My local Dexcom rep kindly arranged to give me a loaner of the new Dexcom Open Choice system. The main difference with this system is how it's calibrated - you can use any meter and enter the blood glucose values by hand.
I carried around both Dexcom receivers, the Dexcom 7 and the Dexcom Open Choice, for over a week. In this test I set them both to read from the same transmitter, so I could directly compare the results. Here's a short video that shows how to calibrate with the new system.
Below I've also got some details comments on the pros and cons of the changes.
I think this small change is a major improvement to the Dexcom system. It gives you the freedom to use your favorite blood glucose meter, so you don't have to worry about getting insurance coverage for two sets of test strips. The WaveSense Keynote meter that I used is extremely accurate, so I hope to benefit with better control and tighter A1Cs.
Dexcom updated their software so that the modal view is available once again. You can now see the reading graphs for up to nine days of readings. I've used this to see problems that happen at specific times each day. It was the only thing I missed from the first version of the Dexcom software.
I have two minor issues with the new features.
First when inputting the glucose value you use the up/down arrows to change the existing value shown by the Dexcom. The scroll speed for those arrows is much too fast. Most of the time the current value is going to be close to the reading from your meter. So you need to change the value only a little. The scrolling is so fast that it's only useful if the difference is over 100 mg/dL. Dexcom please reduce the speed here.
The other issue is even less important, it's to do with the location of the calibration screen. After you've removed and replaced a sensor the first thing you need to do is tell the receiver. You use the sensor insert screen that only appears when the receiver isn't already connected to a transmitter. Dexcom placed this screen after the calibration screen. It should be placed before the calibration screen. Most users will not be calibrating without a sensor in place.
The Dexcom Open Choice is being shipped to all new customers. Existing customers can pay an upgrade (about $200 currently). Dexcom is waiting for FDA approval to provide a download capability for software upgrades. The hope to get this approval by July and will then provide the upgrade for free to existing customers.
Update: I received the software upgrade from Dexcom so I could give them feedback on how it worked. Read more on my post about the Dexcom Open Choice upgrade. They will start shipping the upgrade to all Dexcom Seven users soon.
Note: I currently own shares in Dexcom, I try not to let this ownership influence what I say about the company or its products.
This year the challenge has two prizes. $1,000 for 18 and over and the same for those under 18. The competition is open until May 26th. Read Amy's blog for full details.
Designers, ask someone you know with diabetes about the devices they use several times a day. The 'design' is close to awful. Some of the newer devices are an improvement, but very small. Look at the market reaction to the UltraMini blood glucose meter, and that's just because it's got a cute shape and is available in colors.
I do hope this year produces some designs that will make it into real devices. I can't wait to watch the entries on YouTube.
We finally have a replacement wireless meter for the Minimed Paradigm insulin pumps. The new model is the OneTouch UltraLink meter.
It uses existing OneTouch Ultra test strips, with 5 seconds before you have a reading. The meter lets you flag readings as before or after meal so you can get these averages. It stores up to 500 readings and runs on 2 AAA batteries. For more details read the 90-page user's manual (PDF).
The meter is now being shipped with new Medtronic Paradigm insulin pumps. Those of you who already have a Paradigm pump will have to wait a little longer.
This meter is only available to US customers. Outside the US, the replacement meter will be from Bayer. Currently there's no word on the release date for the Bayer wireless meter.
If you have, or want to use, the OneTouch diabetes management software you'll need the latest version (2.3.2). You'll also need to download the newest meter driver to your PC so the UltraLink can be recognized.
The diabetes search engine now has about 900 sites and pages that it searches for information all about diabetes. So far the advertising revenue is about $55 and that's all going to Dr. Faustman's research at MGH.
Here's some of the sites that I just added recently.
The misadventures of peabody is a new blog from emily who was diagnosed with type one in March 2008. That's about seven weeks ago. Drop by and welcome her to the diabetes OC.
The ultimate hike for a cure! Ty Hover is either crazy or wildly ambitious. He's planning to hike from Detroit to Alaska and raise $290,000 towards diabetes research along the way.
I use this term for a product that you may already like that then surprises you with a feature that you didn't even know existed. Like a car that turns off the interior lights before the battery runs dead, even if you'd left them on by accident.
I had one of those experiences today with my Cozmo. Yesterday my pump had started to complain that the battery was almost empty. And today I was running on voltage fumes.
I knew that I had to replace it, but I kept forgetting to. That is, until I was putting in a combination lunch and correction bolus. While the pump was delivering the bolus I decided to test what would happen if I removed the battery, essentially mimicking loss of power.
After replacing the battery I was pleasantly surprised to see a Bolus Interrupted message on my Cozmo. This is the kind of attention to detail that I've seen in other parts of the Cozmo pump. Those firmware engineers (the folks who write the code that runs the pump) really thought about this - good for you folks!
Another customer delight for me, this time from those great Dexcom folks. Today I got the new Dexcom CGM model to try out for a week or so (one sensor life). I'm going to replace my 16-day old sensor this evening and tomorrow I plan to try and use both receivers against the same sensor and see what happens. I'll use the OneTouch meter with the older receiver and my AgaMatrix WaveSense meter to calibrate the newer receiver.
What I'm hoping is that the newer receiver will show my readings to be higher that on the older receiver. If I'm right then it may prove my theory for my A1C being higher than expected.
The trial model also came with the slightly newer version of the Dexcom software. They've re-introduced the modal day view, which is very useful when you want to see recurring patterns in a number of days.
I'll blog about the new receiver and software after I've had a chance to play with it for a few days.
Update: I've posted a video on YouTube showing how to calibrate the Dexcom open choice. I still need to talk about the software.
Note: I currently own shares in Dexcom, I try not to let this ownership influence what I say about the company or its products.
Phase 2 is where potential drugs are tested to see if they're safe and they work (efficacy). The capsules will need to complete a phase III trial before they can be sold to people with diabetes.
The main challenge to taking insulin by mouth is that the insulin protein is broken down in the stomach before it has a chance to be used by the body. Oramed claims to have solved this problem and the challenge of getting the insulin through the walls of the intestine.
Prof. Hanoch Bar-On, a leading Diabetologist on the Oramed team, states that the route of the insulin from the swallowed capsule “imitates nature” in that it passes to the liver and then to the bloodstream. Injected insulin goes straight to the bloodstream.
I've been unable to get any information on dosing (figured out in phase 1B) or the duration of insulin delivered by the Oramed capsule. I hope to get this after phase 2A is completed. It took Oramed about seven weeks to complete phase 1B, so this information may be available sometime after mid-June.
Oramed is planning to get approval first in the US and then Europe.
In addition to their oral insulin capsule, Oramed is also working to develop an insulin suppository. This product is in Phase 1 trials at present.
Update: I exchanged some e-mails with Oramed. They told me that the phase 2a trials are 'expected to last a few months'. Also that while the trials are on people with type 2 diabetes the product may be usable by people with type 1. I'll post again once I have more news.
Today I'm joining other folks with type 1 diabetes to make a little noise about it.
This used to be called juvenile diabetes because most people were diagnosed before they ended their teens. But now it's clear that you can get it at any age.
When you get type 1 diabetes, your pancreas has stopped working properly. This organ contains cells that create insulin, glucagon and other hormones. The insulin is needed so the cells of your body can process the blood sugar created whenever you eat food containing carbohydrates. Without insulin your blood sugar increases and there's no way for your body to use it.
What are the symptoms for type 1 diabetes?
Extreme thirst. This is the most obvious one. My mother described it as "wanting to drink out of the toilet bowl". Think about drinking several glasses of water and still feeling thirsty.
Lots of peeing. That's because of the water and your body trying to get rid of the sugar floating around your blood stream. Your urine is actually sweet. Mellitus (as in diabetes mellitus, the medical term for type 1 diabetes) is the Latin word for honey.
Extreme loss of weight. You've got sugar in your blood, but your body can't use it. So it breaks down its energy reserves (fat). One of the by-products of fat break is ketones. The night before I was first diagnosed with diabetes I lost over 10 pounds.
Extreme hunger. Even though you've got all this sugar in your system, your body can't digest it so you feel hungry.
Blurry vision. The density of your blood changes. This changes how your eyes focus.
Slower wound healing. Instead of clearing up in a few days a small cut or scrape can take over a week, or even longer. When I was diagnosed I had a cut on my toe that was over three weeks old. Once I started on insulin it disappeared in about five days.
Fruity breath. This is from the ketones. It tastes fruity and the smell may remind you of nail polish remover. Dentists often diagnose diabetes due to this smell or .
Itchy genitals. That sugar in your urine can cause urinary tract infections.
Fatigue. The extremely high blood sugar can cause urinary tract infections.
If you see several of these symptoms please contact your doctor. Untreated diabetes can cause coma and ultimately death. This is serious business.
These days the tools for treating diabetes are pretty good. But it still takes a lot of support and help to really manage living with diabetes. Don't try to do this alone.
If you've already got diabetes there's lots of useful places online where you learn more about taking care of yourself and your diabetes. Try the Diabetes OC for a list of diabetes blogs. TuDiabetes.com is the first of many other social networking sites for people with diabetes. There's even a weekly television program for diabetes, dLife.
I created a diabetes search tool to make it easier to find diabetes information online. I use the advertising revenue to support the research by Dr. Denise Faustman into a possible type 1 diabetes cure. To date, I've raised about $50 for this cause.
If you've already got type 1 diabetes, today is the perfect day to raise awareness. Do people at work know how to treat you if your blood sugar goes low? Can you share information about living with type 1 on your blog, or maybe an article in your local newspaper? Do your best to spread the word.
For today, I'll be using Twitter every time I do something due to my diabetes. This way others can see what I do to control it, and maybe learn more to help themselves or others.
Have a wonderful Type 1 Diabetes Awareness Day.
And why not give a hug to anyone with type 1 diabetes today?
To stop you from worrying I have not had a heart attack. Or any inkling of one.
Recently when I saw my excellent endo we had a discussion about whether I should continue to take a statin to reduce my cholesterol.
I've been taking Lipitor for about a year. I changed my use of the medicine (this may not work for you) from a 10mg pill every day to half of a 10mg pill every other day. I see a substantial reduction in my cholesterol level with this dose and I don't seem to have any of the possible side effects, thank God.
But a while ago, I read news about investigations into the benefits of taking statins. This was why I had the conversation. I was especially taken by the quote from the NY Times article.
"If a patient has had a heart attack," Dr. Afilalo said, "they generally should be on a statin."
For people who haven't had a heart attack the investigation showed there isn't as much evidence that taking statins provides a substantial benefit to enough folks to justify everyone taking it.
I was shocked by her response. "But you've already had a heart attack." For a moment I thought I was in an alternate dimension. I reminded her that I'd not actually had one. She told me that type 1 diabetes increases my risk of heart problems. Just as much as if I'd actually had one. Yikes.
Now I do really like and respect my endo. I've moved medical offices to follow her from Massachusetts to New Hampshire. But I still like to verify what I'm told, it's my natural cynical nature.
Then earlier this month I saw this news report. She was right! A recent study found that folks with diabetes (both type 1 and type 2) have double the risk for a heart attack.
So for now I'll be staying on my statin and living with yet another drug to reduce the risk of "bad things" happening in my future.
Attribution: This beautiful picture was taken by Conny. She retains all rights to the image and I'm grateful to her for letting me use it in this post.
My intention is to maintain this blog for review of diabetes devices and comments on usability and future technology trends. Currently I'm hoping to review the Pelikan Sun device, once I can get my hands on one.
In the meantime, I'm still writing posts on my Diabetes Daily blog. I've recently started a daily set of NaBloPoMo posts focused on letters.
With luck and effort I can make it through the entire month of April. So please follow me there.
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.
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 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.