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
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.
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 0.3µL 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.
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!
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?
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
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.
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 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.
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.
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 conferenceand 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.
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 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.
The Diabetes Technology Blog is focused on using technology to life better with diabetes. I review: blood glucose monitors; continuous glucose monitor; blood sugar meters; diabetes software and living with diabetes.
About Me
Name: Bernard Farrell
Location: Massachusetts, United States
I was born in Ireland and now live in the US.
I have had Type 1 diabetes for over 36 years. I struggle with my blood sugar, the same as most people with diabetes.
I wear a Cozmo 1800 insulin pump and a Dexcom SEVEN CGM to track my blood glucose levels.
I'm blessed by God, and every day brings the possibility of a cure.
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.
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.
