From time to time I'm reminded about just how devastating diabetes might be. In this case I'm not thinking of the various complications that we think about all the time. This is a situation that those of us in the US are more in danger of encountering
Until yesterday, I thought that personal bankruptcy was really reserved for those of us without insurance. But the article Insured, but Bankrupted by Health Crises in yesterday's New York Times points out that being insured doesn't mean I'll be saved from financial woes. Hearing that "an estimated three-quarters of people who are pushed into personal bankruptcy by medical problems actually had insurance when they got sick or were injured" does not make it easy to sleep at night.
For me living with diabetes is all about balance, nothing new about this if you've been living with diabetes at all. But here's a situation that I just can't balance out.
Since being laid off earlier in the year my insurance is provided thanks to COBRA. But that will expire in the middle of next year and my insurance choices at that stage may be severely limited. With an 'existing condition' my chances of getting coverage for diabetes costs are zero unless I have a full-time job with health insurance by then.
But here's something that I may be able to affect positively. I'm going to write to my federal representatives and let them know just how important health insurance legislation is for me and my family. Not being covered is a challenge for me that strains our budget. But declaring bankruptcy affects my family and I don't like it when something threatens people I love.
Can I ask for your help?
I know from years of contacting elected officials that a note in the mail is often the most effective way to get their attention. A hand-written note really wakes them up, but even a typed letter goes a long way. Look up your elected federal officials and drop them a quick note telling them why access to real insurance is so important to you. If they hear from a handful of us it might just make the difference when it counts most.
Those of us living with diabetes think a lot about technology choices. Which blood glucose meter is smallest, coolest looking, fastest. Will a specific continuous glucose monitor work for me. Should I be thinking about a pump?
How about the humble lancet? Here's a device that someone with type 1 diabetes could use between 1,200 and 4,000 times a year. It injures our fingers for the sake of a tiny drop of blood and it's probably the biggest physical pain involved in diabetes management. I've spoken with many parents of children with diabetes and they all tell stories of the challenges of blood testing due to the pain of lancing their child's fingers.
So why is it that most of us just use the lancet that comes in the box with our blood glucose meters? Frequently these lancet devices have been built cheaply to improve the profit for the meter, and they vary widely in quality. Right now, I can recommend two specific makes of lancet devices based on personal experience.
But before we get there, let's talk about wire gauges. The wire gauge for lancets typically ranges from 28 to 33. The bigger numbers mean finer lancets. So all things being equal, you should be choosing a lancet with the bigger possible number. Unfortunately not all lancets carry gauge sizes on the box. My advice, don't buy it unless you can confirm the gauge in advance. Almost all lancet devices now provide depth adjustment, so this is a less important consideration when choosing what's right for you or your child.
The picture above is from the BD site, makers of one of the Ultra-Fine 33 lancets that I recommend strongly. They are truly almost painless, when I first started using them many years ago they were a pleasant surprise. Note: BD also make an Ultra-Fine 30 lancet, these are not as pain free. So make sure you pick up the box with the Larry Bird number on it. A box of 100 lancets costs about $10 and are available over the counter. They also fit many other lancet devices, check the BD page above for pictures of some compatible ones.
In the last six months I changed to the Accu-chek Multiclix after hearing from other d-bloggers about the success they'd been having with it. Although it's 30 gauge lancet size is bigger than the Ultra-Fine 33, it does seem less painful overall. This lancet device comes with many Roche meters. The Multiclix uses a cartridge device with six lancets, so you don't have to carry around as many spare lancets. The cartridge design does not allow you to ever injure yourself, because the lancets themselves are never exposed (and I've tried). And you choose when to rotate to the next lancet in the device so, although it's not recommended, you can choose when to move onto the next lancet. While it's generally painfree in use, it does seem to produce more longterm fingertip damage for me. The lancet device costs about $24 over the counter and a box of 34 cartridges (204 lancets) is about $20.
The BD Ultra-Fine 33 and the Accu-chek Multiclix share first place in my recommendations. They're relatively inexpensive and readily available across the US.
The other contender that I have to mention is the Pelikan Sun.
This high-tech and elegant looking device comes highly recommended by my d-blogger friend David Mendosa. But it's expensive at $199 for the device plus 50 lancets and $15 for each disk with 50 lancets. I cannot recommend personally because I have not been able to try one out, despite repeated requests to Pelikan Technologies. If you're a user, please comment and let us all know how this works and whether the bigger cost is worthwhile.
One thing I've not mentioned here is alternate site testing, where you can take a blood sample from somewhere besides fingertips. Lancet devices for alternate site testing usually have a transparent lancet cover with a larger opening. I don't use alternate site testing, so I can't tell you if any of these devices will work on alternate sites.
Please leave comments if there are other lancet devices that have worked well for you. This is one area where diabetes management can be greatly improved for as little as $30.
Yesterday I was fortunate to spend a few hours with Manny Hernandez, founder of TuDiabetes. Over lunch we talked about various efforts that underway to help folks with diabetes to improve their control.
Manny and David Edelman of DiabetesDaily are collaborating on a new site called simple steps for health, and they're looking for input from you.
They are asking you to submit simple ideas that make it easier to live with diabetes, and simple is key. Your idea should not cost a lot or take much time to use.
You can submit these until the end of April (2009) and we can vote on them if you add a link to your submission.
Yes, there's some prizes, see the bottom of the Simple Steps for Health page. But you may also help others with diabetes, and that has to be better than any prize.
I was sitting in the dentist's office this afternoon and looking at some tweets, when this one from Manny caught my eye.
It pointed to his page about the news that Smiths-Medical is getting out of the diabetes market and taking the Cozmo insulin pump off the market.
My jaw almost dropped. I've been a happy Cozmo insulin pump user for about 18 months and I had planned to continue using them. Smiths-Medical distributed and supported the Cozmo pump. They announced today their "intent to stop selling the Deltec Cozmo® insulin pump, and manage an orderly, carefully controlled exit from the diabetes business over time."
Smiths-Medical has created a special web page with all the details about this announcement. It also contains answers to a set of frequently asked questions (FAQs). Basically those of us with pumps will be supported until the end of our warranty and Smiths-Medical will continue to provide supplies and support for the Cozmo pump.
As Kerri pointed out in her post on the announcement, this wasn't a big market for Smiths-Medical and it required a large support organization. So perhaps it was inevitable.
I've enjoyed and benefited from the features and flexibility of the Cozmo pump and I'm sorry to see it disappear from the market. We're now left with three main players in the insulin pump market: Minimed Medtronic; Animas; and Insulet Omnipod. I'd really like to see much more competition.
Perhaps some new ideas will happen as a results of Amy's 2009 DiabetesMine™ Design Challenge. I'd sure like to see another choice when it comes to insulin pumps.
I had an interesting conversation last week with Dick Rylander of Enject. We spoke at some length about their product, the GlucaPen, that they hope to have on the market before long. It's a simpler way to give people Glucagon injections.
Glucagon is a hormone that's produced in the pancreas. When it's released by the pancreas it causes the liver to take it's glycogen reserves and convert it into glucose. So it rapidly raises blood sugars levels. In emergencies, the glucagon reserve can be depleted by people who have type 1 diabetes (thanks for the correction from Mr. Sven below). It's a treatment for extremely low blood sugars where food or liquids can't be given. So it's really only used when there's an emergency.
The picture shows a glucagon kit from Eli Lilly. You may notice that the vial on the left contains a white powder. This must be combined with the liquid in the syringe just prior to use. Reconstituted glucagon has a shelf life of up to 48 hours when refrigerated.
So here's how it works. Your loved one is lying on the floor unconscious. You get the glucagon kit (you did put it in a well-known place, didn't you?). Before you can inject the glucagon into them, you need to follow about a half-dozen steps written on the enclosed leaflet. It's really difficult. One paper says the process "requires a manually dexterous operator who is composed, confident and competent in the whole procedure."
Let's look at the GlucaPen approach. Here's a picture of the GlucaPen prototype.
It will be a single unit, slightly longer and larger than an EpiPen. So you easily carry it with you, or pack it for a trip. And there are two simple steps before using it. These are displayed clearly on the side of the pen.
GlucaPen is looking for your opinions, they have a survey that includes a short video of the prototype being used. There's one survey to complete if you're an adult patient with diabetes, and a different one if you are a caregiver for someone with diabetes.
The GlucaPen folks have been developing this for about three years now and hope to have it on the market before too long. I think it's a great example of innovative design to make living with diabetes a bit easier. I'd love to hear any stories you have about using glucagon and whether something like this might make it easier.
Update: The GlucaPen has been entered in the DiabetesMine design contest, so there's now an animated video showing how it works. You can watch this below.
TuDiabetes.com, the social networking site for "People Touched by Diabetes", was started two years ago. It is a very active community with over 7,000 people and it grows at the rate of 15% every month. At this stage, TuDiabetes has members all over the world.
I asked the founder, Manny Hernandez, what most surprised him since he started TuDiabetes. His answer? The number of people with diabetes who have never met anyone else with diabetes and who have no support group of folks with diabetes.
You only need to spend a little time on the TuDiabetes.com site to realize how much support and sharing goes on there are all hours of the day. People have an opportunity to create groups such as Pumping Our Insulin or Diabetes and Women. TuDiabetes also has an events section where members can organize meetups, or let other members know about upcoming diabetes-related events.
I only wish that more people with diabetes knew about this great resource. If you have any friends or family with diabetes, please spread the word and get them to take a look. It might help them really change how they view living with diabetes.
There are two opportunities to meetup with folks in Massachusetts this month. This coming Sunday a group of us will be getting together in Marlboro for a presentation on the Latest and Greatest Diabetes Technologies. Dr. Howard Wolpert of Joslin clinic will be presenting, he's a great speaker and worth hearing.
The following Saturday, ADA is holding a diabetes expo in Boston. It runs from 10 AM to 4 PM, but a group of us is planning to meetup at 2 PM beside the DESA booth and then gather in the food court area.
You may have heard me say this before. If you're nearby to either of these locations I recommend getting to one of the events.
Meeting up with a group of folks with diabetes is uplifting and supportive. We don't get together and complain about our challenges. We do talk about the latest things we've learned and support those of us who are having some issues. It's fun and liberating to sit down to eat and be with others who are pulling out test kits, injecting insulin or playing with the buttons on their pump. If you've never used a pump or a CGM it's a great chance to talk with others who have and learn some of the pros and cons.
The Dexcom SEVEN continuous glucose monitor has been approved for 7 days of use. I usually get 10 to 11 days of use by restarting the sensor after 7 days have elapsed. Your results may vary, so make sure this works for you before relying on it.
Based on the abstract from the Diabetes Care website, it appears that the results on the 10th day are still fairly accurate. Notice how the difference goes down slightly on the 7th day, showing that the Dexcom is more accurate after it's been in place for a few days.
The median absolute relative difference for CGM versus YSI was 12.6, 11.3, and 14.5% on days 2, 7, and 10, respectively (P = 0.63). CGM performed better on day 10 when compared with self-monitoring of blood glucose as compared with YSI.
I expect to see more papers like this before Dexcom applies to the FDA for 10-day use of the sensors. The good news is that this ultimately means less sensors changes will be needed. It also probably means that Dexcom will raises the price of the sensors.
I do hope that before Dexcom takes this move they improve the adhesion of the sensors. Mine usually look like they're falling off by day 9 and they rarely last beyond day 11 because they peel off.
Have you been able to get sensors to stay in place for longer? What tricks have you used to make this work?
Amy Tenderich of DiabetesMine has just announced the start of the 2009 DiabetesMine Design Challenge. This year the grand prize is $10,000. So you can improve the state of diabetes design and win some serious prize money.
The competition is open from tomorrow March 2, 2009, to end of day (PST) on May 1st, 2009. Each entry is judged on three criteria: Relevance; Clinical Efficacy; Aesthetics. You can submit a video or a paper describing your idea. Full details are on the entry page for the competition.
I know we've got got lots of devices that are efficacious (FDA criteria), but with lousy design. This presents a great opportunity to make life easier for everyone with diabetes.
So think about anything diabetes related that's driving you nuts. Have you some way to fix the problem? Or maybe a completely new idea to make it easier to live with diabetes. I can't wait to see what folks come up with.
I know, I know. It's been a long time since I last posted. I'm busy looking for a job and I seem to let anything else slide in the meantime.
I came across the blog my new islets. The author Kathy had a pancreas transplant on August 23rd 2008 and is writing about the experience.
That made me realize that the Diabetes search engine wasn't looking at any sites that had information on pancreas transplants. So I spent some time this evening fixing that, and I've added over 20 sites with information about pancreas, or kidney/pancreas, transplants. Many of these are hospitals that have transplant programs.
Since we're going into summer planning. I also added a large number of diabetes camp sites. I was fortunate to get to most of these by using the Children with Diabetes Camps page.
The diabetes search engine now looks for diabetes information on over 1400 sites or pages, including over 450 diabetes related blogs. I have looked at each one before adding it, to make sure they're valid. It's been used over 10,000 times, which means that it now ranks in the Google directories. And it's raised over $150 to support Dr. Faustman's research into a type 1 cure.
Let me know of any ways I can improve this tool for you.
The Diabetes Technology Blog is focused on using technology to life better with diabetes. I review: blood glucose monitors; continuous glucose monitor; blood sugar meters; diabetes software and living with diabetes.
About Me
Name: Bernard Farrell
Location: Massachusetts, United States
I was born in Ireland and now live in the US.
I have had Type 1 diabetes for over 36 years. I struggle with my blood sugar, the same as most people with diabetes.
I wear a Cozmo 1800 insulin pump and a Dexcom SEVEN CGM to track my blood glucose levels.
I'm blessed by God, and every day brings the possibility of a cure.
For me living with diabetes is all about balance, nothing new about this if you've been living with diabetes at all. But here's a situation that I just can't balance out. 
It pointed to 
I do hope that before Dexcom takes this move they improve the adhesion of the sensors. Mine usually look like they're falling off by day 9 and they rarely last beyond day 11 because they peel off. 
