#TwoBits from Industry. Glucagon Training App and Bayer Meter Talks to Medtronic Pump.

#TwoBits of news today. I use to call this stuff From the News Wire!

Bayer / Medtronic 

Bayer and Medtronic have a press release out today announcing the Contour Next Link.  Think Bayer USB that connects to a Medtronic meter - except this is charcoal grey not black. It uses new, improved and more accurate strips. I hope to read up on the more accurate part at a later date. I will be back when I do. Mean time read Riva.  

Groovy Photo from: http://diabetesselfcare.blogspot.com/

Review of the meter:  http://diabetesselfcare.blogspot.com/2012/04/medtronic-trial-bayer-contour-next-link.html

From the Press Advisory: 

Medtronic, Inc. (NYSE: MDT) and Bayer HealthCare today announced that Bayer’s CONTOUR^® NEXT LINK, a new blood glucose meter, is now available in the U.S. with Medtronic’s compatible integrated diabetes management systems. 
Bayer’s new meter provides exceptional accuracy utilizing high-performance CONTOUR^® NEXT test strips, helping optimize insulin delivery through wireless communication with the MiniMed^® Paradigm™ REAL-Time Revel™ insulin pump and the MiniMed^® Paradigm™ REAL-Time insulin pump. People with diabetes can have greater confidence that seamless integration with Medtronic’s Bolus Wizard^® makes bolus calculations quick and easy, eliminating inaccuracies due to manual entry errors.

This will be available to new Medtronic pump users starting now. The expectation is that existing customers can get it over the "next few months." I think you should look for the Bat Signal or a message from Medtronic in January. 

OK Bat Signal aside - here is the real text from the release:

Starting today, new Medtronic customers will receive CONTOUR^® NEXT LINK with any new pump order. Existing customers will be contacted by Medtronic and provided with new meters over time, beginning in January of 2013.

More from Medtronic:
http://www.loop-blog.com/blog/Update-on-Linking-Blood-Glucose-Meters-for-Medtronic-Insulin-Pumps

Lilly

Lilly Diabetes today announced the release of a new mobile application designed for caregivers and healthcare providers who support people with type 1 diabetes. The Lilly Glucagon Mobile App is a tool to teach how to use Glucagon for Injection, through simulated practice. 

The app is here:

http://itunes.apple.com/us/app/glucagon/id553314007?mt=8

More information is available from the Lilly press release here: 

https://investor.lilly.com/releaseDetail.cfm?ReleaseID=704061

Statement from Bayer on Contour Strip Recall

I just received this statement form Bayer: 

BAYER HEALTHCARE RECALLS 10-COUNT and 25-COUNT VIALS OF BLOOD GLUCOSE TEST STRIPS IN UNITED STATES

US Action Follows Stop-Ship That Began in June


Tarrytown, NY --Bayer HealthCare confirmed today that it is recalling all 10- and 25- count Contour strips and 10-count Contour TS test strips from US retail stocks, retail distribution channels and offices of US healthcare professionals. The FDA is aware of this action.

These actions are not taken as a result of any adverse events reported to Bayer.  Instead, Bayer is taking this action out of an abundance of caution to address a packaging issue which, under certain conditions, can cause some test strips packaged in some small-count vials to operate outside of US FDA-cleared performance specifications and produce a low-bias reading during blood glucose testing. In the FDA’s view, this deviation from US-approved specifications constituted a technical violation that required a field corrective action under US regulations.

50-count vials of Contour test strips are not affected, and strips used with Bayer’s Breeze™2 blood glucose meters are not affected.

This action follows Bayer’s decision in late June to stop new shipments of products containing the small-count vials of these test strips world-wide.  And with no new shipments of small count vials into the market since that time, we believe remaining unused quantities of potentially affected product in the market are likely very small.

While it resolves this issue, Bayer has increased its stocks of 50-count vials and is using these to fulfill new orders to ensure continued, uninterrupted market access to unaffected strips.

Contact:

Susan Yarin
Bayer HealthCare
(914) 366-1738
susan.yarin@bayer.com

Possible Bayer Contour Test Strips Issue

Amy at Diabetes Mine tweeted information about Bayer test strips false low readings. She wrote:

Quality issue w/ BAYER CONTOUR TEST STRIPS 4 #diabetes - some batches create falsely low #bgnow readings cot.ag/qui8Mc

Thanks Amy for brining up the issue.

I wanted more than a tweets worth of information so I called Bayer communications team. There are some possible issues strips that come in cans that shipped with small strip counts. For example: the ten count cans that came with a  new meter.

This is my less than expert understanding: The issues apparently stems from shipping the low count cans and the amount of gas in the can vs strips. It seems the fewer strips and more gas can alter the chemistry of the strips slightly. This creates the possibility of reading slightly lower than they should. For you error grid fans (and there can't be anyone who is an error grid fan) Bayer told me the possible errors are in the non clinically significant error grid ranges.

My conjecture is that the issue also involves time in the cans before being opened as well but that is pure speculation on my part.

Bayer said they have stopped shipping the low count cans.

Bayer says the 50 count cans are OK. They suggest if you have any concerns to talk with you health care team or call their Bayer support number. That number as far as my search engine knows is 1-800-348-8100.

1) Don't stop testing.
2) If you have Bayer strips in cans that came with less than 50 strips call Bayer or your health care team.
3) See #1 above. 

Didget III - To the Internet and Beyond

The ambition of the Didget is very impressive. Bayes has built a meter with a Nintendo component and an online community for kids. This, my third review of the Didget, looks at that internet component.

YDMV's other Didget bits can be found here:

Didget First Look

Didget II

Kids need to connect the Didget to their computer to get to the community. This may help some build the habit of connecting and downloading. Good idea. Very clever.

Bayers Diabetes tag line is Simple Wins. They use a standard USB cable to connect. That is simple. Kudos to the design team for skipping over the proprietary connector.

Maybe the plug team should sit down with the software guys. It was anything but simple to connect and register to the site. First in my lack of caffeination I tried to use my Mac with FireFox and I couldn’t load the browser extension needed. Then I used my daughter’s PC. I was doing this early and clearly needed more coffee. Every time I missed a field on the sign up form it erased three others. It wanted a little more information than I really wanted to share like my kid’s date of birth (and the drop down didn’t go back prior to 2000 unless you pick 200 and then re-drop down.)

OK I did get signed up in due course but it wasn’t simple. Much of that seemed to be for security. That is great. Kids should be secure and part of that, IMHO, is asking less.

In time and in need of Starbucks, I got in.

There are a number of sections starting with a set up screen. You can see here it is looking for the Didget serial number, building the connect habit:

After signing up there is an arcade where you can buy more games with points earned primarily from testing and testing consistently over time.

The Arcade looks like this:

For everyone concerned about making value judgments on BS, blood sugar testing and testing at least four times a day, every day over time is how the vast majority of points are earned in the game.

Another tab is a mood Ring that kids can use to express their mood with a drop down and there is a lot of choices.

Themes some are free and some need points and I didn't capture the screen.

A Tiki Mask answer machine (aka magic 8 ball). Here I ask it why it doesn't like my Mac.

A game leader board which I don’t have a picture of because it had user names on it and I will not even show a made up name of someone else’s kid on the internet.

Carb Calculator: Pick food and servings and it estimates carbs. It looks like it uses carb exchanges. For the scale and count users it may not be accurate enough. I do like the idea of making carb counting accessible to kids and in the context of their world and for a lot of kids (Your Kid May Vary) games are their space.

Kids can ask other users to be friends. I didn’t test this because well I try not to be a creepy old guy talking to kids online and that how it would have felt asking of a friend. I couldn’t see any thing about other kids than their name and a button to request being friends. There didn't seem to be a lot of users yet.

When you sign in as a parent you see completely different stuff. One piece I was impressed to see was that considered that a parent may have more than one type 1 kid. As a parent you also get a menu screen and it looks like this:

From the parent menu we geezers can view logs and such, well that is if you have been using the meter and as I said in Didget II my kids found out the Didget strips fit the Contour USB and they have been fighting over that meter. This is what the screen looks like, you can imagine numbers:

Editorializing to follow:
My older kid doesn’t see the value in a diabetes only communities online. At least that was his response to some of the big advocacy groups sites. Diabetes isn’t the only thing about him or define him and he prefers to stay in touch with his type 1 friends with Facebook and text messages. (Most of these friends are from CWD’s Friends For Life gotta get that plug in. It is a great program.)

However just because my kids isn’t into the idea doesn’t mean other kids will feel the same. Other may like it a lot, and the target demo here is younger than most Facebook users and this is a way less public place. (You have to connect a meter to get in.) In fact the value of FFL (see plug in prior paragraph) is being around and connecting with other kids with type 1. I think the value of focused community is huge. I think communities work best when one size fits the size it fits. One site doesn't fit all. People connect from the state of mind that they are in and facilitating small communities makes that possible. Marketers call it niche marketing. I think it is more significant than marketing.

Let me digress a bit here and talk right into the camera at Bayer.

Dudes (and I mean that in a non-gender specific way) - suck it up and get back to FFL. I don’t know why you stopped coming. I can guess but I don’t care why. In the words of the Beatles, “Get back to where you once belonged.” I miss your presence and I know others do to. You have some seriously strong products and families with diabetes need to see them. Rejoin the community there.

Back to the Didget and off my rant. I think this is a very significant product. It doesn't try to be the meter for everyone including your uncle with type 2. It take the idea of diabetes care and focuses on habits, specifically rewarding regular testing in the day, every day all month. The rewarding is in the context of a particular user community, kids. It maybe too old for some and too young for other and in that it is brilliant. It was made to fit one size not all.

The Didget is not a meter it is a system designed to promote the development of habits of care in kids. The system is the meter, the Nintendo game and the online components working together. Building a set of tools that are a kid focused system is brilliant.

I doubt we will be users. Our kids are part of the too old. Still I applaud the effort to bring management tools into kids' worlds. It is well conceived, focused and as such not for everyone, not even all kids. That is brilliant.


YDMV DIDGET posts:
http://www.ydmv.net/2010/05/bayer-didget-first-look.html

http://www.ydmv.net/2010/06/didget-ii.html
http://www.ydmv.net/2010/06/didget-iii-to-internet-and-beyond.html

Didget II

We have had the Didget rattling about the house for a while and I haven’t done much with it.

By design.

I opened it up read over the literature and handed it (the meter not the literature) over to Delaney. We laughed at the manual (Particularly the right side up part - Good Friend of the Blog Lorraine explains why in her review of the Didget) and then we watched Top Gear because that is what we do. After the Botswana Special, she played the game and announced it was a lot like Pokemon.

This information meant very little to me. What I know of Pokemon is the sum total this; before blood test strips, there were Pokemon cards all over the house. In fact for all I know there may still be Pokemon cards under the carpet of used strip we call the floor.

Anyway, I intentionally didn’t interact with Delaney as she used the Didget. I was curious to see what her reaction would be.

I think I should preface this next bit with - she is a few days from being a teen. I suspect that she is older than the target market for this meter-game combination.

After the initial, “It is cool!” her comment was, “It is huge.”

It is. Maybe not large enough to have it’s own moon orbiting it but I think it’s gravitational pull effects the tides.

I found it very interesting that when she discovered that the strips worked in the Contour USB she started testing with the USB. Then Connor stuck it in his pocket. Some where in this the Didget fell off the coffee table in the living room and nobody picked it up for a few days where it risked being layered into a geological strata with the strips and Pokemon cards.

My first test was this: Will the Didget hold the interest of an almost teenaged kid in my house?

No.

I think my baby daughter is too old and so experienced with meters that the game and the large meter form factor do not work for her.

So I poked around (get it poked around, diabetes, Pokemon?!? I kill myself with this stuff! - Ok ok you want to kill me too, I’ll knock it off.) I think there is a very distinct market for this thing. Connor was diagnosed at 9. Delaney at 7. We charted and used stickers as rewards for their testing the number of times they were meant to and all kinds of happy smoke blowing stuff like that. Still sticking sharp steel in their fingers got old before it became a habit.

This meter would have been crazy useful in helping build those habits and making the whole crappy newly diagnosed experience a little better - a little more of their world and less of the medical industrial complex's world.

A little then is a lot.

I am way in favor ever little bit.

With that big picture said, time fo I wish that some of the game / bonus parameters were user definable. As in Your Diabetes May Vary so how you would like to use the game interface to reinforce care behaviors may vary too.  Specifically I would like to have control over the target of 4 test per day to reach the bonus points. I would make the magic number a little higher. Say test before each meal two snacks and bedtime for the grand total of 6. Yeah that is a little nit picky but what the heck I am meant pick nits aren’t I?

From what I have read there are other aspects of the Didget ecosystem (stole that ecosystem phrase from Continua) that I hope to investigate in future post. 

Until then I am a fan of what the Didget is trying to do. Specifically demystify the freaking meter, make it common and accessible and encouraging kids to make care behaviors habits in their world.

I am fascinated but not suppressed by my kids’ using the Didget strip in the Contour USB and their little turf war over it. Bayer has stepped up their game in meter design. I love the creativity and kid appeal of the Didget and the adult sophistication of the Contour USB. Good design rocks!

I believe in options and markets that deliver choices to consumers.

If Your Diabetes May Vary so should the tools used to manage it.

Kudos to Bayer for getting that.

For more T1 parental perspectives on the Didget visit my friends and fellow T1 Bloggers:

Lorraine - This is Caleb

Leighann - D-Mom


YDMV DIDGET posts:
http://www.ydmv.net/2010/05/bayer-didget-first-look.html

http://www.ydmv.net/2010/06/didget-ii.html
http://www.ydmv.net/2010/06/didget-iii-to-internet-and-beyond.html

Bayer DIDGET: First Look

The DIDGET has landed. Here's a first pass quick look and some initial impressions. As we get some experience with it I will share more details.

First things first -  Disclosure. Bayer was kind enough to send a meter for review at no charge to my personal pocketbook. Schwing! They also sent me an extra can of strips. Bonus Schwing! I made no promises other than to speak my mind and to make full disclosure that they gave me the stuff if I wrote about it. So there ya go.

DIDGET a meter and a Nintendo game. Like the old SNL bit it a floor wax and a dessert topping. Well except DIDGET is for real. I have been interested in this meter since it was announced. I think outside the box is cool and this thing is clearly different.

DIDGET seems to be trying to reach T1 kids where they live. It says, “You’re kids, you like games here’s a care tool that tries to be fun.” A significantly different approach than, “... or you will die.” Now don’t get me wrong there is a place for, “... or you will die.” Specifically in the Top Gear Botswana special. The relevant part of that starts about 30 seconds into this:

We love top gear and the specials are just brilliant. I suggest you buy them in iTunes as the quality is way better than YouTube and this is quality TV. Watch them with your kids. It is way more fun than diabetes.

OK back to the what is inside the box, Here is the DIDGET unpacking sequence:

You have a bright kid friendly box.

It unfolds 

Inside is a pack of documentation including user guides for both the meter and game in english and spanish.

It a lot of stuff when it all gets unpacked. 

At about this point my soon to be a teen started paying attention and was psyched that it was a meter. Somehow that hadn’t sunk in.

Possibly I don’t read the user guides that well but this is the first meter that I recall having an issue with the direction it gets held to test. Anyone else ever read that in a meter manual? I feel the need to test upside down and backwards just to see if it makes any difference. This is the point of the book Delaney and I added "... or you will die" to every sentence we read in the users guide and it got to be quite funny.

Over at CWD some parents have expressed concern that the DIDGET rewards in range numbers and because that is indirectly punishing numbers that is a problem. Their point being numbers are numbers not good or bad. So what does DIDGET do?

Well we just unpacked it so the jury is still out. The book says it does give slightly higher game points for in range numbers than out of range numbers (or you will die.) More significantly the game rewards multiple test in a day up to 4 test. It also rewards consecutive days of testing with bonus points if user tests at least 3 times a day (or you will die.) Here is the section of the meter manual on game points.

We haven't been using it enough to see what the game / meter interaction is. Not that I will let a little thing like not having a clue keep me from opining on the matter. I think parental actions have a bigger effect than any game will on punishing numbers. I include passive aggressive signals in that and I am guilty of far worse than a few points in a game, like projecting instead of joking "or you will die."

More importantly (not than you will die) I think the goal, as I read it, is to support having fun and build a habit of regular testing with positive feed back. Again I think parental signals are more important than any game but I think giving families tools that reinforce the idea of positive feed back for good habits is brilliant.

On the plain old meter side of things DIDGET has two levels of settings: basic and advanced. Advanced gives you the option of before and after meal marking, after meal reminders and the above mentioned personal settings for HI and LO.

So far very good.

YDMV DIDGET posts:
http://www.ydmv.net/2010/05/bayer-didget-first-look.html
http://www.ydmv.net/2010/06/didget-ii.html
http://www.ydmv.net/2010/06/didget-iii-to-internet-and-beyond.html

Bayer Contour USB: First Look

The good folks at Bayer sent me a Contour USB. Here's a quick look.

(See the Update Here)

Bernard my friend, you will be impressed.

Bernard and I have "issues" with proprietary cables. Your Diabetes May Vary, your meter cables don't need to but they do. Except for this one - check it out - no cable. Standard USB plug built in.

Wait, wait, before I say anymore - the full disclosure: When Bayer announced this thing a few weeks ago, I thought it looked cool. So I call to asked about it. They were kind enough to send me one to test out. Wohoo!

No conditions on their part.
No promise other than to try it out on my part.

The full review will have to wait for some more actual use. I'm going to give it to the teen T1 and he'll do most of the BG tests and contribute to the comments. Unill he sheds some blood for the cause - here is the initial out of box experience.


Nice packaging and not too much of it. The meter is behind a little plastic bit. There is a sticker on the screen. BG at 93. Well at least it isn't 104 and some of the documentation shows the meter at a whopping 127 - LOL.

For those of you who have had little girls in you life you will be happy to hear there is no Barbie packaging. Barbie is lashed into her packaging by some freak with a bondage fetish and a heck of a lot of wire. The meter pops right out unencumbered by fasteners.

The Contour USB has rechargeable batteries. That is a first in my experience. It is real clear when you open the box you should charge the thing. The box flap says, "HELLO! - Charge me," or something there about.

USB - figuring out how to charge it isn't rocket science. Find an open USB port or use the charge in the box.

So far the out of box experience is a whole different class than your average crammed in folded cardboard for stable shipping packaging. Nice. Not clinically significant in any way but it is a clear expression of how they feel about their product and how they want you to feel about it.

You get one first impression. Score one for Bayer. Let see what else is in the box.

• Meter
• Charger
• USB extension cable
• Strips
• Bulky Bayer lancing device
• Lots of documentation
• Quick Start guide in case you don't want to read the above mentioned documentation.
• Paper logbook (as if)
• Web Registration card
• Wicked Cool Colored Lancets.

I didn't think Lancets could be cool.

I was wrong.

Colored lancets are cool. Don't take my word for it. Delaney spoke for the 'tweens of the world definitively claiming all the pink ones. The Tuesday Little Dude, speaking for the 4 year old PWD community, was also psyched choosing purple then blue for his 7:00 check. He was grabbing at them like they were Halloween candy when mom came to pick him up an hour later. Oh TLD you have no idea how much you amuse me.

Apparently Lancets can be cool. Who knew?

Having no actual experience with the meter we seized the moment and had TLD test drive the meter for his 7:00 check in. Both he and Mrs. YMDV made all kinds of happy sounds at the color screen. OK was new toy syndrome but what the heck! This is a first impressions bit and so far this thing is making friends with flashy first impressions.

As you can see the meter isn't large. Just a little bigger than a USB memory stick.

I lined it up against the usual suspects. A little smaller than a One Touch Ultra Mini. Longer but skinnier than a Jazz.















It is significantly smaller than the Ping meter that came with Connor's pump. (I noticed taking this picture he hadn't even bothered putting batteries in it.) I didn't put it in it's case but the case seems bigger than it needs to be and not gray as cool as the Jazz cases.

I did notice two things worth mentioning before I call it a day. The documentation I didn't read says the software runs on a Mac and while the box was about the size of a CD but look up there at that picture - there wasn't a software disk in the box.

D'OH! It is a USB stick!