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.
Update: If you want to keep track of Team USA results the TeamUSA.org web site will have all the latest news. If you're feeling generous, you can also donate to support our team by clicking below.
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 itís not that easy with this meter. It has some good points and ways in which it can be improved, I donít 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 thatís 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. Hereís 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 thereís no backlight, so using the meter in low light levels is really not an option
The strips require a 0.3ĶL 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 didnít do this and wasted several strips until I talked with MyGlucoHealth support. Hereís 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 Iíve used.
Even after learning this I continued to waste strips because Iíd apply blood after the code disappeared but before I chose an Ďactivityí. 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 Iím surprised this wasnít 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 donít 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 wasnít accepted. Unfortunately I didnít 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, youíll need to install the Microsoft .NET Framework Assistant before doing this.)
The first time you do this, youíll 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 thatís provided, or you can connect directly if youíve 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. Itís 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.
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 youíre 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 donít 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.
Thereís 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. Iíd 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.
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.
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 theyíd 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.
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 excellentDiabetes 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.
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?
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.
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.
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.
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.
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 Cozmoģ 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 DiabetesMineô Design Challenge. I'd sure like to see another choice when it comes to insulin pumps.
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.
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.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.
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.
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.
In this blog I try to focus on new developments in diabetes technology (devices and software). I know there are many readers who are very interested in learning more about what's available and what's coming.
But I realized that there are many folks with diabetes who'd also like to know more about some of the basics in diabetes 'technology'. Maybe learning about testing for foot problems with monofilaments. Or techniques for using an insulin pump more effectively.
Is this a suitable place to write about more of the basics, or are there enough blogs and communities out there that already cover this stuff? I'd be interested in knowing what you think. And I know I can depend on you to let me know.
Maybe this would be a good time for some of the blog lurkers to leave a first time comment, I'd value your opinion.
We, the undersigned, appeal to the leadership of the U.S. Food and Drug Administration (FDA) to reduce barriers to innovation in diabetes treatment development, in the interest of public health.
The FDA's job is to protect the safety of patients in its use of drugs and medical devices and to advance public health by speeding innovations that make medicines and technology more effective, safer and more affordable. That is its mission.
But we believe the FDA has adopted a stance of excessive caution in its regulation of diabetes drugs and technology that is counter to its duty to serve patient needs.
Specifically, it has established new rules that will impair research and innovation into diabetes therapy. (A copy of the letter sent to manufacturers in November 2008 can be found at http://www.diatribe.us/fdaletter (PDF).)
This worries us. For example, new requirements for additional multi-year long-term outcome studies prior to approval for drugs with no cardiovascular signals will assuredly discourage research and innovation to the detriment of public health.
The need for improved treatments for the 24 million Americans with diabetes could not be clearer. Many of the drugs available now have tolerability issues . Poorly controlled diabetes increases the risk of devastating long-term complications, including blindness, end-stage renal disease, amputation, and heart disease. Complications cost our country at least $58 billion per year  -over twice what is spent on technology and therapy annually .
Nearly 50 percent of patients in the US do not meet A1c goals  using current therapies and technologies. No therapy today stops diabetes from advancing. As patients are living longer with diabetes and therapies stop working, the need for new therapies increases. We need better technology and drugs that help slow or avoid long-term complications as well as more therapies that cause fewer side effects1 and last longer. And, despite the epidemic in the number of diabetic patients, no drugs are yet available that can prevent diabetes. Innovative, safe, and effective prevention is the key for people at risk and for cost savings to society.
Ironically, excessive regulatory hurdles ensure the continued use of the very drugs and devices that have proven ineffective for many patients.
There is no value in an ideal diabetes drug or device if the regulatory costs are so great that the product never makes it to market. Make rules reasonable.
Due to the very nature of the severity and prevalence of diabetes, the following leaders within the diabetes community, who have signed this petition, implore the FDA for the immediate creation of a Diabetes Advisory Council, whose goal would be to improve options for patients. This council would include practicing endocrinologists, diabetes educators and others communicating directly with patients. Our experience, focus, and keen awareness of the needs of the diabetes community would be an invaluable resource to the FDA as it faces the arduous process1 of evaluating new diabetes treatments. Our aim is to improve options for patients.
We urge the new FDA leadership to recognize the urgent need for more safe and effective treatment options for diabetes and to reduce barriers to innovation. More treatment options will benefit patients. The disease is progressive. Delays in the availability of new treatments will only result in tremendous cost to public health and the economy. Our recommendation can benefit patients without sacrificing their safety.
Notes:  "Glycemic Durability of Rosiglitizone, Metformin, or Glyburide Therapy," New England Journal of Medicine, December 7, 2006. ADOPT, a four-year clinical trial of over 4,000 patients, was designed to test the how long diabetes therapies last. In this trial, 23% of those on sulfonylureas (SFUs) and 38% of those on metformin experienced nausea, diarrhea and/or vomiting from taking the drugs. 10% of those on TZDs, 11% on metformin, and 39% on SFUs experienced hypoglycemia. 7% and 14% of those on TZDs experienced weight gain and edema. 12% on women on TZDs experienced fractures. The trial also found that within five years of starting therapy, 15% of those on rosiglitizone (TZD), 21% on metformin, and 34% on glyburide (a sulfonylurea [SFU]) had fasting blood glucose over 180 (~ roughly equivalent to an 8% A1c), suggesting that even if patients could tolerate the therapy, it wouldn't last longer than a few years for many.
 "Economic Costs of Diabetes in the US in 2007," Diabetes Care, March 2008, page 13.
 "Economic Costs of Diabetes in the US in 2007," Diabetes Care, March 2008, page 13.
 "Is Glycemic Control Improving in US Adults?," Diabetes Care, January 2008, page 81.
I picked up the mail today and opened a letter from my wonderful endo (Dr. Elizabeth Spatola of St. Joseph's in Nashua NH).
Inside it was the latest A1C test and (....drumroll....) my A1c is 6.6%
For me this is the lowest value I've ever had, and I'm more thankful than I can say.
In 2009, I'd like to keep my A1C at around 6.6% for the year. I'm grateful that I can use technology (insulin pump, Dexcom CGM) and rely on many people at TuDiabetes and the entire Diabetes OC (online community) for support and advice. Without all my friends in the d-blogosphere, I think living with diabetes would be a lot harder.
In 2009 may your blood sugars be steady and your diabetes frustrations be few.
For all of us I hope to see some exciting diabetes research development in the next 12 months.
First of all, I've got to confess. I'm writing this at 9 PM, but using publish features to make it appear tomorrow. I'm still nursing some type of cold, so I can't wait until midnight to watch the blue circle come down in New York with 1000's of folks waving meters, syringes and pumps cheering wildly.
What will you be doing to bring attention to diabetes? Lots of buildings will be lit up in blue tomorrow evening. I'm going to wear my blue One Shot at a Time t-shirt from Five Humans. I'm afraid I'm such a publicity hound I'm almost tempted to color some of my teeth blue, but that might be going overboard... "So I guess Bernard's really lost it, must be that insulin he's been taking for years."
This year's campaign for World Diabetes Day is focused on children with diabetes. This includes raising awareness of the signs of type 1 diabetes in children. It's hard to believe but this is sometimes misdiagnosed until children end up in DKA comas, which can be fatal.
So put on something blue, maybe wear a diabetes pin for the day. And if anyone asks why tell them a little about the warning signs of diabetes.
The 2nd World Diabetes Day is coming up this November 14th. Manny Hernandez of TuDiabetes and David Edelman of DiabetesDaily have a petition asking Google to create a doodle for November 14th. This would be a great way to get publicity for World Diabetes Day, as the Google home page gets about 30% of the world's internet traffic every day.
A new 12-page report published by Diabetes UK calls diabetes (all types) one of the biggest health challenges for the UK.
This report, Diabetes: beware the silent assassin (PDF) shows that diabetes costs the NHS (National Health Service) in the UK £1 million ($1.72 million) per hour, and causes more deaths that prostate and breast cancer combined.
If this is true for the UK (population 60 million, and 2.3 million with diabetes), you can image the impact in the US, which has five times as many people and about ten times more people with diabetes.
Diabetes is a serious disease with no simple solutions, there may not be all that much we can do in the short term to reduce the impact. Although page seven of the report does have some suggestions for reducing the risk of developing type 2 diabetes.
In my mind one of the key factors for success in diabetes management is having a good support organization. These days I can't recommend a better place for support than TuDiabetes.com. It's an amazing resource for sharing information and getting help with all types of diabetes-related issues and I wish many more folks with diabetes were benefiting from the site.
While not directly related to diabetes, the New York Times posted an article Doctors and Patients Start Talking that points to a new series being written by an oncology doctor, Dr. Pauline Chen. She is the author of Final Exam: A Surgeon's Reflection on Mortality. I have not read the book, but there's a huge amount of discussion on her article at the NYT site.
Those of us with chronic illnesses understand the importance of good, honest communication with our healthcare team. Some doctors and nurses aren't good at that, others don't have time to really explain things or answer questions. So we turn to help from folks on TuDiabetes.com and other supportive sites. I think this is part of how healthcare is evolving in the US. What do you think? Maybe you can leave a comment on the NYT site.
While I'm talking about reading, here's a free book that may be really useful if you're dealing with the US healthcare system. I just started reading My Healthcare is Killing Me! earlier today and I've already got some ideas for better handling myself within our (sometimes challenging) system.
Finally, if you're one of many of us who'd like to see insurance coverage for CGM devices, please go and sign Gina Capone's petition. If you'd like to know more about Gina and the petition, read Amy's interview with her.
You know how challenging it is to live with diabetes. Those days when it seems nothing is going right. You can't control your blood sugars, then you get a bleeder when changing an infusion set and your meter runs out of batteries at the worst possible time. The countless times when the possibility of complications weigh heavily on our hearts. The frustrations of not being able to eat something without first having to do some math.
You get the picture, you know the story.
It's hard to see any positives to diabetes, but they do exist.
Given my love of carbs, if I didn't have type 1 diabetes I probably would have eaten myself to death by now. Despite diabetes I've been able to do pretty much anything I want. And diabetes has led me to things I wouldn't have done without it.
So I see joy is some aspects of diabetes. And it seems I'm not the only one.
I got a copy of Bob Hawkinson's excellent book The Joy of Diabetes, and I've read it twice. I plan to try and do this every other month.
Bob's message is simple but important. Diabetes is serious, but if you take care of it properly then you can have joy in your life despite the big D. His book is also a great high-level overview of type 1 diabetes, outlining what's important without drowning the reader in details. Excellent reading for diabetes newbies.
His book starts six points for a 'Life of Joy'
Accept the disease
Understand the disease, as much as possible
Be there for folks who need you
Remember to laugh at myself from time to time
Relax and take charge of my life
For me, this was a quick read. It helped me focus on some important points. I especially liked the idea of ensuring that I will be there for others. The best way to do this is to take charge of my diabetes.
I like the colorful drawings and I especially liked the slightly larger type face. Some might think this makes it more like a children's book - it's certainly approachable enough to be read by teenagers. But this choice of font makes it easy to read and is probably even better for folks who may be struggling with eye problems.
Etiquette is all about being polite. It's also (for me) is a hard word to spell. I need to practice writing it some more.
Have you ever sat down to eat, you're about to put a bite of food into your mouth and a colleague says "I didn't know you were allowed to eat that"? I've one specific co-worker that's probably said that to me several times in the last two months. And boy does it make me mad. I'm planning on sending her a copy of this nice diabetes etiquette card(PDF) that's been put together by the folks at the Behavioral Diabetes Institute. The card offers 10 suggestions expressed as DOs and DON'Ts. For example
DONíT look so horrified when I check my blood sugars or give myself an injection.
DO realize and appreciate that diabetes is hard work.
DONíT tell me horror stories about your grandmother or other people with diabetes you have heard about.
They're all good points and they may stop you from strangling that person who just won't stop giving 'helpful' advice.
My latest video shows how I used the Diabetech HomeCheck A1c test kit to test my A1c at home.
This is the second time I've used this kit to check my A1c levels. Total cost for the kit is $35.34 including shipping to my home and shipping the test sample back to the Diabetech labs.
In the video I show how to use this simple kit. In the video I mention a form that needs the test date not your birth date. My mistake.
I mailed the test to Diabetech on Tuesday and last night, 3 days later, I got the results back my e-mail (I can also ask for them by postal mail) and they showed my A1c had improved from 7.6% in November to 6.8% in May.
It's a great improvement and I really like that I can do this so easily at home. Total time from ordering the kit to getting the results was 10 days. Pretty good and I really liked the results I got.
Full disclosure: Kevin McMahon, the CEO of Diabetech, is a blogging acquaintance of mine. I've paid in full for both these tests and did this review without being asked to by Kevin. I like the product and admire the work that Diabetech has done to make diabetes management easier.
The diabetes search engine now has about 900 sites and pages that it searches for information all about diabetes. So far the advertising revenue is about $55 and that's all going to Dr. Faustman's research at MGH.
Here's some of the sites that I just added recently.
The misadventures of peabody is a new blog from emily who was diagnosed with type one in March 2008. That's about seven weeks ago. Drop by and welcome her to the diabetes OC.
The ultimate hike for a cure! Ty Hover is either crazy or wildly ambitious. He's planning to hike from Detroit to Alaska and raise $290,000 towards diabetes research along the way.
I use this term for a product that you may already like that then surprises you with a feature that you didn't even know existed. Like a car that turns off the interior lights before the battery runs dead, even if you'd left them on by accident.
I had one of those experiences today with my Cozmo. Yesterday my pump had started to complain that the battery was almost empty. And today I was running on voltage fumes.
I knew that I had to replace it, but I kept forgetting to. That is, until I was putting in a combination lunch and correction bolus. While the pump was delivering the bolus I decided to test what would happen if I removed the battery, essentially mimicking loss of power.
After replacing the battery I was pleasantly surprised to see a Bolus Interrupted message on my Cozmo. This is the kind of attention to detail that I've seen in other parts of the Cozmo pump. Those firmware engineers (the folks who write the code that runs the pump) really thought about this - good for you folks!
Another customer delight for me, this time from those great Dexcom folks. Today I got the new Dexcom CGM model to try out for a week or so (one sensor life). I'm going to replace my 16-day old sensor this evening and tomorrow I plan to try and use both receivers against the same sensor and see what happens. I'll use the OneTouch meter with the older receiver and my AgaMatrix WaveSense meter to calibrate the newer receiver.
What I'm hoping is that the newer receiver will show my readings to be higher that on the older receiver. If I'm right then it may prove my theory for my A1C being higher than expected.
The trial model also came with the slightly newer version of the Dexcom software. They've re-introduced the modal day view, which is very useful when you want to see recurring patterns in a number of days.
I'll blog about the new receiver and software after I've had a chance to play with it for a few days.
Update: I've posted a video on YouTube showing how to calibrate the Dexcom open choice. I still need to talk about the software.
Note: I currently own shares in Dexcom, I try not to let this ownership influence what I say about the company or its products.
Phase 2 is where potential drugs are tested to see if they're safe and they work (efficacy). The capsules will need to complete a phase III trial before they can be sold to people with diabetes.
The main challenge to taking insulin by mouth is that the insulin protein is broken down in the stomach before it has a chance to be used by the body. Oramed claims to have solved this problem and the challenge of getting the insulin through the walls of the intestine.
Prof. Hanoch Bar-On, a leading Diabetologist on the Oramed team, states that the route of the insulin from the swallowed capsule ďimitates natureĒ in that it passes to the liver and then to the bloodstream. Injected insulin goes straight to the bloodstream.
I've been unable to get any information on dosing (figured out in phase 1B) or the duration of insulin delivered by the Oramed capsule. I hope to get this after phase 2A is completed. It took Oramed about seven weeks to complete phase 1B, so this information may be available sometime after mid-June.
Oramed is planning to get approval first in the US and then Europe.
In addition to their oral insulin capsule, Oramed is also working to develop an insulin suppository. This product is in Phase 1 trials at present.
Update: I exchanged some e-mails with Oramed. They told me that the phase 2a trials are 'expected to last a few months'. Also that while the trials are on people with type 2 diabetes the product may be usable by people with type 1. I'll post again once I have more news.
Today I'm joining other folks with type 1 diabetes to make a little noise about it.
This used to be called juvenile diabetes because most people were diagnosed before they ended their teens. But now it's clear that you can get it at any age.
When you get type 1 diabetes, your pancreas has stopped working properly. This organ contains cells that create insulin, glucagon and other hormones. The insulin is needed so the cells of your body can process the blood sugar created whenever you eat food containing carbohydrates. Without insulin your blood sugar increases and there's no way for your body to use it.
What are the symptoms for type 1 diabetes?
Extreme thirst. This is the most obvious one. My mother described it as "wanting to drink out of the toilet bowl". Think about drinking several glasses of water and still feeling thirsty.
Lots of peeing. That's because of the water and your body trying to get rid of the sugar floating around your blood stream. Your urine is actually sweet. Mellitus (as in diabetes mellitus, the medical term for type 1 diabetes) is the Latin word for honey.
Extreme loss of weight. You've got sugar in your blood, but your body can't use it. So it breaks down its energy reserves (fat). One of the by-products of fat break is ketones. The night before I was first diagnosed with diabetes I lost over 10 pounds.
Extreme hunger. Even though you've got all this sugar in your system, your body can't digest it so you feel hungry.
Blurry vision. The density of your blood changes. This changes how your eyes focus.
Slower wound healing. Instead of clearing up in a few days a small cut or scrape can take over a week, or even longer. When I was diagnosed I had a cut on my toe that was over three weeks old. Once I started on insulin it disappeared in about five days.
Fruity breath. This is from the ketones. It tastes fruity and the smell may remind you of nail polish remover. Dentists often diagnose diabetes due to this smell or .
Itchy genitals. That sugar in your urine can cause urinary tract infections.
Fatigue. The extremely high blood sugar can cause urinary tract infections.
If you see several of these symptoms please contact your doctor. Untreated diabetes can cause coma and ultimately death. This is serious business.
These days the tools for treating diabetes are pretty good. But it still takes a lot of support and help to really manage living with diabetes. Don't try to do this alone.
If you've already got diabetes there's lots of useful places online where you learn more about taking care of yourself and your diabetes. Try the Diabetes OC for a list of diabetes blogs. TuDiabetes.com is the first of many other social networking sites for people with diabetes. There's even a weekly television program for diabetes, dLife.
I created a diabetes search tool to make it easier to find diabetes information online. I use the advertising revenue to support the research by Dr. Denise Faustman into a possible type 1 diabetes cure. To date, I've raised about $50 for this cause.
If you've already got type 1 diabetes, today is the perfect day to raise awareness. Do people at work know how to treat you if your blood sugar goes low? Can you share information about living with type 1 on your blog, or maybe an article in your local newspaper? Do your best to spread the word.
For today, I'll be using Twitter every time I do something due to my diabetes. This way others can see what I do to control it, and maybe learn more to help themselves or others.
Have a wonderful Type 1 Diabetes Awareness Day.
And why not give a hug to anyone with type 1 diabetes today?
The Diabetes Technology Blog is focused on using technology to live life to the full with diabetes. I review new diabetes technology including: blood glucose monitors; continuous glucose monitors; blood sugar meters; diabetes software and living with diabetes.
Name: Bernard Farrell
Location: Massachusetts, United States
I was born in Ireland and now live in the US.
I have had Type 1 diabetes for over 36 years. I struggle with my blood sugar, the same as most people with diabetes.
I wear a Cozmo 1800 insulin pump and a Dexcom SEVEN Plus CGM to track my blood glucose levels.
I'm blessed by God, and every day brings the possibility of a cure.