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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  1. Hah! Wouldn't that be ideal?! BTW, I think the Sheldon pics could be more colorful! Visit http://goo.gl/h1HSg on CBS.com for some examples!

  2. Great post Bennet. Boy, it's almost hard to think of what a dream device would be...my brain has been limited by current stuff for so long!

    One feature that I really wish existed today is the ability to program a temp rate BEFORE it is time to start it.

    Basketball is the example I'll use. When I play basketball, I need to remember, at 10:30'ish, to start a temp basal rate reduction.

    I'm thinking of it now, but I can't take action because it's not 10:30 yet. But I can guarantee that I'll almost forget by the time 10:30 rolls around.

    Then my basketball enjoyment is compromised because I'll spend my time and energy chasing lows.

    What if, right now, I could tell my pump to start a temp rate AT 10:30?

  3. DEWY sounds great! :-) What I would like for him to be able to do is preprogrammed boluses. Let me explain. I don't have gastroparesis, but if I eat a big meal (yes, I DO want to do that sometimes), my bolus insulin finishes before all the food is out of my stomach. So I'll have a nice flattish curve on my CGM for 3 hours, and then, UP it goes! Now, I KNOW that's going to happen, and IF I remember to check in 3 hours (there IS a BG check alarm on my pump), AND I am in a place where I can test and bolus, well, OK, but what if I'm at the movies, or some place or involved in some activity where it just doesn't work? I've tried a square wave for that, but a square wave doesn't deal with what for me, is an actual peak. So, what if DEWY could just tell my pump to give me 3u at the time I specify? That would make life so much easier.

    I also wish MM would get their butts in gear and give us a food/carb library. I am really lousy at carb counting, and as long as I'm at home, and eating pretty much the same thing, I do OK, but I'm hopeless at a party or a restaurant. Also, I've tried the square wave thing for those situations, but it doesn't work for me. I want to be able to tell DEWY what and how much I just ate and have him figure out not only how much insulin I need, but when and how it should be administered. 2u now, and 3u in 3 hours, while having a 0.5u square wave going on at the same time for 6 hours? I ain't asking for much, am I???? :-)

  4. Your insight is spot on here. Ultimately, every diabetes product needs to be build intentionally with integration functionality. Although, it is up to the consumer to demand such functionality. At Kewl Innovations, we've created a product that solves the insulin portability problem with ultra-convenient heating and cooling technology (no more gel packs or coolers to lug around!) We realize this is only one variable in a HUGE diabetes management equation... so with the big picture in mind, we've incorporated a data feed into the product that measures the shelf life of your personal insulin supply. That data could potentially be packaged and re-deposited in a DEWY type of product/app/service. Maximizing the usefulness of our device.


  5. We're trying to make our ManageBGL.com system into DEWY.

    It's a cloud-based system for disseminating information about bgls, carbs, insulin etc, to everyone who needs to know - teachers, parents, doctors, carers.

    ManageBGL accepts manual input via iphone/ipad/ipod, PC, website etc. We have a tested and working import facility for all Abbott devices (more to follow). We are testing an API (available shortly) to allow other devices to automatically add data. It also allows a user to pull data about their active insulin, predicted BGL, charts of bgls/insulin/carbs etc into their own apps, or into say an Excel spreadsheet or webpage.

    It predicts BGLs 3 hours ahead without a CGMS.

    It recommends doses with a bolus wizard the same as most pumps. If you get low, rather than just saying 'You're Low', it tells you EXACTLY how much carb to have to get back to target, and if there is active insulin, it tells you how much EXTRA food you need to avoid getting low again.

    Similarly, if you are high, it tells you exactly how much insulin you need to get back to target.

    ManageBGL uses factors to measure magnified or reduced insulin requirements, such as exercise (3 levels), stress, illness, adrenaline, pre-menstruation etc.

    We are also working on an analysis mode where it detects if your ratios are consistently wrong, and advises you on exactly what to change and how much.

    The fantasy is starting to be realized!

  6. I would just be happy with a single piece of software that can combine all the data from my pump, dexcom and meters! Am I really asking for that much in 2012?

    And I could much use the preset temp basal feature. :)

    Great ideas here!

  7. Erik Strout has left a new comment on the post "Of Fantasy Diabetes Devices, Sheldon & Dewy". I mistakenly deleted it when trying to approve it with my iPhone. In my defense the scree is tiny He wrote:

    I love this post. I love the passion and the fact that I'm not the only one frustrated by the lack of adaptation of technology for important purposes. It's all (at least mostly) possible. Thanks Bennet - this is the type of thing the T1D community needs to speak up about. Great post!