I have just posted on my other blog about my data analysis of the volatility within a month’s worth of CGM readings. Using R, I wanted to explore ways of judging readings by methods other than just average daily blood sugar. This was completed for my Data Without Borders class at NYU’s ITP. The full post is here.
Last weekend, I headed to Philly for the ADA’s 72nd Scientific Sessions. It was my first time attending an ADA event and I found it quite interesting. Throughout the day there were speeches on all the major topics, with researchers presenting their most recent findings. The exhibition hall was also filled with device manufacturers and pharmaceutical companies.
The most interesting session I attended was on closed loop systems, the combination of insulin pumps and continuous glucose monitors. It was my first chance to hear Edward Damiano, the Boston University biomedical engineer. He was one of several speakers researching a combination pump/CGM that delivers both insulin and glucagon. The thinking is that having both hormones available allows for greater control, with one lowering and one raising blood sugar levels. Other speakers noted the encouraging results from the Medtronic Paradigm Veo. It suspends insulin delivery if blood sugars go low and the patient does not respond to alarms. Together, all the research looks quite encouraging. At the same time, I highly doubt that this technology will be widely available for several years. Multiple presenters talked about how difficult it has become to get government clearance for the U.S. market, even after approval in multiple other world markets.
Strolling through the exhibition hall, I checked out several new insulin pumps and CGMs. I was certainly impressed with the Cellnovo pump. Produced by a British team, it is one of the most stylish and well designed systems I have seen. They have certainly studied the Apple design aesthetic. The device is a small patch pump with an accompanying touch screen handset. The handset has a glucose monitor conveniently built in. Most interestingly, their pump contains an internal accelerometer for sensing the activity level of the patient. The thinking is that the pump can warn a user if excessive activity levels are about to lead to low blood sugars. Cellnovo is still awaiting approval for their system in the U.S.
Tandem’s new T:Slim insulin pump also got a fair amount of attention. It bills itself as the first touch-screen pump on the market. The device is quite small and also has a carefully considered design. Yet when you look at the details, Tandem’s product fails to deliver as great a user experience as the Cellnovo. For example, the T:Slim gives a readout for insulin on board by noting the amount recently delivered and a countdown until the insulin has passed through the system. But since rapid-acting insulins have such a clear spike after their delivery, it would be more helpful to see this data displayed differently. The last 2-3 hours of activity are rather low and should only factor in minimally to patients’ decisions.
Nonetheless, I am excited to see more competition in the pump marketplace. Medtronic currently has 72% U.S. market share. The U.S. market also represents a similar 72% of global sales. More choices for patients will certainly inspire greater product innovation.
I also visited Dexcom’s booth, which also housed the team from SweetSpot (Dexcom acquired SweetSpot in February). I am often amazed by how accurate my Dexcom CGM is most of the time. On display was their next generation CGM. The transmitter remains about the same size but the receiver has gotten about 30-40% smaller. It closely resembles an older version of the iPod Nano. The transmission range will be greater as well. They are hoping to have it on the market within the year.
With every device manufacturer I visited, I asked them about data format standardization and accessibility. Each representative had no idea how to respond to my question. None seem particularly interested in building an API to allow patients greater access to their own data. Just like developments in the hardware design, I assume it will take one or more smaller manufacturers to disrupt the current system. I wholeheartedly believe the trends in patient-centric design will mean that patients will insist on having easy and complete control over their data. It is amazing to me that hardware manufacturers continue to produce these mediocre proprietary software. Let’s hope that a new system will emerge soon that gives patient full data portability, allowing for greater software innovation. This will give patients greater options for improved feedback loops, data analysis and notification systems. I am confident these changes will empower patients and lead to improved health outcomes.
As part of my grad school work at ITP, I recently completed a project called “Ready to Start” for my Collective Storytelling class. “Ready to Start” tells the stories of athlete’s first long-distance race, be it a marathon or a triathlon. It focuses on the motivating factor for people to take on this challenge, dedicating both the time and energy needed to train and complete it. In total we conducted nine interviews, three of whom are patients with diabetes (including myself). For a longer description of the project, please see my ITP blog post. Or just jump to interviews with my inspiring fellow type-1 patients Rachelle Glantz and Jen Davino.
I’ve recently completed my most recent data visualization called Insulin on Board. I looked at 100 days of blood sugar and insulin data to see whether a low-carb diet was effective in keeping my blood sugars in range. To see a PDF of the final version, click here: http://bit.ly/KRTCzP
To learn more about the project, I have another blog post here detailing how and why I made it @ http://bit.ly/Jca8tX
This project was included in the show at NYU’s ITP where I recently completed my first year of grad school. It was also featured on the Flowing Data blog @ http://bit.ly/KR2Tf2
I recently got a quarterly check-up and A1c. I was quite interested in seeing the results since I have begun this project and been so focused on my data. My A1c has stayed at 6.4 for the last few years. That has been my best result ever. For about the last decade, it has slowly dropped from about the 6.7 range.
So I was quite shocked and excited to get a result of 5.6! Not only is it my best ever, but it is a significant drop in 3 months. In addition to a close focus on my data, I think a low-carb diet was also helpful. In particular, I have been trying to my lunchtime insulin dosages from the 7.5 u range down closer to 2.5 u. I’ve seen much less of a spike in blood sugars in the early afternoon as a result.
It’s also obviously been helpful to be running a lot lately. I’ve made a weekend long run of 10-13 miles my norm and tried to get in another 2-3 5 mile runs during the week. It’s been helpful in lowering my insulin pump basal rates and also given me a lot of energy.
With the exercise and diet changes, I was also able to drop 12 lbs. and drop my cholesterol over 20%. Hopefully I can maintain and build on these successes.
In preparation for a 14 mile run on a Saturday morning a few weeks ago, I broke from my normal low-carb diet the night before and decided to carb load. The week before, I had lost energy the last few miles of a 13+ mile run. I wanted to see whether a change in my diet could help.
I ended up getting fluctuations in my blood sugar in really unexpected ways. For the entire 2 hour run, I struggled to get my blood sugar up to normal levels despite eating massive amounts of carbs along the way.
I am a big fan of my Dexcom in most ways. The majority of the time, I find it to be extremely accurate. I am frustrated by the physical design of the receiver. I am shocked that the device is the same size as an iPhone, but only serves one function. Nonetheless, as an asset for a patient, I think the Dexcom is great.
Lately however I have come across another problem with the device. The sensors are supposed to work for a week after inserting the needle. But almost every week the last few months, I get a full 12 hours of the “???” message. After that, it seems the device gets its bearings and works accurately. This is frustrating because these sensors are not cheap. Losing half a day from a 7 day cycle seems like a substantial flaw.
Happy New Year, everyone! I am starting this blog to document a new, year-long project related to Databetes, the company I have founded. Throughout the year, I am recording all my diabetes-related data in an effort to improve my type-1 diabetes control. This includes every blood sugar reading, medication dosage, exercise statistic and A1c blood test. I will also record nutritional information for every meal, snack and (non-water) beverage. I’ll also be adding photographs, geolocation data and other information from my mobile phone.