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ADVOCATE: n. [ad-vuh-kit, -keyt]: a person who speaks or writes in support or defense of a person, cause, etc.

It’s really not very hard … and it’s really important. After all, who’s more important to your own life than you? It is survival.

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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.

Savvy Update, 5/29/2017: Fiasp, Senseonics, Apple, Nevada Law

Here are some great blog posts by Tim Street about his experiences and comments about the new faster-acting insulin, Fiasp.

 

 

 

 

 

48 hours with Fiasp. What are my first thoughts on Faster insulin Aspart?
My month with the newest kid on the block & a hypothesis on the #Fiasp effects

And from ASweetLife.com: Just How Quick is Fiasp, Novo Nordisk’s Faster-Acting Insulin?
 
Roche helps Senseonics raise $41M to push diabetes device, as reported in FierceBiotech, 5/26/2017. 
Senseonics is set to raise $41 million to support the anticipated commercialization of implantable continuous glucose monitoring (CGM) system Eversense. The fundraising attracted the support of major existing shareholders New Enterprise Associates (NEA) and Roche.
Senseonics’ is developing an implantable sensor. Once inserted by a doctor, the sensor uses fluorescence technology to measure glucose levels in the interstitial fluids. The sensor sends readings to a wearable patch that, in turn, processes the data and relays information to a smartphone app. Users are alerted when the technology forecasts glucose levels will exceed preset targets. The sensor lasts up to 90 days.
Read more: Roche helps Senseonics raise $41M to push diabetes device
 
Apple CEO Tim Cook Test-Drives a Blood Sugar Tracker, as reported by CNBC, 5/18/2017.
Tim Cook has been spotted at the Apple campus test-driving a device that tracks blood sugar, which was connected to his Apple Watch.  A source said that Cook was wearing a prototype glucose-tracker on the Apple Watch, which points to future applications that would make the device a “must have” for millions of people with diabetes — or at risk for the disease.
Read more: Apple CEO Tim Cook test-drove a device that tracks his blood sugar
 
 
Nevada bill could force Sanofi, Novo and Lilly to reveal their insulin pricing secrets, as reported […]

Savvy D-Blog Week 2017: It’s ONLY Money!

Today’s blog topic is: The Cost of a Chronic Illness.  Woooo, there’s a lot of room for writing here, including insurance, Medicare, coverage, cost of our care, accessibility and much, much more! 

I’m talking today about the cost of being an Early Adopter!  I simply can’t help it.  I admit it! When something comes out and looks fairly safe, I WANT IT!  I don’t want to wait (hence, #WeAreNotWaiting)!

I had one of the very first blood glucose meters in the early 1970’s called the Ames EyeTone Reflectance Meter.  It was a clunky, plug-in device, not terribly accurate … and cost about $450. But it was better than testing urine with Clinitest!

When I first heard of CGM, I wanted to start with Abbott Navigator … but Dexcom beat them to market … so I jumped in with the very first CGM, the Dexcom STS … it was NOT very accurate but I knew it was going in the right direction.  When Navigator came to market, I switched over, until Abbott pulled it off the market … then right back to Dexcom, by then, Dex3. 

I heard rumblings from the NightScout group … bought all the pieces for the “rig” and jumped in there too, using a Pebble watch. Loved it.

Cautiously, I decided to try Looping … and am learning every day and am amazed at the smoothness of my CGM data, especially throughout the night.

FIASP!  Approved in EU and now in Canada, it won’t be approved by the FDA until the end of 2017.  So I want it!  Others in the D community are trying it … and even Loopers are figuring out the algorithm using it. 

Do you know what it is?  Fiasp (Faster-Acting Insulin Aspart), made […]

Savvy D-Blog Week 2017: Diabetes and The Unexpected, LOOPing

So happy to be back blogging for www.BitterSweetDiabetes.com’s annual Diabetes Blog Week, hosted by Karen Graffeo.  Some great topics coming your way this week!

Today’s topic is Diabetes and The Unexpected.  And my latest, of a lifetime of “Unexpected’s” occurred last week, as I’m learning about Looping with RileyLink. 

I noticed that, while running in Closed Loop mode, sometimes after an infusion site change, my Loop started a 0% temp bolus rate during a rising blood sugar.  It made no sense.  If I turned of the temp rate, it would turn it back on. 

Was there a demon living inside my RileyLink motherboard? 

NO!  I finally posted the question on the Facebook page, Looped … and got several very excellent answers, including how to resync the clocks on my phone and my pump.  But the big answer:  When I change my infusion site but use the same reservoir, as I fill the tubing and the cannula, Loop sees that as IOB.  Suddenly I’m showing 11 units of IOB, so OF COURSE, it should shut off!  And believe it or not, from the amazing folks on Looped, there is a definite work-around by deleting history so the Loop doesn’t get confused. 

Ta-Da!  Done … 2 problems solved!  Loving my RileyLink more and more every day, as I experience more “Unexpected’s”!

Savvy Apps Update 5/11/2017

The hot buzz these days is all about health apps.  Some track exercise. Some act as insulin bolus calculators. Others are log books and reminder alarms … and more.  Here’s just an update on the app market.

 

Fitness Trackers … Are They Accurate? as reported on MedPage Today, 1 May 2017.  A study conducted by Cadmus-Bertram test 4 popular trackers on the market vs. the gold standard ECG at rest and at 65% of max heart rate during exercise on the treadmill.
The trackers in this study:

Fitbit Surge
Basis Peak
Fitbit Charge
Mio Fuse

The results matched closely with the results from a Cleveland Clinic study conducted last year.  The ECG results and repeatability coefficient compared well at rest for some devices, such as the Fitbit Surge. However, the accuracy and precision of the measurements seem to vary a lot during exercise.
While these devices may be “close enough” for assessing daily activity and exercise, more study is needed to use the data clinically.
Read more: iMedicalApps: Are Fitness Trackers Accurate?
 

Glooko & Fit4D Combine Digital Diabetes Management, Human Coaching, reported on FierceBiotech, 27 April 2017. 
Glooko and Fit4D, a diabetes-focused health coaching service, are combining their offerings to provide patients with an “end-to-end” solution for diabetes management.
Under the partnership, the duo will combine Glooko’s digital platform, which integrates data from an array of diabetes devices, and Fit4D’s technology that connects patients to a team of certified diabetes educators—including clinicians and dietitians—that coach individuals who are learning to manage their disease. The combined platform will result in one of the most “scaleable, integrated diabetes management offerings,” the companies said in a statement.
Read more: Glooko, Fit4D combine digital diabetes management, human coaching
 

FDA Clears Apps to Optimize Basal Insulin Dosing, published on […]

Savvy Guest: Looping Update by Jessica Ching

I’ve know Jessica for many many years … we go way back and we were about the first T1’s to start on Dexcom STS, first generation.  Jessica went on to work for Dexcom and then Abbott (when they were selling the Navigator CGM).  She’s now a technology consultant based out of Berkeley.  Her comments are excellent and I must tell you, she manages her diabetes with a great deal of technical skill and attention.

 

Jessica’s Take Away after 3 or so months of looping with the RileyLink

The Good:  

 Average has dropped about 5-10 points (not much, but it’s a bit)
 Time spent above 160 reduced by more than half (now around 13% vs used to be 29%).  That is awesome
 Less swings; std deviation was 52 but is now 36.  I think this will improve, even before we take the next step

The Bad:

I spend a lot more time managing diabetes, mainly because RileyLink goes from online to offline throughout the day.  So I have to constantly be checking on it.  If the red circle was there for a while sometimes I manually compensate (I couldn’t agree with her more.  It does require a lot of attention and rebooting and retuning.  But I am reminded that this is still a do-it-yourself project!)
Pump battery only lasts 5-6 days.  I’m using cheap Duracells from Costco.  (Very true … I’m trying to make my AAA battery in my Medtronic 723 last 7 days but just barely.)
Exercise is problematic as my basal manipulation pattern for exercise doesn’t work any more.  My software partner told me he thought it was because my body was accessing and using glucose differently. My goal is to tell Loop up to 4 (?) hrs in advance when […]

Savvy LOOPing: their language!

I am far from even being semi-technical but I can, very slowly following instructions and ask questions kindly, always saying please and thank you. 

But I just saw an exchange on a site about figuring out how to break the codes on other pumps:
This week, there’s been some discussion on the Slack channel about how to get a bit deeper into the radio packets involved in the communication protocol. I’m semi-technically literate, but no where near the group of folks that are actively banging away on this problem, so I asked for an explanation of the current problem. Dan was kind enough to reply: 
Think of the radio packet like an onion. it has several “layers.” the network layer is the outermost layer. we understand all of those fields. inside that layer is the data layer, which we understand many of the commands and fields. but there are a few bits of data that are used to verify the integrity of the command. think of this like a wax seal from the middle ages, used to verify the integrity of a letter from a king. we need to be able to re-create that wax seal, (the verification bytes) in order to reliably craft packets of data which the pod will accept.  
There is an algorithm, which we think is a CRC style algorithm, that is used to generate that wax seal. I believe it’s a 16-bit CRC. Pete has pointed out that there is some “bit-masking” going on, which makes it hard to crack.
Got it?!  Me neither, only a bit.  HOWEVER, I am EXTREMELY grateful for these passionate, dedicated programmers/hackers for good to help the D community.  I don’t know most of them but I love them […]

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 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 […]

Savvy in Hollywood: I Was the T1 CoHost on the Bonnie Sher Show AGAIN!

Oh, what fun!  I was invited back onto the Bonnie Sher Show today to speak about LOOPing … running a closed loop hybrid insulin delivery system, using RileyLink.  I had about 20 minutes to explain about the closed loop system and my experiences over the past 6 weeks.  It was exciting and a blast!  In addition, the first 1/2 hour on the show featured Dr. Andrew Drexler, a super endocrinologist in Los Angeles whose been taking care of T1’s for over 40 years … wow, is he ever knowledgeable!

Here you go … or as they say in show business, Take It Away!!!