At the end of April I posted about the Dexcom Open Choice model. I was fortunate to get a loaner model for a short while. Since then I've been waiting impatiently to get the software update.
Dexcom had been offering a new system for an upgrade price. But I really didn't want to spend even more money on my third system upgrade in 15 months. Yes each of these have introduced useful new features, but knowing that they were going to allow you to upgrade for free made me want to wait. Apparently the delay was in getting FDA approval to allow this type of home update for an existing device.
Last week Dexcom contacted me and asked me to try out their software update process. They sent me two CDs with a new system manual and a new version of their DM system software. The upgrade also came with several pieces of paper including an important letter from Dexcom marketing with several steps that you need to complete before starting. I cover those below.
In a nutshell, the software update works well. I am now the owner of a Dexcom Open Choice model and I've switched to the WaveSense Keynote meter full-time. Goodnight OneTouch and the terrible cable (meant to sound like Goodnight Moon). From start to finish the whole process took about 15 minutes, including the download of about 3 weeks of reading from my receiver.
Dexcom marketing has told me that they're going to send upgrade kits to Dexcom Seven customers in order of purchase. Those of you who first bought the Seven will get these first, and folks who bought in February will get them last. They're going to send a letter out next week explaining the process.
There are a few gotchas to this update and I'll explain these as I show you some of the upgrade screens below. I'd recommend reading to the end of this post before starting.
You should:
Download all the readings from your receiver (it'll save time later).
Get the transmitter serial number from the receiver screen that's used to change it. It will be something like JTJLR, and you can see it without changing it. During the software upgrade process your receiver is completely reset. So you'll have to re-enter this number. You'll also have to restart your sensor, or change to a new one.
Make sure your receiver is fully charged. There are dire warnings about disconnecting during the upgrade and the process does drain the batteries some. If your receiver battery went dead in the middle of the update I think this would be a bad thing.
You'll have to connect to the internet to do the update. As part of the upgrade Dexcom gives you a keycode that you'll enter to get the new software. The value is similar to 2ABD-E512-3210 (this is not valid).
When you install the new version of the DM software and run it, there's now a new option under Tools menu in the upper right.
After you connect your receiver the update process starts and you'll see a screen with six steps on it, you cannot disconnect your receiver until all steps are completed.
At step 3 you're prompted to enter the code and the new receiver software is brought to your PC.
You can then download all your data readings from the receiver or just skip this step if you're downloaded beforehand
The receiver update then starts.
Several minutes later the update is done and you now have an Open Choice Dexcom model.
You'll need to re-enter the transmitter serial number and insert a new sensor (Dexcom's advice) or just restart the one you're using (my advice). After the usual 2-hour startup period you can now calibrate using whatever meter you wish. My YouTube video shows how this is done (skip forward to about 3:10).
I did this update five days ago and I've been using my restarted sensor since then. Being able to calibrate with the meter of my choice is a wonderful feature, but I've even more excited that Dexcom can now issue future software changes that we can make at home.
Vista Therapeutics has licensed some Harvard University technology that uses nanowires to look for proteins in your blood. These are small wires, about 10,000 could fit inside a hollow human hair.
According to TR this is initially targeted at inpatient use and it's very early in development. Eventually they may be able to create implantable glucose sensing devices...but don't hold your breath.
I stumbled across the Pharma 2.0 blog recently after getting a Google News alert about a posting there.
Bunny's post is about the influence that certain key people (patient opinion leaders) have on others. In her post, she explains
These are individuals who are well-versed on their disease and are influencing thousands of others with their writing. I’m not saying that KOL’s (Key Opinion Leaders, usually refers to physicians) are on the wane, but industry should start paying more attention to this new generation of influencer.
She lists several well-known bloggers and me. I can't really think of myself as in the same league as the rest, so I'm grateful for the compliment.
I have to agree with her. For someone living with a chronic disease I'm much more influenced by what I learn from friends online and in real life. That's because their experiences are based on the tricks they've learned from managing this irritating condition.
Doctors and CDEs are important, however unless they also have diabetes they can only advise and guide based on the experience they've had in dealing with hundreds of patients and in their study and reading. I don't trivialize any of this, but living with the disease does give an empathy and connection that can't always be appreciated.
Medtronic clearly sees a lot of revenue potential in future devices. According to Reuters, they are planning to spend 35% more this year on their next generation of diabetes devices. According to the article they want to make these
simpler to use and more effective in managing the disease
I do hope they also consider other design aspects like the fun factor and how they look. Ease of use is definitely important, but I'd also like a device package that doesn't necessarily look like another mobile phone. I'd also like to move away from the Henry Ford-like approach to diabetes devices. "You can have that in any color as long as it's black or blue".
As a long-time Minimed pump user, I moved to a Cozmo last year because I just didn't see any innovation in what Minimed were doing. The design of the sensor for their CGMS is just plain ugly and way too large.
Do you want proof? See klil's picture from the Diabetes 365 project. How did they manage to make something this big? Have they checked out what Dexcom managed to do?
Despite my cynicism, I think this commitment from Minimed is a good thing. They're the big dog of diabetes devices and if their additional spending produces innovative designs, it's a sure thing that competitors and start-up companies will take up the challenge.
While I'm talking about device design, I hope you've had a chance to see Amy's post about the recent DiabetesMine design contest.
My latest video shows how I used the Diabetech HomeCheck A1c test kit to test my A1c at home.
This is the second time I've used this kit to check my A1c levels. Total cost for the kit is $35.34 including shipping to my home and shipping the test sample back to the Diabetech labs.
In the video I show how to use this simple kit. In the video I mention a form that needs the test date not your birth date. My mistake.
I mailed the test to Diabetech on Tuesday and last night, 3 days later, I got the results back my e-mail (I can also ask for them by postal mail) and they showed my A1c had improved from 7.6% in November to 6.8% in May.
It's a great improvement and I really like that I can do this so easily at home. Total time from ordering the kit to getting the results was 10 days. Pretty good and I really liked the results I got.
Full disclosure: Kevin McMahon, the CEO of Diabetech, is a blogging acquaintance of mine. I've paid in full for both these tests and did this review without being asked to by Kevin. I like the product and admire the work that Diabetech has done to make diabetes management easier.
He's going to post the interview once he's had a chance to transcribe it (be patient, this will take time).
Dr. Faustman did an excellent job of explaining how they arrived at the approach being trialled, to use BCG as part of a possible type 1 diabetes cure. The current trial (and remember that many trials fail) is to determine whether a low dose of BCG has any effect on the bad T-cells. The trial completion and trial results won't happen until sometime next year. Remember, these are phase 1 trials and many phase 1 trials fail.
I asked her how much it would cost to complete phase 2 trials. The price tag is $25 million. That's a lot of fund raising and asking people for support.
They can't do trials in multiple centers because the equipment they've developed for testing results is not portable. In one case they moved a piece of equipment across the lab. It took 9 MONTHS to recalibrate it and get it working again.
We saw the equipment (no photos allowed). It's complex and large. The size of a full sized fridge on its side. To take a blood sample and extract the T cells takes an entire day. This is not fast work. They're doing it in a methodical and painstaking ways. At the same time she's taken some bold steps to move forward when others might have held back.
Each time I've met Dr. Faustman I've been impressed by her ability to clearly explain complex processes and experiments in layperson terms. She clearly understands the urgency of this work, but she needs to do it 'the right way' so that the results cannot be questioned. Remember when her original work was published in 2001, 2002 a lot of scientists did not believe the approach would work. It's now been replicated in several other labs.
I know the timescales aren't fast enough for any of us. This type of scientific experimentation takes time and a lot of effort. The lab has had delays in the past because they were waiting for funding. The best way we can speed the process up is to continue to fund the work.
I'm hoping to run in a triathlon later this year and use that for fund-raising. I also use the (small) ad revenue from my diabetes search engine to support the lab. There are many other ways to sponsor the work of the lab.
Once David blogs about the interview, I'll update this post with a pointer to it.
They're working on developing a closed loop system where readings from a continuous glucose monitor (CGM) are used to directly control an insulin pump. Currently those of us with CGMs and insulin pumps have got an open loop system, we need to take the readings from the CGM and decide whether we need insulin or food.
Clearly this is a difficult problem to solve. How would such a system know if you were sick? What would it do when you're about to exercise? How would it handle changing insulin needs for children who are growing?
Now you have a chance to learn more about this project. On July 21st and 22nd the FDA, NIH and JDRF are holding a public workshop 'focused upon the state of the art in the research and development of an artificial pancreas'.
The meeting will be in Bethesda Maryland at the NIH campus. Building 38A on this map. Space is limited so you do need to register.
I would love to go to this workshop, but I'll be out of the country.
Can I ask you a favor? If you go the workshop can you write up a summary of what's discussed and post it to the blogosphere?
Attribution: The illustration above is from the JDRF site.
My local Dexcom rep kindly arranged to give me a loaner of the new Dexcom Open Choice system. The main difference with this system is how it's calibrated - you can use any meter and enter the blood glucose values by hand.
I carried around both Dexcom receivers, the Dexcom 7 and the Dexcom Open Choice, for over a week. In this test I set them both to read from the same transmitter, so I could directly compare the results. Here's a short video that shows how to calibrate with the new system.
Below I've also got some details comments on the pros and cons of the changes.
I think this small change is a major improvement to the Dexcom system. It gives you the freedom to use your favorite blood glucose meter, so you don't have to worry about getting insurance coverage for two sets of test strips. The WaveSense Keynote meter that I used is extremely accurate, so I hope to benefit with better control and tighter A1Cs.
Dexcom updated their software so that the modal view is available once again. You can now see the reading graphs for up to nine days of readings. I've used this to see problems that happen at specific times each day. It was the only thing I missed from the first version of the Dexcom software.
I have two minor issues with the new features.
First when inputting the glucose value you use the up/down arrows to change the existing value shown by the Dexcom. The scroll speed for those arrows is much too fast. Most of the time the current value is going to be close to the reading from your meter. So you need to change the value only a little. The scrolling is so fast that it's only useful if the difference is over 100 mg/dL. Dexcom please reduce the speed here.
The other issue is even less important, it's to do with the location of the calibration screen. After you've removed and replaced a sensor the first thing you need to do is tell the receiver. You use the sensor insert screen that only appears when the receiver isn't already connected to a transmitter. Dexcom placed this screen after the calibration screen. It should be placed before the calibration screen. Most users will not be calibrating without a sensor in place.
The Dexcom Open Choice is being shipped to all new customers. Existing customers can pay an upgrade (about $200 currently). Dexcom is waiting for FDA approval to provide a download capability for software upgrades. The hope to get this approval by July and will then provide the upgrade for free to existing customers.
Note: I currently own shares in Dexcom, I try not to let this ownership influence what I say about the company or its products.
Last year Amy wrote an open letter to Steve Jobs. The design company Adaptive Path took up the challenge and created a design concept for a new device called Charmr.
Recently Medgadget (co-host of the competition) reported on some diabetes device design work by Sascha Morawetz.
This year the challenge has two prizes. $1,000 for 18 and over and the same for those under 18. The competition is open until May 26th. Read Amy's blog for full details.
Designers, ask someone you know with diabetes about the devices they use several times a day. The 'design' is close to awful. Some of the newer devices are an improvement, but very small. Look at the market reaction to the UltraMini blood glucose meter, and that's just because it's got a cute shape and is available in colors.
I do hope this year produces some designs that will make it into real devices. I can't wait to watch the entries on YouTube.
We finally have a replacement wireless meter for the Minimed Paradigm insulin pumps. The new model is the OneTouch UltraLink meter.
It uses existing OneTouch Ultra test strips, with 5 seconds before you have a reading. The meter lets you flag readings as before or after meal so you can get these averages. It stores up to 500 readings and runs on 2 AAA batteries. For more details read the 90-page user's manual (PDF).
The meter is now being shipped with new Medtronic Paradigm insulin pumps. Those of you who already have a Paradigm pump will have to wait a little longer.
... we plan on sending U.S. customers who own a MiniMed Paradigm 512, 712, 515, or 715 insulin pump a OneTouch® UltraLink™ Meter at no charge later this year.
Minimed gives you a way to find out when you'll get your meter.
This meter is only available to US customers. Outside the US, the replacement meter will be from Bayer. Currently there's no word on the release date for the Bayer wireless meter.
If you have, or want to use, the OneTouch diabetes management software you'll need the latest version (2.3.2). You'll also need to download the newest meter driver to your PC so the UltraLink can be recognized.
The diabetes search engine now has about 900 sites and pages that it searches for information all about diabetes. So far the advertising revenue is about $55 and that's all going to Dr. Faustman's research at MGH.
Here's some of the sites that I just added recently.
The misadventures of peabody is a new blog from emily who was diagnosed with type one in March 2008. That's about seven weeks ago. Drop by and welcome her to the diabetes OC.
The ultimate hike for a cure! Ty Hover is either crazy or wildly ambitious. He's planning to hike from Detroit to Alaska and raise $290,000 towards diabetes research along the way.
The lucky druggie is a blog by Jessica who was diagnosed in January 2007. Today is her 19th birthday, drop by and say hi to her.
Diabetes365
There are now over 4,500 pictures in the Diabetes365 project with more being added every day. Several have been used by the media.
If you'd like to learn how diabetes affects us or makes us feel drop by and have a look. If you do decide to use a picture for any reason, do pleaseask the photographer and give attribution.
I use this term for a product that you may already like that then surprises you with a feature that you didn't even know existed. Like a car that turns off the interior lights before the battery runs dead, even if you'd left them on by accident.
I had one of those experiences today with my Cozmo. Yesterday my pump had started to complain that the battery was almost empty. And today I was running on voltage fumes.
I knew that I had to replace it, but I kept forgetting to. That is, until I was putting in a combination lunch and correction bolus. While the pump was delivering the bolus I decided to test what would happen if I removed the battery, essentially mimicking loss of power.
After replacing the battery I was pleasantly surprised to see a Bolus Interrupted message on my Cozmo. This is the kind of attention to detail that I've seen in other parts of the Cozmo pump. Those firmware engineers (the folks who write the code that runs the pump) really thought about this - good for you folks!
Dexcom delights
Another customer delight for me, this time from those great Dexcom folks. Today I got the new Dexcom CGM model to try out for a week or so (one sensor life). I'm going to replace my 16-day old sensor this evening and tomorrow I plan to try and use both receivers against the same sensor and see what happens. I'll use the OneTouch meter with the older receiver and my AgaMatrix WaveSense meter to calibrate the newer receiver.
What I'm hoping is that the newer receiver will show my readings to be higher that on the older receiver. If I'm right then it may prove my theory for my A1C being higher than expected.
The trial model also came with the slightly newer version of the Dexcom software. They've re-introduced the modal day view, which is very useful when you want to see recurring patterns in a number of days.
I'll blog about the new receiver and software after I've had a chance to play with it for a few days.
Update: I've posted a video on YouTube showing how to calibrate the Dexcom open choice. I still need to talk about the software.
Note: I currently own shares in Dexcom, I try not to let this ownership influence what I say about the company or its products.
The capsules are being tested at Hadassah Medical Center in Jerusalem on 10 patients with type 2 diabetes.
Phase 2 is where potential drugs are tested to see if they're safe and they work (efficacy). The capsules will need to complete a phase III trial before they can be sold to people with diabetes.
The main challenge to taking insulin by mouth is that the insulin protein is broken down in the stomach before it has a chance to be used by the body. Oramed claims to have solved this problem and the challenge of getting the insulin through the walls of the intestine.
Prof. Hanoch Bar-On, a leading Diabetologist on the Oramed team, states that the route of the insulin from the swallowed capsule “imitates nature” in that it passes to the liver and then to the bloodstream. Injected insulin goes straight to the bloodstream.
I've been unable to get any information on dosing (figured out in phase 1B) or the duration of insulin delivered by the Oramed capsule. I hope to get this after phase 2A is completed. It took Oramed about seven weeks to complete phase 1B, so this information may be available sometime after mid-June.
Oramed is planning to get approval first in the US and then Europe.
In addition to their oral insulin capsule, Oramed is also working to develop an insulin suppository. This product is in Phase 1 trials at present.
Update: I exchanged some e-mails with Oramed. They told me that the phase 2a trials are 'expected to last a few months'. Also that while the trials are on people with type 2 diabetes the product may be usable by people with type 1. I'll post again once I have more news.
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 35 years. I struggle with my blood sugar, the same as most people with diabetes.
I wear a Cozmo 1800 insulin pump and a Dexcom SEVEN CGM to track my blood glucose levels. I also take Symlin to help control my post-meal blood sugars.
I'm blessed by God, and every day brings the possibility of a cure.
They're working on developing a 
It uses existing OneTouch Ultra test strips, with 5 seconds before you have a reading. The meter lets you flag readings as before or after meal so you can get these averages. It stores up to 500 readings and runs on 2 AAA batteries. For more details read the 90-page 
