Tag Archives: artificial pancreas

Defining Moment

Every now and then, I look back and realize just how far we’ve come in less than ten years. I realize access is an issue, and it deserves its place and time. But for this moment in time, I’d like to focus on the sheer magnitude of advances we’ve witnessed over the last decade.

Part of the story of the birth of this blog comes from a radio interview heard by The Great Spousal Unit one day. She called me at work, very excited, and told me I needed to listen to it with her after work that night.

The interview was about artificial pancreas technology. The year was 2011.

I’ve told this story several times, so if you’ve heard it, feel free to skip down a little farther. If not, here’s a little background:

I had been wearing an insulin pump for about a year by this point, and my diabetes management was okay, though I really had troubles with highs and lows. The averages were good, the peaks and valleys were not.

After we listened to the interview, the conversation went something like this:

Maureen: ”Isn’t that exciting??? I mean, isn’t that really groundbreaking?”

Me: ”Yeah, well, if they could get it to work, it would be exciting. There’s a long way between here and there.”

Maureen: ”I can’t believe you’re not excited about this. You love this stuff!”

Me: ”Okay, it’s interesting. If it works. What do you want me to do about it?”

Maureen: ”Find out about it! Someone has to be writing about it… find a blog!”

The next morning, I googled “Diabetes Blogs” and found the Diabetes Online Community.

Since then, I’ve seen countless talks and presentations and read position statements and FDA guidance on the subject. I’ve seen a lot of the work that was done at the University of Virginia on the subject.

I attended early Children With Diabetes Focus on Technology events where prototypes of the Bionic Pancreas (as it was known then) were displayed and talked about. I’ve been to FDA public workshops where evidence was presented that shows time in range for blood glucose is better than the simple A1c, and backed up with clinical data on closed loop systems.

I’ve seen the likes of Dana Lewis and Tidepool’s Howard Look speak about DIY closed loop systems, part of the #WeAreNotWaiting movement that has really helped accelerate the pace of development.

I’ve watched as now, finally, every insulin pump manufacturer in America has undertaken ongoing work to bring the best of this game-changing technology to people living with diabetes.

Through it all, I’m amazed at the dedication of the hundreds of individuals who have kept this dream alive through research, and through participation in clinical trials, pushing forward, clearing hurdle after hurdle. #WeAreNotWaiting? How about #WeAreNotGivingUp?

Recently, I’ve also thought about how much of an honor it has been, and what good fortune it has been, for me to witness this time. Access issues aside, we are all so lucky to be around during this defining moment in diabetes history.

There are so many interviews I’ve done, so many questions asked, of those working on this. But I wonder if the best interviews, the best questions, the best answers, might come a few years down the line, after closed loop insulin delivery becomes de rigueur. What stories these pioneers can tell!

In the meantime, I’ll be watching and waiting, and cheering the men and women who are changing what diabetes management looks like for this generation and beyond.

What good is new technology if you can’t pay for it?

My great nephew celebrated his second birthday this past weekend. I celebrated another day on the blood sugar roller coaster.

It was a busy day. Maureen’s sister and two of her children had been visiting for a few days, and they left Saturday morning for the trip back to Ohio. So we were up at 6:00 a.m. to see them off. Maureen also had to pack and leave for a few days taking care of some pets in another part of town. Add in another event on the other side of town prior to the birthday party.

I don’t know if it was the choreography of putting the day together, or my eat-whatever-you-can-whenever-you-can-eat-it dietary selections, but I was sitting over 200 mg/dL for hours. The correction doses of insulin I had been giving myself were finally paying off around 4:30 in the afternoon as I headed off to the birthday party.

My glucose level was coming down, though not fast enough to cause alarm. I was at 109 mg/dL when I arrived. I added a pre-bolus for dinner, and thought I was set.

But as luck would have it, I didn’t time dinner perfectly. It was a little later than I thought it would be, and as we finally sat down to eat, my eyes glazed over and I got that “Stop Talking and Eat!” look from Maureen.

Everything righted itself eventually, but I’ve had a couple of days like that back-to-back now. It shows me that I’m good with my diabetes management, but I’m not perfect. That’s usually a good time to remember that there are tools and technological advancements on the way that promise to help reduce the burden of days like this. In the case of artificial pancreas research, Someday is a lot closer than ever before.

Then, almost in an instant, the next thought popped into my head: But… what good is a great new device if you can’t pay for it?

The U.S. House of Representatives passed their version of “repeal and replace” health care legislation on Thursday. What was already expensive could get prohibitively expensive should the Senate follow suit. We know there are already people using Facebook groups to try and get the insulin they need. Test strips are $1.00 or more per strip, which adds up fast. The retail cost of a new insulin pump is thousands of dollars.

For people who desperately need insurance to help defray some of these costs, purchasing insurance through a high risk pool that costs more (someone my age living with diabetes might have to pay $20,000 or more per year) creates an impossible dilemma.

There are 14 doctors and nurses serving right now in the House, and 3 doctors serving in the Senate. In the House vote, 10 of 14 voted for this legislation. Do No Harm, my ass.

From govtrack.us


Managing diabetes was already expensive before Obamacare. It was still expensive under Obamacare. It will be prohibitively expensive under this new legislation. The House of Representatives, at least, are exacting an impossible price on Americans simply because they hate the previous president.

But I’m not giving up without a fight. And I will remember at the ballot box. I’m going to call and send e-mails consistently, even after this fight is over. If I’m going to have to manage my diabetes every day while protections for myself and my loved ones are being taken away, only because they’re expensive, I’m not going to let them rest. I will make their victory a difficult one. I will make their victory unworth the price they have to pay to get it. What about you?

Let Congress know that you’re not going down without a fight. And if they try again, you’ll fight again.

CLICK HERE to download the DPAC app. With the DPAC app, you can get timely alerts, contact elected officials without going to a website, and insert your own diabetes voice into the conversation faster and easier than ever before.

THIS PAGE has every member of the House of Representatives listed, links to their websites, and most importantly, their phone numbers.

THIS PAGE lists contact information for every member of the U.S. Senate.

Please call!

Sometimes, the Diabetes Community wins.

I need to take a moment to talk about last Thursday. A day like many other days, full of commutes, and workouts, and tasks to complete. Only this time, it wasn’t exactly a typical Thursday.

Sometimes, the diabetes community wins.

Four big announcements took our world by storm that day, and the news was, to me anyway, all positive.

The day began with an announcement from Type Zero Technologies and Tandem, announcing a working agreement to use Type Zero algorithms in future t:slim artificial pancreas solutions. For a pump agnostic group like Type Zero, it’s very cool to see them working with another partner in addition to CellNovo. I hope to provide more insight on this at a later date. For the official word on Type Zero and their work with Tandem, CLICK HERE.

But wait… that’s not all. There’s more!

Thursday was a big day at the U.S. Food and Drug Administration, as a hearing took place to discuss Dexcom and its latest continuous glucose monitor, the G5, to decide whether it could be officially approved for patients to make dosing decisions. That’s not the exact wording, but in simple terms, that’s it. In short, FDA approved the measure, and now we all have to decide what that means for us, individually.

For some, this decision isn’t a big deal, because they’re dosing off of the Dexcom readings they see already. For others, they’re thrilled that they see the okay from an official government agency to do this. For still others (Ally makes some points worthy of discussion here), there are questions like “Will I now be denied test strips because insurers will want me to dose off of the Dexcom?”. Again, many sides to the issue, so it will be interesting to see what the coming years bring.

Another, important side to this story: the fact that this disposition makes it so much easier to include CGM within existing Medicare framework in the future. It will probably still require Congress to act, which they haven’t wanted to do for a while, but there’s no question a major roadblock is out of the way.

This was a real success story for the Diabetes Community, as it rallied behind initiatives from Diabetes Patient Advocacy Coalitionand diaTribe to sign petitions that were seen by FDA as important influences. They really do listen to us, folks.

But wait… that’s not all. There’s more!

Bigfoot Biomedical also heard from FDA on Thursday, getting approval to move ahead with stage 1 clinical trials on their smartloop™ automated insulin delivery system. Bigfoot has been working hard, and there are so many visible, familiar, lovable faces associated with this company that it’s hard not to root for their success.

The stage 1 clinical trials will be starting shortly, in the San Francisco Bay area, in Santa Barbara, California, and in Denver, Colorado. If these trials are successful, they hope to move into stage 2 trials by the end of this year. Yay Bigfoot!

But wait… that’s not all. There’s more!

Ed Damiano, one of the main driving forces behind the iLet bionic pancreas solution, was named by Boston University as Innovator of the Year for his work on their unique dual-hormone system.

Many people have written about Dr. Damiano and his systems over the years, so there’s not much more I can add, except to say that this recognition is long overdue, and if I were to name the ten most important living scientists working on diabetes-related causes right now, his name would be very near the top. What he and his team have been doing has been influencing all of us, whether we know it right now or not.

Can you believe that all of this good news came out over a single 24 hour period? As my news feeds popped up with each new story Thursday, I could hardly contain my happiness.

Particularly gratifying to me were the many tweets and Facebook status updates from people in the Diabetes Community who feel like there’s a reason to hope again. And boy, do we need some hope. For that reason alone, Thursday was a very good day.

Sometimes, the Diabetes Community wins. Thursday was a great day. Thank you for doing your part to help make it happen.

**Note: the original draft of this post noted Bigfoot Biomedical as a non-profit. It was my mistake, which I am happy to correct.

Wordless Wednesday: Innovation and Inspiration.

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I was in Brussels, waiting to board the train back to London. Already through the UK Border checkpoint, most everything on the other side was Great Britain focused. On a TV screen, a promotional video was in a constant loop, promoting the work of the UK Trade and Investment office. That’s where I saw this:

DSC02069

Did they intentionally leave the last digit off?

Who knew the Brits were at the forefront of AP research? Frankly, I don’t care who takes credit for it. I just want it for patients NOW!

If you’re really interested, the full video is right here… the AP portion is near the end, at around the 2:43 mark:

 
 
 

Innovation is good. Innovation WORKS.

My co-workers and I were talking the other day about our recycling, and one of them mentioned that they now put out more recycling every week than they put out actual garbage. I’ve actually lived in places where a couple of decades ago, there were people arguing that recycling pickup wasn’t worth the cost to have it picked up on a regular basis. Now many of us are throwing out less than we’re recycling. Where would we be if we were still throwing everything away?

Just like when there was no such thing as recycling newspaper, plastic and glass bottles (heck, I can remember when all bottles were glass), cardboard, and metal, there was a time when performing a blood glucose check at home was a pipe dream. There was a time when an insulin pump (no injections? get out!) was something out of a sci-fi novel.

But lo and behold, over time, those devices not only became a reality, they’ve become a fixture in our diabetes lives. New things do get developed. New technology emerges. New therapies are perfected.

That’s why I get a little sad when I hear people say bad things about the artificial or bionic pancreas. It’s disheartening to hear someone dis remote monitoring of their CGM.

The reality is that these two ideas are coming to fruition at a rapid pace. We already know that artificial/bionic pancreas technology, when filtered through an appropriate algorithm, functions far better, with far less effort, in a safer way, than the average patient does on their own. Side note: Can I just refer to it as artificial/bionic pancreas now? Even now, after years of development and testing, this technology is changing further to include a bihormonal (insulin and glucagon) solution. Can you tell me you were thinking about that ten years ago?

And what about remote monitoring of your CGM? We know that Nightscout has already rolled out a solution that can allow parents to send their children to school or to sleepovers with a little less apprehension. Adults can use the CGM In The Cloud to keep their family members in the know, on a real-time basis. Was this on your list of cool diabetes ideas six or seven years ago?

I know it takes a long, long time for products to come to market. But I know that with the help of technology and some extremely smart cookies, new diabetes devices and software are going from concept to go live faster than ever before.

I know that there is still so much about diabetes that will remain dangerous, even after the latest innovations come to our doorstep. But I also know that fear of what still exists is not worth not taking steps to erase some or all of the fear of dangerous nighttime lows.

I know that a cure is still out of our grasp. But I also know that I am willing to live with incremental improvements in care and delivery systems until a cure becomes reality. And I am not willing to wait on everything until a cure is within reach.

I don’t believe I’ve ever written this before. But for the record, I am 1000 percent behind the #WeAreNotWaiting movement. Where last year there were only a few isolated pockets of innovation and collaboration in diabetes technology, there are now visible signs that collaboration and innovation are occurring and are at work right now. And that leaves me thinking that with the speed of technology, #WeAreNotWaiting will soon go from a fringe idea of faster implementation of new ideas, to an inventive steamroller that eventually leaves non-believers thinking #WeShouldn’tHaveWaited.

I was not prompted by anyone to write anything on this subject, but I was inspired by this blog post, and this one too.
 
 
 

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