May 28, 2009

From The News Wire: CGMs Work

Science Daily is reporting a JDRF study of CGM use by people with good control. The conclusion: CGMs help maintain control and limit hypos. Film at 11:00
ScienceDaily (May 27, 2009) — People with type 1 diabetes who have already
been successful in achieving recommended blood sugar goals can further benefit
from using continuous glucose monitoring (CGM) devices, according to results of
a major multi-center clinical trial by the Juvenile Diabetes Research

According to the JDRF study, using CGM devices enables people who have
achieved excellent control (with HbA1c levels below 7 percent) to continue to
tightly manage their diabetes while cutting down on the frequency of low blood
sugars, called hypoglycemia.

May 26, 2009

IPhone 3.0 and Life Scan Behind the Scenes

I still get a fair number of hits from iPhone 3.0 diabetes searches. If you missed the edit after the edit on the original iPhone post here at YDMV, this is the back story:

The Ap at the the 3.o show "was of a prototype application that LifeScan created specifically for the event to show what medical devices can do when connected with iPhone 3.0. Detmers stressed that the demo was not meant to represent a fully-defined commercial product that is imminent. Apple asked LifeScan just a few weeks ago to create a prototype for the event and LifeScan was all too happy to participate, but a product like the one shown is not on the verge of a commercial launch."

update Sept 21 2010 Sanofi/WaveSense announce iBGStar 

Tell Your Type 1 Daughter

She can aim high. Like at the high court. Ap is reporting that the President has nominated federal appeals judge Sonia Sotomayor for the Supreme Court. She has been type 1 since age 8.

Our good friend Amy at Diabetes Mine wrote that there was reporting that her diabetes would lessen her chances at a nomination. It good to see that the diabetes didn't stop her.

There is a message for your daughters. She wasn't stopped by her diabetes. Help you kids reach for their dreams.

May 25, 2009

Your Advocates Should Vary

When I say Your Diabetes May Vary I mean of course it will. The only constant with diabetes is nothing is constant. Well almost nothing.

I find it fascinating that the Professional Diabetes Advocacy organizations are remarkably constant. From the emails I receive from them it appears that diabetes to them is one thing and on thing only - Stem Cells.

Both ADA and JDRF fill my in box with emails urging Stem Cell Advocacy. They want me to understand, as the ADA put it that, “It is critical for NIH to hear from as many members of the public as possible letting both the Administration and Congress know that diabetes advocates strongly support the expansion of stem cell research.” Their bolding, not mine.

Here is the deal. I personally am in favor of stem cell research. I am Christian too. I don’t see a conflict between those two. Others do and I try to be as respectful of their convictions as I would want them to be of mine. For me being respectful while differing is part of that “Do unto other…” bit Christianity teaches.

Where the respect starts to break down is with the image of individual diabetes advocates that these organizations project by their focus on stem cell advocacy. I don’t like the idea that type 1 advocacy is de facto stem cell advocacy. As I see it, there are a number of challenges in a family living with type 1. Many if not most are more pressing day to day than stem cells.

I want to be seen as an advocate for the totality of type 1's challenges and not be defined, by others, to a single issue around diabetes, even if it is one of the many I support. I think it would be ideal if those Professional Diabetes Associations would equally reflect the variety of challenges diabetes puts in our lives.

So here are some random thought on where they can do that.

School problems are a day to day reality for many families of children with diabetes. When the schools relationship goes bad, “Critical” is an understatement of its importance. If little Johnny is facing issues with his diabetes care at school, nobody at home gives a hoot about stem cells.

Crystal Jackson at ADA is the National Queen of Diabetes at School issues. After meeting her at Friends for Life a few years ago, I honestly feel an upgrade to Empress of the Universe is in order. Wouldn’t it be great if ADA emailed as much about how to advocate for support safe schools and with the same urgency, polish and organizational attention that stem cell advocacy gets?

Our friends at JDRF invest huge money, as in tens of millions, with for profit companies, trying to move research from the laboratory to peoples lives. They call the program Industry Discovery and Development Partnerships or IDDP. They have a section of their web page about IDDP but it isn’t always kept up to date. I have made a number of passes at learning and sharing more about the program and how it is doing.

In my experience, JDRF shares little about IDDP deals beyond an initial press release. Once I called the PR person whose name was on a particular press release. I wanted to know if a big pharma acquisition of rights of to a process JDRF had an IDDP 'partnership' deal on, triggered a repayment to JDRF of IDDP funds.

‘Good question,’ the PR person said, ‘I don’t know. Can I get back to you?’

The return call never happened. What ever the outcome in that case (and I would think it could it be a success story to share) JDRF certainly doesn't feel the need to share about IDDP like they do with stem cell lobbying.

JDRF is acting as an investment banker / venture capitalist in the diabetes space. I am OK with that. I think those of us who walk would see investing like this, in trials of discoveries, as the JDRF mission.

Sadly that investment banker roll seems to include the lack of transparency that the financial industry is now infamous for. The message apparently is, “Trust us - there are smart real people working on this.” That sounds a lot like Congress’s rational for not regulating derivatives in the close of the ‘90s to me - we all know how well that turned out. Maybe a little more being open with details about IDDP along with the stem cell emails would help all of us see how JDRF gets that type 1 diabetes isn’t a Johnny one note deal. At least it would be something new to read.

Care to step up to a mundane but real every day issue Professional Diabetes Advocates? A number of families with diabetes are concerned that mail order houses (required by insurance) like CVS/Caremark handle insulin in a manner that appears to us to be outside the FDA approved labeling. Specifically that they ship it warm. Want to help insure insulin is shipped cool?

It is not sexy at all. Not taking sides in the big political picture. It's just our insulin - in a hot delivery truck. Don't worry Professional Diabetes Advocates I won't be surprised if it is not your priority. You’re probably working on another critical stem cell email - looking forward to it, honest.

Your Diabetes May Vary. So should your Advocates.

May 23, 2009

From the News Wire: Navigator Complaint Handling & FDA ran a short bit abbout the Navigator, the FDA and customer complaints. FDANews wants a subscription for more and I don't have the coin for their reports so I can only see the teaser. It looks to me like it relates to isolated incidents. Alert CWD readers will have seen the Navigator community talking amongst themselves on supply and customer service issues. So I am not so sure this ranks as actual news to the people most effected, Navigator users.


Abbott Diabetes Care Gets 483 for Complaint Procedures
An FDA investigator cited Abbott Diabetes Care for complaint handling and employee training in a Form 483 that included three observations.

The company received the Form 483 in March after an inspection of its facility in Alameda, Calif., for operations related to the FreeStyle Navigator continuous glucose monitoring system.

Staff did not complete training for complaint procedures or device failure investigations, and the company did not appropriately evaluate a complaint to determine if a medical device report was needed. The complaint came from a customer “who was using the Navigator and was in pain and wanted to return the system,” the form says.

May 20, 2009

From The News Wire: Mini Med Teaser

Medtronic, Inc. F4Q09 (Qtr End 04/24/09) Earnings Call Transcript

The interesting part is the coming attractions bit. I bolded it for you.

In Diabetes, strong double digit performance on a constant currency basis this quarter was driven by the continued success of Continuous Glucose Monitoring and solid insulin pump sales. We continue to have success as the only company with a proprietary Continuous Glucose Monitor Sensor Augmented Pump on the market. At this point, we have a three year lead on the competition. We are also the only company with the iPro, a unique professional CGM tool, and with our Diabetes CareLink therapy management software, we offer the most integrated diabetes data management system on the market.

We continue to execute on our significant new product pipeline, including making strong progress in blazing the trail to a closed loop system so stay tuned for an update on this program at our upcoming Investor Meeting on June 2nd.

As another sign of our increasing business development efforts, later today we will announce details of a strategic marketing collaboration with Eli Lilly, which combines our delivery and glucose sensing leadership with the insulin expertise of Lilly, a recognized leader in diabetes treatment, research, and education.

May 17, 2009

Sorry but there is just no other way to put it..

At the dinner table:

“Why is there a set on ‘Lanes’ arm?” Kelley.

“She is wearing them there now,” Me.


“Better absorption than her butt.”

Looking at her arm, “That is Bad Ass!” Kelley. Then with a little mock contrition, “Sorry but there is just no other way to put it.”

“No problem. Anytime you can describe your 5th grade little sister as Bad Ass, I think you should.”

“Oh and that’s 45 carbs.”

I love family dinner.

Sometime life is just funny.

I am reading my Diabetes Daily email when what to my wondering eyes should appear but this: (I dare you to read line 2 & 3 and not laugh.)

Recent Diabetes News

* Cyloset Approved for Type 2 Diabetes (discuss)
* Vibrate Yourself to a Leaner You (discuss)
* Diabetes Often Affects Women's Sex Life (discuss)
* Is Sugar-Free Ice Cream Healthier? (discuss)
* 70 Years with Type 1 Diabetes (discuss)
* NY Doctor Offers Flat-Rate for Uninsured (discuss)
* Read more in the News & Interesting Links forum

May 12, 2009

From The News Wire: Top Stories

Time to read the Diabetes News and here today’s top stories:

Of Mice and Men - It is YDMV so you know there is some mouse model news to report. This time we are boldly going where no man has gone before, specifically inside the blood vessel walls of healthy mice. Why?

New Evidence Of How High Glucose Damages Blood Vessels Could Lead To New Treatments
or how do all the bad things we don’t like to talk about happen? This one scores as news about real science.

Next up is an article titled, “Blood Glucose Control More Important For Patients With Diabetes Than Previously Believed.

So the first thing I thought was how do they know exactly how important I think blood glucose control is to know it is more important than I previously believed?

The conclusion is, “Even small improvements can make a great difference in the long term.” The article then goes on to talk about types of insulin. Regular and NPH aren’t the favorites. I thought - No kidding.

OK enough of the trivial news this one is WAY AWSOME.
Smart Toilets: Doctors in Your Bathroom

Yes diabetes potty humor fans what could be more ripe for jokes than the idea that the commode can become your glucose monitor?

Toto's new Intelligence Toilet II monitors weight, blood sugar levels, and other vital signs, transferring data to your computer for analysis via WiFi.

Who needs CGM when you can have Pee GM?

Life is good.

Pain in the Butt can be a Shot in the Arm or Visa Versa

I went to see the first night of Kelley’s class Sr Project presentations. Sr Project is a very intense independent study elective at her school. Kelley was MC-ing the first nights presentations.

These kids are amazing.

About two thirds of the way through, I got a text about diabetes care. I was only planning on staying for one presentation but they were so good I was in for the whole thing. But there was the text: ‘Where should Delaney put her new set, Butt or Arm?’

We have shifted her sets to her arm recently. It took some effort on her part to screw up enough courage to change from her comfort zone, aka her tush. She was seeing uneven absorption and maybe that was because the available real estate for sets was getting over used.

She can’t do the arm sets by herself - yet. I texted back to wait and I would be home in a half hour to help do an arm set. She could chill. The cell phone turns out to be a great tool for helping minimize anxiety. I could reassure her that it was OK to wait, that she would get help and still catch the last presentation.

One of the common themes (clearly by design of the Sr Project class) is being pushed outside of their comfort zones and let them experience the benefits of a stretch. Going outside yourself to discover yourself is clearly the agenda. Parts of the class are clearly a pain in the butt but hearing them talk they clearly were proud of working past the anxiety. There I am texting about going outside your set comfort zone listening to students talk about stretching outside their comfort zones. A pain in the butt turns out to be a shot in the arm.

For T1 kids that is true both literally and figuratively. Delaney isn't waiting to Sr year of highschool to learn that.

Adult Stem Cell and Insulin-Free

DiabetesHealth is reporting:

Adult Stem Cell Implants Make Newly Diagnosed Type 1s Insulin-Free
May 12, 2009
After American and Brazilian researchers implanted 23 newly diagnosed type 1 patients with their own adult stem cells, 12 of the patients became insulin-free for periods lasting from 14 to 52 months (the mean was 31 months).

So you read the article and there is bit:

Although the results of the transplantation experiment are promising, the procedure itself is radical. Patients must have their immune systems suppressed by powerful drugs before receiving the stem cells. Significant percentages of the study's 23 patients experienced troubling side effects:

Two patients (8.7 percent of the group) developed pneumonia while undergoing immunosuppression therapy.
Nine patients (39 percent) developed low sperm counts after exposure to one immunosuppressant drug.

What I don't get is why can't the diabetes establishment (ADA JDRF to name two) get as much enthusiasm for other approaches (Faustman perhaps) as stem cells?

May 8, 2009

Do as We say Not as We do

Ok parents, lets all raise our hands if we know that how we behave is more important than what we say when it comes to teaching our kids. If we watch what we eat they mimic the behavior. If we smoke they smoke. Language, accent, mannerisms - you name it, we do it they learn it. On the up side it can make you proud.

Caremark seems to have missed the mark. They think we need to do what they say not what they do. We should refrigerate insulin upon arrival. They don’t even insulate the shipment. Here is our latest (being returned) shippment.

Mrs YDMV called Lilly. They said it should be kept cold. They also said they were aware of some issues and were working on them. Nothing very speciffic mind you, more like mombo jumbo.


Specifically Eli Lilly has very clearly stated that they are opposed to middlemen “…whose interests are making money – not helping patients” when those middlemen are possibilities, that may happen, if the importation of Canadian drugs is allowed and hypothetical web vendors spring up. When the middleman is a huge, real, US Lilly customer, not so much.

Lilly says they are working on something. Thanks for that Mombo Jumbo but we still need insulin, every day as a matter of fact. Who know what they are working on. In the mean time their interest in making money selling Caremark insulin seems to be taking precedent over helping patients to follow Lilly’s FDA approved insulin handling instructions. Why do I say that?

Well - still no reply to my letter seeking some guidance on the matter.

OK maybe the truth is Lilly’s objection to Canadian imports was self serving PR double talk aka mombo jumbo. (Feel free to raise your hand on that too) If it isn’t double talk they need to stand up for patients and cut off middlemen who don't care about patients, like say - Caremark. If not then fess up and shut up about things like opening up Canadian imports.

At some point I think Big Pharma like Lilly needs to be held to their word. It may take a few of us consumers/customers/patients to do it.

I would love to hear from anyone who writes Lilly, Congress, or the FDA. I would love to hear about a reply even more.

May 4, 2009

How Much Do You Bolus for 7,236 Carbs?

We made a cake for the cast party for Bye Bye Birdie. Best I can figure it was 7,236 carbs but I didn't put it on a scale. The inspiration was the play post card.

The cake was in production for about a week. Longer if you include experimenting with gum paste and making fondant.

One of Kelley's classmates drew caricatures of the play characters. Very talented young woman named Ashley, who as her senior project designed and made the leading lady's costumes. Very Cool.

Our house is covered in sugar. My shoes stick to the floor and every blood test is suspect. It was a heck of a lot of fun and like a good play it was enjoyed by the audience it was produced for and is now a memory.