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wejo79-blog · 1 year

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This will be a very long post, but, if insurance-related drama thrills you and/or you’re a professional who could offer advice, I encourage you to read.

I, as many of you know, am a Type 1 diabetic. This has been the case for the majority of my life. For roughly 4-5 of the 30 + years of my diabetic career, I’ve made use of the Dexcom G6 Continuous Glucose Monitor (CGM). A CGM is comprised of a PDA (or a smart phone with an app), a sensor, and a transmitter. The transmitter/sensor constantly checks your blood sugar and sends that data to either the PDA or the smart phone. The Dexcom has been incredibly helpful in my treatment plan. And now that I’m on an Omnipod 5 insulin pump, it’s even more important. My pump is constantly receiving my BS data and adjusting my dosage on the fly. To acquire the Dexcom, Angela Rogers, the APRN I saw at the time, set me up with a company that I THOUGHT was a mail-order pharmacy, Byram Healthcare. Turns out they were not; in actuality, Byram was a Durable Medical Equipment (DME) supplier. That distinction will be important later.

I’d never used a mail-order provider for medication or equipment before. Nervousness abounded; however, after a few months, my apprehension subsided. Eventually it just became a regular part of my routine. I had no trouble ordering from them at all until August 2022. Well, I guess I had no trouble ORDERING in August. The trouble began when I received an invoice for my order the following month. That invoice – again, for 1 month of consumable Dexcom supplies – was for roughly $2,500. They kindly dropped my total down to $1,035 since Anthem covered $0.00. I’d never had anything like this sent to me during my time is a Byram customer, so I immediately called them. I was told that my invoice was generated due to a “contractual change.” I’d be unable to use Anthem to acquire CGM-related supplies from them any longer. They went on to mention a “reimbursement” for that I could acquire from my insurance to get them covered. That sounded a bit sus to me, so I filed it away to be investigated later.

The “contractual change” ended up being a change to my insurance plan. Remember how Byram was a “DME supplier,” not a pharmacy? Well, as of 2022, my Anthem plan covered CGMs exclusively through pharmacy benefits, not medical. That means I could’ve gone to Walgreens (or any other pharmacy) to get what I was being invoiced for with full coverage. Somewhere in all this, I logged into the Anthem site and began looking through my claims; I noticed that all five of my Byram claims from 2022 had been denied. I’d only been invoiced for August, though. I’ve been at my current job for almost 11 years. For the entirety of that time, our insurance has run on a July-to-July fiscal year. We’ve NEVER had any plans change before the end of a fiscal. I thought perhaps that was the reason why I’d not been invoiced for the other rejected claims. That was not the case! The invoices for those arrived a few weeks after I got the one for August.

Byram told me that Anthem had paid those other claims but pulled their funding due to my plan being changed. No one – my employers, staff, the insurance agent we use – was informed of the CGM change to our insurance plans. The only change we were told about was a lower out-of-pocket total. It wasn’t until my first appeal was rejected for my August order that I was directed to page 79 of our Certificate of Coverage which stated that CGMs were now covered exclusively through pharmacy benefits. We sign up for our new plans around June and the coverage doesn’t begin until July. That means I wouldn’t have even had the new COC until right before I’d made my August order. Byram claims that Anthem didn’t inform them which plans covered CGMs for the calendar year. But the calendar year begins in January and my first invoice was for August. I could understand one order slipping by, but they should’ve noticed and inform me of no coverage with the second. Heck, any normal pharmacy will tell you every time something isn’t covered and ask if you still wanted it. Not Byram.

I think both parties deserve some of the blame (and maybe me, honestly, because I could’ve missed some postal mail). I’d love to hear your “fight the man” medical coverage stories, especially if there’s an inspirational ending where the good guys win. I’ve never had to deal with anything like this and am determined to not pay. The total owed now is nearly 4k and it’s ridiculous that I could’ve went down the street to get this stuff from Walgreens with full coverage.

#insurance #diabetes

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your-dietician · 3 years

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Omnipod 5 'Artificial Pancreas' Shows Benefit in Type 1 Diabetes

New Post has been published on https://tattlepress.com/health/diabetes/omnipod-5-artificial-pancreas-shows-benefit-in-type-1-diabetes/

Omnipod 5 'Artificial Pancreas' Shows Benefit in Type 1 Diabetes

Insulet’s investigational Omnipod 5 automated insulin delivery system improves glycemic control in people with type 1 diabetes as young as 2 years of age, new data suggest.

The Omnipod 5 system combines a tubing-free insulin-filled delivery “Pod” with the Dexcom G6 continuous glucose monitor and an algorithm built into the Pod connecting the two devices via a smartphone app to semiautomate insulin delivery. It is currently under review by the US Food and Drug Administration. The company expects to launch it in limited release during the second half of 2021.

Results from a pivotal trial of the system in children aged 2 to 5.9 years with type 1 diabetes were presented during the virtual American Diabetes Association (ADA) 81st Scientific Sessions.

Follow-up data at 6 months were also presented for another pivotal study of 112 children aged 6-13.9 years and 129 adults aged 14-70 years. Those primary 3-month data were reported earlier this year at the Endocrine Society’s annual meeting and subsequently published online June 7 in Diabetes Care. Another study presented at ADA looked at quality of life in children using Omnipod 5 and their caregivers.

If approved by the US Food and Drug Administration, the Omnipod 5 would be the third commercially available automated insulin delivery system — also called hybrid closed-loop or artificial pancreas systems — in the United States. It would be the second approved for children as young as 2 years of age and the first to deliver insulin subcutaneously without tubing.

“No Tubing“ Feature Will Be a Draw for Parents of Young Children

Asked to comment, pediatric endocrinologist Laura M. Jacobsen, MD, of the University of Florida, Gainesville, told Medscape Medical News: “I think the big advantage for the Omnipod 5 is that [if approved it will be] the only tubeless automated insulin delivery system in the US.”

“The automated delivery systems have just been wonderful for helping patients achieve time in range, especially overnight. And the fact that this goes down to such a young age where that can be very difficult is wonderful.”

Another difference between the Omnipod 5 and other systems is the ability to adjust glucose targets (from 110 to 150 mg/dL), although newer versions of the currently available hybrid closed-loop systems are expected to include that feature as well. “They’re all slightly different in the way the algorithms work, but I think the end result is similar,” Jacobsen said.

But, she said, the no-tubing feature might be particularly helpful for some very active young kids. “A lot of small kids do use the tubed pumps, and you can make it work with a lot of kids, but with some kids it just won’t…the tubing gets caught. I think this really helps parents make the step. A lot of them don’t want to try the tubing whereas they see the Omnipod and might feel a little more confidence to try a pump.”

Overall, said Jacobsen, who has no financial disclosures with Insulet, Dexcom, or any of their competitors, “I think any addition to the technology field to improve quality of life for people with type 1 diabetes is important and people need choices.”

Pivotal Data Show Benefit in “Difficult to Manage“ Preschool Children

Pivotal 3-month data for the Omnipod 5 in children aged 2-5.9 years with type 1 diabetes were presented on June 26 by pediatric endocrinologist Jennifer Sherr, MD, PhD, Yale School of Medicine, New Haven, Connecticut.

“As a pediatric endocrinologist, I can attest to the difficulty of managing this age group, due to grazing eating patterns and erratic physical activity. Oftentimes, care providers may fear hypoglycemia as these youth can not verbalize or self-treat lows,” she remarked.

A total of 80 children were enrolled at 10 institutions across the United Sates. There was a single 14-day standard therapy phase (baseline), followed by 3 months of automated insulin delivery during which the children’s eating and exercise were unrestricted.

At 3 months, average A1c had fallen from 7.4% at baseline to 6.9%, a significant difference (P < .05). The proportions achieving the target A1c of less than 7% were 54% at 3 months versus 31% at baseline. The reduction was even greater among the 25 with baseline A1c of 8% or greater, although it was significant even among the 55 who started with a lower A1c (–1.06 vs –0.31 percentage points; both P < .05).

Time in range rose from 57.2% at baseline to 68.1% at 3 months (P < .05).

“These youngsters are spending an average of 2.6 more hours/day in range,” Sherr commented, noting that the difference became apparent shortly after study start and was maintained during the 3 months.

Sherr noted that this 10.9% improvement in time in range with Omnipod 5 was similar to improvements in the previously reported pivotal study of older children and adults. Data from that study showed improvement in time in range from a gain of 15.6% for the 6 to 13.9 year olds to 8.0% for those aged 26-49 years. Interestingly, she noted, improvements in time in range were seen even in the oldest group, aged 50-70, who increased from an already high baseline of 69.9% to 79.1% with Omnipod 5 after 3 months.

In her current study, in the youngest age group, the improvement in time in range was achieved primarily by a reduction of time above range, from 2.4 fewer hours/day above 180 mg/dL, while time below 70 mg/dL was reduced by 4 minutes/day. Overnight time in range improved by 1.4 hours/night, with most of the improvements in reduction of hyperglycemia.

The proportions meeting the combined goals of less than 4% time below range and greater than 60% time in range rose from 29% to 65%.

There were no episodes of severe hypoglycemia or diabetic ketoacidosis during the 3-month study phase.

Another important related metric, sleep quality for parents/caregivers, also improved. The percentage reporting overall sleep quality of “very good” or “fairly good” increased from 65% at baseline to 90% with Omnipod 5, while “very bad” sleep quality fell from 8.8% to 0%.

All 80 patients completed the study and elected to continue in a 12-month extension phase.

Ongoing Benefit Seen in Older Children and Adults

In a late-breaking poster presented on June 25, Anders L. Carlson, MD, medical director at the International Diabetes Center at Park Nicollet, Minneapolis, Minnesota, presented more follow-up data to the previously reported 3-month pivotal study, including 108 older children and 109 adults from the original study.

A1c remained lower after 6 months than at baseline for both children and adults (P < .001). In the children, A1c levels weren’t significantly different at the end of 6 versus 3 months, while in the adults there was an additional 0.1 percentage point decrease (P < .01).

There was one episode of diabetic ketoacidosis and no severe hypoglycemic episodes in the 3-month extension. “Sustained reduction of A1c indicates the potential long-term benefit of the Omnipod 5 System,” Carlson and colleagues concluded.

Reduced Diabetes Distress, Don‘t Forget Parents‘ Quality of Life

Meanwhile, psychologist Korey K. Hood, PhD, of Stanford University, California, presented quality of life data at the meeting for 83 children aged 6-11.9 years and 42 teens aged 12-17.9 years using the Omnipod 5 from the larger study population and their parents.

Significant improvements were seen for both the youth and their caregivers in the Problem Areas in Diabetes score, a measure of diabetes-related emotional distress. Changes were less dramatic on the Hypoglycemic Confidence Scale, although improvements were significant for the caregivers of the younger children.

“We know this is a group that is really worried about hypoglycemia across a lot of situations, not just sleep but also school and outside of the home. So, to increase their confidence to this extent I think is a pretty important finding,” Hood commented.

There were nonsignificant trends in improvement across groups on the Pittsburgh Sleep Quality Index, but overall sleep quality did significantly improve among parents of the younger children. And on the World Health Organization-5 quality of life survey, significant improvements again were seen among the caregivers of young children.

“Reduced diabetes distress and improved quality of life are key benefits of using the Omnipod 5 [automated insulin delivery] system that are complementary to the glycemic benefits achieved,” Hood said.

Jacobsen has reported no relevant financial relationships. Sherr has reported being an advisor for, consultant for, and/or grant recipient from Bigfoot Biomedical, Cecelia Health, Insulet, Medtronic Diabetes, Eli Lilly, Lexicon, Sanofi, and the National Institute of Diabetes and Digestive and Kidney Diseases. Hood has reported being a consultant for Cecelia Health, Havas, and Cercacor.

ADA 2021. Presented June 26, 2021. Abstracts 70-OR, 71-OR.

For more diabetes and endocrinology news, follow us on Twitter and Facebook.

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raylovesrp-blog · 5 years

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This yr's Scientific Periods of the American Diabetes Affiliation didn’t disappoint much of the research into diabetes medicine, gadget improvement, and other essential info on exercise management.

Here is a temporary summary:

AUTOMATIC INSULIN DELIVERY SYSTEMS, HCL SYSTEMS AND PUMP SYSTEMS

1. New Sort Infusion Set – Capillary Band: Angle 13.5 mm, This The package is a steel-reinforced cannula that helps forestall bending. It has four "holes" for insulin to drip out of a versatile tube and seems to offer less irritation to surrounding tissues over a bigger insulin supply range

2. DIY HCL Results (College of Bern) Diabetes Middle Bern Utilizing open APS, Android APS, Loop with 80 DIY customers who have 53 in widespread. 77.5% range, 18% high, four.5% low

+ 9.Three% after altering DIY (comparable time of day and night time)

-1.2% in low range Decrease in day care, not low at night time

3. 670G Expertise – Dr. Lal, Stanford

79 patients (adults and adults) started with 670G, followed for 1 yr

Baseline A1c approx. eight%, 60% at

Automod interruption was widespread and 75% 44% of the lead-through had stopped utilizing the system

12 mo 46% (32% used it at the least 70% of the time)

Those who have been more more likely to cease using it have been younger and those with greater A1c reasons, corresponding to: sensor (60%), provide issues (17%), worry of the lowers (10%), ideally MDI (7%), sports (7%)

4. Gen Three iLet

Twin chamber with both insulin and glucagon transmissions

As well the system, you only have to enter the entered weight and wouldn’t have a run or training

If CGM knowledge shouldn’t be out there, the system offers primary knowledge based mostly on historical past and consumer flows [19659009] The CGM used within the system accommodates each Dexcom G5 and Eversensen

In a research of 34 adults w / T1, beginning with A1c <11, both in injections or in pump therapy

Goal set to 120 on gadget

Mean (days Three -7): 162 (regular tx), 155 (il)

Range (days Three-7): 62%, 70% (vital) [19659009] Low (days Three-7): .6%, .6 %

In a single day stays: .four%, zero%

Sensor MARD is larger w / Dexcom and time in low vary was larger with Eversense

5. i-Let Insulin Only Bionic Panreas

The used CGM system consists of dexcom G5 or Eversense CGM

The consumer only inputs its weight and not using a driving or coaching period

Compared to the MDI / conventional pump consumer combination (iLet vs common) remedy):

Avg 155 vs 162 (no difference)

Time <54: .7% vs. 7%

Time <70: 2.eight% vs. 3.2% (not vital)

vary: 70% vs. 61% (vital)

Night time average: 148 vs 163 (vital)

Eversense users spent more time on hypoglycemia, perhaps d / t sensor differences

INSULIN-TERAPIY

Ultrarapid Lispro (URLi) improves postprandial blood sugar

Excipients: treprostinil (vasodilator), citrate (increases vascular permeability), which helps to offer 10 minutes of earlier onset by 3 occasions the first 30 minutes

43% much less susceptible after 3 hours

Studies have been carried out in adults with T1D & T2D. Three groups: mealtime URL, consuming Humalog, 20 minute meal on Urli. The results included:

The A1c worth of the post-meal URL group led to .2 larger than in different teams

No change / distinction in complete insulin doses, basal or bolus

Submit-meal tour with URLi was about 30 points lower than Humalog with no distinction after 20 min meal URL

No distinction in hypoglycemia ranges except> four hours after meal (less hypo in meal occasions URli, nothing 20 min at postmeal URL)

Destructive use is that

Glargine u300 vs. Degludec

Weakened kidney perform occurred at> 20% of T2, a danger issue for hypoglycaemia resulting from decreased insulin clearance

As the rise of eGFR, Gla-300 Idegin increases ( especially in eGFR <60).

The A1c Discount is 0.four

Finger Head Glucose is Less

No Change in Hypoglycemia Danger

ROAD TO ARTIFICIAL PANCREAS

Everybody has a racing automotive with one of the best synthetic pancreas for diabetes customers.

Overview of Work Included:

International Diabetes Closed Loop (Tandem Management IQ)

Research at the University of Virginia

6-Month Randomized Multicenter Research, Tandem X2, Ant9x9 Gpu

closed loop

The system consists of automated correction plugs along with basal modulation and Hypo blocking system

Gradual enhancement of overnight management to slowly shift to 110-120 quick

168 members, 14 years of age, did not participate in the research; control, extreme downsides

All statistically vital outcomes:

TIR 59% vs. 71%, results achieved immediately maintained (nighttime TIR 59% vs. 76%)

Ne w / A1c <6.5 at baseline, 85% TIR worth achieved

Imply 166 vs. 156

A1c 7.39 vs. 7.06

Time <70 1.93% vs. 1.40% [19659009] Time <54.24% vs. 21%

97% CGM usage; average of 21 finger points per day

92% of the time in closed-loop mode

No onerous decrease limits occurred

Ease of use score 4.7 / 5; want to proceed to make use of four.8 / 5

Meal notification continues to be required

Customers can prolong boluses

Uses the consumer's main primary profile as the start line

Potential starting: 4 th th ] qtr 2019

Use of IQ control in youngsters

Extra glucose variants in youngsters 7-12 years than in another age group

Greatest end result when used 24/7, not just at night time.

82% Time <70: 3.9% vs. 2.eight%

TIR 59% vs. 71%

Horizon (OmniPod HCL) – Stanford

Makes use of a normal smartphone (software [19659009)] 73% time zone

The algorithm is repeatedly updated based mostly on earlier knowledge

"Hybrid" degree speeds – just like previous consumer settings

Meals to be reported [19659009] Potential begin date: Third-4th Krs 2020

] Medtronic Announcements

* Partnership with Tidepool 098] The purpose is to develop and “an interoperable automatic insulin pump for the treatment of diabetes”

* New Analysis – ”Advanced Enhanced Hybrid Closed loop System for Bluetooth Enabled MiniMed (TM) 780G designed to automate repair burners ”

-” Pivotal Trial for Next Era Controller (TM) Steady Glucose Monitoring Sensor. ”

HCL COMPONENTS

CGM T applies the next criteria:

> 87% of all 20% values of YSi

> 80% of 15% of YSi when over 180 AND no values of <70

> 70% 15%: at 70-180

> 85% within 15mg / dl when less than 70 AND no values> 180

Comparable performance in adults and in bed is required

ROC Precision Tips also confirmed

] No clinically vital gaps

EXERCISE

Dual hormone (insulin with glucagon) HCL

Citadel et al., Diabete's Care Vol 41, July 2018

Achieved greatest control throughout and after 45 minutes of exercise compared to single hormone HCL and open-loop use

Prevalence of melancholy: 3.four% (double hormone); 8.Three% (single hormone of HCL); 7.6% (PLGS)

Fasting and PM Exercise

Jane Yardley, University of Alberta

10 adults

24 min HIIT session (twelve 10 seconds) and 10 min warm-up, 11 min. Fasting (7am): Elevated 32 mg / dl (1.8mmol) during exercise, additional elevated 7mg / dl (zero.4mmol) 1 hour later

Afternoon (5pm) 1 hour after gluceran bar: decreased 7 mg / dl (0.4 mmol over time), one other 21 mg / dl (1.2 mmol) 1 h later

(p = zero.039 1 h publish)

Has day by day exercise or train contributed extra to insulin sensitivity ? [juliste]

Mano et al., Kyoto University, Japan

In topics with lower BMI (<23), exercise habits ("sweating point") correlate most strongly with impaired insulin resistance

. greater BMI () 23), non-exercise exercise (strolling for at the very least 1 h / day) correlates most strongly with decreased insulin resistance

Ridell Mike, University of York, Toronto [19659009] Sort 1 Diabetes Coaching Initiative Pilot Research

33 adults w / T1 exercising no less than 30 minutes with a mixture of aerobic, resistance, and interval training, twice weekly.

24-hour training session: TIR 57%; training days: TIR 48%. There are not any differences based mostly on the type of exercise. Time over 180 on 33% on fitness days vs. 44% on non-exercise days. Time under 70: 4.5% on train days vs. Three.eight% on non-exercise days

The difference between the teams began to blur 16-20 hours after coaching periods.

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The post New diabetes innovations and discoveries appeared first on Super Tech Plus.

#Latest #Thinking Like A Pancreas Blog

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hsews · 6 years

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ORLANDO — Three novel investigational “hybrid closed-loop” insulin delivery systems show promise for improving blood glucose levels in people with type 1 diabetes.

Findings for the three systems — the tubing-free Omnipod (Insulet) hybrid closed-loop system (Horizon Automated Glucose Control System), the artificial intelligence-enriched Diabeloop DBLG1 system, and the dual-hormone system — were all presented June 24 here at the American Diabetes Association (ADA) 2018 Scientific Sessions.

Hybrid closed-loop refers to systems that combine insulin pumps, continuous glucose monitors (CGMs), and an algorithm that allows the two devices to interact so that the pump adjusts insulin delivery based on CGM readings. But they are called hybrid because thus far these systems can’t entirely automatically counter post-meal glucose spikes or prevent all hypoglycemic episodes. The term artificial pancreas is also used loosely to refer to these systems.

The new data were discussed during a press briefing moderated by Irl B. Hirsch, MD, of the University of Washington, Seattle.

“From my point of view, these are all very exciting new advances in diabetes technology, especially for people with type 1 diabetes,” he commented.

However, he also addressed the commonly raised concern that these technologies may take a long time to reach the majority of patients with type 1 diabetes. “I worry about this when I see my own patients,” Hirsch said, noting that only 30% of patients with type 1 diabetes in the United States use insulin pumps, and even at the top diabetes centers, only 29% are currently using CGMs.

“Without even considering costs, there’s the need for the infrastructure and offices for training and follow-up. How can we do a better job of getting these important tools to our patients who need them the most?”

But Hirsch also noted that 80% of patients in his practice are now using CGMs. A major reason, he said, has been the much-improved reimbursement, and especially Medicare’s decision in 2017 to cover CGMs.

And the state of Washington’s Medicaid program — as of earlier this year — covers both the Dexcom and Freestyle Libre CGMs for all ages, whereas previously they were only covered for pediatric patients.

“So I think as long as the reimbursement continues to hold true, we’re going to see increases,” he said.

Omnipod Prototype Performs in Adults in Free-Living Conditions

First up was a 5-day feasibility study of a hybrid closed-loop system using the Omnipod’s personalized Model Predictive Control algorithm in 11 adults with type 1 diabetes who wore the system while staying in a hotel with unrestricted meals and daily moderate-intensity exercise, reported by Bruce Buckingham, MD, a pediatric endocrinologist at Stanford University, California.

Compared with 7 days of prior open-loop separate pump and CGM use, overall mean glucose improved from 156 to 150 mg/dL (P = .46), with a decrease in time below a glucose level of 70 mg/dL from 5.1% to 1.9% (P = .001) and time above 180 mg/dL from 8.5% to 4.5% (P = .01).

Overnight results were similar, with time spent below 70 mg/dL reduced from 5.7% to just 0.7%.

Time in target glucose range (70–180 mg/dL) was 11.2% higher overall, and 13.2% higher overnight, with the hybrid closed-loop versus standard care. Hypoglycemia was reduced by 3.2% overall and by 5% overnight.

“Additional longer-term studies will evaluate the Omnipod [Model Predictive Control] algorithm under free-living conditions with extended use in patients of all ages with type 1 diabetes…The algorithm is continually being improved,” Buckingham said.

French Hybrid Closed-Loop Could Reach European Market Soon

Next Sylvia Franc, MD, of Sud-Francilien Hospital, Corbeil-Essonnes, France, presented data for the Diabeloop DBLG1 closed-loop system, which uses artificial intelligence to “safely automate insulin delivery decisions.”

The customizable system allows for personalized algorithm settings for targets, meals, physical activity, and special events, and has telemedicine capability.

In a previous study presented at the ADA meeting last year, the system performed well in “difficult situations” such as heavy meals, with a threefold improvement in time in glucose range (70–180 mg/dL) overnight.

The current study involved 67 patients, 33 who wore the Diabeloop and 34 their usual pump and CGM (open-loop) over 12 weeks under real-life conditions. Time in target range was 69.3% with the hybrid closed-loop versus 56.6% with open loop (P < .0001). Time below 70 mg/dL was 2% versus 4.5%, respectively, overall (P < .001), and 1.3% versus 3.9% overnight (P < .0001).

Mean blood glucose dropped from 168.5 to 156.0 mg/dL (P = .012).

Patients were very enthusiastic about the system, Franc said.

One of them told her, “A big thank you from my family who was finally able to sleep peacefully.” Another said, “It changed my family’s life and mine…A pure moment of happiness!”

The system has been submitted for a CE Mark and a decision is expected very soon, Franc told Medscape Medical News.

Pramlintide Addresses Post-Meal Glucose Spikes

Lastly Ahmad Haidar, PhD, of McGill University, Montreal, Quebec, presented findings for a dual-hormone hybrid closed-loop system that uses both insulin and pramlintide, an amylin analog, a hormone that is lost in type 1 diabetes along with insulin.

Pramlintide slows gastric emptying, suppresses glucagon secretion, and promotes satiety. Sold as an injectable under the brand name Symlin (AstraZeneca), pramlintide has been approved for about a decade for both type 1 and type 2 diabetes.

Haidar and colleagues reasoned that combining pramlintide with insulin in an automated delivery system could overcome the problem of post-meal insulin excursions that persist in most automated delivery systems because of the delay in subcutaneously infused insulin action.

In a randomized crossover study, 12 adults with type 1 diabetes each wore a different system for three 24-hour periods: first a pump with regular insulin plus pramlintide artificial pancreas, followed by rapid insulin plus pramlintide artificial pancreas, and finally, a rapid insulin-only artificial pancreas.

Separate pumps were used to deliver insulin and pramlintide, which were given in a fixed ratio (as if they were co-formulated). Participants consumed three meals and a bedtime snack in a clinical research facility.

Time spent between 70 and 180 mg/dL was 86% with the rapid insulin plus pramlintide, compared with 74% with rapid insulin alone (P = .001) and 68% with regular insulin and pramlintide (P = .36). Mean glucose levels were 133 mg/dL versus 142 mg/dL (P = .01) and 142 mg/dL (P = .79), respectively.

Triple Hormone System on Horizon? Would Be “Amazing”

During the question and answer period, Haidar said that future research plans are to test a triple-hormone system that includes insulin, pramlintide, and glucagon as a hypoglycemia rescue.

“We are hoping companies will look at our data and develop a coformulation of insulin and pramlintide,” Haider told Medscape Medical News.

Asked by Medscape Medical News for his view on a possible triple-hormone system, Buckingham, who has done extensive research on several types of closed-loop systems, said, “I think it’s really exciting…You could really dampen the glucose rise with the meal and could be a little more aggressive with the insulin because you have the glucagon to back it up. You might get away with no carb counting and a full closed-loop system…It would be really amazing.”

But Systems That Can Talk to Each Other Are Needed

However, Hirsch also noted that the onslaught of unique closed-loop systems raises interoperability issues.

“I think one of our goals is to make things interchangeable…It is an issue right now because with each system, you have to know the system…And an even bigger issue is the uploading.” Various systems, including Tidepool and Glooko, have been developed to address that and continue to be upgraded, Hirsch pointed out.

But he added, “We need to do a better job of standardizing the playing field so these systems can all talk to each other, not just for the patient but for the providers.”

Hirsch is a consultant to Abbott, ADOCIA, Bigfoot Biomedical, and Roche Diabetes Care Health and Digital Solutions. He has received research support from Medtronic MiniMed. Buckingham is on advisory panels for ConvaTec and Novo Nordisk, is a consultant to Becton, Dickinson and Company, and Tandem Diabetes Care, and has received research support from Dexcom, Insulet, Medtronic, and Tandem Diabetes Care. Franc is a consultant to Animas Corporation, Johnson & Johnson Diabetes Institute, and Roche Diabetes Care Health and Digital Solutions. Haidar is a consultant to Eli Lilly and receives research support from AgaMatrix and Medtronic MiniMed.

American Diabetes Association 2018 Scientific Sessions. June 22, 2018; Orlando, Florida. Abstract 207-OR.

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apkoffice-blog · 6 years

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Glooko - Track Diabetes Data APK

New Post has been published on https://www.apkoffice.com/app/glooko-track-diabetes-data-apk/

Glooko - Track Diabetes Data APK

Glooko is a subscription-based diabetes management platform that may help you understand how food, activity and medication affect your blood glucose (BG). We also provide a digital logbook, reminders, integration with activity trackers and more. You can use Glooko at no cost if you are sponsored by your doctor, insurance plan or employer. If you are not part of a sponsored program, you can purchase an individual subscription for $5 a month with payment for the first year upfront.

Glooko syncs diabetes data from your BG meter, insulin pump and/or CGM, and lets you easily track your medication, food and lifestyle data. We give you easy-to-read graphs and charts. The app also shows you what time of the day you go high or low, which days of the week are your best days, and how your blood glucose levels compare to previous time periods. The Glooko app is compatible with most BG meters, insulin pumps, and CGMs available in the market. See www.glooko.com/compatibility/ for a complete list of compatible devices.

You can also share your data with your healthcare provider, so they can make informed changes to your care plan and support you in-between office visits! Right in the mobile app you can email or fax reports to your provider, or you can set up automatic data sharing.

A subscription includes any accessories you need to sync your device data and can be purchased online at shop.glooko.com for $5 per month with payment for the first year upfront. Ask your healthcare provider or employer if you are eligible for a free or discounted subscription.

POPULAR FEATURES: – Sync readings from 80+ BG meters, insulin pumps and CGMs to create an automatic logbook. – Create insightful graphs and charts that show your glucose, insulin and carb data. – View your glucose trends in multiple ways: chronologically, by periods in the day, week or month, or compare time periods for insight into your BG trends. – Sync data automatically from popular activity trackers such as Fitbit, Jawbone UP, Strava and Moves to see activity data. – Add foods from the built-in food database to log your carb intake. – Add notes about carbs, insulin and exercise to add context and see how they impact your BG. – Set reminders to check BG, take medications or anything else you want to be reminded about.

WHAT USERS SAY ABOUT GLOOKO: – “I am thrilled & grateful to have Glooko in my life” – Marcia Chmyz – “My recent HbA1c was down 0.4 in just 2 months, thank you Glooko!” – GoodGameNice – “Glooko finally puts diabetes management in your pocket” – Rderek

BG METER SUPPORT: -Accu-Chek AVIVA CONNECT -Accu-Chek AVIVA EXPERT -Accu-Chek AVIVA NANO -Accu-Chek AVIVA PLUS BLACK -Accu-Chek AVIVA PLUS SILVER -Accu-Chek COMPACT PLUS -Accu-Chek GO -Accu-Chek GUIDE -Accu-Chek NANO -Accu-Chek PERFORMA -Accu-Chek PERFORMA CONNECT -Accu-Chek PERFORMA NANO -Ascensia CONTOUR® NEXT ONE -Ascensia (Bayer) BREEZE 2 -Ascensia (Bayer) CONTOUR -Ascensia (Bayer) CONTOUR NEXT -Ascensia (Bayer) CONTOUR NEXT EZ -Ascensia (Bayer) CONTOUR NEXT LINK -Ascensia (Bayer) CONTOUR NEXT USB -Ascensia (Bayer) CONTOUR USB -Ascensia (Bayer) CONTOUR XT -CareSens N (ORIGINAL) -CareSens N POP (ORIGINAL) -FreeStyle FREEDOM LITE -FreeStyle LITE -GlucoCard 01 -GlucoCard VITAL -OneTouch ULTRA2 -OneTouch ULTRALINK -OneTouch ULTRAMINI -OneTouch VERIO FLEX -OneTouch VERIO SYNC -ReliOn CONFIRM -ReliOn PRIME -(Trividia) Nipro TRUE METRIX -(Trividia) Nipro TRUE METRIX AIR -(Trividia) Nipro TRUEBALANCE -(Trividia) Nipro TRUEREAD -(Trividia) Nipro TRUERESULT -(Trividia) Nipro TRUETRACK MORE TO COME!

INSULIN PUMP/CGM SUPPORT: -Dexcom G4 Platinum with Share -Dexcom G5 Mobile -Insulet OmniPod System -Medtronic GUARDIAN REAL-TIME GGM -Medtronic MINIMED 530G -Medtronic MINIMED 530G with Enlite -Medtronic MINIMED PARADIGM REVEL -Medtronic MINIMED PARADIGM REAL-TIME REVEL MORE TO COME!

For questions regarding compatibility, please email [email protected].

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type2diabetestreatments-blog · 7 years

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Tech-Friendly Clothing Choices for Women with Diabetes

New Post has been published on http://type2diabetestreatment.net/diabetes-mellitus/tech-friendly-clothing-choices-for-women-with-diabetes/

Tech-Friendly Clothing Choices for Women with Diabetes

For women especially, wearing a bunch of diabetes devices can be quite a struggle. Personally, I use the OmniPod patch pump that does away with dangling tubes, but in these days of #WeAreNotWaiting and do-it-yourself closed loop system innovations there's a lot of stuff that needs to be portable and easy to tote around.

With Mother's Day coming up this next weekend, it seemed like a perfect time to offer a perspective on this topic from our own Mike Hoskin's T1D mother. As you may recall, Judi Hoskins in Michigan was diagnosed nearly six decades ago as a young girl, and during the past year she's shared her adventures embracing new DIY tools.

Today, she shares some tips on, er... intimate apparel for ladies with diabetes.

Clever Clothes for Women with Diabetes, by Judi Hoskins

Women with a tubed pump at one time or another need someplace to put it out of sight when they have no pockets. Unlike men, not everything a woman buys has pockets.

For those of us who've started on early versions of homemade closed loop technology, that clothing challenge gets even more interesting when you're using an older tubed pump along with a CGM device, carrying around your smartphone and even an extra little box called a RileyLink!

Diabetes Tech-Friendly Shirts (or Camisoles)

For me, I've found a great option iwth the Cari-Cami -- it's a camisole (you know, a sleeveless undergarment for women) that has two large pockets at the lower edge. The pockets are designed to be large enough that you don't have to take a bag or purse along when you go out. Cari-Cami is a 1.5-year-old company out of Murray, UT, founded and run by a husband-wife team.

Currently, there are four colors of basic camis available -- white, black, cream and red -- that will run you $19.95 each.

One unique thing about this company is they are very willing to make accommodations to suit your needs. My request was for a 1" buttonhole on the inside next to the seam of each pocket, completely hidden from the outside. This allows the tubing of an insulin pump to be fed through the hole so it stays completely out of sight. Cari-Cami has now added this choice on their web page -- just order the Cami with Insulin Pump Option, which currently only comes in white and costs $20.95.

My camis arrived quickly and were beautifully packaged with a ribbon and bow around them. They turned out to be wonderful.

One side holds my iPhone while in the other I keep my pump and my RileyLink. It is extremely easy to get the pump in and out of the pocket for bolusing or whenever you need to check. It has plenty of room for larger pumps, such as the new Medtronic 670G or an OpenAPS unit. There is also room for a Dexcom receiver, a 10-pack of glucose tabs, a meter, a lancet device, and a bottle of strips. It is pretty amazing how many things will fit into the cami pockets! And the end of the silhouette tubing fits easily through the buttonhole with room to spare. If you feed the cartridge/reservoir end through, as opposed to the tubing end, a 300-unit reservoir fits through with no problem.

These are not loose-fitting camis. They fit tightly to the body and are made to be worn underneath a blouse or shirt. I did order up by one size and am glad. The upsize is a great fit for me, so might also be a consideration if you order. These camis turned out to be a fabulous find and I've ordered more for everyday wear since my first order.

Another idea that works well for carrying an iPhone, especially if you tend to leave it sitting somewhere and then forget where you left it, is this K-Carroll Accessories phone case for iPhones. This is a wonderful accessory for a RileyLink, where you need an iPhone to dose your insulin. There are two card slots on the back to carry credit cards, a driver's license, money, etc. It hangs cross-body and is an easy way to tote your phone when wearing something without a pocket -- especially if you are prone to losing your phone down the cushions of the chair or in the car. This is my go-to now for everyday use in carrying my iPhone. It makes the phone easily accessible at home, in the car, or out and about.

Bra Options

Last year, Amy interviewed the creator of the PocketBra and I thought it seemed like an interesting product to try out. It turned out to be very comfortable and extremely nice looking, trimmed in lace. The bra has a pocket on each side and also a pocket in each cup. This bra fit true to size. A pump fits easily in any of the pockets and the RileyLink fits beside it. As the OpenAPS units are now not much larger than a RileyLink, they should also fit comfortably in a pocket. A Dexcom receiver also fits into any of the pockets. The pockets are large enough that there should be no problem fitting in a slightly larger pump, such as the 670G. An iPhone 6s will fit into the side pockets.

This is a good way to carry a pump and CGM receiver during exercise, as the pockets hold everything very securely with no jiggling or falling out of expensive equipment. Because I found this product to be so nice and so comfortable, I ordered a second one in the other color offered. They come in pink and black and cost $39.50.

Below the Belt

The last piece of clothing I want to share is a pair of pocket panties from a small London-based company known as Hid-In. I tried out their woman's panty with a pocket stitched inside the front that holds a pump. This sounds like it wouldn't be comfortable at all, but it actually was!

Hid-In offers Body Bands (like small fanny packs) that you can wear different ways under clothing to hide your gear, and also the Pocket Panties sold in two packs of plain black and white or pretty b/w lacy designs.

The package I ordered was the black and white two-pack made of classic cotton jersey, which runs about $32 US dollars. Although this company is in London, they have US sizing options, so I found the panties very comfortable and fit true to size.

After about the first 5 minutes, you stop thinking about it and totally forget the pump is in there. The way the panties are made, the pump stays put and doesn't slide forward or backward. I never found that I was "sitting on the pump" which was something I originally feared. I could also fit the RileyLink in the panty pocket, but it wasn't as comfortable with two things in there. The pocket easily fit my Medtronic 723 pump with enough extra space that there should be no problem fitting in new, larger pumps.

Hid-in also makes men's Pocket Boxers with two pump pockets, one on each side of the front center seam, on the inside. Of course I didn't try these, but they look like they would be just as comfortable as the women's panties, as they're made out of the same cotton jersey. All of these cotton jersey underwear are machine washable and dryable, which makes care extra easy.

The best-selling item are the multi-use, unisex Multiway Body Bands, says owner Katie Isherwood: "That's our customer favorite… see our testimonials page for pumpers' perspective on all our products. Over 70% of all our sales are on this, it receives the most positive feedback and seems to be making the biggest difference to type 1’s!"

With all that in mind, my next purchase is definitely going to be one of those -- especially since I've learned you can get a custom-made body band created to fit your personal preferences. The way it works is you buy a lingerie set and purchase an extra pair of matching panties and send that to Hid-In and they fashion a custom made Multiway Body Band to match your set. Think what a wonderful idea this would be for a bride, a prom, or any special occasion where you might want totally matching, beautiful undergarments.

The only disadvantage to the bra and panties options is that you don't have an easy way to access your pump to dose. But Hid-In offers some great tips on their website for ways to access your pump when it's hidden under your clothing.

And if you have remote dosing options, these clothing items work wonderfully. Since my RileyLink system is dosed from an iPhone, keeping my devices fully out of sight is no problem.

Still, there are times when any woman is wearing something without a place to stick a tubed pump, and these are some wonderful, unique options that I was glad to discover, and I hope you will be too.

Thanks for sharing, Judi! Great to hear about these fixes made especially for PWDs and all of our diabetes gadgets.

Disclaimer: Content created by the Diabetes Mine team. For more details click here.

Disclaimer

This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.

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type2diabetestreatments-blog · 7 years

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On Navigating a Cruise with Diabetes

New Post has been published on http://type2diabetestreatment.net/diabetes-mellitus/on-navigating-a-cruise-with-diabetes/

On Navigating a Cruise with Diabetes

Thinking of taking a cruise ship vacation but worried about managing your diabetes while on board?

Today, we're happy to hand the mic over to our team member Rachel Kerstetter in Ohio, who you may remember is a fellow T1 PWD in Ohio who blogs at Probably Rachel and works with us on social media using her initials, RK. As it happens, Rachel and her husband recently set out on a tropical Caribbean cruise, the latest of several they've taken over the years -- which may make her the DOC's " resident cruise expert." We asked her to please share her top tips about blood sugar management while enjoying the pleasures of a cruise on the open seas.

On Cruising with T1D, by Rachel Kerstetter

My husband and I took a seven-night, Western Caribbean cruise in late February on the Oasis of the Seas. This happened to be my sixth cruise ever, the third since being diagnosed with type 1 back in 2011.

Overall, my diabetes fared well throughout this recent cruise. I only had one persistent low and one stubborn high on pod change day. But in preparing for the cruise, I noticed that a lot of people have questions about cruising with diabetes.

So, here’s how I would respond to each of those based on all my cruises with diabetes through the years.

How do you handle supplies? What's the backup plan in case you run out of something critical?

The first rule of traveling with type 1 is to bring extra supplies. I manage my diabetes with an OmniPod tubeless insulin pump and Dexcom CGM. I travel a lot for work and a little for play and my rule of thumb is:

Double it… plus One.

I would have two, maybe three pod changes during my trip so I brought seven pods. Three of them were decorated for cruising. I didn’t anticipate changing my Dexcom sensor, but I brought two new ones just in case. I also packed: 100 test trips on top of my partial vial, my back-up meter, extra lancets with an extra lancing device, lots of alcohol wipes, a new tub of glucose tabs, batteries for all my stuff, 8 inches of Flexifix tape, syringes, pen needles and my emergency back-up Lantus. All packed in a neatly labeled zip-top bag in my carry on.

Always, always, ALWAYS pack medications in your carry on, NEVER check it! I did however pack my scissors for the tape in my checked baggage, to avoid issues with TSA. I placed my insulins in a small insulated lunch bag with a frozen solid ice pack. The thing about traveling by air with cooled medications, is that the ice pack needs to be frozen solid at the checkpoint.

As an insulin pumper, my back-up plan is switching to MDI (multiple daily injections) if my pump fails, so everything I need for both therapies stayed with me in my backpack.

Is Port security like airport security when it comes to diabetes supplies?

Yes, port security is a lot like airport security in that you should keep all diabetes supplies in your carry on. Your bags will all be X-rayed like at the airport so if you use an insulin pump, make sure you know your pump manufacturer’s recommendations. It is a little less chaotic and strict than the airport however. You walk through a metal detector and you can bring sealed liquids through. That’s the U.S. part of the ports at least. Port security in each country is a little different so it all depends; one of the biggest concerns for the Caribbean ports is drug smuggling, so there may be closer inspections of supplies. I highly recommend carrying a doctor's letter and wearing a medical identification bracelet.

How do you keep insulin cool onboard and in the tropical climates?

The ice pack while traveling is good, I use the kind that comes with my insulin and stays frozen for 48 hours. In advance of my trip, I placed a medical request with the cruise line for a sharps container and a fridge. There’s usually a small fridge in each cabin for a minibar that works, but I request a medical fridge just in case.

I don’t typically take insulin off the ship with me because it's never more than a 20-minute walk back to the boat in port, but the cooler and ice pack would come along if I chose to do a longer shore excursion.

Do you notify any authorities on the boat that you have diabetes?

It’s not required to disclose diabetes to the cruise line, however I do in order to make sure that I’m covered. By notify, I mean that I list it on my passenger profile form, that everyone's required to fill out. Beyond that, I don’t really report it to anyone.

Is there some kind of medical center on board in case you need it?

Yes, cruise ships have medical facilities and doctors on board, and it’s reasonable to go there for minor issues that arise when on board. For bigger medical emergencies they will make arrangements to send patients to the hospital. In fact, on my cruise they did evacuate one patient to the hospital on a helicopter. The Oasis of the Seas had three doctors working in the medical facility and several nurses when I was on board so I didn’t worry about not being able to get help in the middle of the ocean.

How do you keep up with exercise while on board?

This can be as easy or as challenging as you make it. There are ample opportunities to be active on the ship, and just going to and from the places and activities we were interested in took me up to more than 10,000 steps a day, according to my FitBit.

Also, the long elevator waits made the stairs a faster and more active option for moving between decks. Cruise ship fitness facilities vary; the ships that I’ve been on have had excellent gyms and offered fitness classes. The Oasis offered yoga, daily stretching, water aerobics, spinning and other classes. They also had sports facilities where you could play basketball, soccer, ping pong, rock climb and more. There is also a running track, and roughly two-and-a-half laps around the perimeter of deck 5 equaled a mile.

WIth all of the running around, I usually have trouble with plummeting blood sugar, especially when I’m guesstimating carbs. So I usually increase my lower limit on Dexcom alarms so I get a low warning at 85 rather than at 70 to give me time to get to some food.

Cruises are notorious for endless buffets… How do you approach the huge amounts of food?

There are endless jokes on every cruise I’ve been on about the vast amounts of food. In the past nine years that I’ve been cruising, the food situation has continued to improve. But it’s easy to eat very poorly, so it takes a little self-control. I was able to find low-carb options and plenty of fruits and vegetables on our trip. And water was always available, as was coffee and tea. But so were sugary tropical drinks, sweet lemonade and a ton of dessert.

We enjoyed fresh eggs most days for breakfast with my favorite roasted tomatoes and a bowl of fruit. Lunch was a variety of things, but almost always accompanied by salad. Dinner was always a served meal for us in either the dining room or a specialty restaurant. The served meals are usually very good portion sizes. Dessert was an option with every meal but they were typically smaller servings and there was a variety of sugar-free and no-sugar-added options for cookies and ice cream. In general, I’d rather have three bites of anything chocolate than a sugar-free lemon cookie, but my husband was a fan. So aside from shifting my schedule a little, food was fairly easy.

Do you ever get seasick, and if so, how does that play with blood sugar levels?

I was amazed the first time I cruised that I didn’t get seasick. I tend to get car sick, so much so that riding in the back seat of a car is a bad idea for me. But the boat rocking doesn’t make me ill. However, it throws off your equilibrium. We had some rough seas cruising in the winter and I would sometimes feel light-headed or off-balance… sometimes those are symptoms of falling blood sugar for me so I was often checking my Dexcom or with my meter to find out if it was the motion or my blood sugar.

Some people do deal with severe seasickness and have found help in things like Motioneaze or seasickness wristbands. They did give out something for seasickness at the medical facility that seems to help cruisers who suffer from motion sickness. Feeling queasy can make eating unappealing, so keeping an eye on BG levels is a good idea.

Can you share any funny/ quirky/ memorable experiences related to D-care on a cruise ship?

Cruising with diabetes is always an adventure and it definitely has its entertaining moments. Wearing my pod on my arm brings a lot of questions. One night at dinner, I was wearing a sleeveless top with my tropical pod on my arm and the waiter asked what it was, I answered that it was my insulin pump. The lady at the table next to us leaned over and said, “Our son has type 1, he was diagnosed two years ago.” We started talking and came to find out that he was diagnosed at age 22, just like me. Our stories were pretty similar, except his doctors didn’t diagnose him with a pregnancy test!

On another occasion, we were enjoying drinks at one of the bars (drink responsibly friends!) and an older gentleman asked, “Is that thing for treating motion sickness?” I chuckled and explained it was my insulin pump. “Wow! That’s amazing. I know a guy who had one but it was wired to him. Technology can do so much. So you can drink with that thing on?”

On day two of our most recent cruise, I was on the second deck of the Solarium which overlooked the deck below and I spotted a woman with a Dexcom sensor on her arm. She was too far away to talk to and I knew I couldn’t catch up with her, so I was on Dexcom watch the rest of the cruise -- but I never saw her again.

There were definitely plenty of other little special moments sailing the high seas with my diabetes. Cruising can be an extremely fun vacation, and with advanced preparation and a good attitude, managing diabetes on a cruise can be smooth sailing.

Thanks for sharing, Rachel! Definitely sounds like you had a blast, and glad to know we we have you to turn to if we ever have any more Cruise Qs.

So let's hear it, DOC Friends: Any additional inquiries or waterfront cruise tips/ tricks/ tales of your own to share?

Disclaimer: Content created by the Diabetes Mine team. For more details click here.

Disclaimer

Type 2 Diabetes Treatment Type 2 Diabetes Diet Diabetes Destroyer Reviews Original Article

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type2diabetestreatments-blog · 7 years

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Data show positive results for Insulet's hybrid closed-loop system

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Data show positive results for Insulet's hybrid closed-loop system

Insulet (NSDQ:PODD) touted data today from the 1st feasibility study of its Omnipod Horizon hybrid closed-loop system in patients with Type 1 diabetes. Data from the study showed that the Omnipod automated glucose control algorithm performed well, with minimal hypoglycemia, and that it was safe.

The Billerica, Mass.-based company enrolled 24 patients with Type 1 diabetes in the 36-hour study. The feasibility trial used a modified version of Insulet’s Omnipod, a Dexcom continuous glucose monitor and Insulet’s personalized model predictive control algorithm..

Use of the system was associated with significantly less time spent in hypoglycemic blood glucose range, Insulet reported, compared to ranges prior to the study. The study showed that patients hit the target blood glucose control range 69% of the time over the course of the 36 hours and maintained target blood glucose control 90% of the time overnight.

“These very positive results, particularly in the overnight period, demonstrate the potential for the Omnipod Horizon System to improve clinical outcomes in patients with Type 1 diabetes,” principal investigator Dr. Bruce Buckingham said in prepared remarks. “This is a safe system providing significant reductions in hypoglycemia both during the day and night, and the system made significant improvements in overnight glucose control, decreasing glucose variability and bringing fasting glucose values into range. These are very positive early findings and I think I speak for the entire team when I say I am excited to see how the Horizon system continues to perform in future clinical studies.”

“We are incredibly excited by the early results of this trial, which demonstrated excellent glucose control and tremendous promise to make a significant impact for patients,” president & chief operating officer Shacey Petrovic added. “Omnipod allows our users to feel more confident, and to experience improved quality of life and outcomes, and we are thrilled our Omnipod Horizon System is already demonstrating the ability to continue to make a significant impact on improving the lives of people with diabetes.”

Earlier this week, Insulet said it acquired a manufacturing facility in Acton, Mass. that will allow it to more efficiently manufacture the OmniPod system compared to the company’s manufacturing lines at its contract manufacturer in China.

The company anticipates the new facility will add hundreds of jobs in Massachusetts over the next 5 years, Insulet said, and expects to begin production in 2019.

Type 2 Diabetes Treatment Type 2 Diabetes Diet Diabetes Destroyer Reviews Original Article

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type2diabetestreatments-blog · 7 years

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A Preview of "The Wearable Artificial Pancreas Company"

New Post has been published on http://type2diabetestreatment.net/diabetes-mellitus/a-preview-of-the-wearable-artificial-pancreas-company/

A Preview of "The Wearable Artificial Pancreas Company"

Recently I stumbled upon a firm based in Fort Lauderdale, FL, that calls itself Pancreum, "The Wearable Artificial Pancreas Company." Wow. Really? There is such a thing already? I just had to investigate.

The company's website describes a four-part system including a controller (PDA), a CGM sensor called the "GlucoWedge," a small wireless insulin pump called the "BetaWedge," a small wireless glucagon pump called the "AlphaWedge," and a set of "iPancreum" software apps that manage these components and allow for storing and graphing data results. This seems like an incredibly ambitious undertaking for a tiny unknown outfit.

The first thing I did was ping Aaron Kowalski, who heads up JDRF's Artificial Pancreas Project, but he had never heard of this company, so that put me off a bit. Is Pancreum for real?

Turns out that Pancreum's Co-Founder Gil DePaula not only has decades of experience in software engineering and a stint at Medtronic Diabetes working on the Guardian RT system under his belt, but also spent 5 years at Insulet Corp., where he worked together with Marc Anderson, JDRF's Manager of New Technology. Pancreum is currently made up of Gil and a handful of contractors.

I had a call with Gil last week to learn more about the company, which also boasts on the website that users will be able to control the Pancreum system directly from "your own hand-held iPod Touch, iPhone, iPad, Windows Mobile SmartPhone, BlackBerry, Palm or Linux devices."

"We are creating all three wearable devices that make up an artificial pancreas (plus) the handheld controller, which is mainly software and can be run from a PDA or smartphone. The three wearable items are an insulin pump, continuous glucose monitor, and glucagon pump — which is different from what others are doing because there's no commercial 'predicate device' yet for glucagon delivery," Gil says.

"Our system will physically look different than anything you've seen before, and will be configurable in a way that you can use the pieces separately. You can mix and match the three components based on your preferences. The controller will automatically recognize whether you're wearing the CGM and insulin pump only, or the insulin pump and glucagon pump, etc."

"All three devices together will take the space of maybe two OmniPods at the most," Gil adds. "Obviously they can't be next to each other on the body. Think of a circle (or disk) with the diameter of two pods. Three devices will lie on the outside of the circle, at the three points furthest apart, say 4 inches from each other. Our system is going to be flexible, not solid, for comfort and wearability. There's a key technology element that makes all of this possible, but I can't disclose that yet because the patent is not yet ready."

Does the word "Wedge" in the product names imply some sort of triangle shape? Gil doesn't deny this, but says he can't elaborate just yet. He also can't yet share any sketches or visuals other than the "guts" above - darn!

What he does talk about are other big advantages of this enterprising project: lower cost than competing pumps and CGMs, and the ability to use this system "plug-and-play" style with other products on the market. Interoperable diabetes components at last? No way!

Yes, he says, Pancreum hopes to provide an open platform of specs that other companies can develop to, allowing interoperability. In other words, the Pancreum PDA would be able to control your own "custom artificial pancreas" that might be made up of the OmniPod and a Minimed CGMS, along with a glucagon pump from a third provider. The Pancreum algorithm will be the "gatekeeper" that controls all three.

Gil has applied for several patents, and is currently stumping for venture capitalist funding, he tells me. He's in the process of creating working prototypes now, but has made a conscious decision not to approach JDRF until the company is funded and further along. "If you present just an idea, it's worth X. If you have a prototype, it's maybe worth 3X. And if you can show more, it's worth 10X," he explains.

They're planning to roll out the components one at a time, starting with the CGM. "We need to sell that to investors first," Gil says.

Even if Pancreum gets the funding it needs this year, it will be another 2-3 years down the road before anything would be ready for market.

That's not surprising. But what about getting past the FDA with a system that can automatically shut off insulin delivery, reduce it, or initiate glucagon delivery? (With the glucagon pump, you won't have to rely on temp basals to decrease insulin delivery when you go low!)

"With the FDA, when everything is automatic, they fear software bugs. And so do we. We're human," Gil says. "They don't like the automatic shut-off, but we believe that with the glucagon pump portion, it changes things. It can raise your glucose level fast and efficiently. Sure, if your glucose level is raised to 250, you'll maybe get upset. But it's better than plunging down to 20."

Other companies, like Medtronic, are also working on commercializing glucagon pumps, Gil says. What will they look like? Possibly very much like insulin patch pumps. But the cannula may differ greatly. "It depends on the viscosity and corrosion of each liquid," Gil says. If you say so.

If you're like me, you'll find this stuff exciting. Just make it work, Engineers and Medical Experts — oh pleeeeaaaase! I realize it can be hard to hear about early-stage companies whose innovations are still far off. But think of the alternative... And with that I say: Thank you, Gil.

Note: You can follow the company on twitter here - @Pancreum

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Ask D'Mine: Insulin Cool Packs, Pumps with "Spare Tires"?

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Ask D'Mine: Insulin Cool Packs, Pumps with "Spare Tires"?

Our controversial columnist Wil Dubois is back with another spicy edition of our new diabetes advice column, Ask D'Mine.

Need help navigating life with diabetes? Email us at [email protected]

You know the answers you get here will be brutally honest and interesting, to say the least.

Robyn from Colorado, type 1, writes: I have traveled a lot over the years with my insulin in tow. Upon completion of each trip I always come to the same conclusion—there has to be a better way to transport insulin in order to keep itconsistently cool. I am talking cool where I am confident the potency has not been lost, not 'so-so cool' that leaves you wondering: "Is it a bad site, was it that yummy street snack I just consumed, or did my insulin just not travel well?"

Most recently I tried out the Frio Pack which I found to be okay, but would love to know what others are using/doing? I am primarily thinking about long distance air travel, where a refrigerator can be found on the other end within 24-48 hours.

Wil@Ask D'Mine answers: Lots of us don't use anything, actually. My take is that unless you are traveling in the Amazon rain forest or the Gobi desert, there's no need to chill your insulin anymore. Modern insulins—in alphabetical order to avoid playing favorites—Apidra, Humalog, Lantus, Levemir, and Novolog do not need to be kept "cold" at all. Nor do the injectable type 2 meds Byetta and Victoza.

Now before everyone pummels me in comments, I'm talking about the insulin you're gonna use here. You should still keep your unopened inventory in the butter compartment. But don't chill the stuff you are using. There's no benefit. Besides, cold insulin stings like hell when you inject it.

In fact, once a vial or pen is open the clock is ticking. You've officially got 30 days to use it, and keeping it cold won't extend its life at all. I say officially, 'cause you can probably get 45 days out of it (like you don't have to throw milk out on the "sell-by" date) before it begins to lose its efficacy.

And someone was telling me the other day (I wish I could remember who) that the outfits donating insulin to the Third World find that the older-style insulins are even more long-term stable in warm temperatures. Maybe we haven't needed cold packs since, I don't know... Best and Banting? If ever. Makes one wonder.

Personally, I carry a back-up disposable pen of fast-acting in my go-bag in case my pump craps out, or I yank an infusion set, or whatever. After being carried around at room and outdoor temperatures (in New Mexico, mind you) for two months I transfer it into my pump and put a fresh pen in my bag. Even after two months of warm-ish temperature storage, I've never had any issues with the insulin.

Ca-clunk! What was that noise? Oh, just the sound of Frio stock falling.

Sorry, guys.

(Editor's Note: Amy happens to love Frio, in large part because it provides a nice, safe, cushy travel pack for those brittle insulin vials)

Bruce from Kansas, type 1, writes: I'm seriously frustrated. I use the Omnipod and I find it awful. In my last shipment, 8 pods had errors and 5 had occlusion alerts. I tried the Minimed 722, but was disappointed because I had used the Cozmo pump before, which out-classed it, but is now dead and out of warranty. I have not tried Animas, but am afraid to commit in case it turns out to be worse than anything else, and then I'm locked in for potentially forever, as the new thing with insurance companies is that your pump can't be replace until it dies and is out of warranty.

Are there any current pumps, or pens, that are really low hassle, easy to deal with, and don't try to kill me? I also need a company that will back it up, if a failure does happen.

Wil@Ask D'Mine answers: Dude, I feel your pain. No one understands us. But if Apple went out of businesses tomorrow and all the Apple users had to buy PCs, they'd understand exactly how we Cozmo folks feel.

There are a couple of options left for you. One, as you pointed out, is the Animas. Some people love it, but I'm guessing if you find the Medtronic user menus frustrating, then you're really gonna hate the Animas menus. You could look at the Spirit Pump from Roche. It's rather primitive by the standards of most modern pumps, but has the neat feature that you get two pumps in the box: one to wear and a spare.

How's that for the ultimate in customer service? Having a spare unit around would solve a lot of problems for us pumpers, wha?!

But before any of you get too excited about the two-for-one pump special, let me point out that the spare Spirit pump really is just a "spare tire." No kidding! It's equipped with a self-destruct mechanism like the tapes in the old Mission Impossible TV show. After 180 days of run time—phffiit—it shuts down. The idea is to provide you an instant spare while the company figures out what went wrong with your primary pump and get it fixed.

Pretty much every other pump company promises to "next day" out a full replacement pump if you have a failure, but that can be a really long day. If you don't have adequate backup supplies you'll have to run to the pharmacy, if it's not the middle of the night when the pump fails (and of course when else would one fail?) for some basal insulin. The real problem is: once you've been on a pump for any length of time, you'll have no clue how much basal insulin you used to need. A frantic call to your doctor may be in order.

Here's another option: If the current batch of pumps turns you off, why don't you take a break? Take shots for a year, while you wait to see what comes out next.

As to pumps vs. shot therapy, here's my bottom line: you can have wonderful control on a pump, and you can have crappy control on a pump. You can have wonderful control on shots, and you can have crappy control on shots. It's the brain of the PWD that makes the tools work. The pump is really just a fancy syringe.

If you're gonna go back to shots, why not get a smart pen like Lilly's Memoir? It's a beautifully engineered metal pen that takes disposable pre-loaded insulin cartridges. But the best part is that it's got a little LCD screen that lets you look at your dosing history. Because I guarantee, at this very second, six bites into a Big Mac, a PWD somewhere in the world is saying to himself, "Crap! Did I remember to take my insulin?"

Whip out your smart pen. It'll tell you the day, time, and amount of your last bolus.

Remember that going back to shots isn't necessarily forever. I'm betting there are a bunch of new pumps held up in the FDA right now, and plenty more on the drawing board. The nice thing about living in a diabetes epidemic is that we'll have lots of cool new toys to play with!

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

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Diabetes in the UK: Free Care, But Behind the Times?

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Diabetes in the UK: Free Care, But Behind the Times?

Diabetes is certainly not created equal, and it's even more varied when you take into account the various ways countries manage their health care system. Over the past few months, in our new international series, we've peeked into the lives of PWDs in Spain, Germany, Canada and Australia, and this month we're taking a hop across the pond to visit Becky Thomson, a resident of the United Kingdom (which of course encompasses England, Scotland, Wales and Northern Ireland).

Becky is a 26-year-old administrative assistant at a theater in York, England, where she's lived with type 1 diabetes for about two years. She writes the blog Instructions Not Included and tweets away at @instructionsni. She currently uses an Animas insulin pump, but as she tells us, that's not exactly common in the UK...

A Guest Post by Becky Thompson

So the UK — land of hope and glory, right? — we've spell with more U's than you can shake a stick at, and a whole other system of blood glucose measurement. But apart from that, how different is life over here in terms of diabetes?

Speaking from this side of the 'pond,' so much of what I hear about from the other side is like a labyrinthine mystery. And when I was diagnosed two years ago, at the age of 24, having had relatively little interaction with the world of doctors, prescriptions and juggling appointments, I was completely lost. So, since you probably know about as much about dealing with all this in the UK as I did, let me give you a whistlestop tour of our system.

The UK is (in my opinion) extremely fortunate in that we have access to the NHS (National Health Service). Scotland and Wales have their own branches of the NHS — oh-so-creatively named NHS Scotland and NHS Wales. Northern Ireland has a similar institution to the NHS, called HSC (Health and Social Care in Northern Ireland), which operates in much the same way. The NHS is free at the point of use — I pay my contribution to funding through paying my taxes and National Insurance, which is deducted from my wages, rather than having to purchase 'health insurance.'

In the UK, you're issued an NHS number, which entitles you to be able to go to a doctor without worrying about having to pay a fee. The same goes for hospital admissions. During my five-day stay at diagnosis, I was never presented with a bill, nor did I ever expect one. I've never paid for test strips, insulin, needles, or now, pump supplies.

Most people pay a prescription charge, of £7.20 (around $12.00) each time they need a prescription filled. This is just an England thing; Scotland and Wales have done away with it. However, having a chronic health problem, I get sent a nifty little card, which means that I'm exempt from paying charges, which I'm very glad for. Even with free health care, this would still make a bit of a hole in my (not very well-lined) pocket.

I have what's known as a GP (General Practitioner), who I see for most health issues. There's often some confusion about whether the GP's practice or the hospital clinic is supposed to look after the diabetes care of people with type 1. I happen to go to the hospital's diabetes clinic, where I have my endo, who I see once a year, and access to a team of four DSNs (Diabetes Specialist Nurses). Normally, you wouldn't actually have contact with as many, but for various reasons, I've dealt with all of them at some point or other! For questions about my care, the DSNs are my point of call on all matters diabetes-related. I'm free to call up or email whenever I need to, and I generally see one of them about every six months as a matter of routine.

In terms of treatment? Most people here are on MDI. I was started off on twice-daily mixed insulin, which didn't work at all for me. I quickly moved on to Lantus and Novorapid. I'm very lucky in having access to an insulin pump, as they're very hard to get hold of over here. Last time I checked, it was only 2-4% of type 1's who had one.

For CGMs, the number will be even lower. I've never seen one in person, and I don't dream of getting hold of one within the next 5 years. This is mainly because each area of the country gets a specific amount of money from the NHS budget to spend. I'm fortunate that my area has an extremely well-maintained budget, which gives me opportunities that people in other areas don't get. It's what's 'lovingly' referred to as a 'postcode lottery,' which I've happened to come up trumps on. Ah well, as I don't gamble, it's the only one I'm likely to, despite what many emails seem to tell me about the Nigerian lottery.

Technology seems to be 'drip-fed' though over here. It's a long time before we get anything new. Omnipod took its time, we don't have the Animas Ping or Dexcom. But we are getting the new Vibe (Animas pump & Dexcom combo), so perhaps things are looking up.

So you have things we don't have, and we have things you don't have. But all in all, we still probably carry around the same amount of gear on a day to day basis. The rules are a bit different, but we're still playing the same game. Just that our blood glucose numbers are a bit different, and I would love to get glucotabs in flavours other than raspberry or orange.

Thanks for that little jaunt into your world, Becky. Everything in life is a trade-off, for sure!

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Grand Prize Winner Pancreum: A Small, Modular Artificial Pancreas

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Grand Prize Winner Pancreum: A Small, Modular Artificial Pancreas

The Pancreum closed loop (automated insulin + CGM + glucagon) system that won a Grand Prize in the DiabetesMine Design Challenge this year may look like a pipe dream, but designer Gil DePaula assures us it is "visionary but real."

Have a look at the video, below, and also Gil's company website.

This is what the small company's founder says about this Pancreum AP system:

"The glucagon part is definitely a futuristic concept — because there's no predicate device for glucagon delivery with the FDA, so that's a huge question. But the insulin pump and CGM are as real as OmniPod was when I joined Insulet in 2002 (he worked there 5 years). And now that's real and on the market; there are predicate devices out there. So if I want to introduce a new disposable tubeless insulin pump, I can do it. I won't have to climb mountains."

— Gil DePaula, Pancreum LLC

Based in Fort Lauderdale, FL, Gil DePaula is a software and electronic engineer who previously worked on the Guardian Real-Time CGM at Medtronic Diabetes, and also helped launch OmniPod with Insulet Corp. He went out on his own a few years ago to pursue his dream of developing a flexible, open-platform, high-performance closed-loop system for diabetes.

We interviewed Gil about Pancreum this past winter, before anyone was thinking in design contest mode; he hadn't even heard of the competition back then. Once he learned about the contest, he decided it was worth "going public" with his only-partially-patented ideas, because above all, he wants to see the diabetes device market evolve. "I think we're stuck with too many old ideas," he says.

"When I saw all the other videos and entries this year I was nervous. I wondered if we had a chance. I still can't believe we won!"

We talked with Gil again last week, to get some more detail on where he is now in the process of developing the Pancreum system. One thing he was excited to share was that he'd connected with last year's DiabetesMine Grand Prize winner Mauro Amoruso, a professional designer based in Turin, Italy, who has helped Gil refine the form and function of the Pancreum system.

DM) I think the big question for many people looking at your design is, how do the cannulas work?

GdP) The pump cannula is similar to OmniPod, with automatic insertion, except that OmniPod has two springs and we hope to need only one.

In the OmniPod, the cannula is wrapped around the needle. It inserts, and a second spring fires and pulls the needle out and leaves the cannula. We're working to make this a one-step process.

For the CGM, if the needle is the cannula, which is currently the case with most models, then you also need just one spring. But current CGMs have manual insertion devices. We hope to do away with that and offer automatic insertion there too.

Right now our whole circular unit with two wedges (the insulin pump and CGM portions) is about the size of the OmniPod.

If it's so small, how can it house enough insulin to be useful for most patients?

We think the reservoir size is going to be 400 units, so it's actually 2x the capacity of the OmniPod reservoir.

We've designed it mechanically — a 400-unit reservoir and drive mechanism — that fits inside our little 'wedge.' It's a narrow and long device.

So you already have working prototypes of all the pieces of this system?

I have a physical prototype that I'm bringing to the ADA conference this week. It's not the black one you see in the video — that looks like Darth Vader! — but a cooler color. The prototype is now much smaller too. It's half the size of a cell phone.

The only thing that hasn't been touched in real development work yet is the mechanical part — the drive mechanism and reservoir I mentioned. We've designed it, but haven't created the necessary plastic pieces yet.

For me to have someone design an electronic board that fits inside the footprint we've created, I need money. That's why we're looking for investors now.

What will the system offer patients, beyond connecting the pump and CGM? Like automatic shut-off of insulin if you dip too low?

This is not just sticking several devices on a patient. We'd like to take the functionality a step further. For example, if you've had to correct several times in a row, should you not increase your basal rate? In other words, if the system has to suggest correction boluses frequently, it's also gonna suggest a basal rate increase as well. It will also suggest decreased basal rates, stopping basal rates, and will take insulin on board (IOB) into account — multiple features like that.

And also automatic shut-off should definitely be part of the system once the FDA will allow it!

So that and glucagon delivery are the biggest FDA hurdles?

Yes. I don't understand why FDA picks on glucagon so much. Unlike insulin, if you mess up with glucagon (or automatic shut-off) all you're gonna do is raise somebody's BG levels for a while. But if you mess up with an overdose of insulin, you're gonna do some serious immediate damage.

Isn't the Artificial Pancreas Project already testing with glucagon delivery in the mix?

We've gotten a lot of information from different people, including Dr. Russell from Massachusetts who's done testing using all three devices on pigs. He's doing a lot of great work, but still there are a lot of questions to be answered:

How much glucagon do people generally need for six-day wear?

Does glucagon's viscosity effect how wide the cannula needs to be?

What is the glucagon ratio? As in how much does one unit raise your BG?

Do we need basal rates for glucagon or just boluses?

These are all questions to be answered, and it will take time.

So what's your next step? What will you do with the prize money, for example?

We're developing an app that runs on Android right now. We're doing this first because of Apple — they require too much before you can develop something that can connect with their platform.

I'll use the prize money towards improving the Pancreum Android App and building a real-size electronic prototype for the CoreMD and wedge(s).

We'd like to get in touch with others who did CGMS software entries (like mobiLIFE) to discuss possible collaborations.

That's great, Gil! Anything to add?

I wanted to say that as soon as I saw the BLOB entry, I thought from the start this design will win! I don't have diabetes, but one of the oldest technologies in the field is insulin pens. The BLOB idea totally revolutionizes that space.

We hope so, Gil. And as one of readers commented on the winners' announcement: Go Pancreum!

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Brushing Up On Advanced Pumping Techniques

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Brushing Up On Advanced Pumping Techniques

Ever indulged in a little pizza with the kids or Italian food on date night, gone to bed at a perfectly respectable blood sugar, but then woken up in the middle of the night with a sky-high number that has you racing for the bathroom?

If you have, then you've encountered a dreaded delayed postprandial spike, which happens when food takes longer than insulin to enter your system. Usually it's the other way around. Fast-acting insulin starts working in 10-15 minutes, peaks at 1 to 2 hours, and then slowly tapers out. It's usually out of your system after 4 to 5 hours. But in a few special cases, the insulin finishes working long before the bulk of your food ever hits your system.

Typically this happens with high-carb meals that are also high in fat, like pizza, Chinese food, Mexican food, etc., because the fat delays the impact of all those carbs on your blood sugar. Sometimes even super high-carb meals, like some Italian dishes, which have a lot of carbs but is low on the glycemic index, and perhaps not as much fat, can still take hours to digest. According to endocrinologist Dr. Lauren Golden, that's because "the food essentially sits in a ball in your stomach. The more carbs you have, the longer it takes to digest." Dr. Golden and her team at the Naomi Berrie Diabetes Center recommend using a so-called "dual wave bolus" for any meal with carbs over 70 grams.

Ever heard of the dual wave? Medtronic has actually trademarked that term...

The deal is that most modern insulin pumps now have an option for changing how a bolus is delivered to deal with this latent effect. They allow you to set a certain percentage of your total meal bolus to be given immediately, with the rest to be slowly delivered over a period of time. In Medtronic pumps, it's called a dual wave bolus, and as noted, that company has cornered the market on that terminology. So in Animas and Cozmo pumps, it's called a combo bolus, and in the OmniPod, it's called an extended bolus.

Despite best intentions, using this setting is tricky. Personally, I shamelessly use a regular meal bolus for everything under the sun. But I almost always suffer the consequences with a middle-of-the-night run to the bathroom when a sudden surge of carbs hits my system that my insulin is no longer prepared to handle. This is often after sliding into bed with a low or almost-low blood sugar because of too much upfront insulin.

Want to brush up on this technique? Warning: it can be very tricky to know exactly how long some food will take to absorb, so this is likely going to take quite a bit of practice. Different high-fat, high-carb meals will affect you differently. First recommendation is to try it while using a continuous glucose monitor (CGM), even if only temporarily, so that you can literally see what's happening with your BG in real-time. Many clinics now have CGMs that patients can check out as loaners for a week, so you can test out how you react to certain foods.

Kelley Champ Crumpler, a diabetes nurse educator and type 1 herself, shares this tidbit: "At the ADA Scientific Sessions in 2009, I attended a talk discussing CGM, and some slides were shown on extended bolusing. Of the T1s wearing CGM that ate pizza, many were still absorbing the carbs (hence experiencing the glucose rising) after 8 HOURS!! What the frappuccino?! This was VERY eye-opening. So for pizza, I have patients extend their bolus for at least 6 hours to prevent this!"

What the frappuccino is right!

If you're just starting to explore this advanced pumping technique, give the 60/40 rule a try. Upfront, set your pump to deliver 60% of your bolus at the meal, with the remaining 40% being delivered over the next four hours. Some people might find that too little, so you can also try out 70/30 or 80/20, depending on how what you're eating. But don't just ride it out — you have to fine-tune with lots of testing. Kelley recommends checking every 30-60 minutes when testing the split-bolus method.

"An excursion of 30-50 mg/dL is acceptable," Kelley says, "But a rise of greater than 2 mg/dL per minute is too fast, and I would consider more insulin."

Another advanced pumping tool I've been looking into is the square wave or extended bolus (again, the name depends on your pump company). Less common than the dual wave, it's a constant drip of your bolus insulin over a period of time, with no upfront insulin given. Since at least some food hits the system right away, this doesn't work for a lot of scenarios. However, holiday parties (which are just around the corner — November is next week, ya know!) are a perfect opportunity to employ this tactic.

"The square wave bolus is good for a cocktail party, grazing, or if you will be eating a constant amount of food over a period of time, like popcorn for 1+ hours at a movie," says Caroline Bohl, CDE and registered dietician at the Naomi Berrie Diabetes Center.

Of course, just because you're not on an insulin pump doesn't necessarily mean you're not still facing this problem. If you're using multiple daily injections with Lantus or Levemir, you can still partake in extending your insulin action. Gary Scheiner, type 1 PWD and famous CDE at Integrated Diabetes Services, recommends using one of the following options:

Take the meal dose after eating

Split the meal dose into two parts: half before eating, half after eating

Take Regular (R) instead of a rapid analog insulin

Mastering the dual wave bolus looks like it could be aggravating... Good thing there are many ways to handle heavy carb/fat-laden meals, with the dual wave being just one of them. Some folks use a temporary basal rate to handle sneaky spikes. Personally, I'm not sure a four-hour dual wave does much for pizza. Then there are times where I seem to spike no matter how much insulin I give or how much I extend!

But Kelley has some words of wisdom: "Diabetes is like a fingerprint, so different for all of us. What works for me won't work for you, or for my hubby [also a PWD]. A lot of advanced pumping is trial and error, so if it doesn't work the first time, don't get frustrated. Just make adjustments the next time! You are in an even better position if you have, and wear, a CGM, as you will know immediately if something isn't working."

Although pizza and Mexican food are not on my regular menu, they are foods I enjoy and don't want to give up permanently — but sure as heck don't want to suffer the late-night wake-up calls either! Assuming you indulge every once in awhile, how do you handle the ramifications from high-carb meals? Are you pro-active with your bolus settings or do you just "ride the highs"?

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May DSMA - Why Data & Device Interoperability Matters

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May DSMA - Why Data & Device Interoperability Matters

This month the Diabetes Social Media Advocacy (DSMA) blog carnival is taking a personal look how technology and its outputs affect our D-lives.

It refers to the #WeAreNotWaiting campaign, a D-Community push for diabetes innovation now.

It's a grassroots initiative calling for diabetes data and device interoperability -- so that we PWDs have full access to our own data, can share it as we like, and can use on whatever apps or platforms we choose without being locked into some proprietary product from just one manufacturer. For the month of May, DSMA is asking:

Why does open D-data & device interoperability matter to you?

How might your life improve if open data were the norm?

We're asked to share a story about how proprietary software or product incompatibilities have impacted our lives.

* * *

Downloading data from diabetes devices... It's a tangle of cords. At the doctors' office, at home -- we've got a jumble of cables that eventually, if all goes well, lets us see some of our diabetes data in a format restricted to the imagination of the manufacturer's engineers. It's often an equally confusing jumble of charts telling us little to nothing about what to do next.

THIS IS NOT ENOUGH, FOLKS.

WE CAN DO BETTER.

And if you happen to use a Mac -- which btw is set to outpace use of PCs this year -- forget it! Your choices for diabetes data software are incredibly limited, because for some inexplicable reason, most Pharma companies haven't bothered to develop solutions for the super-popular Apple iOS.

... which tells me they don't yet understand (or certainly haven't embraced) the fact that we now live in a new era of consumer pressure for transparency, and improved choices!

Despite all my work in diabetes innovation causes, I'm almost embarrassed to admit that I personally am one of the non-data-downloaders with my diabetes devices. I use the OmniPod tubeless pump and the Dexcom G4 continuous glucose monitor, both of which help me tremendously to live a more controlled and comfortable life with this illness. But God knows I could make better use of my data, IF...

- the Dexcom Studio software managing my CGM data were actually compatible with the FreeStyle CoPilot software that allows me to view my pump data

- I could easily access the software when I'm out and about using my MacBook Air

- The software did a better job of pinpointing trends, in a more consumer-friendly way (I ain't no engineer)

- I could choose from a variety of mobile apps to help with my carb-counting and exercise records, etc., that actually paired with my pump and CGM data for a full picture!

- My pump and CGM could "talk to each other," despite which manufacturer made them

Dream on...

Our own DiabetesMine Patient Voices Survey last year showed that frequency of downloading data from our D-devices is incredibly low, even among the most "engaged" of us patients.

As Howard Look, CEO of Tidepool, the non-profit working to change all this, wrote recently:

"At best, 5% of people use proprietary device-linked software to review their data with their doctor (according to a study by Dr. Jenise Wong). Why? Because it's so darn cumbersome to make it work, and when it does work it's too hard to understand. The effort required does not even come close to being worthy of the benefit."

AMEN!

And I'm proud to say we at the 'Mine are working with Tidepool to be part of the solution.

The group discussion Howard led during the 2013 DiabetesMine Innovation Summit (a gathering of stakeholders we host at Stanford University), focused on what needs to be done to improve the tools, devices and technologies we PWDs rely on each day. The rally cry was to "make diabetes data more accessible, intuitive and actionable."

This got people talking about the need to improve how diabetes data is collected, and ensure patients can access it, sparking the #WeAreNotWaiting movement. Its goal is simple: to demolish the innovation bottleneck that's holding us back.

How are we working to achieve this? First, by asserting that the diabetes community is tired of waiting for others to deliver innovative digital solutions for us. We're taking matters into our own hands by:

Actively developing platforms, apps, and cloud-based solutions

Reverse-engineering existing products so that we can improve them

Helping people with diabetes better utilize devices and health data for improved outcomes

Providing people with trusted guidance and reviews about diabetes products and services

Just look at some of the work that Tidepool is doing, as they push to get device manufacturers to publish their communication protocols so they can be shared and improved-upon. They tell me that Medtronic has the most thorough data collection of any device company, and that for example with this GitHub site for Medtronic Carelink they were able to discover important details, like the fact that CareLink doesn't log temp basal rates the same as normal basal rates... This is not wrong, it is just different, and very useful for patients to know.

Obviously, diabetes device companies are businesses, and need to protect certain assets to remain afloat. But they could also profit nicely from a more collaborative approach -- and give us patients a huge boost in knowledge and control at the same time.

"It's a New World and we have to take careful steps," Howard says. "We can make things better -- find better ways to log."

No doubt there is huge room for improvement!

NOTE: This post is our May 2014 entry in the DSMA Blog Carnival. If you'd like to participate too, you can get all of the information here.

Disclaimer: Content created by the Diabetes Mine team. For more details click here.

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