to blog about how she's working on getting back to software engineering. She's the love of my life and I'll bet her blog will be of interest to some of you.
We've been together since the early 1990's, so she's also seen me transition from shots to an insulin pump and from blood glucose meters to a continuous glucose monitor. And she's stood by my during various diabetes advocacy issues and even my current crazy bike ride.
I've posted a video to YouTube that shows how to reset the Dexcom 7 receiver to tell it that the sensor has been removed. You can do this if you want to end a sensor early.
The second part shows how to tell the Dexcom 7 receiver that a new sensor has been inserted. You can do this whether or not you have actually replaced the sensor.
I hope you find the video is helpful. Sorry it's a little shaky.
One of the things that really bothers me about diabetes is the sheer amount of stuff that we go through.
I'm using a Dexcom CGMS and two insulin pumps and a OneTouch Ultra right now. So over the course of a month I basically throw away about this much disposables stuff
9-10 insulin infusion sets, with tubing, reservoirs, packaging, used IV prep wipes, etc.
180 used blood glucose test strips with blood on them
3-4 empty test strip containers
1-2 used lancets
2-4 Dexcom sensors plus their inserters and wrapping
1-2 empty insulin vials
1 empty Symlin vial
It really bothers me to generate this amount of completely unrecyclable waste.
I know it would be a challenge, but couldn't some of this be made from recycled materials, or at least coded to that it is recyclable? It might only be a small amount of possible recycling but over the course of a year it would really add up.
I'd like to challenge materials folks at the various companies to think about this as they design packaging. See how you can reduce the waste so we're leaving less of an imprint behind us.
For example, I really liked the wrapping for my new Dexcom system. It arrived in a big plastic bubble (like cell phone gadgets at stores) and I was not looking forward to opening it. Imagine my joy when it popped right open and it was marked with a #1 PET symbol so I could actually recycle it. Nice job Dexcom folks.
I got two similar questions recently about the Dexcom 7 continuous glucose monitor (CGM) and I realized it's probably worth summarizing what I know about it for those who might be interested in using one. So here's a fairly long post with most of what I know about this interesting device. Note that the Dexcom 7 is officially approved for use in adults, but there are some folks on that list who are using it successfully with their children.
For the record. I start using the Dexcom 3 in March 2007, after a one week free trial. I switched to the Dexcom 7 on July 24th 2007 and have been using it ever since. After 35 days I'm on my 3rd 7-day sensor, so I'm getting an average of at least 12 days out of each one. Remember the sensors are approved for 7 days of use, but most people continue to use them after the seven days are up. I'll post in the future about how to do this, because it's not immediately obvious for everyone.
There are several bloggers who have posted a lot about their Dexcom experiences. You can find a list using the Diabetes Search Engine. Anthony has his Dexcom Seven blog, and Clemma has her Comrade Dex blog, both of which are very informative.
Trying out the Dexcom
You should not purchase a Dexcom without first trying it out. The cost of a Dexcom 7 system with four sensors is $640. And each box of four sensors is $240. And, no you cannot buy these individually.
I do not (yet) have insurance coverage for the Dexcom or the sensors. I'm hoping to start filing for this sometime during this week. From the Yahoo! diabetescgms group it sounds as if more companies are starting to cover the costs of this system. Unless you know that your insurer actually covers it, you need to consider the ongoing Dexcom sensor costs ($60 each for at least 7 days) before deciding to use one.
On the Yahoo! diabetescgms group, someone pointed out that CGMS users seem to be broken into 4 groups.
Those for whom the Minimed REAL time works well.
Those for whom the Dexcom 7 works well.
Those for whom either system works well, and
Those for whom neither works well.
Unless you try it out, you can't tell whether it will work for you. Contact your endo's office and see if they'll arrange a trial for you. You will need a prescription from your endo before you can get a trial. Originally I tried out the Dexcom 3 for a week, which allowed me to make a sensor change. I think this is crucial, so make sure you get to try out the Dexcom 7 for at least 9 days, ideally aim for 2 weeks. And make sure you get a copy of the software when you're doing the trial, the system is much better when you can actually use the (PC-only) software.
Sensor Insertion
Inserting a Dexcom sensor takes some work. With the Dexcom 7, the insertion is a lot less painful than with the Dexcom 3, but it's still tougher than for a pump. There's no spring-loaded inserter, you just have to jab it in. I continue to use it in my abdomen, but I know several people on the Yahoo! diabetescgms group have used arms and buttocks.
Once the sensor is inserted you connect the transmitter to the back of it. This combined unit is waterproof, and you can shower or swim with it and don't need to cover it in any way. The waterproofing is done by having the transmitter lock very firmly in place on the back of the sensor. You can only remove it using the plastic 'safety lock' that stops you from first accidentally inserting the sensor.
The Dexcom requires care and feeding. You need to calibrate it at least twice each day with a test taken using a OneTouch Ultra meter. Calibrating means you take a test with the OneTouch and then connect the OneTouch to the Dexcom via a supplied 5-foot cable, the synchronization takes about 10-15 seconds.
Alarming
You can change the alarm settings on the Dexcom with one setting for the low alarm (changeable in 10 mg/dL increments) and one for the high alarms (20 mg/dL increments). There's a hard-wired alarm that triggers at 55 mg/dL.
Except for the hard-wired one, the alarms only trigger each time the readings cross the boundary from normal to high or to low. So if your high alarm is set to 160 and the reading goes from 155 to 164, the alarm will trigger. If the Dexcom is reading 210 an hour later and the numbers never went below 160 you will not get another alarm. In the case of the hard-wired alarm, you'll get another one 15 minutes after the first.
The alarms can be loud. The first one is a loud buzz. If you miss it, or don't acknowledge it the next alarm is a loud buzz and noise. This happened to me yesterday and three co-workers in surrounding cubes wondered what it was and whether I was OK. So if you're easily embarrassed, watch out for this. In a recent webcast, the Dexcom CEO mentioned that the next generation Dexcom (no idea on dates) will have must more customizable alarms.
The Receiver
The receiver unit is fairly large, a little bigger than most of the insulin pumps available today. I usually carry it in my jeans pocket. It comes with a carrying case, but this is basically unusable. It sticks out very far from your belt and you can't connect the sync cable to it while it's in the case. And remember that it needs to be within 5 feet of the transmitter, so carrying it in a purse may not work.
The Dexcom receiver must be synchronized with a OneTouch Ultra meter at least twice a day. The recommendation is that you check your blood glucose using the meter before making decisions based on the Dexcom readings. In practice I probably test an average of 5 times a day, so don't expect a huge decrease in finger sticks because of the Dexcom. Note that Dexcom provided me with the OneTouch Ultra when I purchased my Dexcom 3 system, I assume they're still doing the same with the Dexcom 7. I also know that many insurance companies won't cover you for two makes of test strips. So if you're going to use the Dexcom, you're forced to switch from your current meter to the new one. The good news is that the Dexcom software will show you both the Dexcom system readings and the meter readings.
The picture below shows the 9-hour graph from the new and the old Dexcom receivers.
You need to charge the receiver about every 3 days, with the supplied charger. It's about the same size as my cellphone charger. I generally do this at night by plugging it in and then sleeping on top of the charging cable so the Dexcom can be beside me in bed. When sleeping I usually leave the Dexcom beside me because the receiver needs to be within 5 feet of the transmitter/sensor. And leaving it on my night stand means I may not hear it when it alarms.
With the Dexcom you'll get their new data management software. I complained loudly on this blog about the original DM software. The new version is much better with lots of useful and useablestatistics. You can also export the data as an XML file, or a comma-separated values (CSV) file which Excel can read.
What do I think about the Dexcom?
In April 2007, I described this as like having a superpower. And I still feel like this about it. My April A1C, just after starting the Dexcom, was 8.2% and my July A1C was 7.0%, a 15% reduction. I don't think I could have accomplished this without the Dexcom. It's also partially due to using Symlin more, and I really found the Dexcom invaluable to help me manage using Symlin.
For me, this has been a life-changing device. Diabetes management has become a lot easier all round. But there are also times when I want to throw it out the window. If I'm woken in the middle of the night (tonight) by a sensor alarm, it can be very annoying. If the usually smooth graph starts to have a lot of gaps in it for no reason that's also a pain.
But I'll stick with it, and I'm aiming for a further improvement in my A1C.
I hope this writeup helps you some in deciding about this device. Note: I still own shares in Dexcom. I try not to let that influence what I say in any of my posts.
Today I'm in wonderful South Boston (Southie) attending the Adobe on AIR bus tour.
I'm hoping to learn a lot more about both Flex and AIR, which is Adobe's technology for installing Flex applications on the desktop. I've already done experimenting with this stuff and I really like it. Of course I'm already a bit of a Flex zealot. That's not hard considering the very pleasant UIs that you can build with a small amount of Flex code.
So I apologize in advance to my normal reader population. I'll be back to normal after the kool-aid has worked its way through my system.
OK, everyone is starting to quiet down, the show must be about to start. More later.
According to a Medtronic press release, Medtronic and Bayer will work together to distribute a new blood glucose meter for Medtronic patients outside the US. Originally I missed the fact that within the US, Medtronic has made a similar agreement with LifeScan. Thanks Kevin and Amy for pointing this out.
The new meter for those in Canada and Europe will be based on the Bayer Contour and will transmit results to Minimed insulin pumps and the Guardian REAL-time CGMS.
The new US meter will be based on the OneTouch platform. I wonder whether they'll use a version of the more stylish OneTouch UltraMini, the Ultra2 or something completely new because of the need to include the circuitry for wireless transmission.
And once again, I hope that one or more of these three companies (Medtronic, Bayer, or LifeScan) will finally decide to work towards a standard format for representing diabetes data.
You've probably noticed that there quite a few conferences about diabetes. But most of those are aimed at anyone with diabetes (mostly Type 2) or for children or parents of children with Type 1 diabetes.
Well those children grow up to be adults. I'm one of them. And there aren't any conference choices for those who left childhood far behind and who still have Type 1 diabetes. We're the minority within a minority.
Until now.
A small number of us are working to organize a conference for adults with Type 1. And we'd like your help. Head over to Allison's blog and learn some of the details. Then go and complete the survey for us. And thanks
A while ago, some of us on the Yahoo! diabetescgms group were asked to participate in a survey about our continuous glucose monitoring systems (CGMS) and what we thought about them.
This short and readable document includes the following sections:
Key Findings about CGM Users
How Patients Use CGM Systems
Comparison between Minimed and Dexcom
Why Patients Stop Using CGM systems
Some thoughts on Reimbursement
I think you'll find this a useful document and well worth the read.
On a personal note, I'm about to start the reimbursement process for my Dexcom 7 STS with my insurer this week. Can I tell you how much I'm not looking forward to this? Why is this so hard?
Given that my A1C went from 8.2% to 7.% while I was using my Dexcom STS without hardly any significant lows it should be clear this system is beneficial and reduces costs in the long term. I just hate having to argue this all with many levels of insurance bureaucracy. I'll let you know how that goes also.
My aging Minimed 512 is due for replacement in September. This time, I'm planning to evaluate up to three models before deciding on the right one for me.
And tomorrow, I'm going to be fitted with a Cozmo 1800 insulin pump for a trial run. I'll be wearing it for a week or two with saline and testing it out.
What I've already heard about the Cozmo from friends is that it's a little bulky but very easy to customize.
I've also asked for the software that goes with it. And I'll blog about my impressions with both.
Because I don't see the software as an add-on for the insulin pump. It's an integral part. After all, what use would your iPod shuffle be if you didn't have iTunes? Probably you could use it as a door stop. Otherwise it wouldn't be worth all that much.
I'll post tomorrow about how the 'training' and first priming goes for me.
My diabetes blog has been nominated for Best Health Blog on Bloggers Choice.
I know that there are many other blogs that belong in this category. But the nice thing is that you can vote for more than one of them. While you're considering all your choices, please consider voting for mine. Think of it as a practice run for 2008!
And thanks for continuing to read here.
Note: Some days are better than others. I've updated this post a few time because I kept pointing the URLs to the wrong place to vote. Some of them pointed you to the voting location for the blog, Schuyler's Monster. I couldn't correct this post again without pointing out Rob's blog. It's well worth reading, and voting for.
There's a little trickle of comment spam coming in here, so I've re-enabled Captcha for right now. If you're a potential spammer, please be aware that you're wasting your time. I will delete fake comments that are really links for product sites.
I saw a great video demanding a cure on YouTube. You can watch it below.
It would be great to get pictures of adults with Type 1 diabetes and make a video out of that. Maybe I'll do that sometime in the future.
There's an interesting article in the New York Times this morning Looking Past Blood Sugar to Survive With Diabetes. The article talks about other things, besides blood sugar control, that are important for people with diabetes (Type 1 and Type 2)
Mr. Smith thought his biggest risk from diabetes was blindness or amputations. He never thought about heart disease and had no idea how important it was to control cholesterol levels and blood pressure. He said his doctor had not advised him to take a cholesterol-lowering or blood pressure drug and he did not think he needed them.
Read the NYT article. If you agree with what it's saying think about getting the Know Your Numbers book. It's very readable and really helps you focus on the most important things (A1C, Blood Pressure, Lipids, Microalbumin, Eyes) for your diabetes. I liked this book a lot.
Marston and the folks at SugarStats.com have added a great new feature. Now you can add blood glucose readings and other information to your SugarStats logs from Twitter.
Twitter is a simple web application that lets you update your contacts with what you're doing. It limits your updates to 140 characters, because you can tweet from your phone. When you first start using it, it feels strange. But it turns out to be a useful way to keep in touch with others.
To see how it works in practice, check out what I'm tweeting about?
If you haven't already tried SugarStats, I think you'll enjoy the logging and graphing facilities. With Twitter integration, they've made it even easier for you to keep all this information up to date.
And SugarStats lets you share the data with people in protected ways. I think it's a preview of what Personal Health Records for diabetes will look like in the future.
Today's New York Times has an article about Google and Microsoft and their planned move into the health care arena.
And no, they're not going to do this by paying for our doctor visits. Their approach is really all about empowering us to take more control over our own health. They'll do this with a combination of better search tools (like my own Diabetes Search Engine that's built with Google technology) and enabling us to maintain personal health records (PHR).
Now Electronic Health Records (EHR) or Medical records (EMR) are nothing new. There are several versions of these around provided by different companies. I believe the question will be whether Microsoft and Google can work together to develop a standard for PHRs. That would be a trick worth watching.
Right now the Google version has only been shown to a small number of people. The Google Blogoscoped site has shots of some of the screens from the Google system.
From the NYT article is sounds like Google is trying to do the 'right thing'
At Google, we feel patients should be in charge of their health information, and they should be able to grant their health care providers, family members, or whomever they choose, access to this information. Google Health was developed to meet this need.
I'm just wondering when they actually start working with real patients as they evolve this system.
Amy Tenderich posted an open letter in April that expressed her frustration with current diabetes devices.
This has been a recurrent theme on diabetes blogs for some time. In the book Universal Principles of Design, there's a Hierarchy of Needs that follows Maslow's hierarchy for self-actualization. This principle argues that a design can't be Creative before it empowers people to be Proficient. And it can't enable Proficiency until the design is Usable. Usability builds on Reliability and Reliability on Functionality.
The trouble is that the diabetes devices have been stuck at the Reliable and Functional levels of the hierarchy for way too long.
Amy's challenge was to get past what we use today and start providing us with devices that are 'insanely great', like this types of things we expect from Apple.
The (insanely) great news is that the design firm Adaptive Path have taken up this challenge. They've created a concept device called the Charmr, and they've blogged extensively about their design process for the Charmr. There's even a Charmr video on YouTube.
My hope is that diabetes device makers take this challenge seriously. And that they also remember that all devices are part of a larger system.
This system includes: those of us with diabetes; our various devices; the data collected by the devices (insulin intake, blood glucose readings, health information, etc.); and our healthcare team(s).
Remember the iPod? It's successful because it combines the iPod hardware with software that allows us to add music from a variety of sources.
Our diabetes devices will only really be successful when they combine beauty (creativity) and all the other important design attributes with the ability to get the data off the devices and easily share it with other devices and systems. In other words when the accompanying software is an integral part of the system, instead of an afterthought.
I read about this in the latest CWD newsletter, and it seems like a great tool to use if you're doing carb or calorie counting.
CalorieKing and the Joslin clinic have combined to create a Web Browser toolbar. This allows you to search for food information (carbs, fat, calories) quickly from your browser. And it works for both Internet Explorer and Firefox!
Here's what the installed toolbar looks like. And here's an example of the results that it returns.
I know this story has been on the wires for the last few days, how a company called SemBiosys has been able to produce (human recombinant) insulin from safflowers.
Then I see tonight that even Business Week is excited about the development. Look at what it might do to their stock price.
Think about the increased demand for insulin, because if you believe the numbers quoted by SemBiosys that demand will more than double in the next five years.
I think what everyone in marketplace may be overlooking is that Insulinisnotacure.
I think that as long as the 'market' continues to get excited about these developments, it's not thinking about how to get rid of this terrible disease.
I don't want more insulin, or cheaper insulin, or purer insulin. I don't want insulin.
Go to his new website and fill out a simple form. They'll send you a free copy of this new booklet.
In the booklet, The 7 Habits of Highly Effective PeopleŽ with Diabetes, written by Covey in collaboration with the American Association of Diabetes Educators (AADE) and with support from Bayer Diabetes Care, you will learn habits that will help you become more effective in managing your diabetes on your own, with your medical team, family and friends.
I've ordered mine. It's not too late for me to learn something new.
I was reading an interesting post today about the term 'user' and how it's become over-used in computer systems and software manuals.
Josh Bernoff does a good job of pointing out how that simple label affects how we think about people who use our systems and software.
I can't help thinking about the companies that make products we depend on. Glucose meters, syringes, insulin, insulin pumps, continuous glucose monitors.
Are the makers of these things thinking of us as diabetics, or patients, or something else? I hope that they remember we're also: children; moms; dads; people who are trying to live our lives despite the challenge of diabetes.
So I'm going to take his pledge here and now. I'll try and let it affect how I write this blog and my life as a software architect. I promise to avoid the word user whenever possible.
I will think of people who use technology as people, customers, and friends. I won't use them, and they won't use me.
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.
