The Dexcom SEVEN continuous glucose monitor has been approved for 7 days of use. I usually get 10 to 11 days of use by restarting the sensor after 7 days have elapsed. Your results may vary, so make sure this works for you before relying on it.
Based on the abstract from the Diabetes Care website, it appears that the results on the 10th day are still fairly accurate. Notice how the difference goes down slightly on the 7th day, showing that the Dexcom is more accurate after it's been in place for a few days.
The median absolute relative difference for CGM versus YSI was 12.6, 11.3, and 14.5% on days 2, 7, and 10, respectively (P = 0.63). CGM performed better on day 10 when compared with self-monitoring of blood glucose as compared with YSI.
I expect to see more papers like this before Dexcom applies to the FDA for 10-day use of the sensors. The good news is that this ultimately means less sensors changes will be needed. It also probably means that Dexcom will raises the price of the sensors.
I do hope that before Dexcom takes this move they improve the adhesion of the sensors. Mine usually look like they're falling off by day 9 and they rarely last beyond day 11 because they peel off.
Have you been able to get sensors to stay in place for longer? What tricks have you used to make this work?
An article published in the journal Nature reports how scientists have converted pancreatic cells into insulin-producing beta cells. In a bid to make this more interesting (my opinion) they're calling this process "extreme makeover". This is of great interest because it means that stem cells may not be needed to produce replacement cells for different parts of the body.
I think that, for those of us with type 1 diabetes, it still leaves us with the problem that these newly-converted cells are still subject to the same destructive forces that killed off our original beta cells. But it's certainly a step in the right direction.
He's going to post the interview once he's had a chance to transcribe it (be patient, this will take time).
Dr. Faustman did an excellent job of explaining how they arrived at the approach being trialled, to use BCG as part of a possible type 1 diabetes cure. The current trial (and remember that many trials fail) is to determine whether a low dose of BCG has any effect on the bad T-cells. The trial completion and trial results won't happen until sometime next year. Remember, these are phase 1 trials and many phase 1 trials fail.
I asked her how much it would cost to complete phase 2 trials. The price tag is $25 million. That's a lot of fund raising and asking people for support.
They can't do trials in multiple centers because the equipment they've developed for testing results is not portable. In one case they moved a piece of equipment across the lab. It took 9 MONTHS to recalibrate it and get it working again.
We saw the equipment (no photos allowed). It's complex and large. The size of a full sized fridge on its side. To take a blood sample and extract the T cells takes an entire day. This is not fast work. They're doing it in a methodical and painstaking ways. At the same time she's taken some bold steps to move forward when others might have held back.
Each time I've met Dr. Faustman I've been impressed by her ability to clearly explain complex processes and experiments in layperson terms. She clearly understands the urgency of this work, but she needs to do it 'the right way' so that the results cannot be questioned. Remember when her original work was published in 2001, 2002 a lot of scientists did not believe the approach would work. It's now been replicated in several other labs.
I know the timescales aren't fast enough for any of us. This type of scientific experimentation takes time and a lot of effort. The lab has had delays in the past because they were waiting for funding. The best way we can speed the process up is to continue to fund the work.
I'm hoping to run in a triathlon later this year and use that for fund-raising. I also use the (small) ad revenue from my diabetes search engine to support the lab. There are many other ways to sponsor the work of the lab.
Once David blogs about the interview, I'll update this post with a pointer to it.
They're working on developing a closed loop system where readings from a continuous glucose monitor (CGM) are used to directly control an insulin pump. Currently those of us with CGMs and insulin pumps have got an open loop system, we need to take the readings from the CGM and decide whether we need insulin or food.
Clearly this is a difficult problem to solve. How would such a system know if you were sick? What would it do when you're about to exercise? How would it handle changing insulin needs for children who are growing?
Now you have a chance to learn more about this project. On July 21st and 22nd the FDA, NIH and JDRF are holding a public workshop 'focused upon the state of the art in the research and development of an artificial pancreas'.
I see this news is being reported in severalplaces. It's interesting because there's been so much talk about using stem cells to treat diabetes. Now Novocell says that they were able to use human stem cells to control diabetes in mice.
In early January I visited the Mass General Hospital research lab where Dr. Denise Faustman is leading research into a possible cure for type 1 diabetes. I was there to give a blood sample for use in this research.
If you've ever met someone you've admired for a while, or maybe a rock or movie star, then you'll know how I felt as I spent time with her.
Over the last two years I've taken part in two bike rides to raise funds for this research. But now I had a chance to actually help support the research in a more direct way.
The lab is drawing samples of blood from people with type 1 diabetes, and 'healthy' volunteers. Because they're having trouble getting healthy volunteers, they ask everyone with diabetes to bring a volunteer with them. These folks must not be directly related to you, and not have any auto-immune diseases. I was fortunate that a friend of mine from work kindly offered to come with me. Paul is one of the founders of the yard sale search site GoYarding.com.
I met Dr. Faustman early in the morning. They do all the sample collection early in the morning so it doesn't interfere with work and school schedules. While we talked, she collected four test tubes of blood from me. She explained that some of this blood was tested using machinery they're developing and some was tested manually by one of the researchers. I believe that manual testing takes about one day to complete.
They're trying to accurately measure the amount of T cells that I have. Her theory is that these T cells are responsible for destroying my insulin producing beta cells. These cells also produce amylin. This is now available as an injectable drug called Symlin that I've written about several times.
You can see a short video of Dr. Faustman and an animation of how they believe the T cell process works on the Iacocca Foundation website.
Some of the blood is also sent to another research lab. They have a method for measuring autoantibodies in blood. She explained that autoantibodies are produced when beta cells are destroyed. So if these were found in my blood, that would indicate that my body had recently lost some beta cells. Which would mean that my body is still making beta cells, 35 years after I first got diabetes.
She hopes to start trials before too long where they will be administering low doses of BCG to see if this can destroy these T cells. BCG is used in Europe as an inoculation against tuberculosis, and is also used as an immunotherapy treatment for bladder cancer.
BCG has been around for a long time. As it's already approved for use as a medical treatment, it is likely that getting approval to use this for other purposes will be quicker and easier than for a new drug. It will probably also be less expensive.
Dr. Faustman's hope was that the FDA would permit trials with low number of subjects. This makes it easier to administer the trials because getting enough people is always a challenge and testing the outcomes is easier with smaller numbers.
She explained that there will likely be several trials with increasing doses, so they can determine if it works, and at what dosage levels. Clearly having automated measurement machinery will make this process a lot faster. They've been working on developing this machinery over the last few years.
I told her that it would be wonderful if they started a blog, even a low-volume one to keep everyone informed about their progress. But she's concerned that will take away from research time and also that the blog may draw a lot of comments that would need to be read and handled.
I imagine the entire lab must feel a little like Banting and Best after insulin was first discovered. They had hundreds of parents from around the world contacting them to try and get their children treated. And that was in the days before the internet and e-mail.
It was a real pleasure spending some time with Dr. Faustman and getting an update on their progress.
I have another appointment in September to get another blood draw. As Dr. Faustman pointed out, this is an easy way to get the latest news. And by then I hope to have completed another bike ride to support her exciting research. I can't wait!
Intensive blood sugar control - dangerous in type 2 diabetes?
You may have seen the news about changes in the ACCORD Trial. This is a clinical study of adults with type 2 diabetes who are at a higher risk for cardiovascular disease.
Some of the people in the trial were following an intensive approach to managing their blood sugar. The aim was to keep their A1C results below 6%. Others in the trial were following a 'standard treatment' with a target A1C between 7% and 7.9%. This second range is much closer to what most people with type 2 diabetes achieve.
Over 10,00 people were taking part in the trial. Over about a four year period 257 people in the intensive group died, compared to 203 people in the standard treatment group. This was equivalent to 3 additional deaths per 1,000 participants per year. And both of these death rates were lower than similar populations in other studies.
About half of the additional deaths were due to cardiovascular disease, the rest were from other issues such as cancer. But it's not clear why these happened.
Because of safety concerns about this increase, the NHLBI who sponsors the trial has decided to stop using the intensive treatment approach and have all participants use the standard one with it's less demanding A1C goals.
If you want more information about the trial and what has changed, the NHLBI has an excellent FAQ page.
And remember, if you have type 1 diabetes, these findings don't apply to you. You should still aim for the best blood glucose control you can safely achieve.
Update: Kelly Close of Close Concerns has a good blog post about this trial, it's also worth reading.
The ACCORD Trial has its own web site, which gives more details about what the study was attempting to find out. From this page you can see that 5,128 people were in the intensive blood glucose control group and 5,123 people were in the standard blood glucose control group.
If you'd like to see other coverage of this situation across the diabetes internet, the diabetes search engine returns a lot of interesting hits for "ACCORD trial".
An article in today's Washington Post reports on research that has found stem cells in the pancreas of mice. I'm not sure whether it matters, but it appears these were regular mice or NOD (non-obese diabetes) mice.
"This demonstrates a stem cell repair mechanism in the pancreas that, if we understand it more, then we can help develop more cures with either transplantation or with drugs that can increase the body's own stem cells and beta cells," said Paul Sanberg, director of the University of South Florida Center for Aging and Brain Repair in Tampa.
I think this is another example of research that can contribute to thinking differently about how our pancreases truly work. It may be a long time before this research leads to human treatment, but it's another step in the right direction.
Researchers have been able to get liver and pancreatic cells in diabetic mice to produce insulin by using a naturally occurring protein. According to the article I read, by injecting a protein called Pdx1 into the abdomens of mice, insulin production is restarted in the mice. Pdx1 has a structure that allows it to pass into the pancreatic cells, enter their nucleus and cause insulin production to start.
According to Dr. Li-Jun Yang, founder of Transgeneron Therapeutics, "What is remarkable is that the protein also promotes regeneration of insulin-producing cells in the pancreas, allowing the diabetic mice to become normal."
It all sounds like it has possibility. I'd just caution readers not to get too excited.
This is research and I'd guess it's many years away from any kind of application for people with type 1 diabetes.
Those of us with diabetes that take insulin know a lot about needles. We inject many times a day. We may also use needles to take Symlin, or simple to puncture our skin for blood glucose testing.
Well now there's a possibility that we'll see truly pain free needles in the future.
A team of researchers has created hollow needles, made of ceramics, that are so fine that you don't feel them.
There are no pictures of these yet, and it's not clear when or if they'll be on the market. But I'm intrigued by the quote in the press release:
“Microneedles may be integrated with micropumps and biosensors to provide autonomous sampling of blood, analysis, and drug-delivery capabilities for treatment of chronic disease,” he said. “For example, one needle, pump and sensor unit would assay the glucose level in interstitial fluid of patients with diabetes mellitus. Another needle, pump and drug-delivery unit would deliver insulin in a continuous or programmed manner.”
I like the idea of having a micropump instead of the pager-sized unit I carry around with me all the time.
I know that I've been very quite on the blogosphere for the last several weeks. I appreciate more than I can express all the comments and e-mails asking me how I'm doing and wishing me the best.
I won't bore you with the details here except to say that I'm in the middle of some type of depression. It's not earth-shattering and for those of you who have diabetes, it's probably not entirely unexpected. Taking care of a chronic disease is a big burden and it takes its toll. The good news is that I'm working pro actively to get this under control and get through it. And in the meantime I'm focusing on essential activities because I've not got a whole lot of energy for other things.
It's been a busy year on the blogosphere and busy one for me. I've been blessed with a lot of accomplishments over the last year, in no particular order:
I met Allison and Mel in Boston. It's always fun to get together with fellow diabetics! If you're going to be near Boston in 2008, please let me know.
I got to some meetings of the insulin pumpers group that meets in Woburn, MA each month. A fun, supportive and informative group. Every state should have a group like this.
I marked my 35th year with diabetes by raising over $11,500 for research in a diabetes bike ride. Hint: it's not too late to support this.
I received an award from Lilly and Joslin for 25 years with diabetes. Thanks Dr. Spatola for organizing this one.
I setup the diabetes search engine. It now indexes over 800 sites and I like to think that it's helpful for folks.
I joined the great TuDiabetes.com social networking site for diabetes. Big kudos to Manny for starting this.
I worked together with Beth to start the diabetes365 project (originally her idea). As of today there are about 1,750 photos that give some insight into what it's like to live with diabetes.
I almost completed NaBloPoMo for this year. I didn't post for every day of November. Next year will be better.
I started using the Dexcom STS continuous glucose monitoring system and moved to the Dexcom SEVEN system later in the year. Life with a CGM is a lot easier, though it still has its frustrations.
And of course I posted many blog entries. Along the way I hope that I informed some readers. I know that I learned a lot from your comments and I also managed to get lots of practice with my writing skills.
So what's in the cards for 2008?
I'm getting some blood drawn in January as part of the research for Dr. Faustman's work on a possible cure for Type 1 diabetes. No, I'm not getting an early version of the cure, I'm just donating blood samples for the work. I hope to meet her and ask a few questions, I'll let you all know what I learn.
I'll keep blogging, though maybe a little less.
I hope to get involved in another fund-raising bike ride in September.
I stumbled across this interesting article that outlines what it might take to actually turn a stem cell into a beta cell. Beta cells are the pancreatic cells that produce insulin.
The author, Paul Myers, is an associate professor of biology at the University of Minnesota, so I'd hope he's fairly accurate in his description of the process.
Let me summarize the article by saying, making beta cells from stem cells isn't going to be easy. Reading the steps involved reminds me of the song Dry Bones, 'With the leg bone connected to the knee bone, and the knee bone connected to the thigh bone...'.
To make a beta cell, you have to first convert ES cells into mesendoderm, then into endoderm, then into Anterior Definitive Endoderm (ADE), then into midgut endoderm, then into general pancreatic tissue, then into pancreatic endocrine cells, and finally, you can apply a signal to switch them into the beta cell state.
And even if this could all be done, you'd still need to deal with the
chronic difficulty of removing whatever destroyed the patient's original set of beta cells.
So I won't be holding my breath on this line of research. I think it'll bring benefits, but probably not anytime soon. My money is still on the research being done by Dr. Denise Faustman.
Technology review has an interesting article about a new compound that may soon be tested as a treatment for Type 2 diabetes.
The drug is being developed by Sirtris Pharmaceuticals. It's essentially a super strong version of resveratrol, which is normally found in plants and is contained in red wine.
The drug activates an enzyme called SIRT1 possibly producing an effect in the body that's similar to reducing caloric intake substantially.
Tests on mice with the new compound found the drug "improved insulin sensitivity and blood glucose levels in three rodent models: diet-induced obese mice, genetically obese mice, and a rat model of type 2 diabetes." According to the article clinical testing may start in 2008.
I've recently started drinking an occasional glass of red wine because of the possible health benefits. Maybe in about five years I can just pop a pill instead! Though I think I'll likely stick with the red wine.
This is slow work and Dr. Faustman is conducting it in a careful and rigorous way. Which makes some of us impatient for results. But I'm eternally optimistic about it all.
In early January I'll be at the lab to get some blood drawn that will be used in the research. A good friend from work will also be there as a healthy volunteer! What a guy. While I'm there I hope to meet with Dr. Faustman and ask her some questions about the work. I'll post what I learn online (mid-January).
Updates: I did meeting with Dr. Faustman in January. In March there was an announcement about the start of clinical trials for a possible cure for type 1 diabetes, based on her work.
Today's New York Times has posted a long article In Diabetes, A Complex of Causes that describes interesting new research into how the body regulates blood sugar.
We already know that the pancreas and liver regulate blood sugar levels. This article also describes how a skeletal hormone, osteocalcin, can signal fat cells and the pancrease. Experiments show that it may be possible to boost ostecalcin and affect blood sugar levels, though this will only benefit those with Type 2 diabetes.
The latter part of the article also describes how the brain may actually work to affect blood glucose levels. They've been able to knock out certain receptors in the brain and cause diabetes in mice. And research seems to point to the hypothalamus.
The brain, therefore, appears to be listening to — and weighing and making sense of — a chorus of signals from insulin, leptin, free fatty acids and glucose itself. In response, it appears to send signals to liver and muscle cells by way of several nerves, though additional mechanisms are probably involved. The gut also seems to chime in, said Dr. Rizza, adding that for him, this aspect of sugar regulation came as “the biggest gee whiz of all.”
This article is a very interesting read into new diabetes research. The New York Times has been doing some great reporting on diabetes treatment and research this year. I'm impressed by the amount of attention they're giving to diabetes.
I was diagnosed with Type 1 diabetes on September 10, 1972. 35 years ago today.
I went to the hospital after a doctor diagnosed me during a phone call with my Mum. I had many of the usual Type 1 diabetes symptoms:
Extreme thirst. I was drinking non-stop. Unfortunately a lot of it was sodas of various sorts.
Non stop peeing. See previous item. Some of this would have been my body flushing excess sugar from my system.
Weight loss. In the week or so before going into hospital I lost almost 12 pounds.
Leg cramps. I'd wake up in the night and pound my calf muscles trying to get them to relax. This was one of the worst symptoms for me.
Fatigue. I thought this was because of waking up to pee or fix the leg cramps.
Ketones. At the time I had no clue what this was. I just had a fruity smelling breath, especially if I belched. And I seemed to be doing that a lot.
Infections that won't heal. I had a small cut on my foot that had been there for over 2 weeks and wasn't getting any better.
When I got to hospital my first blood sugar test was 800 mg/dL. (The usual range for someone without diabetes is about 75 to 100 mg/dL.) Shortly after getting there I had my first insulin injection, and I've been taking it ever since.
Now it's 35 years later and what's to look forward to? Plenty I think.
Yesterday at my bike ride, I spoke to someone from Dr. Faustman'sresearch lab in Boston. They're continuing to make progress on a possible cure for Type 1 diabetes. Personally (this is just me talking) I'm expecting that I won't be taking insulin by the time my 50th d-anniversary rolls around. Maybe because of Dr. Faustman's work, or because of other research that's happening around the world as I write.
And what happens if I'm wrong? Well that's OK. It won't be the first time.
God has some plan for me. He's a good guy and he's taken great care of me and my family so far. So I'll just continue to place my trust in Him, because I'm fearfully and wonderfully made.
Yesterday was such a lovely day that I decided to dust my bike off and start training in earnest for my fund-raising bike ride. Which explains the title of my post.
Like many of us with Type 1, I feel that I'm in charge of my control and my destiny with this disease. I can get help from my healthcare team, and from my great friends online at TuDiabetes.com or the Diabetes OC community. But I'm the one who lives with the disease 24 hours a day.
I've walked and ridden many times over the last 10 years to help push this disease back. Last year I was able to raise about $7,500 to fund the important research being done by Dr. Denise Faustman. She really seems to be close to figuring out some important parts of the puzzle that is a diabetes cure.
This year I really want to raise $10,000, which is an impossibly large amount. I've been e-mailing and talking with friends and family, but that amount of money doesn't come easily. So if you feel like supporting me, do it now. Just drop by my fund-raising page and give as much as you can afford.
Yesterday I was on my bike for about an hour and managed to cycle for 11 miles. I practiced a lot on getting up hills without dropping my speed too much and without having to get out of the saddle. I need to get my average speed up to 15 miles per hour, so I can complete a 50 mile ride in a little over 3 hours in the saddle. So I've got a ways to go. And now I'll need to start getting up really early so I can get in a 40 minute ride before work.
It's hard work. But what pushes me forward is this thought.
What if the money that I raise (with your help) hires the researcher. You know, the person who figures out a key part of the cure. Wouldn't that be something?
I've been wearing both Dexcom CGM systems for about 24 hours now. It amazes me how closely they track one another, though yesterday the old one was always about 10 points below the new one. Today I'm seeing about the same difference. You can also see there are some gaps in readings for the Dexcom 7. I think the receiver is a bit fussier about rejecting possibly bogus readings. I wonder how that will look when I'm more than seven days into the Dexcom 7 sensor.
I came across a 19-page HSBC Global Research report(PDF) comparing Minimed and Dexcom based on the ADA conference and a survey that HSBC took. The report estimates there will be about 140,000 CGMS users by the end of 2009 versus about 15,000 today (and 6,000 at the end of 2006). That's a huge growth rate, and you know it will impact insurance coverage. I think it will also drive the demand for software to help healthcare teams interpret the huge amount of numbers they'll see in place of log books.
I hope this quote will come about
We would view any such collaboration between DexCom and any of the leading insulin pump manufacturers – Johnson & Johnson (Animas), Roche (Disetronic), Smiths Group (Deltec), or Insulet – as a positive for both parties, as both companies would better com
Personally, I think that CGM will become the standard for testing for anyone with Type 1 diabetes. Read the report, I think you'll find it interesting.
I'll post some pictures from the Dexcom 7 software later in the week. I did try the new software with my old data values and it worked just fine. So I've much more interesting statistical views of my readings available back to March.
Note: I currently own some shares in Dexcom, I work not to let this influence what I say about the company or its products.
Finally here's a picture from last weekend of some of the lovely flowers in my sister-in-law's place in Rhode Island. What a lovely weekend we had there.
The Diabetes Technology Blog is focused on using technology to live life to the full with diabetes. I review new diabetes technology including: blood glucose monitors; continuous glucose monitors; blood sugar meters; diabetes software and living with diabetes.
Name: Bernard Farrell
Location: Massachusetts, United States
I was born in Ireland and now live in the US.
I have had Type 1 diabetes for over 36 years. I struggle with my blood sugar, the same as most people with diabetes.
I wear a Cozmo 1800 insulin pump and a Dexcom SEVEN Plus CGM to track my blood glucose levels.
I'm blessed by God, and every day brings the possibility of a cure.