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!
Dexcom delights
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.
Note: I currently own shares in Dexcom, I try not to let this ownership influence what I say about the company or its products.
My intention is to maintain this blog for review of diabetes devices and comments on usability and future technology trends. Currently I'm hoping to review the Pelikan Sun device, once I can get my hands on one.
In the meantime, I'm still writing posts on my Diabetes Daily blog. I've recently started a daily set of NaBloPoMo posts focused on letters.
With luck and effort I can make it through the entire month of April. So please follow me there.
The picture shows an already available chip that's about the size of a grain of rice and that contains some patient identification information. There are no details about the size of the planned glucose sensor device, but the company claims
"This system will allow for one injection every 4-6 months (approximate) that permits the diabetic to externally scan the device and retrieve a blood sugar reading as often as necessary."
Today Technology Review has an article about a Massachusetts company that's also working on implantable devices. MicroCHIPS is working on a device for osteoporosis treatment that provides daily delivery of a drug for treating that condition.
They are also working on an implantable glucose sensing device that contains an array of individual sensors. So when one sensor degrades, the device can turn a new one on and continue monitoring. The device will transmit the readings to an external monitor. The article claims that this information could be sent to an insulin pump.
My guess is that either of these devices are several years away. And when available not everyone will be comfortable with the idea of implanting something. For example what happens with MRIs or when passing through X-ray systems at airports?
So there's a need for education that covers the benefits and the likely issues with this type of device. Maybe these companies can look at how pacemaker companies have succeeded in getting their devices accepted.
It's a short read that outlines the ways in which healthcare may change in the future.
What's interesting to me is that a lot of the things mentioned in the Empowerment through Internet Technologies part of the article are already available.
For social networking look at the success of the excellent TuDiabetes.com site. I see a lot of members that are thrilled to find others with diabetes and that are actually learning about better ways to treat the disease and are getting lots of support from others.
For Twitter and updates via e-mail, you can look at the wonderful SugarStats.com site that lets you track blood sugars and other things related to diabetes care by sending messages via e-mail, SMS or Twitter.
From my perspective there are many ways to improve care for chronic illnesses. But thanks to the internet and the work of some great people the future is looking a lot better for many of us who work hard to have normal lives despite our imperfect bodies.
Richard Kahn of the ADA recently gave a speech where he seemed to be against the technology that I depend on every day to keep me alive and well. Amy Tenderich and others have blogged about his comments.
I'm not saying much on the topic because his speech(PDF) makes me so mad. It strikes me that he has a lot of nerve for someone who doesn't seem to have diabetes and therefore doesn't need these devices to maintain his health or quality of life.
Here's where I stand on this.
I wear and use several diabetes devices that have really given me my life back.
The first of these was my blood glucose meter. Before I had one of these I used urine testing. I called this the "closing the stable after the horse had bolted" test. Because all it told me was a value after my blood glucose was high enough to spill into my urine. So the test might say I was 'negative', but my blood glucose could have been 190 mg/dl. And the thing was stinky and a pain to use.
About nine years ago I started using an insulin pump. Before that I was on multiple daily injections. On a good day I only had about 6 injections. On a bad day, 9 shots or more. My blood sugar control was pretty lousy. And before the pump I really couldn't exercise because it's impossible to undo an insulin injection.
In the last year I got a continuous glucose monitor. This has freed me from a lot of worry. No nighttime lows without a warning. Long distance driving? No problem.
Life is a lot easier with all of these. But they do have challenges.
It's extra stuff to carry, to program, and to download information from. The cables alone are a pain. And when the pump and CGMS alarm multiple times in the middle of the night, I want to throw them away.
But you'd have to pry them from my cold dead hands before I'd give them up.
I drove down to Connecticut this afternoon for my bike ride tomorrow. The organizers have done an awesome job marking the route. I drove around it after arriving and it looks challenging and fun.
You'll notice that I now have a Patient Blogger badge in my sidebar. I applied for this after reading Amy's great post about ethics. I hope this gives you some confidence that I work hard to write a blog that follows these rules.
Tomorrow I'm planning to try a little experiment in live blogging. Recently I signed up for a Jott account. Marston made me do it! This nifty web 2.0 application lets you send messages by calling a toll-free number and talking carefully. I've set it up so that I can Twitter and/or blog from my mobile phone.
So tomorrow during my bike ride I plan to use Jott to update Twitter on how things are going. I may also post to the blog during a rest in the ride. We'll see how well it works in real life.
Today is the second day of Mix07. There's a lot more people, and much more buzz than yesterday.
Twitter is being used to send updates out to folks, and enable impromptu sessions and meeting among folks.
As a result of twitter I got a chance to meet with Scott Hanselman and talk with him some about CGM devices and the challenges of handling different data formats from these data collection devices. And Scott did a great job summarizing the announcements from day one of Mix.
Mix07 seems to be much more around rich media and media delivery to you via desktop apps, web browsers, or mobile devices. For those of us who are building enterprise applications, the rich media stuff is not immediately of interest. But we're also seeing a lot more tools around developing UIs for Silverlight. And once you're on that platform - the world is yours (or so Microsoft would have you believe).
At lunch I was chatting with the Microsoft Program Manager responsible for the MSDN user interface. She showed me how they've used Starlight to add videos to the front page, and how they've improved the search experience. Nice job, and it sounds as if more is coming soon to MSDN.
My biggest complaint so far? Too many interesting sessions on at the same time: I guess that's a good complaint. Having the videos on the Mix07 site will help, but it's not really the same. And as of right now (late on Tuesday) very few of the videos are actually there.
Tomorrow I'm looking forward to a session on Amazon Web Services and much more on Silverlight.
I just left the tail-end of the Ray Ozzie and Scott Guthrie keynote session at Mix07.
The session was jam-packed with folks standing at the back of the room (probably around 1,000 in attendance).
Ray was repurposing SaaS from Software as a Service to Software and a Service. It really sounds like they're embracing the approach that was first widely deployed with the iPod. Software running in the network cloud, and on the desktop (or in a browser), and on a mobile device. As Ozzie said, software 'embracing the value of the client'.
Most of the session was devoted to Silverlight and some new announcements around Silverlight design and development tools. Lots of cool demos from MLB.com, CBS, Netflix and others.
Lots of examples of rich content (especially live and streaming video) embedded in the web page. And they showed these running in IE7 and Firefox on Windows Vista and Firefox and Safari running on Mac. There also a nice demo showing a debugger running on Windows that was debugging a client session running on a Mac - that was impressive!
I also noticed an emphasis on the size of the download and the user experience in installing a Silverlight application. With broadband, it may seem that size no longer matters but remember there are still a large number of user environments (for example retail stores) that don't have a huge bandwidth connections to the client.
Scott Guthrie also pointed out several times how Silverlight is much faster for development and execution that JavaScript. He showed a simple chess program with a .NET chess player running against a JavaScript player. Silverlight 1.5 million move node calculation \versus JavaScript 500 node calculations for the same game. .NET wins. A little cheap but effective.
I'm in the big ballroom at the Venetian Hotel waiting for the start of the general session for Mix07. Microsoft has setup quite show with four huge screens (I'm guessing about 15 feet by 20 feet each) plus a central area where currently a three piece band is playing some interesting music.
There's quite a buzz in the crowd and the room is filling up (enough room for about 1,000 people I'm guessing).
I plan to blog some about the sessions that I attend and let you know what I think about each of them. So until Wednesday, most of the posts will be related to Microsoft and MS technology. More later.
I'm curious about what you're using to manage your diabetes.
So here are my questions.
1. What type of diabetes do you have? 2. What blood glucose meter(s) do you use? 3. If you use an insulin pump, what is the make and model? 4. If you have a Continuous Glucose Monitor, what make? 5. If you have a computer(s) at home, is it Windows or Mac?
I'd like to get as many answers as possible. So please forward these to others if you can.
If you'd like to do a completely different poll, check out the questions that Curious Girl is asking. Update: I just realized I should answer my own questions. 1. Type 1, 34+ years. 2. OneTouch Ultra, recently OneTouch UltraSmart. 3. Minimed 512. Can't wait to change this in September. 4. Dexcom as of 3 weeks ago. 5. Several Windows XP desktops and laptops.
I'm still wearing and using the Dexcom and for the most part really finding it useful.
This week I'm starting to gather supporting paperwork so can make a submission to my insurance company. I hoping that I'll get coverage and I'll post here to let you know how that goes.
I found this useful post on the JDRF website that outlines what you should do to get coverage for a CGM device. I call it the eight steps to getting a CGM. Because I'm not sure that I'd do the final two suggested steps: tell JDRF about what happens, and become a JDRF advocate.
I'm already working hard on advocacy, and JDRF has enough advocates of its own.
Let me point out a few things that I've noticed about wearing this device (and I'm sure the same is true for any CGM device.
First is that this gives you immediate feedback when your control is not good. So it's not like waiting 20+ years to see if you develop complications. It buzzes at you each time you cross the high threshold. If they'd just add a feature so it would shock you, then I might be motivated to reduce my highs!
Second is along the lines of a good news/bad news observation. The good news is that when my readings are behaving properly, it's nice to get the positive feedback. The bad news is when I have a night like last night where my readings were about 200 mg/dL from about 1 AM to 6:30 AM, I get to see that all displayed out as a high line. Yuk.
Despite its shortcomings, I still like the device. I'll try and post some more photos next time round.
Yesterday I met with the Dexcom representative and actually bought the unit.
The 'system' (receiver, transmitter, charger, cables, software) was $375, and the first 5 sensors cost $175. Total cost $550.
Officially the 5 sensors will give me values for 15 days. However I'm currently wearing a sensor that I first started on Monday and it's still working fine. So if I get an average of 7 days per sensor I have enough for about 5 weeks.
Now there are definitely aspects of this device that I don't like. But when it works it gives me great results. For example, if I'm about to drive I can look at the value and if it's stable and between 120-160 then I feel comfortable getting into the car without testing.
Next week I'll start the paperwork with Aetna and see how much of this I can get covered. I'll post on that as the process unwinds.
I agree with the Dexcom representative that Dexcom is committed to CGM devices, that's all they do right now. Whereas Minimed is really all about pumps, and they use the CGM device more as an accessory for the pump. I know this is over simplifying things, but the pricing models are very different.
I'll post more about this decision later. I'm rushing off to an all day Code Camp at Microsoft.
I found a very useful slideshow that compares the Dexcom and Minimed devices. It's written by John Walsh and Ruth Roberts authors of the excellent book Pumping Insulin. You can find the slideshow on the Diabetes Mall forums.
I need to point out that I also decided to buy some shares in Dexcom. Despite my interest in seeing the company do well, I'll continue to be upfront about the pros and cons of the system.
Yesterday I met with the Dexcom representative and actually bought the unit.
The 'system' (receiver, transmitter, charger, cables, software) was $375, and the first 5 sensors cost $175. Total cost $550.
Officially the 5 sensors will give me values for 15 days. However I'm currently wearing a sensor that I first started on Monday and it's still working fine. So if I get an average of 7 days per sensor I have enough for about 5 weeks.
Now there are definitely aspects of this device that I don't like. But when it works it gives me great results. For example, if I'm about to drive I can look at the value and if it's stable and between 120-160 then I feel comfortable getting into the car without testing.
I agree with the Dexcom representative that Dexcom is committed to CGM devices, that's all they do right now. Whereas Minimed is really all about pumps, and they use the CGM device more as an accessory for the pump. I know this is over simplifying things, but the pricing models are very different.
I'll post more about this decision later. I'm rushing off to an all day Code Camp at Microsoft.
I found a very useful slideshow that compares the Dexcom and Minimed devices. It's written by John Walsh and Ruth Roberts authors of the excellent book Pumping Insulin. You can find the slideshow on the Diabetes Mall forums.
I need to point out that I also decided to buy some shares in Dexcom. Despite my interest in seeing the company do well, I'll continue to be upfront about the pros and cons of the system.
Update: I had posted the wrong location for the comparison slideshow. You can find the presentation here. Sorry.
I was reading a post today on Jon Udell's blog and noticed a really interesting facility that displayed a preview when you hovered the mouse over a hyperlink.
bestowed upon companies that have carried out new research, which has resulted in innovations that have or are expected to bring significant contributions to the industry in terms of adoption, change, and competitive posture. This award recognizes the quality and depth of a company’s research and development program as well as the vision and risk-taking that enabled it to undertake such an endeavor.
Has anyone out there heard about this device? It looks like it would be 'interesting'.
Suppose you were out and your blood sugar got low? Perhaps so low that you lost consciousness and medical personnel wanted to contact someone on your behalf.
Who would they contact? And how would they figure it out?
Maybe you have an emergency bracelet or necklace that contains some details. That's definitely a great idea.
These days, you probably have a mobile phone. And that's where ICE comes in. ICE is an acronym for In Case of Emergency. And you can use it to store the phone number of someone to be contacted if an emergency occurs.
a report presented at a recent gathering of the American Conference of Emergency Physicians said doctors should encourage their patients to start using it. ... Traditionally, hospital workers have searched for a wallet and then tried to find relatives through the identification inside — a slow and not always successful method.
But with cellphones so common, Dr. McKenna [Albany Medical Center] said, hospitals now often search through cellphone address books for clues about whom to contact. While efforts to teach people to add an emergency contact listing have begun, doctors can do more to popularize the idea, he said.
Have you a mobile phone? If you were unconscious would someone looking at the phone know who to call?
Please take out your phone now and add an ICE contact.
As a past user of their meters (it came with the Minimed pump) this is no surprise to me, it was a most frustrating meter to use. What I wonder is what this means to current Minimed pump users that are using that particular meter.
I'm hoping that Minimed goes with a OneTouch-based solution, these are reliable and the strips are covered by most health insurance carriers.
Are you using one of the BD meters from Minimed? If so, please let me know if you've heard from Minimed about their replacement plans.
Diabetes: technology, devices, software, and other stuff.
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 35 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 also take Symlin to help control my post-meal blood sugars.
I'm blessed by God, and every day brings the possibility of a cure.
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. 
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.
