January 11, 2012

Of Fantasy Diabetes Devices, Sheldon & Dewy

Victoria’s Secrets holiday runway special has past, football is winding down so maybe we need some new fantasy league to talk about. How about insulin pumps? 
I had a fascinating conversation with Greg from Medtronic at CWD’s Friends For Life last summer on the topic of what would be my fantasy pump. A plausible device, that is one based on current technology, insulins etc.. I would say that a full artificial pancreas is beyond that scope but only a little. 
Yes it takes a particular lack of a real life to have fascinating conversations about fantasy pumps. You can call me Sheldon if you must. It turns out for me the fantasy isn’t a pump, and so the talk expanded out to a fantasy diabetes management system. Greg asked if I thought FDA would approve my fantasy devices. I allowed as how they  probably wouldn’t but industry would probably wouldn't make it either.
Meet DEWY, he's a winner. 
I think the tools available to manage diabetes are fairly good. I think there is a significant opportunity for better diabetes care through breaking down the technological towers of Babble that separate devices from each other and our lives. My fantasy device would be a common collection point for diabetes information in a way that would facilitate managing lives with diabetes not just adjusting parts of those lives. 
Our meters, pumps, CGMs need to talk together and work through a common Diabetes User Interface. A D.U.I. 
WAIT! We can’t call it D.U.I.! That’s been used. 
How about DEWY for ah.. um.. er.. Diabetes Equipment Works for You.   
Dewy’s job is to listen for information from devices and lives. Then to integrate that into a possible responses. Dewy should work for us, patients, in our lives. Dewy should try to accommodate our individual life styles not define them. 
Dewy should help out with the basics. If we are low or high Dewy needs the wizard logic already in pumps to help calculate corrections or carbs based on our particular insulin and carb sensitivity. Dewy should have access to food databases with the ability to create a meal list in a way that approaches the ease of use of making play lists in iTunes. Drop and drag foods into a meal, easily adjust quantities of food in a meal, calculate carbs and even make note of fat, fiber and protein. Parents will want to be able to store these 'cause kids eat the same meal over and over again, by choice. Dewy should be able to help adjust boluses based on all of that but like any good friend of a diabetic not be too pushy about it. 
Dewy could even help out tracking trends. He could gently mention times of the day that he sees spikes. He could pay attention to our post workout BGs and see if there are trends worthy of note. Along the same lines Dewy could even try to pay attention to two hour post meal BGs and make suggestions about I:C rates. He could look for between bolus times when basals are responsible for what happening with BG and point out trends. 
Dewy would scream bloody murder if he ever sees serious overnight lows. He would turn off basals and wake up everyone and anyone we say with phone calls and text messages and keep at it until we tell him it is OK. That is just the kinda guy Dewy is.
Some folks like patch pumps, some traditional pumps and some folks like shots. To accommodate those life styles choices Dewy should be independent of device manufacturers. That is Dewy should be able to accommodate what ever meter, pump or cgm an individual chooses. Dewy should be smart and tag along with us patients where  we do our living, so he will need to reside on the smart phone or device of our choice. 
Dewy isn’t an artificial pancreas, not that he wouldn't be willing to work with one. An AP tries to be a pancreas. AP wouldn't care what you ate or if you worked out. Dewy being a really good diabetes assistant would, if we wanted him to, track what we eat or how our workouts impact our lives. 
Dewy would talk wirelessly to devices; pumps, meters, CGMs. He would do this securely and let us know if he is in touch or lost connection to devices. He would be the universal remote to the show that is our diabetes lives. When we change to a device that woks better in our life, Dewy could cope. He would have simple friendly ways to enter shots, exercise, and daily, weekly and monthly cycles. He would let us invent variables of our own because, well, our diabetes many vary. 
Until there are artificial pancreases, smart insulins, encapsulated implantable functioning beta cells and the cure that reverses the autoimmune glitch that causes type 1 diabetes families will need to manage diabetes. Managing diabetes will requires multiple devices to measure and adjust blood glucose but wouldn’t be cool if they all played nice? 
Well that’s my crazed fantasy pump. This got me wondering what others would see as a fantasy diabetes device? What is yours?

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