We Hold TheseTruths to be Self-Evident, Except Trials are Required.

Medtronic has a press release out today that says with Low Glucose Suspend (LGS) folks spend less time in hypos. That seems kind of intuitive to me but hey the studies need to be done. It it wasn't a small difference IHMO. 19% less time in hypos.

You can read the press release here or click this graphic to see what is said in markets that aren't the USA and where people with diabetes can get a LGS pump.

YDMV has burned a fair number of electrons on and around LGS. Here is hoping this helps the FDA focus on the value this step brings living safe lives with insulin infusion.

What do yo think?
Would you like LGS?
Would you use it?

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Anyone have a Dummies Guide to @ANTPlus

Or maybe a not so dumb but new to it patients guide to how ANT+ may impact the diabetes space?

The headline reads:

ANT+ Expands Established ULP Wireless Ecosystem to Further Support Mobile Platforms and Augment Unique Use Cases in Sport, Fitness and Health

and down in the text it has this bullet: 

• Dexcom Continuous Glucose Monitoring (CGM): showing real-time glucose information at a glance. ANT+ technology will be incorporated into future products to enable connectivity with personal electronic devices.

Anyone up on this? 'Cause I aint and I would like to be. Here's why in case you forgot:

http://www.ydmv.net/2012/02/dexcom-acquires-sweet-spot-is-dewy-on.html

Best Diabetes Parenting Advice - Updated

As theBetes:NOW has reposted a short video of my diabetes parenting hero.



At my first CWD Friends for Life I heard this dad simply say, "My wife and I are our daughter’s primary care team.”

Brilliant. This piece of wisdom had been updated when theBetes:NOW caught up a few years later. The new message,"She'll become her own Primary Care Giver.”



What do yo think, who is the primary care giver in your diabetes life?

Previously on YDMV: Of Independence and Angry Mobs

#TwoBits on Green and Orange at CWD Conshy

Children with Diabetes held a tech conference in Philly, will Conshy (Conshohocken) PA over the weekend. A very good friend asked why I go to these. Simple because when it is all said and done I need to recharge the batteries to have the energy to do the right stuff as opposed to the easy stuff. Diabetes Burn out takes different forms with parents, doing to little or even worse doing to much and making diabetes the focus of life.

So for me the focusing on diabetes for a day helps me focus on not over focusing on diabetes the rest of the time.

Here two other great views of the event form around the DOC. Kerri talks about some of the frustrations and diabetes burn out stuff and definitively defines CGM'er and Art Panc.

I finally got to briefly meet another DOC dad, Scott Benner, (Like the DOC needs another Scott, someone needs to do a study of the name Scott and the correlation to T1D.) He is someone I have admired from a far (and someone I swiped a this image from, Thanks Scott). We're both orange but I would say we bleed green.

Love to know who else is orange or green.

@GlookoInc Upgrade: Carbs

Glooko has an upgrade out. Makes it easier to look up carbs and "with one click add the value to your note."

Their email goes on to say,"Say goodbye to your bulky carb counter book and hello to a comprehensive digital food database. No more adding up carbs in your head, or recording them on paper. Use Glooko Logbook to search nutritional information, adjust for serving sizes, and automatically enter in your logbook.  Tracking the food you eat anytime, anywhere on your iPhone and putting it context of your blood glucose readings, helps you stay on top of monitoring diabetes.   

Upgrade to the newest version of the Glooko Logbook app on iTunes." 

Click here for a previous YDMV Glooko post

Check them out on the web http://www.glooko.com/
or Twitter: http://twitter.com/GlookoInc

Dexcom Acquires Sweet Spot. Is Dewy on the way?

Dexcom released their earnings call online today. (Listen here for your self to see how off I am in my reporting.)


These calls are like a crystal ball. Fun but future looking. I looked for a picture of a Dexcom and a crystal ball ad found Kerri's Dexcom isn a glass with a super cute cutest Birdie picture. Close enough.

Right off the bat I found it interesting. Terry Gregg announced the acquisition of SweetSpot http://www.sweetspotdiabetes.com/.

Even the most casual reader of YDMV knows I have a particular interest in diabetes data. SweetSpot was identified on the call as adding sophisticated diabetes data management to the Dexcom portfolio. Terry Gregg identified two shortcoming in the Dexcom offerings; CGM pump integration and universal data integration. Ultimately they hope to see seamless data flow from the CGM to a mobile device and into the cloud.

Dexcom also mentioned the recent Tandem and Roche agreements. Interestingly the used the term “open architecture” repeatedly on the call in the CGM pump context.

Generation 4 sensors were said to be expected to be submitted to the the FDA end of Q1 early Q2 2012 and it sounds like CGM/Pump about a quarter days after Gen 4. YDMV.

Gen 5 was briefly mentioned and in the context of connecting out to open architecture devices including mobile and the cloud. Also accuracy was said to be at therapeutic levels.

The business model for sweet spot was covered in a question. At times it sounded a little big brother like with the VA, clinics and possibly insurers being customers of the data service. Naturally I would love to hear more about patients and later in the call they noted that the current product is approved for clinics.  Patients can see see what the clinic sees gets, so i guess (key word guess) patients aren't approved recipients of SweetSpot. A desire for a more patient centric data model was shared by one of the Dexcom C suite dudes. Anything is ways off in the future. There was also mention of criticism from the physician community of Dexcom for not having a means of connecting Dexcom information to the clinic. The future is digital and the acquisition of SweetSpot look like good positioning of the future.

At about 36 minutes into the call there was an interesting exchange on the Gen 5 product and the FDA. Specifically comments about the FDA concern that the health data being primary in on the mobile device. There were some interesting real world comments about os upgrades and aps running on devices. It was brief but good to know someone is having the conversations with the FDA and helping move the ball forward. I am sure the conversations are happening elsewhere but still it comforting to hear about the exchanges. Also interesting comments at about 56 min about their relationship with FDA. I'm "happy" with the FDA, industry has to make an effort.

On a personal note my kids don’t like carrying another thing so getting the CGM into the pump and ultimately the cloud is a step that may help them choose to wear sensor more.

Full disclosure, I own Dexcom shares.

http://www.ydmv.net/2012/01/of-fantasy-diabetes-devices-sheldon.html

JDRF Research Summit on theBetesNOW

Over on theBetesNOW.com there is one of the presentations from last weekend's Research Summit put on by the Capital Chapter. Mark Atkinson talks about the top ten things we don't know about Type1 Diabetes. Worth the 25 minutes.

Love to know your thoughts.


http://www.ydmv.net/2012/02/huge-props-to-jdrfcapitol.html

theBetes:NOW Back from a crash

theBetes:NOW is a project directed by my daughter Kelley and often featuring Connor with some producing by YDMV. The goal has been a more visual less text based and quick media around diabetes. One key part of the process was to be joyful.

If you have been to a CWD event like Friends For Life you know that teens living with diabetes are kids. First and foremost they are optimistic, happy, joyful people and diabetes is coming along for the ride.

Sadly theBetes:NOW was hacked and had to be taken down last summer but it is back. The catalogue of films is being reposted and new material is going up. In fact a new piece made at the JDRF Research Summit with AYUDA Inc. just went up. In line with the message that Andreas offered about a big world and a small community while this message is not in english I would love your thoughts on if the message of happy, optimistic joy rings true.

Juntos somos más Fuertes! / Together we are stronger!


http://www.ayudainc.net/

This week on #dsma

Huge Props to @JDRFCapitol

Next to CWD’s Friends for like the JDRF Capital Chapter Research Summit has to be the best type 1 event of the year. Great presentation by folk dedicated to making life with diabetes better on the way to cures. The order matters. Improving care is critical and will come as a result of searching for cures.

Cures. I don’t see a magic bullet coming but I do see different approaches to tackling things that will count as a cure. Those will happen like everything does in increments. Along that journey we’ll see better care before cures. Like everything with diabetes you better care and your cure may vary. So prevention may come before restoration of beta cell function, that’s cool, steps matter.

I get energy from this summit. The strength to keep hoping.  Maybe even believing there will be a cure someday. In the mean time life progresses is being made to better. Better understanding. Better ways of care. Better Lives. That progress requires individual involvement, starting with believing, then learning and participating from knowledge.

That is how all life works, believe, learn, act.
Why should diabetes be any different than life?

More later. First things first. Thanks and appreciation to the JDRF Capital Chapter. Until then here are some links that may be interesting:

JDRF and IDDP
Last Year's Capital Chapter Research Summit

From the News Wire: iPhone App Connects to Glucose Meters

Telcare’s New iPhone App Connects to Glucose Meters Even Oceans Apart:Telcare, the maker of the Telcare BGM cellular enabled blood glucose meter, has released an iPhone app that can gather data from the meter even if they’re physically apart. 

This not only allows you to watch your own glucose, but a parent of a diabetic child can make sure the kid takes regular readings and almost immediately know what the output is.
More

OmniPod and One Touch to Connect

From the News Wire:

Johnson & Johnson's market-leading LifeScan blood glucose monitor will be incorporated intothe remote controller for Insulet's next-generation OmniPod insulin pump.

The next generation of Insulet's (NSDQ:PODD) OmniPod insulin pump, which is awaiting 510(k) clearance from the FDA, will be compatible with the LifeScan blood glucose monitoring technology made by Johnson & Johnson (NYSE:JNJ).

The 2 companies inked a deal for LifeScan's OneTouch technology to be incorporated into a new personal diabetes manager that patients use to control the OmniPod. Insulet's chief commercial officer, Peter Devlin, told MassDevice.com that the company is targeting a mid-2013 commercial release.

More: http://www.massdevice.com/news/diabetes-insulet-inks-deal-with-jjs-lifesscan-next-gen-omnipod

How Good Was Animas Customer Service?

Hint: I’m writing thank you notes.

A milestone in our kids' school careers is the 8th grade play. All the kids participate in a a number of ways - acting, makeup, making props and other team building processes. Delaney was practicing acting yesterday. Her part calls for her to dramatically roll across stage or some such thing. As she did her pump slipped out and she dramatically rolled it was across more than the actual stage. Exit one cracked Ping pump screen, stage left.

Amimas has always been great about replacing pumps when life happens. Life, not accidents. Being a regular kid is no accident. It is the goal.*

Sometimes when life happens, pumps need to be replaced. That is a great thing! It means the T1D kid was more focused on being normal than being T1D with an inulin pump.

While replacing a pump sounds easy, it actually isn’t. Our friends in the device business have to keep track of everything to keep the regulators happy. They gotta know who has what device, made when, with what parts, by what factory and probably at what time and if that time was daylight savings time or not. That way, if anything ever goes wrong, with any of the parts, they know who they are gonna call. Dotting i-s and crossing t-s takes systematic processes, rules, records, people and time.

Aminas’s offices are about 45 minutes from my house. When I can, I drive down for replacements. It saves a night time without a pump. That Animas can, at times, make that happen is brilliant.

I know the names of two of the people who made that happen yesterday, Steve and Bill. They made magic because of who they are and because they could. All too often we ascribe the role of villain to the companies who make the tools we rely on. The truth is way more often they are the mild mannered alter egos of super heroes who are trying to live with in the rules. They get what we are trying to do, which in this case is let life happen. When they can, they slip into the spandex and become super heroes.

I think there is probably more than one Steve and Bill at Animas. I’m waiting on a return call to get last names so I can mail LY/MI pins with thank you cards. All in all if they are busy helping others with real emergencies I’m cool. Somehow if getting a name takes longer than getting a pump replaced that would be magic where it matters.

Got as story of Magic Service? I would love to hear about it as a post here or as a link here to your own blog post about a hero.

*More Your Diabetes May Vary ramblings about The Goal:
http://www.ydmv.net/2008/08/what-is-your-goal.html
http://www.ydmv.net/2008/03/newbie-advice-long-run.html

Who best to say, "You will be okay."

“If I could, I would tell you although you might not believe it right now, you will be okay…” Julie Keon. She wrote that as a mom at children's hospital looking at another mother. 

Julie offers a perfect description of why am committed to the diabetes online community (DOC). Why I went to the point to get a master degree in health communication.  She explains it in that simple idea, I want to help others believe they will be okay.

I know peer to peer support is critical in many healthcare situations, particularly chronic conditions. When our first child was diagnosed with type 1 diabetes a message similar to Julie’s helped me through the first few days. Well okay it was an irreverent and funny message not too like Julie’s but the point was the same, we would will be okay, in time we would laugh again. 

Hearing that from a veteran patient is different from hearing it from anyone else. In master program classes, my fellow students and I talked academically about the credibility of the messenger. In the real world I know that credibility comes from empathy. Someone who know the shoes you have beed asked to walk in, is a source of credibility beyond any other. 

An article on Peer-to-peer healthcare by Susan Fox the Pew Research Center quotes Susan Sontag about dual citizenship in the lands of the well and sick. With a chronic condition like type 1 the passport to the kingdom of the well that Sontag speaks of is permanently revoked. With type 1, try as you might you will never, as Fox says, “get the hell out of the kingdom of the sick and back to the kingdom of the well." Except most of the time with a people with a chronic condition aren’t what people understand as actually sick. They are 'just' managing a condition.

Fox, I think wonderfully, points out that peer-to-peer healthcare does not replace health processionals. She observes, “doctors, nurses, and other health professionals continue to be the first choice for most people with health concerns, especially among people living with chronic conditions.” She however says, The picture shifts when we ask about emotional support in dealing with a health issue: fellow patients, friends, and family are the much more popular choice.” 

That is an opportunity for medical professionals to suggest health 2.0 as an asset to help their patients. Kim Liu writes in her article “Patients Week 2011: How Health 2.0 can improve patient compliance” that there peer-to peer connections, well improve patient compliance.  

Peer-to-peer online heath communities need not be seen as a threat by healthcare professionals, because, well, they are not a threat. In fact care givers recommending quality peer-to-peer sites may improve patient outcomes. 

Liu comments on a summit of diabetes educators and online opinion leaders sponsored by my friends at Roche. I was there. It wasn’t quite as pretty as Liu makes out. In fact initially it was a bit of a clash. However from that event ongoing an working relationship has evolved between the diabetes industry and social media writers. One that hopefully moves towards connecting the power of peer-to-peer communications into care programs particularly recognizing the credibility of peers to help those living with chronic conditions.  

I want to be a part of that - a collaboration that helps the newly diagnosed feel that they “will be okay.”

Peers can best provide desperately needed emotional support  at diagnosis. Who better to say, "You will be OK."



References:
Julie Keon Julie Keon http://www.whatiwouldtellyou.com/
Bennet Dunlap http://www.ydmv.net/2008/01/little-help-from-your-friends.html
Susan Fox http://www.pewinternet.org/Reports/2011/Medicine-20/Part-1.aspx
Kim Liu http://social.eyeforpharma.com/patients/patients’-week-2011-how-health-20-can-improve-patient-compliance

Talking with Teens

I had a conversation about teens and type 1 diabetes the other day. It was kind of an interview. I answer a lot of questions. I strayed off topic too.  (I know me digress! Who would think it possible?) 

Some how I think I forgot my favorite teen digression: if you expect your teens to talk with you, you need to have invested time talking with them before they were teens. If you were too busy watching the game, playing golf or skipping the occasional midnight movie premiere when they were tweens, you may have taught them you are not interested in them. 

Learn to be interested in what they like. This may come as a shock but all their music doesn’t suck and a lot of your’s does. Some where there is a balance in there. Netflix can help you both find stuff you didn’t now about and can enjoy a conversation on; Man on Wire, Exit Through The Gift Shop. 

It also helps to be genuinely willing to hear what they have to say if they do talk with you. If they like something you don’t, be open to why. Five will get you ten your behaviors taught them the why and you didn’t even know it. 

I like teens, so far they are the most fun age the kids have been. They start showing flashes of real interesting stuff as teens. Some is a reflection that is an interesting perspective of yourself and some is a fascinating tangent from who know where. Either way teens are as good as the time you have invested in them. 

That guess that isn’t any kind of a surprise.




Also on YDMV about teens at T1D: Dr Freud - Endocrinologist and Teen Motivator


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Succeed in Safe Schools - PA HB 1338

Kids should be safe at school.

Including kids with diabetes. Some kids may need support to be safe.  Legitimate budget, scheduling and other reasons may keep a school from having nursing coverage. Safe at school means the kids can go to school and be safe if the nurse has a family issue, traffic problem, heaven forbid needs to escort another kid to the hospital in an emergency or if the school doesn't have a nurse.

There are best practices recommended for diabetes and schools created by the leading health and education professionals. They are in a document called Helping the Student with Diabetes Succeed: A Guide for School Personnel. It was written by the NDEP, a partnership of the National Institutes of Health, the Centers for Disease Control and Prevention, and more than 200 public and private organizations.

Not exactly bums.

"Helping" anticipate that, while not ideal, some schools without a nurse may still need to help a child with diabetes succeed. Succeed what a great word.

Let's focus on succeeding.

Legislation is pending in Pennsylvania to try to help kids succeed in safe schools. There is a op/ed piece in @PhillyInquire on the topic and it is well worth reading. One commenter at the paper asks if proponents would send their diabetic child to a school without a nurse.

I have and would.

While we currently have the World Greatest School Nurse, we have never insisted upon a school nurse. I recognize that safe at school can be accomplished with non medical professionals who are open, communicative and trained. That said even a great nurse will be constrained by narrow minded and uncommunicative people in power who refuse to consider best practices for their own ends.

To help kids succeed in safe schools, I support PA HB 1338. I encourage you to learn about best practaces and support it, or similar legislation in your state, too.

Voices of YDMV.

I am honored to be a guest on Just Talking this week.  Christopher and I had a great time talking and I probably got over passionate about my favorite BBC Top Gear episode (Hint: Trying to Killing a Toyota Truck.) I may have been as interested in community support, the DOC, #DSMA and why I follow @SStrumello on twitter or maybe not. Have you seen that Top Gear?

I think PodCasting is brilliant. The first diabetes online resource I followed was DiabeticFeed. That feed is on hiatus for the spectacularly wonderful grounds that chasing around a toddler is serious work. Fortunately Just Talking, DSMA Live and other shave stepped up to the plate with podcast production. Good thing. I couldn't do it.

Also sharing the voice of the YDMV household is my former toddler and now tall young adult Connor. He spoke to a group of potential corporate sponsors of ADA’s Tour de Cure  in the packed conference room of a very prestigious law firm in downtown Philly this morning. Closing the presentation, he took the scary statistics and made them a both positive and personal. He was optimistic and appreciative of the support networks, including advocacy groups and their corporate sponsors, that make it possible for people to pursue dreams in their lives with diabetes.

Sadly the Tour is the day of Connor high school graduation or we would ride.

Connor did a fantastic job if I do say so myself. And in case independent no aligned testimony is required, a partner in the firm told Connor he would make a great litigator and the executive director of the local ADA chapter wants him back at other events. I rest my case.

Want Industry to Know What Matters Most to You? @Diabetes_Sanofi is Listening! (limited time offer)

I recently asked about devices. I am not the only one who's curious to know what matters to people living with diabetes. The Sanofi folks want your two cents and they are willing to entertain a wider perspective than just gadgets. They are also more in a position to do something about it. Sanofi are the makers of some useful stuff. Stuff like Lantus, the soon to come to market iBGStar and sponsors of my favorite bike racing team. Good folks. You may know them on Twitter as @Diabetes_sanofi.

They they want to know, “What Matter Most to You.” I shared my views. (I know! Who would think I, of all people, would share my view?) But Your Diabetes May Vary, in fact I bet it does. Sanofi wants to hear from all of us in the Diabetes Online Community. 

Here's my two cents:

Act NOW the survey closes on Feb 12. 

How about filling out their from.  If you feel inclined, share your essay question reply to:
"I see the biggest challenge in diabetes as _______" as a comment here. 


Who knows your comment may inspire someone else to think about what matters most to them and maybe even share it.

Dexcom and Tandem Announce CGM Development.

From the News Wire:

SAN DIEGO--(BUSINESS WIRE)-- DexCom, Inc. (NASDAQ:DXCM - News), a leader in continuous glucose monitoring systems, announced today that it has entered into a Development and Commercialization Agreement with Tandem Diabetes Care, Inc. to integrate a future generation of DexCom’s continuous glucose monitoring (CGM) technology with Tandem’s t:slim™ Insulin Delivery System, the first ever touch-screen insulin pump.

Under the terms of the Agreement, Tandem will pay DexCom a technology license fee of $3 million, reimburse DexCom’s development, clinical and regulatory expenses, and upon commercialization of the combined system, Tandem will pay DexCom a royalty of $100 for each CGM-enabled insulin pump sold. 

more here

So that is Animas, Omni Pod, Roche and Tandem all working with Dexcom to integrate DGM into their pumps. I think the Animas agreement is exclusive outside the US (see this post). So all the agreements are nice and all, I hope that we see some products in the marketplace.

Maybe this will help speed up the FDA process.

From the New Wire:

FDA and industry reach agreement in principle on medical device user feesThe FDA and representatives from the medical device industry have reached an agreement in principle on proposed recommendations for the third reauthorization of a medical device user fee program. 

The recommendations would authorize the FDA to collect $595 million in user fees over five years, plus adjustments for inflation. Details of the agreement, such as the fee structure, are expected to be finalized soon 

Under a user fee program, industry agrees to pay fees to help fund a portion of the FDA’s device review activities while the FDA agrees to overall performance goals such as reviewing a certain percentage of applications within a particular time frame. more..