Diabetes Technology Blog

Dealing with one of my fears

2009-07-01T19:34:00.005-04:00

From time to time I'm reminded about just how devastating diabetes might be. In this case I'm not thinking of the various complications that we think about all the time. This is a situation that those of us in the US are more in danger of encountering

Until yesterday, I thought that personal bankruptcy was really reserved for those of us without insurance. But the article Insured, but Bankrupted by Health Crises in yesterday's New York Times points out that being insured doesn't mean I'll be saved from financial woes. Hearing that "an estimated three-quarters of people who are pushed into personal bankruptcy by medical problems actually had insurance when they got sick or were injured" does not make it easy to sleep at night.

For me living with diabetes is all about balance, nothing new about this if you've been living with diabetes at all. But here's a situation that I just can't balance out.

Since being laid off earlier in the year my insurance is provided thanks to COBRA. But that will expire in the middle of next year and my insurance choices at that stage may be severely limited. With an 'existing condition' my chances of getting coverage for diabetes costs are zero unless I have a full-time job with health insurance by then.

But here's something that I may be able to affect positively. I'm going to write to my federal representatives and let them know just how important health insurance legislation is for me and my family. Not being covered is a challenge for me that strains our budget. But declaring bankruptcy affects my family and I don't like it when something threatens people I love.

Can I ask for your help?

I know from years of contacting elected officials that a note in the mail is often the most effective way to get their attention. A hand-written note really wakes them up, but even a typed letter goes a long way. Look up your elected federal officials and drop them a quick note telling them why access to real insurance is so important to you. If they hear from a handful of us it might just make the difference when it counts most.

Lancets, bloody lancets

2009-06-07T10:03:00.004-04:00

Those of us living with diabetes think a lot about technology choices. Which blood glucose meter is smallest, coolest looking, fastest. Will a specific continuous glucose monitor work for me. Should I be thinking about a pump?

How about the humble lancet? Here's a device that someone with type 1 diabetes could use between 1,200 and 4,000 times a year. It injures our fingers for the sake of a tiny drop of blood and it's probably the biggest physical pain involved in diabetes management. I've spoken with many parents of children with diabetes and they all tell stories of the challenges of blood testing due to the pain of lancing their child's fingers.

So why is it that most of us just use the lancet that comes in the box with our blood glucose meters? Frequently these lancet devices have been built cheaply to improve the profit for the meter, and they vary widely in quality. Right now, I can recommend two specific makes of lancet devices based on personal experience.

But before we get there, let's talk about wire gauges. The wire gauge for lancets typically ranges from 28 to 33. The bigger numbers mean finer lancets. So all things being equal, you should be choosing a lancet with the bigger possible number. Unfortunately not all lancets carry gauge sizes on the box. My advice, don't buy it unless you can confirm the gauge in advance. Almost all lancet devices now provide depth adjustment, so this is a less important consideration when choosing what's right for you or your child.

The picture above is from the BD site, makers of one of the Ultra-Fine 33 lancets that I recommend strongly. They are truly almost painless, when I first started using them many years ago they were a pleasant surprise. Note: BD also make an Ultra-Fine 30 lancet, these are not as pain free. So make sure you pick up the box with the Larry Bird number on it. A box of 100 lancets costs about $10 and are available over the counter. They also fit many other lancet devices, check the BD page above for pictures of some compatible ones.

In the last six months I changed to the Accu-chek Multiclix after hearing from other d-bloggers about the success they'd been having with it. Although it's 30 gauge lancet size is bigger than the Ultra-Fine 33, it does seem less painful overall. This lancet device comes with many Roche meters. The Multiclix uses a cartridge device with six lancets, so you don't have to carry around as many spare lancets. The cartridge design does not allow you to ever injure yourself, because the lancets themselves are never exposed (and I've tried). And you choose when to rotate to the next lancet in the device so, although it's not recommended, you can choose when to move onto the next lancet. While it's generally painfree in use, it does seem to produce more longterm fingertip damage for me. The lancet device costs about $24 over the counter and a box of 34 cartridges (204 lancets) is about $20.

The BD Ultra-Fine 33 and the Accu-chek Multiclix share first place in my recommendations. They're relatively inexpensive and readily available across the US.

The other contender that I have to mention is the Pelikan Sun.

This high-tech and elegant looking device comes highly recommended by my d-blogger friend David Mendosa. But it's expensive at $199 for the device plus 50 lancets and $15 for each disk with 50 lancets. I cannot recommend personally because I have not been able to try one out, despite repeated requests to Pelikan Technologies. If you're a user, please comment and let us all know how this works and whether the bigger cost is worthwhile.

One thing I've not mentioned here is alternate site testing, where you can take a blood sample from somewhere besides fingertips. Lancet devices for alternate site testing usually have a transparent lancet cover with a larger opening. I don't use alternate site testing, so I can't tell you if any of these devices will work on alternate sites.

Please leave comments if there are other lancet devices that have worked well for you. This is one area where diabetes management can be greatly improved for as little as $30.

Meeting Manny and Simple Steps for Health

2009-04-03T15:06:00.003-04:00

Yesterday I was fortunate to spend a few hours with Manny Hernandez, founder of TuDiabetes. Over lunch we talked about various efforts that underway to help folks with diabetes to improve their control.

Manny and David Edelman of DiabetesDaily are collaborating on a new site called simple steps for health, and they're looking for input from you.

They are asking you to submit simple ideas that make it easier to live with diabetes, and simple is key. Your idea should not cost a lot or take much time to use.

You can submit these until the end of April (2009) and we can vote on them if you add a link to your submission.

Yes, there's some prizes, see the bottom of the Simple Steps for Health page. But you may also help others with diabetes, and that has to be better than any prize.

Cozmo Insulin Pump no longer being sold

2009-03-25T19:24:00.005-04:00

I was sitting in the dentist's office this afternoon and looking at some tweets, when this one from Manny caught my eye.

It pointed to his page about the news that Smiths-Medical is getting out of the diabetes market and taking the Cozmo insulin pump off the market.

My jaw almost dropped. I've been a happy Cozmo insulin pump user for about 18 months and I had planned to continue using them. Smiths-Medical distributed and supported the Cozmo pump. They announced today their "intent to stop selling the Deltec Cozmo� insulin pump, and manage an orderly, carefully controlled exit from the diabetes business over time."

Smiths-Medical has created a special web page with all the details about this announcement. It also contains answers to a set of frequently asked questions (FAQs). Basically those of us with pumps will be supported until the end of our warranty and Smiths-Medical will continue to provide supplies and support for the Cozmo pump.

As Kerri pointed out in her post on the announcement, this wasn't a big market for Smiths-Medical and it required a large support organization. So perhaps it was inevitable.

I've enjoyed and benefited from the features and flexibility of the Cozmo pump and I'm sorry to see it disappear from the market. We're now left with three main players in the insulin pump market: Minimed Medtronic; Animas; and Insulet Omnipod. I'd really like to see much more competition.

Perhaps some new ideas will happen as a results of Amy's 2009 DiabetesMine� Design Challenge. I'd sure like to see another choice when it comes to insulin pumps.

The GlucaPen, a big improvement on Glucagon shots

2009-03-17T21:21:00.009-04:00

I had an interesting conversation last week with Dick Rylander of Enject. We spoke at some length about their product, the GlucaPen, that they hope to have on the market before long. It's a simpler way to give people Glucagon injections.

Glucagon is a hormone that's produced in the pancreas. When it's released by the pancreas it causes the liver to take it's glycogen reserves and convert it into glucose. So it rapidly raises blood sugars levels. In emergencies, the glucagon reserve can be depleted by people who have type 1 diabetes (thanks for the correction from Mr. Sven below). It's a treatment for extremely low blood sugars where food or liquids can't be given. So it's really only used when there's an emergency.

The picture shows a glucagon kit from Eli Lilly. You may notice that the vial on the left contains a white powder. This must be combined with the liquid in the syringe just prior to use. Reconstituted glucagon has a shelf life of up to 48 hours when refrigerated.

So here's how it works. Your loved one is lying on the floor unconscious. You get the glucagon kit (you did put it in a well-known place, didn't you?). Before you can inject the glucagon into them, you need to follow about a half-dozen steps written on the enclosed leaflet. It's really difficult. One paper says the process "requires a manually dexterous operator who is composed, confident and competent in the whole procedure."

Let's look at the GlucaPen approach. Here's a picture of the GlucaPen prototype.

It will be a single unit, slightly longer and larger than an EpiPen. So you easily carry it with you, or pack it for a trip. And there are two simple steps before using it. These are displayed clearly on the side of the pen.

GlucaPen is looking for your opinions, they have a survey that includes a short video of the prototype being used. There's one survey to complete if you're an adult patient with diabetes, and a different one if you are a caregiver for someone with diabetes.

The GlucaPen folks have been developing this for about three years now and hope to have it on the market before too long. I think it's a great example of innovative design to make living with diabetes a bit easier. I'd love to hear any stories you have about using glucagon and whether something like this might make it easier.

Update: The GlucaPen has been entered in the DiabetesMine design contest, so there's now an animated video showing how it works. You can watch this below.

TuDiabetes turns two

2009-03-05T20:43:00.003-05:00

TuDiabetes.com, the social networking site for "People Touched by Diabetes", was started two years ago. It is a very active community with over 7,000 people and it grows at the rate of 15% every month. At this stage, TuDiabetes has members all over the world.

I asked the founder, Manny Hernandez, what most surprised him since he started TuDiabetes. His answer? The number of people with diabetes who have never met anyone else with diabetes and who have no support group of folks with diabetes.

You only need to spend a little time on the TuDiabetes.com site to realize how much support and sharing goes on there are all hours of the day. People have an opportunity to create groups such as Pumping Our Insulin or Diabetes and Women. TuDiabetes also has an events section where members can organize meetups, or let other members know about upcoming diabetes-related events.

I only wish that more people with diabetes knew about this great resource. If you have any friends or family with diabetes, please spread the word and get them to take a look. It might help them really change how they view living with diabetes.

March meetups in Massachusetts

2009-03-04T08:48:00.003-05:00

I couldn't resist the alliteration, sorry.

There are two opportunities to meetup with folks in Massachusetts this month. This coming Sunday a group of us will be getting together in Marlboro for a presentation on the Latest and Greatest Diabetes Technologies. Dr. Howard Wolpert of Joslin clinic will be presenting, he's a great speaker and worth hearing.

The following Saturday, ADA is holding a diabetes expo in Boston. It runs from 10 AM to 4 PM, but a group of us is planning to meetup at 2 PM beside the DESA booth and then gather in the food court area.

You may have heard me say this before. If you're nearby to either of these locations I recommend getting to one of the events.

Meeting up with a group of folks with diabetes is uplifting and supportive. We don't get together and complain about our challenges. We do talk about the latest things we've learned and support those of us who are having some issues. It's fun and liberating to sit down to eat and be with others who are pulling out test kits, injecting insulin or playing with the buttons on their pump. If you've never used a pump or a CGM it's a great chance to talk with others who have and learn some of the pros and cons.

I hope I'll see you at one of these events.

Dexcom gets a positive review for 10-day use

2009-03-03T14:51:00.003-05:00

The March issue of Diabetes Care contains a paper about testing the Dexcom SEVEN for 10-day use with adults with type 1 diabetes.

The Dexcom SEVEN continuous glucose monitor has been approved for 7 days of use. I usually get 10 to 11 days of use by restarting the sensor after 7 days have elapsed. Your results may vary, so make sure this works for you before relying on it.

Based on the abstract from the Diabetes Care website, it appears that the results on the 10th day are still fairly accurate. Notice how the difference goes down slightly on the 7th day, showing that the Dexcom is more accurate after it's been in place for a few days.

The median absolute relative difference for CGM versus YSI was 12.6, 11.3, and 14.5% on days 2, 7, and 10, respectively (P = 0.63). CGM performed better on day 10 when compared with self-monitoring of blood glucose as compared with YSI.

I expect to see more papers like this before Dexcom applies to the FDA for 10-day use of the sensors. The good news is that this ultimately means less sensors changes will be needed. It also probably means that Dexcom will raises the price of the sensors.

I do hope that before Dexcom takes this move they improve the adhesion of the sensors. Mine usually look like they're falling off by day 9 and they rarely last beyond day 11 because they peel off.

Have you been able to get sensors to stay in place for longer? What tricks have you used to make this work?

Moving diabetes design forward

2009-03-01T20:16:00.004-05:00

Amy Tenderich of DiabetesMine has just announced the start of the 2009 DiabetesMine Design Challenge. This year the grand prize is $10,000. So you can improve the state of diabetes design and win some serious prize money.

If you need some ideas, Amy's posted videos of last year's competition entry videos.

The competition is open from tomorrow March 2, 2009, to end of day (PST) on May 1st, 2009. Each entry is judged on three criteria: Relevance; Clinical Efficacy; Aesthetics. You can submit a video or a paper describing your idea. Full details are on the entry page for the competition.

I know we've got got lots of devices that are efficacious (FDA criteria), but with lousy design. This presents a great opportunity to make life easier for everyone with diabetes.

So think about anything diabetes related that's driving you nuts. Have you some way to fix the problem? Or maybe a completely new idea to make it easier to live with diabetes. I can't wait to see what folks come up with.

Transplant Information

2009-02-18T22:26:00.002-05:00

I know, I know. It's been a long time since I last posted. I'm busy looking for a job and I seem to let anything else slide in the meantime.

I came across the blog my new islets. The author Kathy had a pancreas transplant on August 23rd 2008 and is writing about the experience.

That made me realize that the Diabetes search engine wasn't looking at any sites that had information on pancreas transplants. So I spent some time this evening fixing that, and I've added over 20 sites with information about pancreas, or kidney/pancreas, transplants. Many of these are hospitals that have transplant programs.

Since we're going into summer planning. I also added a large number of diabetes camp sites. I was fortunate to get to most of these by using the Children with Diabetes Camps page.

The diabetes search engine now looks for diabetes information on over 1400 sites or pages, including over 450 diabetes related blogs. I have looked at each one before adding it, to make sure they're valid. It's been used over 10,000 times, which means that it now ranks in the Google directories. And it's raised over $150 to support Dr. Faustman's research into a type 1 cure.

Let me know of any ways I can improve this tool for you.

Some questions

2009-01-14T10:12:00.003-05:00

In this blog I try to focus on new developments in diabetes technology (devices and software). I know there are many readers who are very interested in learning more about what's available and what's coming.

But I realized that there are many folks with diabetes who'd also like to know more about some of the basics in diabetes 'technology'. Maybe learning about testing for foot problems with monofilaments. Or techniques for using an insulin pump more effectively.

Is this a suitable place to write about more of the basics, or are there enough blogs and communities out there that already cover this stuff? I'd be interested in knowing what you think. And I know I can depend on you to let me know.

Maybe this would be a good time for some of the blog lurkers to leave a first time comment, I'd value your opinion.

My challenging week

2009-01-10T08:12:00.003-05:00

I got laid off from work on Tuesday. Of course, my first thought is health insurance. Seriously.

Not where I'll get my next job, or how can we afford our house, food, etc. Having a chronic illness really changes my perspective on things that might be challenging when I don't have a job. (It also means I'll never be on programs like Survivor.)

I had to make two additional trips to the office to pick up all my books, I have way too many technical books.

I did get a severance package and I've already signed up for unemployment insurance. We're going to cut back to essentials and we'll can stretch things to the early fall. In this economy that doesn't seem like enough time to land a new job.

If you don't already know, I work as a software designer and developer. I usually focus on user experience, how software feels to the user. It goes beyond how it appears (forms, pages, etc.). But I've been in tough situations before and, if necessary, I'm happy to work at anything that comes along. So if I end up with a job in a hardware store, or washing windows that's fine with me. These are all honorable jobs. I may not be doing what I'm best at, but I'll be keeping out of mischief and making a living.

Please don't feel sorry for us. We're doing just fine. God has blessed us in many, many ways. So we're trusting in him, dusting off our resumes, and starting our search for new jobs.

In the meantime, I'll blog about this transition and how we're doing for a while. So stay tuned.

New web site for Faustman lab

2009-01-09T11:31:00.003-05:00

Dr. Faustman, whose lab is doing research into a possible cure for type 1 diabetes, has a new web site.

The new site design includes information about the current phase 1 clinical trials for the diabetes cure. The support section provides information about organizing an event to support the research work. And the news section lets you read all of the newsletters produced by the lab.

Dr. Faustman plans to start phase II trials later this year. To support this work we need to raise $25 million. You can now donate directly to this work from another part of the support section of the site.

The new layout makes it much easier to read all the current information about Dr. Faustman's research. Now all we have to do is wait for more news about the progress!

Ask FDA to Better Serve Diabetes Patient Needs

2009-01-05T22:35:00.002-05:00

You may have noticed that the FDA isn't doing a great job approving new diabetes treatments and diabetes technology.

This isn't accidental, they are tightening requirements in a way that make it much harder to get FDA approval for new diabetes treatments.

With our new president later this month comes a change of FDA leadership. It's an ideal time to try and work to get changes in the FDA.

We've created an online petition and we're asking you to sign. You do not need to have diabetes to sign, so please pass the word on to family and friends.

Amy Tenderich has posted some quotes from Rebecca Killion on the FDA changes. Rebecca is a patient representative on the FDA advisory committee for diabetes related drug.

Manny Hernandez of TuDiabetes has posted a video about this.

Here's the full press release about the petition.

We, the undersigned, appeal to the leadership of the U.S. Food and Drug Administration (FDA) to reduce barriers to innovation in diabetes treatment development, in the interest of public health.

The FDA's job is to protect the safety of patients in its use of drugs and medical devices and to advance public health by speeding innovations that make medicines and technology more effective, safer and more affordable. That is its mission.

But we believe the FDA has adopted a stance of excessive caution in its regulation of diabetes drugs and technology that is counter to its duty to serve patient needs.

Specifically, it has established new rules that will impair research and innovation into diabetes therapy. (A copy of the letter sent to manufacturers in November 2008 can be found at http://www.diatribe.us/fdaletter (PDF).)

This worries us. For example, new requirements for additional multi-year long-term outcome studies prior to approval for drugs with no cardiovascular signals will assuredly discourage research and innovation to the detriment of public health.

The need for improved treatments for the 24 million Americans with diabetes could not be clearer. Many of the drugs available now have tolerability issues [1]. Poorly controlled diabetes increases the risk of devastating long-term complications, including blindness, end-stage renal disease, amputation, and heart disease. Complications cost our country at least $58 billion per year [2] -over twice what is spent on technology and therapy annually [3].

Nearly 50 percent of patients in the US do not meet A1c goals [4] using current therapies and technologies. No therapy today stops diabetes from advancing. As patients are living longer with diabetes and therapies stop working, the need for new therapies increases. We need better technology and drugs that help slow or avoid long-term complications as well as more therapies that cause fewer side effects1 and last longer. And, despite the epidemic in the number of diabetic patients, no drugs are yet available that can prevent diabetes. Innovative, safe, and effective prevention is the key for people at risk and for cost savings to society.

Ironically, excessive regulatory hurdles ensure the continued use of the very drugs and devices that have proven ineffective for many patients.

There is no value in an ideal diabetes drug or device if the regulatory costs are so great that the product never makes it to market. Make rules reasonable.

Due to the very nature of the severity and prevalence of diabetes, the following leaders within the diabetes community, who have signed this petition, implore the FDA for the immediate creation of a Diabetes Advisory Council, whose goal would be to improve options for patients. This council would include practicing endocrinologists, diabetes educators and others communicating directly with patients. Our experience, focus, and keen awareness of the needs of the diabetes community would be an invaluable resource to the FDA as it faces the arduous process1 of evaluating new diabetes treatments. Our aim is to improve options for patients.

We urge the new FDA leadership to recognize the urgent need for more safe and effective treatment options for diabetes and to reduce barriers to innovation. More treatment options will benefit patients. The disease is progressive. Delays in the availability of new treatments will only result in tremendous cost to public health and the economy. Our recommendation can benefit patients without sacrificing their safety.

Please sign this petition and tell others about it. Make your voice heard!

Learn more about the issues here:
Problems at FDA prompting slowdowns in development - should patients accept this?

The FDA in Transition: Diabetes Treatment at Risk

The FDA Needs Your Input on Diabetes Medicines!

Petition sponsors:
Kelly Close: Editor, diaTribe
Manny Hernandez: President, Diabetes Hands Foundation; Founder, TuDiabetes
Amy Tenderich: Creator and Author, DiabetesMine
Allison Blass: Author, Lemonade Life
Jennifer Block, CDE: Stanford Medical Center, Stanford University
Nancy Bohannon, MD: Director of Clinical Research, CVD Risk Reduction Program, St. Luke's Hospital, San Francisco
Bruce Buckingham, MD: Professor of Pediatric Endocrinology, Stanford University
Stead Burwell: CEO, Alliance Health Networks, Inc.
Priscilla Call Essert: Author, My Life As A Pancreas
Gina Capone: Co-Founder, the Diabetes Talkfest Blog
Fran Carpentier: Author Diabetes, Day-By-Day on Parade.com
Kitty Castellini: Founder, CEO, Producer and Host, Diabetes Living Today - Talk Radio
David Edelman: Co-Founder, Diabetes Daily
Steve Edelman, MD: Professor of Medicine, University of California, San Diego; Founder, Taking Control of Your Diabetes
Bernard Farrell: Author, the Diabetes Technology Blog
James S. Hirsch: Author, Cheating Destiny
Irl B. Hirsch, MD: Professor of Medicine, University of Washington
Lois Jovanovic, MD: CEO and Chief Scientific Officer, Sansum Diabetes Research Institute
Francine R. Kaufman, MD: Professor of Pediatrics, Keck School of Medicine, USC; Head, Center for Diabetes, Endocrinology and Metabolism, Childrens Hospital Los Angeles; former ADA President
Tom Karlya: Author, Diabetes Dad
Rebecca Killion: Diabetes advocate
David Mendosa: Diabetes Journalist
Kerri Morrone Sparling: Author, Six Until Me
Jenny Ruhl: Author, Blood Sugar 101
Lisa Shenson: Diabetes Parent & Advocate
Scott Strumello: Author, Scott's Web Log
Virginia Valentine, CNS, BC-ADM, CDE, CEO, Diabetes Network, Inc. Albuquerque, New Mexico

Notes:
[1] "Glycemic Durability of Rosiglitizone, Metformin, or Glyburide Therapy," New England Journal of Medicine, December 7, 2006. ADOPT, a four-year clinical trial of over 4,000 patients, was designed to test the how long diabetes therapies last. In this trial, 23% of those on sulfonylureas (SFUs) and 38% of those on metformin experienced nausea, diarrhea and/or vomiting from taking the drugs. 10% of those on TZDs, 11% on metformin, and 39% on SFUs experienced hypoglycemia. 7% and 14% of those on TZDs experienced weight gain and edema. 12% on women on TZDs experienced fractures. The trial also found that within five years of starting therapy, 15% of those on rosiglitizone (TZD), 21% on metformin, and 34% on glyburide (a sulfonylurea [SFU]) had fasting blood glucose over 180 (~ roughly equivalent to an 8% A1c), suggesting that even if patients could tolerate the therapy, it wouldn't last longer than a few years for many.

[2] "Economic Costs of Diabetes in the US in 2007," Diabetes Care, March 2008, page 13.

[3] "Economic Costs of Diabetes in the US in 2007," Diabetes Care, March 2008, page 13.

[4] "Is Glycemic Control Improving in US Adults?," Diabetes Care, January 2008, page 81.

Pain Relief

2009-01-03T08:27:00.004-05:00

My shoulder has been killing me for the last few days. So far stretching exercises haven't helped all that much.

No problem you say, take a pain killer. That would work except...I'm allergic to everything except acetaminophen. And that causes my Dexcom readings to go haywire.

Within 20 minutes of a dose of acetaminophen (generic form of Tylenol), the Dexcom receiver reports super high readings. Quickly up to 400 and then into HIGH. That continues for about 6 hours in my case. And there's a long list of drugs that contain acetaminophen.

This is because acetaminophen changes the reaction that is used by the sensor to measure glucose values in interstitial fluid.

So I take my tablets and put the receiver far away from me for 6 hours or so.

How can I tell when it's safe to use it again? I carry it around for a few minutes and see if it's still reporting off the wall values. If so, I put it away again.

It's frustrating. If I keep it with me for the duration the high values throw off the statistics reported in the Dexcom software.

I've asked them to change the software so I can mark a set of readings as invalid. I think this is a relatively small software change. That way I can continue to use the receiver and my statistics won't be affected by 6+ hours of values over 400 mg/dL.

If you're having the same problem, do please call Dexcom customer support at 1-877-Dexcom4 (1-877-339-2664) and let them know. Maybe we can influence them to make this fix.

Note: I currently own shares in Dexcom, I work not to let this influence what I say about the company or its products.

New Year gift

2009-01-01T17:28:00.002-05:00

I picked up the mail today and opened a letter from my wonderful endo (Dr. Elizabeth Spatola of St. Joseph's in Nashua NH).

Inside it was the latest A1C test and (....drumroll....) my A1c is 6.6%

For me this is the lowest value I've ever had, and I'm more thankful than I can say.

In 2009, I'd like to keep my A1C at around 6.6% for the year. I'm grateful that I can use technology (insulin pump, Dexcom CGM) and rely on many people at TuDiabetes and the entire Diabetes OC (online community) for support and advice. Without all my friends in the d-blogosphere, I think living with diabetes would be a lot harder.

In 2009 may your blood sugars be steady and your diabetes frustrations be few.

For all of us I hope to see some exciting diabetes research development in the next 12 months.

Storm coming

2008-12-19T08:06:00.003-05:00

We had a lot of 'fun' last Friday. The ice storm in the Northeast took out our power at 4:30 AM. I tried to get back to sleep, but the sound of tree branches cracking and then the THUMP as they hit the ground was hard to sleep through.

The weather was bad enough that school was canceled for the day, and when I called the office they were also without power. So we all got to spend the day together at home.

A big branch, maybe 10 feet long, crushed part of the fence that keeps the goats in place. It also collapsed part of the chicken coop. And there was lots of other debris of various sizes covering the yard. But I wasn't going to go out and try to clear it away when the trees were still making ominous sounds. The branch was sticking up because it was buried in the ground was warning enough.

We were fortunate. A good neighbor helped clear that big branch and some of the other debris. He was happy to take away the hardwoods for his stove. We had power back by bedtime. We'd also been able to use a camping stove (I set it up in the garage) to make essentials like morning coffee and hot water. We used a big fire to keep the first floor warm and lots of small candles to light up parts the house.

But the storm made me think about preparing for emergencies. Some of the town only got power back on Wednesday, and some folks in this region are still without power. Would I be able to manage my diabetes if we lost power for 5 days? And what if we were evacuated and had to go to an emergency shelter?

Earlier this year I found a suggested emergency diabetes kit on the Children With Diabetes site.

But did I use it to put something together. Oh no, because we never lose power in our town. Except for last week.

I'm planning to be better prepared for the next storm that rolls into town, like the big one that's threatening to roll in today!

One bonus from the storm was the lovely fire that was perfect for toasting marshmallows on. Here's my family hard at work.

i-port injection port

2008-12-17T18:28:00.006-05:00

I've heard about the i-port injection port some time ago and thought I should try it out.

So because I like sticking holes into my abdomen, here's what the i-port looks like in action.

I know the picture is a bit fuzzy. The i-port is on the left of the image; my dexcom receive and pump insert are on the right.

I visited my endo last week and I got some i-port starter kits while I was there. I wanted to try it out as if I was really using it for injections. This isn't a full review, more on that later.

Even though this isn't me on the left, it really does work like this. I'm using standard insulin syringes with a 28-gauge 1/2" needle, and I've had no pain when injecting with it. I'm doing this 4-5 times a day (and I am using saline).

One really nice surprise (for me) is that much of the packaging for the i-port is recyclable. The two pieces of transparent plastic are labeled as HDPE (#2).

I'll try and get more information about the i-port for my full review. In the meantime, the i-port people have a FAQ page that you may find useful.

Dexcom skins

2008-12-17T17:41:00.002-05:00

I was at a pumpers support group meeting last month. We listened to a presentation on continuous glucose monitoring from a Dexcom representative, and I was surprised to see she had a pink Dexcom receiver.

It turned out she had a skin for the Dexcom receiver. Apparently Dexcom made a small number of these in pink and blue. I managed to get a blue one from here, and started using it immediately.

I like that it protects the receiver from a certain amount of wear and tear. It does not make it waterproof.

Amalas's comment about the thickness made me measure the skin. It's 1/8" (0.32 cm) thick and weighs about 1/2oz (16 grams). The receiver already weighs 84 grams, so the skin adds almost 20% to the receiver weight.

Dexcom does not sell these at present. But I think they're a great idea (anything is better than black). Why don't device makers realize that we all like to personalize gadgets? Just look at what's available for cell phones or iPods. Heck you can even get laptop skins.

Why not contact your local Dexcom rep (ask your endo's office for a phone number) and tell them you'd like one of these? Who knows, maybe you'll get it in time for Christmas.

And while you're at it, tell them you'd like to see more of these. Personally, I'd pay $10 to make the ginormous receiver look a little better.

(Oh and I'm still waiting on a much smaller receiver.)

Avandia and Actos may double risk of fractures?

2008-12-10T11:56:00.004-05:00

Several news sources (including the Washington Post) reported a new analysis that Avandia and Actos may double the risk of bone fractures in women.

This study(PDF) did an analysis of 10 randomized, controlled, trials that evaluated 13,715 people with diabetes who were taking Actos(pioglitazone), Avandia(rosiglitazone), or neither drug. It concluded that these medications reduced bone density in the spine and hips of women. A similar effect was not found for men.

Both of these drugs belong to the Thiazolidinediones class. They are used by people with type 2 diabetes to help control their blood sugar levels.

In an associated commentary(PDF) the Canadian Medical Association Journal asks whether the side effects of these drugs outweigh their benefits. Thiazolidinediones have already been associated with increased risks for heart attack, especially in older adults.

Earlier this year an FDA advisory panel had called for longer term trials of new drugs for type 2 diabetes. Currently these drugs are mainly tested to determine if they help control blood sugar levels.

Social Networking and Your Health

2008-12-07T20:56:00.005-05:00

In the last week I've read two different sources on social networking (AKA health 2.0). Together they beg the question: will your health improve if you use social networking to become part of a larger community?

What is social networking?

According to the Health 2.0 blog, it's "the use of social software and light-weight tools to promote collaboration between patients, their caregivers, medical professionals, and other stakeholders in health".

For me, this means sites like TuDiabetes.com, DiabetesDaily.com, and others. It also means using Twitter to keep in touch, or even sharing photographs (see Diabetes365) with friends who can help you maintain better health.

The first source was an article in Business Week magazine Health 2.0: Patients as Partners talks mostly about PatientsLikeMe and how members there are sharing details on their medical conditions to try and determine better ways of treating them. It points out

PatientsLikeMe and a proliferation of similar startups are building a new business predicated on the belief that the wisdom of crowds of patients will bring insights, solace, and most of all, power.

Power because, as it turns out, patients talking among themselves on a global scale with complete transparency produces all kinds of unexpected results. Drug side effects can be reported to regulators by the patients experiencing them, without waiting for the manufacturers to come forward. Pharmaceutical companies can use social networks to recruit subjects quickly for clinical trials, speeding up the pace of research. For that matter, patients can simply band together and run their own clinical trials, leaving drug companies and physicians out of the loop.

The other thing I read was a post on TuDiabetes.com that posed the questions

Do social networks bring about positive behavioral change?
Is there a role for insurance companies in this conversation, or is this level of mis-trust so high that they should just stay out?

My experience after many years with diabetes is that anytime several people get together to share experiences and frustrations we all benefit from it.

These may be small things, like suggestions for exercising while on insulin, or using new sites for placing an insulin pump infusion set, or testing blood sugar.

But engaging with others who are going through the same health challenges can produce much bigger results like: persuading Disney to pull an episode of Hannah Montana because of how it portrays life with diabetes; or changing laws to help protect the rights of those using insulin to drive or pilot planes.

What's your experience with social networking sites?

Have they helped you improve your diabetes control, or your quality of life with diabetes? Which sites have helped you the most? What is missing from these sites?

And if you have found some that work for you, do you think you'll continue to use them?

OneTouch Ultra Test Strips recall - Lot 2829235

2008-11-17T21:40:00.002-05:00

I've seen this on the blogosphere, but just in case you've missed it.

Lifescan has announced a recall on 25-count boxes of OneTouch Ultra blood glucose test strips with a lot number of 2829235. Boxes with 50 or 100 strips are not affected. And only boxes with the lot number are of concern. The lot number is printed on the outside of the box and on the label of each test strip vial.

According to LifeScan "a very small number of vials in this lot many contain strips that could product inaccurately low (my emphasis) blood glucose test results".

If you have any of these packages you can contact LifeScan at 1-866-247-1281 to get replacement strips. While waiting for replacements they advise "do not use the OneTouch Ultra Test Strips from lot number 2829235".

Edwards and Dexcom to develop CGM for Hospital Use

2008-11-14T20:50:00.002-05:00

In news announced recently, Edwards Lifesciences is establishing a relationship with Dexcom to develop CGM devices for use in hospital.

Dexcom has mentioned this possible market in presentations over the last year, so this was an expected market development for them.

Edwards Lifesciences will pay an upfront fee of $13 million and follow up with further payments for product development based on meeting regulatory milestones.

Dexcom's CEO has talked about a standalone Intensive Care Unit monitor in the past for in hospital use. But they also realize that the ICU is a crowded spaces and integrating the Dexcom system into existing equipment is important for product acceptance.

In intensive care, stress and other conditions means that patients' blood sugar control is often bad, even when they don't have diabetes. Tight glucose control leads to a faster recovery and better wound healing., leading to reduced costs and improved outcomes for patients. Currently about 25% of ICUs will try to do this using 12-24 fingersticks per 24 hours which costs a lot and keeps ICU staff busy. Using a CGM with programmable alarms leaves them with more time to care for patients.

In this agreement Edwards is responsible for sales and marketing. Given they already have a sales staff focused on the ICU market, this would be much more effective than growing an appropriate in-house staff at Dexcom. In return, Dexcom will receive a royalty of up to 7%.

For those of us, like myself, with Dexcom shares this might ultimately boost the share price which has been down substantially for some time now.

World Diabetes Day #2

2008-11-14T00:02:00.005-05:00

First of all, I've got to confess. I'm writing this at 9 PM, but using publish features to make it appear tomorrow. I'm still nursing some type of cold, so I can't wait until midnight to watch the blue circle come down in New York with 1000's of folks waving meters, syringes and pumps cheering wildly.

Because it's World Diabetes Day, the second official one.

What will you be doing to bring attention to diabetes? Lots of buildings will be lit up in blue tomorrow evening. I'm going to wear my blue One Shot at a Time t-shirt from Five Humans. I'm afraid I'm such a publicity hound I'm almost tempted to color some of my teeth blue, but that might be going overboard... "So I guess Bernard's really lost it, must be that insulin he's been taking for years."

This year's campaign for World Diabetes Day is focused on children with diabetes. This includes raising awareness of the signs of type 1 diabetes in children. It's hard to believe but this is sometimes misdiagnosed until children end up in DKA comas, which can be fatal.

So put on something blue, maybe wear a diabetes pin for the day. And if anyone asks why tell them a little about the warning signs of diabetes.

Above all have some fun. Happy Friday all.

Which health plan are you voting for?

2008-10-22T07:45:00.002-04:00

With the US election less than two weeks away you may already have made up your mind about the candidate that will get your vote. (And you are voting, right?)

If you have a chronic illness like diabetes, one important consideration is how the future president might impact health care in the US. If you're like me, you've probably got a lot of questions about this. To help you make up your mind about this, here's some assigned reading!

Today's Wall Street Journal talks about A Blizzard of Numbers and how these are obscuring the details of the health plans for the two major candidates. Their main point is that some experts have produced the numbers for each health plan option, but these are estimates, not exact figures. The WSJ article also refers to an article from yesterday's New York Times On Health Plans, the Numbers Fly that calls these figures "the roughest of estimates".

Jenny's post at Diabetes Update, Joe the Plumber and McCain's Health Plan points out

The US Chamber of Commerce and Business Roundtable, two highly conservative business lobbying groups, have both stated that they believe McCain's health plan to be deeply flawed (my emphasis and likely to increase the number of the uninsured, not lower it.

Finally the National Federation of Independent Business has a nice side-by-side comparison of where McCain and Obama stand on health care.

Remember, your vote does count. If you need more information about voting where you live use this handy site provided by Google.

Update: The New England Journal of medicine published a somewhat related (short) article Three "Inconvenient" Truths about Healthcare. The summary is that our current approach to healthcare needs to be changed for the reasons covered in the article.

Update 2: The Wall Street Journal has an editorial page article on health care choices between the two candidates. According to this, Mr. Obama "would impose new nationwide rules on insurance companies to prohibit "cherry picking," where companies sometimes reject applicants on the basis of pre-existing conditions" while Mr. McCain "believes such regulations are one reason health coverage is so expensive".

My take is that many of us with chronic illnesses would be served extremely badly if we were excluded for coverage of our 'pre-existing' conditions.