diabEddie's musings and thoughts on Type1 diabetes

I will be coming up on 2 years of using the Dexcom 7 (since May 5, 2010 for continuous blood glucose monitoring and the Insulet Omnipod (July 15, 2010) as an insulin pump.

Am I happy with the technology and the devices?  As a geek/tech guy who tries to take advantage or in interested by new technologies, I have to say that for being 1st/2nd generation products, they have given me a more comfortable life for the consulting lifestyle with travel that I currently live.  They devices have added some flexibility to the management of my type 1 diabetes, but there are several things I would love to see improved:

• accuracy and longevity of Dexcom and Omnipod (in terms of readings, delivery of insulin, algorithms for insulin on board)
• better software — why do I have to jump through hoops with two different software types that are not compatible?  My diabetes management team has to make sense of 2 graphs with real BG readings from the FreeStyle + basal/bolus/correction readings — both of these on the OmniPod PLUS the Dexcom data which tracks BG readings, onto which I add my bolus and correction factor readings + carbs
• aesthetics of the devices — smaller pods are coming at the end of 2012 according to Dexcom (variation in canulas as opposed to a on-size-fits-all would be nice) and nicer looking device electronics (both Omnipod PDM and the Dexcom receiver are horrendously ugly )

That being said, let’s hope that as technology advances and new generations of these devices come forward, they allow us to live a life closer to that of a ‘normal’person.

I’ll preface my recommendations stating up front that I am an Omnipod pump user and a Dexcom CGM user, though I do often take breaks from both and give myself a vacation by going back to multiple-daily injections (MDI regimen).

That being said, the following books have been instrumental for me to try and grasp the complexity of emulating the behavior of my malfunctioning pancreas either with devices (CGM/pump) or insulin injections and plain old finger-sticks, the first on pancreatic functioning and management with insulin, the last two on insulin pumping (Walsh’s book is an encyclopedia of knowledge for pumping insulin):

• Think like a Pancreas – A practical guide to managing diabetes with insulin – Gary Scheiner
• Pumping Insulin – John Walsh (5th edition coming out soon?)
• Insulin Pump Therapy Demystified – Gabrielle Kaplan-Mayer

I hope this is useful/helpful reading for any of you looking for helpful guides to our disease.

Just wanted to make you aware of 2 Type 1 related diabetes events happening this weekend:

• ADA Los Angeles Expo at LA Convetion Center – Register Link – Saturday, March 17, 2012 from 10:00 a.m. – 4:00 p.m. @ Los Angeles Convention Center West Hall A
• Los Angeles Dawn Phenom – Hermosa Valley Greenbelt walk/run/breakfast – Sunday, March 18, 2012 from 09:00 AM – 11:00 AM PT Hermosa Valley Greenbelt, Rosecrans and Sepulveda, Manhattan Beach, CA 90266 — check link for more details

I have been lucky enough to be using Dexcom’s Seven Plus (I must disclose that I do own some Dexcom stock) Continuous Glucose Monitor (CGM for short( since the day that Mexico defeated the French (aka Cinco de Mayo).

I must say that the technology and the accuracy of the device are amazing.  I was skeptical at first, and had read some initial issues with adhesiveness of receiver, accuracy, and bad sensors.  Although I did experience a rash of bad sensors over the first two weeks of having the product, I have to commend the Dexcom technical support folks who graciously would FedEx me a replacement receiver.

I am now consistently getting 7 days of use out of each sensor (I have worn them up to 12 days, but as time passes past the intended 7 days of allowed use, the difference between the CGM readings and actual meter readings starts becoming greater and greater.  On average, during the 7 day period that a sensor is valid, I am typically ~10 pts off from when I verify with a finger stick and a traditional blood glucose monitor (BGM). 

Although the strategy is to discover patterns and to evaluate the effectiveness of insuling/carb rations, basal insulin, and bolus insulin in order to approximate good blood glucose control, I find myself staring at the ugly pager (and I do mean ugly Dexcom folks, due mainly to his size) more often than not and making decisions or confirming with a finger stick *this is not medical advice, talk to your doctor and/or CDE before making any changes or relying exclusively on a CGM device*.

The Dexcom is a 2nd generation product that can us some software enhancements as well as ergonomic softening of its ugly receiver.  All in all, a good quarter of use with the Dexcom7 and I am loving it (though not letting it rule my life or spoil my fun).

More to come soon, now, preparing for starting on the Omnipod insuling pump in June 2010.

Found out that my insurance provide provides 100% coverage for certain durable medical equipment, which continous blook glucose monitors (CGM) tend to fall under.  After doing some research, and mostly based on anecdotal feedback from my CDE and the online reviews I read, I have decided to give the Dexcom Seven+ a try.  One of the only CGMs whose sense lasts a full 7 days and whose size is miniscule enough to not be too noticeable (after all, I will be looking to insulin pumps next depending on how my CGM trial proceeds).  Go approval from my doctor and the sales staff was quick at responding to my requests and inquiries via email…. more to come.

We live in the world of personal computers and the internet, and nowadays, most major glucose meter and glucose pump manufacturers provide software to retrieve and analyze data from their specific devices.  Not all software is the same though, and the amount of analysis and information that software captures varies widely from manufacturer to manufacturer.

Let us first start by summarizing the major software titles available from vendors for the major glucose meters and pumps:

There is no universal format and all of the software vendors will miss some analysis features that are available in one piece of software versus another.  I will have another post that deals with converting data between tools (the data is there, either as an exportable CSV file with the OneTouch software or as a SQLLite db file in the GlucoFacts software, but this is for another post).

Although there are several meters to choose from for those of use with Type 1 diabetes living active lifestyles (I am a technology consultant who travels the world), I have had a tough time finding a suitable meter that has the following characteristics (they usually fail on 1 or more of the points):

1. Portable in size and easily worn
2. Ample memory and event tagging to replace full-size meter
3. Connectivity to some type of data management software on a computer

The top market contenters seem to be the the LifeScan OneTouch Mini Ultra and the new Bayer Contour USB seen below for a size comparison:

Comparing the One Touch Mine to the Countour USB

Next post will evaluate the winner of my little comparison….. more to come

Started out a bit rough on the tripe to Buenos Aires, I apparently dropped my cell phone at Ezeiza airport purchasing a present to bring to my godparents (yes… I pulled an ‘eddie’).

Also, weather has been less than stellar, with barely some sunshine showing up today for the first time.

I rediscovered an old love of mine….. Freddo Ice Cream which makes a Light version of their Dulce de Leche ice cream (24 g of carbs per 140 g serving… not bad and tastes like the real thing).  This is dulce de leche flavor, and not ‘cajeta’ like in Mexico.  Funny how spanish has colloquial regional phrases that vary by country (‘cajeta’ is a euphemism for vagina in a not so nice way).

I also had an idea for a book, but not sure I want to disclose the details just yet.   Speaking of books, 1/2 way done through Teddy Kennedy’s True Compass which is really an interesting read of one of the few great politicians from an American political dynasty.