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21th Annual Shooting Stars JDRF Walk to Cure Diabetes Sunday, October 23, 2016 in Newport Beach, CA at The Waffle House

For a contribution of $50 (or MORE!), walkers will receive a VERY COOL Shooting Stars Team T-Shirt while supplies last. Contact Joanne if you are interested in attending the event. joanne@TheSavvyDiabetic.com. To donate on-line, please go to: http://tinyurl.com/z5c2x8e.

Afrezza, the Amazing Inhalable Insulin

 

I’ve been using Afrezza intermittently for the past 2 years … and am continually amazed at how well and how fast it works! 

What is Afrezza?  Developed by Al Mann (who also developed the insulin pump and the cochlear hearing implat, among many other great advances – see a tribute to him in my blog archives), Afrezza is the only inhalable insulin available on the market today. 

Afrezza is dried human insulin produced in a lab from recombinant DNA. The powder is placed into carrier particles (called Technosphere particles) that are so small that once inhaled they can reach your deep lungs, which have the surface area of about half the size of a tennis court.

Just take a moment and visualize one side of a tennis court … that’s the amount of surface that is reached when you inhale Afrezza into your lungs. 

It comes in 4-unit, 8-unit and 12-unit cartridges, which equate, roughly, to 2.5U, 5U and 7.5U of liquid fast-acting insulin. 

 

 

But there are very distinct advantages:

Enhanced absorption: this is due to the very large, accessible surface area within the alveoli of the lungs
Rapid onset of action: Since the lung tissue consists of a large alveoli-capillary network, protein molecules such as insulin cross a thin barrier formed by the alveolar wall and the capillary wall, allowing for rapid delivery into the bloodstream.  Indeed it starts working within 10 minutes of inhaling and is mostly out of your system within 2 hours (as opposed to injectable insulin with an onset of 1/2 hour and duration up to 4 hours)
Absence of digestive enzymes that can inactivate insulin

 

 

On the downside:

About 1/4 of patients using Afrezza have reported a cough
Some decline in pulmonary function

My take on using Afrezza:

I think Afrezza […]

Savvy LOOPing: Running Open Loop

Here’s my LOOPing update.  I’ve been running the RileyLink for about 8 weeks.  I started running it OPEN, which means that it is ON but not making and implementing decisions with my insulin pump, based on the algorithm and CGM and carb inputs.  After about 2 weeks, I CLOSED THE LOOP!  Just overnight!  It was exciting.  NOTHING BAD HAPPENED!  In fact, my blood sugars seemed to run flat all night, between 100 and 140.  A miracle.  The next few nights were more bouncy but still good.  I never had a low while running the OPEN loop. 

About 3 weeks ago, I decided that I needed to tweak my pump settings, which haven’t been re-evaluated since I started pumping over 14 years ago.  And I think I may have entered some wrong settings when I was setting up basals on a new pump (I mean, really, how can my I:C ratio exactly equal my Insulin Sensitivity?!?!).  So I’ve been basal and ratio testing.  After all, GIGO (garbage in, garbage out) … I need to be sure the LOOP has as accurate settings as possible. 

I expect to CLOSE the loop soon … just running it CLOSED sometimes through the night. 

My take on using the CLOSED loop so far:

It’s safe!
It’s interesting to see how many corrections it makes throughout a 24 hour period
Seeing my data on Nightscout is a WEALTH of information.  THANK YOU, Nightscout folks for all the hard work you’ve given to make our lives better, using our own data!  #WeAreNotWaiting.

More to come on how to test your settings. 

Medicare, CGM and Liberty Medical: How to Work with Liberty

Let me start by saying that I am tempering my frustration with Liberty Medical.  It has been a rocky road dealing with them.  And they only get a one star rating on Yelp.  This doesn’t bode well.  But …

Liberty Medical is the ONLY way to buy Dexcom cgm supplies if you have Medicare coverage, at this time.  THE ONLY ONE!  And they are based in Florida, with only local EST time zone hours.  You’d think they might consider at least extending their hours to cover the US business hours … but no, not yet.

 

Given that we must get along, here’s what I’ve learned:

Liberty and Dexcom were caught by surprise by the sudden Medicare decision, and were totally unprepared for the “onslaught” of the demand.  Liberty was apparently considered the only medical supply company that could handle the volume of orders.  As a result, they’ve had to add staff and train them. 
According to Tim Jones, senior patient rep, about 80% of the staff are truly able to answer our questions.  Strange, huh?!  Why not give them an answer sheet AND POST THE ANSWER SHEET ON THEIR WEBSITE?!  Not yet.
They’ve reduced the on-hold time to under 30 minutes to reach a rep.
However, if you did get put on hold for longer than 10 minutes, you can call Dexcom directly, who will then patch you in to the Liberty direct line and get answers right away.
The Medicare billing codes were published on March 13, 2017, allowing Liberty to take your order and bill Medicare. You do NOT have to pay upfront and hope that Medicare will reimburse you.  However you must sign an ABN form that allows them to bill Medicare and, if Medicare does not determine […]

Savvy Top 15: Here are the Top 15 Pharma Companies of 2016

I just found this really interesting.  As published in FiercePharma.com, 14 March 2017, here’s the list of the top 15 pharma companies by 2016 revenue … and these are some BIG revenues! Don’t see Novo Nordisk in there.

 

 

1. Johnson & Johnson (who own Animas and One Touch in the Diabetes Care unit, whose revenue drops 7.2% to $1.8 billon)
2. Pfizer (Lyrica for neuropathy)
3. Roche (who recently dropped out of the insulin pump market)
4. Novartis
5. Merck & Co. (Januvia)
6. Sanofi (Lantus)
7. GlaxoSmithKline
8. Gilead Sciences
9. AbbVie
10. Bayer
11. AstraZeneca (Farxiga)
12. Amgen
13. Teva
14. Eli Lilly (Humalog, Trulicity and Jardiance)
15. Bristol-Myers Squibb

Savvy Humor: Mankoff’s “Not Covered”

Just a little “giggle” from Bob Mankoff, the cartoon editor of The New Yorker for the past 20 years.  He is stepping down from that post but certainly not retired! Thanks Mr. Mankoff for all your humor!

Savvy Updates 3.12.17: Alexa, Live Stem Cell Imaging, New Cause of T1

Wow, some really neat stuff in the news!
Merck aims to put Amazon’s Alexa to work on voice-enabled diabetes tools, according to a post on FiercePharma.com by Beth Snyder Bulik, 8 March 2017 … thanks to Mike Hoskins for the heads up.
Using Amazon Lex, the brains behind the Amazon Echo device and its well-known voice-enabled assistant Alexa, Merck & Co, in a new partnership with Amazon Web Services, plans to initially work on diabetes. Its first initiative will be a call to entrepreneurs, techies and industry types for an innovation challenge expected to begin within the next month.
The yet-to-be-named challenge will be run by strategy and innovation consultancy Luminary Labs. While specifics haven’t been released, the call to action will “be open to solutions broadly enough that innovators of all stripes can come up with really novel ideas but being narrow enough to provide guidance and carefully evaluate submissions,” said Sara Holoubek, founder and CEO of Luminary Labs.
Read more: Merck aims to put Amazon’s Alexa to work on voice-enabled diabetes tools
 

Live stem cell imaging technique opens new windows into pancreatic regeneration, as posted on www.diabetes.co.uk, by Camille Bienvenu, 3 March 2017. 
Richard Tan, a PhD student from the Heart Research Institute, in Sydney, Australia, has developed so called “bioluminescent” (that emit a light signal in order to track their fate in real time once injected into the body) stem cells as a non-invasive way to give scientists immediate feedback on whether organ tissue regeneration is actually working.
In type 1 diabetes, stem cell-based therapies hold promise to regenerate cells of the pancreas. The goal is to have the stem cells transform into insulin-producing cells.
Read more: Live stem cell imaging technique opens new windows into pancreatic regeneration
Stem cells are […]

Savvy Sweet Fun: SUGAR

I just read a fun and comprehensive blog post on the FIFTY SIX (56) names for sugar, thanks to Nicole Pajer on ASweetLife.com.

Sugar is everyone and in so many of the foods we eat.  According to the article, added sugar is in (hiding or not obvious) in 74% of packaged food! 

“A sugar or carb, no matter what the source, with increase your blood sugar,” says Danielle Carlesimo, a registered dietitian at Henry Ford Macomb Hospital in Michigan. Carlesimo is quick to add, however, that just because “natural” sweeteners like honey have some nutritional value, they will still cause blood glucose to spike and should therefore be avoided.

 

The list is long and detailed and fascinating! 

Here’s the list … but definitely read all about each sugar: You Should Know These 56 Names for Sugar
Agave nectar, Barley malt, Beet sugar, Blackstrap molasses, Brown rice syrup,  Brown sugar, Buttered sugar, Cane juice crystals, Cane sugar, Carmel, Carob syrup, Caster sugar, Coconut sugar, Confectioner’s sugar, Corn syrup, Crystalline fructose, Date sugar, Demerara sugar, Dextrin, Dextrose, Diastatic malt, Ethyl maltol, Evaporated cane juice, Florida crystals, Fructose, Fruit juice, Fruit juice concentrates, Galactose, Glucose, Golden sugar, Golden syrup, Grape sugar, High-fructose corn syrup, Honey, Icing sugar, Invert sugar, Lactose, Malt syrup, Maltodextrin, Maple syrup. Molasses syrup, Muscovado sugar, Oat syrup, Panela, Panocha, Raw sugar, Refiner’s syrup, Rice bran syrup, Sorghum syrup, Sucanet, Sucrose, Syrup, Treacle, Tapioca syrup, Turbinado sugar, Yellow sugar

CGM under Medicare: Liberty Medical Takes Order and Ships!!!

Here’s an update from Frank, one of my readers:

“Liberty” phoned me Tuesday and said Medicare had OK’d the new billing codes and they could start filling claims. They emphasized that if Medicare denies the claim & any appeals, I will be responsible, which is okay with me since I’m currently paying cash anyway. This morning I got a email from Liberty saying that my G5 starter kit was shipped. The UPS tracking says I’ll receive it on the 16th.

Congratulations Frank and thank you, Liberty!  Looks like there is progress on the Medicare/CGM front.  Billing codes are in place.  Now, as soon as Medicare publishes their coverage criteria, we can all feel more confident that our Dexcom CGM supplies will indeed be covered by Medicare!  And I’m sure that is coming.

Maybe even Dexcom will allow us to order directly from them, unless this is a stipulation by Medicare.  And watch for the Medicare requirements for each order.  Still looks like you can’t only order sensors and not sure about the meter and strips they are sending along with each kit.

Savvy Updates 3.5.2017: Fasting, Finns, Funding

As always, lots happening in the diabetes world of technology, research and more!

Fasting Diet Regenerates Beta Cells in Mice was featured on InsulinNation.com, 24 February 2017.  The subtitle: The cyclical diet also restored insulin sensitivity.
Researchers from the University of Southern California and the University of California have published findings in the journal Cell that suggest that a fasting-mimicking diet induced the bodies of diabetes-model mice to grow new beta cells and restore insulin sensitivity.
They added (PLEASE READ THIS): Multiple news stories reporting on these findings contain a “do not try this at home” disclaimer paragraph, and with good reason. These findings should not be considered a license to stop insulin therapy. Also, no one with diabetes should consider undertaking a major shift in diet without discussing it with their medical team. Finally, it’s important to remember that what works in mice may not work the same way with humans; the mouse pancreas is more simple in structure than the human pancreas, and there have been many mouse “cures” for diabetes that do not provide nearly the same results for humans.
However, this study joins a growing body of research that suggests that carefully regulated, scientifically-approved fasting may induce short-term and long-term changes in the body, and that some of those changes could be found to provide health benefits for people with chronic conditions or who are undergoing chemotherapy.
Remember, we are NOT mice!
Read more:

Fasting Diet Regenerates Beta Cells in Mice
Fasting-Mimicking Diet Reverses Diabetes in Mice
Cell Metabolism: A Periodic Diet

 

Finns Have a Higher Risk of Type 1 than Russians, as reported again in InsulinNation.com, 11 July 2016.
One in every 200 Finnish children under the age of 15 has Type 1 diabetes. In the neighboring region Karelia, […]

Medicare CGM Saga Continued

I am not trying to stir the pot of frustration about Medicare and Dexcom … but here goes.

As I mentioned, Dexcom absolutely CANNOT sell me any product, for cash, because my file shows that I am covered by Medicare.  Even if I just want to BUY a transmitter CASH, the answer is NO.  They are referring everyone over to Liberty Medical Supplies in Port St. Lucie, FL, only open from 8am-5pm EST. 

I finally was able to get to my desk early enough to call them today … and I sat on hold for 42 minutes.  I finally reached a lovely rep named Liana (they’ve all been very pleasant).

 

Here’s today’s scoop:

I first had to register as a new patient with Liberty … no problem, as, for some reason, I was already in their database?!
Then they will request a new prescription from my endocrinologist … also no problem, even though there is one on file with Dexcom.
Next, she emailed me the ABN (Advance Beneficiary Notice of Noncoverage) form.  AHA, there’s where I learned a lot!

Medicare will cover orders as follows:

Dexcom G5 Kit, a 90 day supply for $745.14, which may include

1 Transmitter
3 boxes of sensors
4 boxes of test strips, 2 meter batteries
1 blood glucose meter (brand unidentified), even if I don’t need one

Dexcom G5 Receiver, for $277

After I submit this form, on which I choose whether I want them to bill Medicare, not to bill Medicare or not to order supplies, I can then call and place my order.  Remember, today’s call lasted 62 minutes.

I was reminded that I would be fully responsible for $745.14 if I do not qualify under the Medicare criteria, which have not yet been published! 

In other words, I will place an […]