Diabetes Technology Blog

Kris Freeman Interview

2010-02-01T20:10:00.009-05:00

Kris Freeman, is the reigning US National cross-country champion. Recently he was selected to compete as a part of the US Ski Team in the 2010 Olympic Games this February, which puts him in a very elite club. He was diagnosed with type 1 diabetes in 2000, before his first Winter Olympics in 2002. He also competed in the 2006 Winter Olympics.

What sets Kris apart from others with type 1 diabetes is that he competes in endurance sports: the 15 kilometer freestyle cross-country (XC) race lasts about 45 minutes. Kris will also compete in the 30k pursuit race, the 50k mass start classic, and the individual and team sprints.

I was given a chance to ask Kris some questions and he kindly answered all of them. I've only edited these to add some hyperlinks.

Q: Your diabetes story: How did you first find out you had diabetes? Had you been ill before this and how did you feel at the time of your diagnosis?
A: I was training full time with the US Ski Team in Park City Utah. Every two months I had a blood test to see how well I was handling the training and to screen for any abnormalities. The tests always included iron levels, cholesterol, red-blood cell counts etc. One screening included a glucose test as well and mine came back at 240. I was sent to an endocrinologist in Salt Lake City who diagnosed me with type 1 in five minutes.

Q: If you remember it, what was your initial BG value?
A: My initial BG levels were low for a new diagnosis because my abnormal blood sugar was discovered very early in the "honeymoon" phase. I had only mild symptoms of diabetes including frequent urination, feeling light-headed and occasional blurry vision. I didn't notice the extent of the symptoms until after the diagnosis.

Q: At the time, your doctors seemed to think that your skiing days were over, what made you sure you could continue?
A: I was crushed when I was first diagnosed and told that my Olympic aspirations were over. I immediately started studying the disease and the history of its treatment. I learned that many breakthroughs in diabetes care had been made recently. Glucose monitors were getting faster and more accurate and pump technology was improving rapidly. The invention of Lilly's Humalog fast-acting insulin excited me most though. With these breakthroughs being so recent, I realized that no one could know what was possible for a diabetic athlete using them, especially when they were told not to try.

Q: What preparation, if any, did you make to return to training with diabetes? How did you change your approach to training to accommodate diabetes?
A: I trained the afternoon of my diagnosis. I went for a kayak with tears in my eyes. I was not going to give up. I didn't change my training at all. I changed my diet and learned the nutritional values of every food I had been eating. I studied the glycemic index and stocked up low index carbs. Over the years I have gotten to the point where I can glance at a plate and know how many carbs are on it where they fall on the index. I prepare for training and racing through a strict diet of what my body needs not what it is most appetizing. Whole grains, lean protein and lots of fruit and vegetables are essential. I try to eat all my food in as close to its natural form as possible. I avoid processed foods like the plague.

Q: Before you started using an insulin pump, how many shots were you taking a day? What changes did you make so you could still exercise while on shots?
A: I used injections for the first seven years I was diabetic. I used Lantus as a basal and Humalog as a bolus. I took my basal at 9:00 PM and the Humalog injections with my five daily meals. I eat about 5000 calories a day when I am in heavy training. I would also take correctional Humalog shots if my sugar was too high after eating. Some days I would take six shots others I would take over a dozen. I do whatever I have to do keep my sugar near normal levels at all times. Diet and a strict insulin regimen make it possible for me to train and race like any other athlete.

Q: For attending a race, what kind of diabetes-related things did you bring with you?
A: I always bring two Lifescan Mini Glucose monitors. I keep one in my water-bottle belt which I keep warm with two chemical hand-warmers. The second monitor I keep in my backpack which I always leave in a heated building. I keep my Personal Diabetes Manager (PDM) for controlling my OmniPod in my waterbottle belt as well. I also bring a vial of insulin and an extra pod in my backpack in case of a freak accident.

Q: Why did you choose an Omnipod over other insulin pumps?
A: In international XC ski races the minimum temperature for holding an event is -4 degrees fahrenheit (-20 C). At that temperature my doctor and I were concerned that the exposed tubing on the infusion set of a traditional pump would freeze. The OmniPod adheres to the skin with the delivery tube going directly into the body. The direct placement allows my body heat to keep the pump from freezing at any legal racing temperature. Also there are occasional high speed crashes in XC ski racing. I have crashed in races going well over 30 mph. Destroying an OmniPod in a crash is not a huge loss since it is replaced every three days anyway. Destroying a traditional pump would be a serious financial and logistical problem.

Q: How has your race preparation and racing changed because of the Omnipod?

A: The OmniPod has allowed me to use only Humalog insulin which is much more predictable than basal insulins. I am able to change the basal drip of Humalog at any time using the PDM. This has allowed me to experiment with different basal rates in training and racing to find the ideal dose for each of my events. My initial testing was done rollerskiing on a huge treadmill at US Ski Team's gym, The Center of Excellence. I was hooked up to an oxygen monitoring helmet and had my glucose and lactate levels monitored at different exertions.

Q: Have you considered using a continuous glucose monitor to reduce time needed to test and correct your blood glucose levels during races?
A: My doctor and I have not learned of a continuous glucose monitor that would work reliably enough to use during a race. I am anxious for the technology to develop though.

Q: It's usually cold where you're training or racing, how do you overcome temperature issues with your Omnipod and testing?
A: The chemical hand-warmers that I mentioned previously keep my glucose monitor and PDM warm while I am skiing so I can make on the fly tests and adjustments. Before a race I always try to make my final tests and adjustments in a heated location for maximum reliability.

Q: Has there been a time when having diabetes helped you in some way? Can you give us some insight into that?
A: Having diabetes has forced me to learn about diet and nutrition. I have also learned more about my physiology than I ever would have without the diagnosis. I am more aware of how I am feeling at all times.

Q: Have you a general message for our readers?
A: The technology exists to treat diabetes in a way that it does not have to have a negative impact on any goal or dream you may have. Be diligent with your diabetes care and there are no limits to what you can achieve.

Type 1 diabetes hasn't stopped Kris from getting to the top of this tough sport. The Winter Olympics in Vancouver start on February 12th. The first cross-country race with Kris is the 15k freestyle on February 15th. You can also find Kris on Twitter.

Bayer Contour USB meter big step forward for design

2009-12-17T18:39:00.004-05:00

Bayer USA sent me one of their Contour USB blood glucose meters to review some time ago. For me the summary is easy: this is a great meter with slim design that's easy to use. I like it a lot. Read on for the details and lots of pictures.

LifeScan created a buzz when they released the OneTouch UltraMini a few years ago. Given their sizes, looking at the two meters together is a good way to get a quick comparison point. In the picture both meters have a strip inserted and are prompting for a blood sample. Note the Contour uses standard strips that need a 0.6 microliter drop of blood, by comparison the OneTouch needs 1.0 microliters. Both meters provide results in 5 seconds. The Contour meter is auto calibrated with each strip, while you have to calibrate the OneTouch meters each time you get a new batch of strips.

I'm comparing the readings with my WaveSense Jazz meter, and they are usually within about 10% of each other. So I believe the Contour USB accuracy is good. I need to use the meter over several A1C tests, to do a real comparison.

The color is really eye catching, and the text is very readable. Here's a picture of the Contour USB meter showing a low blood sugar reading of mine.

The designers have used this high resolution screen and color very effectively. When your BG is lower or higher than a range that you set, the result is displayed in an salmon color.

One the right hand side of the meter are three buttons, in the picture above they're between the column reading Reminder|Notes and the Bayer symbol. You can press the button to set a reminder for a later test, or to add some basic notes from a small selection list.

The next picture shows the meter immediately after you apply a blood sample. You're prompted to mark the reading as before or after a meal, or just to continue on to the results. While you're doing this, the result is being calculated. So this step makes the whole thing seem faster.

And don't worry, if your blood glucose is out of range the meter won't wait longer than 5 seconds (time to calculate result) for you to make a choice, it will just display the value.

In case you're wondering where the USB part of this meter is, here's a picture.

The meter has a rechargeable battery that gets powered up whenever you connect it to a standard USB port. They also provide a standalone charger you can plug into an standard outlet (which also works for charging an iPod).

One last picture. If you're testing in the dark, it's really easy to see the results on the screen. But you know how difficult it can be to get the strip into the meter and a sample on the strip. If you click the button at the top of the meter (not visible in my photos) twice, then the area to insert the strip lights up. Note I deliberately took this picture in low light conditions to show you the overall results.

Bayer arranged for me to talk with Rick Case, the project director, and Eric Nelson. These folks were leading the design team, which was completely within Bayer. We had an interesting discussion about product design and some technical issues.

Their target audience for this meter was people in their late teens or early 20s. (Which means that folks like Bennet and me can't get too excited about it!)

They wanted to get the product into the market, so initially it's only in black. But they're considering different meter colors and hope to have these available before too long.

If you use the GlucoFacts software that's provided on the meter itself, it doesn't actually remove the readings off the Contour USB. As the meter holds 2000 readings, you'll get almost a year's worth of readings if you're testing 6 times a day.

You can register at the Bayer site and download a different version of the GlucoFacts software that does take the readings off the meter. The built-in software doesn't allow you to manually enter new values, or A1C readings, but the installed version does. Both pieces of software are written in Java and run on Windows and Mac operating systems.

Because of speed to market, they purchased an off the shelf charger. When you use it, the meter is facing away from you, a minor annoyance. They plan to fix this in later models.

They are reading the sites of many diabetes bloggers, so they're taking note of suggestions and complaints for future versions of their products. One suggestion from me is to enable me to download the readings in some standard format (CSV), so I can look at them using other software. I hope the next version will also include an ability to upload readings to a central server like the MyGlucoHealthMeter.

For the first meter from this team, I think Bayer have done a superb job, and I'd recommend having a good look at this meter.

FYI: The User Guide(PDF) is available.

Final pictures:
A graph from the GlucoFacts software showing blood glucose readings over several days.

Summary of blood glucose readings with some statistics below it.

Summary of readings with a pie chart.

MyGlucoHealth Blood Glucose Meter

2009-11-27T19:37:00.004-05:00

Recently I was given the MyGlucoHealth blood glucose meter for review. It's made by Entra Health Systems a new entrant to this enormous market.

I considered giving a summary up front, but it�s not that easy with this meter. It has some good points and ways in which it can be improved, I don�t think a summary would do justice to these.

The meter arrived in an elegant white box somewhat like an Apple product. I was really pleased to see the meter picture on the front had a blood glucose reading of 157 mg/dL. Finally, a manufacturer that�s not scared to show a more realistic reading.

The box contained the meter and the usual accessories (lancing device, lancets, some test strips, a carrying case, a USB cable, and an instruction manual). Two AAA batteries were included. I'm glad to see that is uses these instead of the more expensive button batteries used on many other small meters. The cost of this kit is $89.95 on the http://www.myglucohealthstore.com site. I was also given 50 test strips, which are worth an additional $49.95.

While small, the meter is not compact. Here�s a picture of the myglucohealth meter (on the right) beside a OneTouch UltraMini (on top), a WaveSense Jazz on the left and a Bayer Breeze2 Meter in the middle.

From this picture you can see that the blood glucose readings are large and easily readable. Unfortunately there�s no backlight, so using the meter in low light levels is really not an option

The strips require a 0.3�L drop of blood and results are shown in about 3 seconds, which is fairly standard features on the better meters available today. The meter is self coding, when you insert a strip the code is read off it and displayed, so you save a little time on each new vial of strips.

You can use the meter straight out of the box, though MyGlucoHealth strongly suggests you read the manual. I didn�t do this and wasted several strips until I talked with MyGlucoHealth support. Here�s the problem, after you insert the strip and the code is displayed you have to select an activity code before you can add a blood sample. This is not obvious and completely different to the many other meters that I�ve used.

Even after learning this I continued to waste strips because I�d apply blood after the code disappeared but before I chose an �activity�. There are four activities to choose from: before a meal; after a meal; after sports; after taking drugs. This is a very limited set of options: what about sickness or fasting options? What if I didn't want to add an activity code?

I think the need to choose the activity before testing is a poor design choice and I�m surprised this wasn�t fixed when the meter was being field tested before release.

The meter has a neat little slider at the top which makes it easier to extract the used strip.

The supplied kit also comes with a 3-month MyGlucoHealth.net subscription. This is the site where you can upload your readings, add other health information and share these with your healthcare providers. I don�t know what the annual costs are for an ongoing subscription.

I did hit a snag when trying to upload readings from my meter. I had chosen a password that contained invalid characters, so it wasn�t accepted. Unfortunately I didn�t get a warning about this and had to contact MyGlucoHealth support to resolve this problem.

To upload readings you create an account, logon and press the big blue Get Readings button on the home page of the web site. This launches an application from the web site that asks you to connect your meter. (Firefox users, you�ll need to install the Microsoft .NET Framework Assistant before doing this.)

The first time you do this, you�ll need to fill in a short form so this application can connect with the web site to send the data from your MyGlucoHealth meter.

Then go back to the Meter tab on this application

Now you need to connect your meter. You can either plug in the standard USB cable that�s provided, or you can connect directly if you�ve got Bluetooth on your PC. I tried both approaches and they worked equally well.

After all the readings are downloaded the Meter tab will change to show the most recent blood glucose reading. You can add a comment to go with this reading, or use the arrows to add comments to any other readings. (You can also add comments to readings on the web site.) Press the Continue button and all your data is on the MyGlucoHealth.net website.

On the website you can view your readings as a chart

Or as a table

You can also add other readings, such as my HbA1c line in the middle of the above table. And you can export your readings to an Excel spreadsheet from this page

If your doctor is registered on the MyGlucoHealth site then they can review your readings and exchange messages with you through this secure site. It�s not clear to me how healthcare providers register, currently there are less than 30 doctors listed on the My Doctors tab.

The site allows you to set reminders when your testing frequency is below a specified level, or when the supply of test strips is below a certain amount, and other options. You can also setup alerts when your blood sugar is out of range and have these sent as email or text messages to several people.

Summary

For the first meter from a new company in this space I think the MyGlucoHealth meter scores about 70 out of 100. These days I assume that meters will be full featured and well designed, unfortunately the meter doesn't score top marks for either of these.

It can calculate averages, store up to 250 results, and remind you when you need to test. But the lack of any backlight is surprising. The user manual is barely adequate and really needs improvement. For example the explanation for setting alarms and average results were very hard to follow.

The ability to upload readings directly to a website is innovative. With electronic health records (EHR) and personal health records (PHR) I think many new meters are going to have a feature like this. This is forward thinking.

The Bluetooth connectivity and the use of a completely standard USB cable is nice (WaveSense take note). However you need to install a serial driver if you�re going to use the USB cable, which is irritating even if other meter companies do the same thing.

The website is nicely interactive using Adobe Flash technology appropriately. But the upload software is Microsoft .NET based, so I don�t think it will work on non-Windows machines. These days, all diabetes device makers should be building software that runs on Windows, Mac OS and Linux.

There�s no way to take readings off the meter without the software from the website, which means you need internet access to use the meter effectively. I�d believe there should b separate download software than can be used without the need to be online, but I know this won't be important for everyone.

I hope that Entra Health Systems succeeds with this meter and the website, so that more manufacturers follow this integrated approach.

Update: The MyGlucoHealth meter can be purchased here http://www.myglucometer.com.

Happy 5th D-Blog Day

2009-11-09T18:28:00.003-05:00

Gina Capone of DiabetesTalkFest started D-Blog day in November 2005 and this year, we can all celebrate the 5th anniversary.

While World Diabetes Day is coming up quickly, today is a great opportunity to celebrate the richness of the online diabetes community (the DOC). When I started blogging about 3 years ago, people were blogging about diabetes and online communities did exist. Since then, the diabetes presence online has soared!

Today, we're blessed by social communities like TuDiabetes, DiabetesDaily, JoyOfDiabetes, and others. According to the diabetes search engine, there are over 525 blogs that cover life with diabetes. And many of us are also online using Twitter.

Today Twitter was full of #dblogday tweets, but any hour of the day you can find a lot of us at the Twitter water-cooler talking about diabetes, swapping blood glucose readings (especially on Wednesdays). To my view, Twitter has become a way to quickly update folks, look for help, or share successes.

Thank you to all my many online friends. Those that I've met, and all of you that I hope to say hello to in person before too long. I appreciate your insight, helpfulness, common sense and cold water. I know that living with diabetes is far easier because of you all.

On Saturday I'm planning to take part in the Big Blue Test, organized by Manny Hernandez. I'll be exercising for 14 minutes at 2 PM EST, and reporting my after exercise blood glucose readings afterwards (on Twitter and TuDiabetes). It's an easy way to get involved in the fun of the DOC, won't you join us?

The Ultimate Diabetes Resource

2009-11-08T19:37:00.001-05:00

Earlier in the year at the Diabetes bloggers summit, my friend Gina gave me a preview of The Diabetes Resource. Even though this was waay back in July and long before the official launch, I was impressed by the design of the site itself and the sheer amount of really useful information that's in there.

Gina, is responsible for the DiabetesTalkFest site and the CGM Anti-Denial Campaign site and has been online for many years. She really understands the kinds of diabetes information that people are looking for and she and her team have done an awesome job at providing a great resource that's easy to use and well organized.

For example, The Diabetes Resource currently lists 41 web sites that provide diabetes accessories, most of which I didn't even know about. The events page on The Diabetes Resource gives you all the information about upcoming events, and makes it easy for you to add information about your event. There's also a chat room at The Diabetes Resource, so you have extra chances to connect with others who are living with diabetes.

I know, from maintaining the diabetes search engine, that the number of sites focusing on diabetes is constantly expanding. Many of these are useful and informative, but there are also a lot of sites with misleading information and spam. It takes a lot of effort to separate these sites from one another, luckily The Diabetes Resource has a great team that knows all about life with diabetes, so it can be depended on to keep this well maintained.

FDA warning - fatal errors with some glucose test strips

2009-08-13T17:10:00.010-04:00

I received a public health notification this afternoon from the FDA. You may get high blood glucose test results if you're using test strips based on GDH-PQQ and you're taking medication that contains non-glucose sugars. Note: this is not a recall, it's a warning.

The partial list of medications includes:

Extraneal (icodextrin) peritoneal dialysis solution
Some Immunoglobulins: Octagam 5%, Gamimune N 5% (no longer distributed in US), WinRho SDF Liquid, Vaccinia Immune Globulin Intravenous(Human), and HepaGamB
Orencia (abatacept)
Adept adhesion reduction solution (4% icodextrin)
BEXXAR radioimmunotherapy agent
Any product containing, or metabolized into maltose, galactose or xylose. (Usually over the counter products)

The FDA has provided a list of test strips affected by this warning. These include: many Accu-chek products; Abbott FreeStyle strips, including those for the Cozmo and Omnipod insulin pumps; and TRUEtest strips.

If you're affected by this warning and you encounter a false high reading, you can report issues directly to the FDA.

If you're not affected by this warning, it's a good reminder to wash your hands before testing. It's way too easy to get a false high reading because of foodstuff on your fingertips.

You can subscribe to these kinds of warnings but very few of them are related to diabetes devices, just fill out the simple form on this FDA subscription page.

Update: I received several press releases on this issue from various manufacturers of blood glucose test strips. Assuming it's reasonably accurate, the most useful is this document (PDF) from Roche Diagnostics. Table 2 below (click to see it in a readable size) lists some of the drugs that can cause maltose interference, about how many people are using them, and how they're delivered. Most of these drugs are used in hospital settings. From this table it seems like Extraneal users is the group most likely to have people with diabetes, and I'm assuming hospitals have been notified.

Bayer has posted a press release to say that their products are not affected by this warning. I spoke with someone from Agamatrix (makers of WaveSense meters) and their strips are also not affected by this warning as they use glucose oxidase.

Trying out lower carb living

2009-08-07T22:29:00.004-04:00

At the recent diabetes care summit, I was fortunate to share a ride from the airport with a great diabetes blogger, David Mendosa.

David has type 2 diabetes. and one of the things we talked about was low carb diets and the benefits of using them. I know I'm not alone in this, but I have a terrible time controlling my cravings for carbohydrates. David told me that it had taken him about 2 weeks to get over the desire for carbs. And he can talk about the benefits, including better blood sugar control and weight loss.

Despite my Dexcom and insulin pump, I still have too many days where the curves look like the ocean on a stormy day. This week I decided to experiment a little with changing what and how I eat. For the last 3 days I've been avoiding excess carbs and eating more vegetables, protein and fiber.

And the results? See for yourself.
The green area represents readings between 80 mg/dL and 140 mg/dL. And I'm spending a lot of time in that range.

What have I learned so far?

First of all I can live with fewer carbs and it makes a huge difference to my blood glucose control. And with some thinking I can still exercise and maintain a semblance of control. Part of those 2 days included two 14-mile bike rides and my levels were reasonable for most of those.

I also know that 3 days does not make for a really changed relationship with food. Tomorrow I'm going to borrow Dr. Bernstein's book Diabetes Solution: The Complete Guide to Achieving Normal Blood Sugars. And I'm going to checkout whether I can take some of his approach and use it for my life with type 1.

Have you tried a lower-carb diet? What challenges did you have and did you figure out a way to deal with them? I'd love any help you can offer.

Update 10/26: I just got my A1C and the number was (drum roll) 6.8%. This is a great number, but not really as good as I was hoping and expecting. Mostly I've managed to stay away from snacking and over doing the carbs. Some days are better than others. The biggest problem I've found? Getting a good set of low carb recipes to replace all the old recipes I already have.

More on the Medingo Solo

2009-08-03T19:07:00.006-04:00

I blogged last week about the approval of the Medingo Solo insulin pump by the FDA. This week Medingo is showing it at the AADE conference and they've finally unveiled more details at the Medingo Solo website solo4you.com.

While the technical specifications are not available, they do have this video that shows some of the features.

The PDA part (Solo Remote) comes with different colored skins.

There are four parts to the Solo pump itself: Solo Remote; Reservoir; Pump Base; and Cradle.

The pump base is described as a '3-month insulin Pump Base that stores all your pump parameters'. Medingo says it last 90 days. Medingo provides you with a spare pump base, which will make replacement much less of a problem.

The reservoir holds up to 200 units of insulin and has a single mercury-free battery (grey circle to the upper right of the picture above). So each time you change the reservoir you get a new battery, it's not clear how recyclable it is. The cradle is the part that's attached to you, it's got the cannula. According to the site, a bad insertion can be fixed by just replace the cradle without losing much insulin. Changing the 'set' means replacing the reservoir and cradle. It's not clear how waterproof the base/reservoir are, so you need to detach these if you're swimming.

The Solo Remote has a color screen. It downloads settings to the pump base so that it will operate to some degree without the remote. The pump base has buttons (highlighted in orange in the picture) that allow bolusing without the remote. I assume this is like other pumps where you set a predetermined bolus amount and press a certain number of times to get a bolus of a certain size.

The Solo website does have a page to sign up for "Size Up Solo" demo kit. I've already done this, just be aware that the address entry fields are front to back and you'll be all set.

I'll update this post as I learn more. There are no posted specifications for the Medingo Solo system that I can find, from the video it looks very slim but I'll suspend judgment until I can get a copy of the user manual.

From what I've seen online, this looks like an improvement in usability and design over other pumps. I think we're going to see more of these insulin patch pumps over the next few years.

Healing wounds with insulin

2009-07-31T17:49:00.002-04:00

It's been known for some time that applying insulin to wounds can speedup healing. Now there's news (thanks to MedGadget.com) of a new approach to applying the insulin -- Nanodiamonds.

According to a 2006 article from ScienceDaily "Insulin applied topically stimulates human keratinocytes [a major part of your epidermis] causing them to profilerate and migrate into the wound tissue." It also affects microvascular endothelial cells, these line the walls of blood vessels. The can lead to improved blood flow.

The article suggests that part of the reason why people with diabetes have wounds that don't easily heal may be due to the lack of insulin.

The described nanodiamond approach provides a way to deliver insulin more easily. One challenge is that the insulin molecules connect tightly to the nanodiamonds. But by altering the pH (acidity) this binding can be reduced. The compound is promising and "could be integrated into gels, ointments, bandages or suture materials."

What are nanodiamonds? They're microscopic diamond particles that range in size from 45 nanometers to 180 nanometers. That means if you lay about 3,000,000 of them end to end they'd be an inch long. The electron microscope picture is from Nabond.com.

JDRF and Type 1 Diabetes Clinical Trials

2009-07-30T20:50:00.003-04:00

JDRF has launched an online service to connect folks with type 1 diabetes to clinical trials related to type 1.

The JDRF Clinical Trials Connection site gives you an opportunity to participate in trials that may lead to better treatments for type 1 diabetes. I know from participating in clinical trials at the Joslin Diabetes Center and for Dr. Faustman that many of these trials have problems recruiting qualified individuals.

According to the press release I received: "people can provide criteria like the type of trial they are interested in, how long they have had diabetes, and how far they�d be willing to travel, and the site will let them know about studies that match those characteristics. Clinical Trials Connection can help them search for trials, compare one trial with another, and update them on new trials that might match their interest. Plus, the service provides contact information for the researchers conducting the trial, so people interested in trials can contact them directly for more information, after discussing options with their healthcare provider."

The site also includes the following public service announcement ad about clinical trials.

Initial registration at the clinical trials site requires your name, email address and date of birth. After getting your password by email, you then enter much more details including: your date of birth (again); whether you or a family member has type 1 diabetes; date of diagnosis; address; states you would travel to for trials and other details.

I registered and the search for trials turned up the following five:

Study of Islet Transplantation in Type 1 Diabetic Kidney Transplant Recipients
Comparison of Lantus and NPH Insulin in the Dawn Phenomenon
Closed-Loop Glucose Control for Automated Management of Type 1 Diabetes
Imaging Inflammation in Autoimmune Diabetes
Glycemic Stability of Insulin Aspart Versus Insulin Lispro in Insulin Pump Therapy

For each of these studies they provide a more detailed description including: eligibility; exclusion criteria; the clinical phase of the trial; location and contact details.

What have you got to lose? I'd strongly recommend registering so that you can move the state of diabetes research forward.

Medingo Solo Micropump approved by FDA

2009-07-28T21:17:00.008-04:00

I can't find any pictures of this device, but there are various announcements today that the FDA has given formal clearance to Medingo Ltd to market its Solo MicroPump in the US.

On the Medingo site, this device is described as having "two parts: a miniature insulin dispensing patch and a remote control, which allows you to completely personalize and guide your patch for your body�s insulin needs."

I note that Prof. David Klonoff of the Journal of Diabetes Science and Technology is
listed as a member of their scientific advisory board. And Amy Tenderich has a post from 2007 that contains about as much information as is available today.

There were also presentations recently on this device at the recent CWD Friends for Life conference and the ADA Scientific sessions in New Orleans last month.

From the barebones information it's hard to tell if this is just a variant on the Insulet OmniPod or something very different. Please let me know if you're aware of any other information.

Update: Medingo will be unveiling the Solo MicroPump at the AADE meeting in early August. They also plan to launch their Solo website at that time. According to Craig Crease, Medingo's Director of Sales, they want to hold off on other information to "create an element of surprise". As I learn more I'll post it here.

Further update: I've posted separately with pictures and details of the Medingo Solo.

Diabetes Social Media Summit

2009-07-27T21:06:00.003-04:00

I think I'm the last person to write-up about this meeting so consider this a short recap.

Roche Diagnostics organized this meetup with help from Amy Tenderich and Manny Hernandez. Roche paid all of our expenses to and from the meeting and put us up in a comfortable hotel. I know that going into this summit I was nervous because I really didn't know what to expect. One concern we all shared was whether Roche was going to use the summit to do a big sales job to us. In the end, we all learned from the experience and Roche did an excellent job focusing on social media, and how to engage with it, while keeping marketing away.

We arrived at our hotel on Wednesday evening and had a dinner hosted by Roche at a local restaurant. Each table had 2-3 bloggers and a corresponding number of Roche staff. Despite this, and I know I wasn't alone, we had an opportunity to talk with Roche people about a number of topics including, in my case, the Disetronic insulin pump (aka Accu-chek Spirit) and when it might be available again in the US. At some stage I'd like to review it, hopefully I will have that opportunity.

After a late night talking with each other, we were up early (and not so bright) for a 7:30 trip to Roche offices. Manny Hernandez led us in an exercise where we tried to think about how to increase our outreach to people with diabetes. The 500,000 to 1 million (estimated) people that read our collective blogs already know we exist, but what about the millions of people who are struggling with diabetes without much support except from office visits 2 - 4 times a year.

Some ideas that I liked:

Provide information to doctors offices with a list of qualified online resources that can help people with diabetes. (Gina Capone's excellent Diabetes OC is a great reference site if you're trying to get information about diabetes.)

Form a loose association of blogs and try to focus on a single topic once every few months. We could issue a press release to media around this event and spread awareness of a specific diabetes issue. Eventually media might pay attention to this reliable source for diabetes information and news.

In the afternoon we focused on social media and how to best engage pharma in our world. Here we're all really interested in a relationship that will benefit all of us. We need better information and products; pharma would like to increase awareness of their offerings and get more market share. Getting this right is a delicate balance and I'm sure mistakes will be made. I think Roche wanted to try and learn from our experiences so they don't screw up too much. Of course the problem here is that there aren't really any rules about how to use social media effectively and sometimes we all screw up. But we learn quickly!

I think Roche showed a lot of courage in organizing this first-time event. We bloggers benefited because we had a chance to build stronger connections. I hope that some of the very direct feedback we gave Roche will help them as they try to improve their message for folks with diabetes. (Hint: don't use stock photos, show real people with diabetes in realistic situations: carb counting; testing while exercising; correcting a low; etc.)

Our smiling faces are below, if you click on it you'll get to a page with a link to each blogger. If you want more information about the summit, each of them has provided a slightly different take on it.

Travelling to the Roche Diabetes Care summit

2009-07-22T09:54:00.003-04:00

Just a quick post while I'm waiting to board a plane.

The event has been organized by Roche, makers of the Accu-Chek line of products. Among other things we'll be talking about is How can bloggers and community leaders best represent and help other patients?

I will be there along with some of my favorite diabetes bloggers including: Scott Johnson; Scott Strumello; Chris Bishop; Bennet Dunlap; Kerri Morrone Sparling; Kelly Kunik; Manny Hernandez; Kelly Close; Amy Tenderich and others.

So you know what we'll spend a lot of our time talking about.

But I'd love your input, how do you think diabetes blogger could better represent you and reach out to help the millions of others with diabetes?

More about this summit over the next few days.

An effusion of testing

2009-07-14T21:21:00.005-04:00

At 4 PM EST today, a lot of folks were testing their blood sugar readings. Paraphrasing Kerri, you could almost hear the collective shunk of our lancets.

Anyone with diabetes tests their blood sugar from time to time. If you've got type 1 diabetes you probably test at least five times daily. After a very short while you get used to it, it's just part of the wearing routine that's living with diabetes.

But today it felt very different because of a great idea from Kelly Rawlings. What if we tried to get a lot of people to test and post the results online at the same time.

How many people? 14,000 -- it's a good target number because sometime soon there will be 10,000 members in TuDiabetes.com, one of the best diabetes online communities. And EsTuDiabetes.com, the Spanish language version, has about 4,000 members. So all we needed was for each of those members to test and post.

Watching the Twitter feed at 3 PM today surprised me. There were hundreds of tweets all marked with the #14kPWD hash tag as people counted down to the test time. Folks were giving pointers to time clocks for folks in other parts of the world.

I have never seen so many people who were giddy about testing. People were posting test results in advance to see if they could get their number to a reasonable level. Some of us were wondering how many people would hit the magic 104 number. (That's the reading shown of the box of many blood glucose meters and a number that few of us see during the course of a week or even month.) Others were counting down to 4 PM, the official test time.

Was it effective at raising diabetes awareness? I can't say...yet.

But we did have A Parade of Test Strips and speaking for myself it was a lot of fun. In the end about 700 results were posted. I'll bet that for some of those posting it was the first time they'd shared a BG reading with anyone.

Thanks for pulling this together everyone in the diabetesoc and here's to the next wacky event that makes living with diabetes a little more of a community thing.

Omnipod eco-friendly disposal

2009-07-09T06:15:00.005-04:00

Yesterday Insulets, makers of the OmniPod insulin pump, announced a disposal program. To my knowledge they are the first diabetes product maker that's working to reduce the waste we all deal with to some extent, and they deserve a lot of kudos for it.

I spoke with Kevin Schmid, Insulet�s VP of Engineering, about how this works. Each OmniPod has a 357 watch battery, and usually uses up most of the charge so they cannot be reused in any way. In this disposal program the batteries are removed and recycled appropriately.

It's hard to recycle much of the OmniPod because they contain leftover insulin and have been worn, so they're 'contaminated'. This disposal program grinds up the remains of the OmniPod bodies, which substantially reduces the amount of space they occupy in a landfill.

Starting next month customers will get a disposal kit with their shipped OmniPods. They can return a months worth of used OmniPods for about $3. Insulet has also provided a set of answers to possible questions about their program.

Now I know some of you reading this will see all the reasons why this is not a perfect approach. But it's the first step towards making more of the items we use recyclable or easier to dispose of safely. Kevin told me that Insulet will be looking for ways to make this even more eco-friendly in the future.

There are a lot of us who wish living with diabetes didn't have such a big carbon footprint. Take a look at some of the photos in the Diabetes365 project that have been tagged with trash to see the stuff we collect.

I just hope that other diabetes suppliers will sit up and take notice of this important first step by Insulet. I know this will let me look more closely at the OmniPod system when I'm getting my next insulin pump.

Attribution: The photo above was taken by Kate Lilly and is one of many excellent photos on the Diabetes365 project site. She kindly let me use it in this post and retains all rights to this image.

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

2009-06-07T10:03:00.005-04:00

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.

Update: I've been reading the book Dr. Bernstein's Diabetes Solution. In chapter 4 he describes how to use the knuckle side of your hand (dorsum) to get blood for glucose testing. I've highlighted the areas suggested on my hand below.
Dr. Bernstein attributes this technique to Ron Rabb of Insulin for Life. Since reading about it yesterday I've tried this a few times and couldn't feel anything.

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.