The Hardest Thing

I was going to write this after a week, but my desire to be kind overcame my desire to spill my guts. One of the most valuable things I've realized over the years is that writing angry is simply a bad idea. In overcoming my anger and frustration I chose silence until I could accurately come to grips with my feelings about my diabetes technology. I was more concerned about being nice than voicing my unhappiness, which is a horrible thing as a consumer (and blogger). So here are my thoughts as unfiltered as possible. Scroll down to the bottom for a brief recap.

I forgot how much picking a pump is like buying a car. You have these perceptions and this belief in what you'll get: sometimes it's better and sometimes it's worse. You never know until you drop into the driver's sear for a while. Fun fact that I learned: Medtronic Minimed (MM) has a 30 Day Return Policy. It's not advertised anywhere but they will tell you if you ask. If they really want to continue testing out their device, they will offer to extend that to 60 or 90 days. Honestly, I wish the 60 or 90 days was standard because how can you really know whether the system isn't for you or if you just need to become more comfortable with using it? More on how I knew for sure later.

After one week, I wrote this: "I've been waxing and waning between excited and apprehensive. So far, the Minimed 530g has me running Barenaked Ladies lyrics through my head, but the pump should be singing to me, including the the anger and frustration to the mutual apologies." I stopped there. I may have gotten a little stuck in the symbolism.

The first Enlite sensor I put in with the Minimed trainer was surprisingly comfortable. The insertion was easy-peasy. Loading the sensor into the insertion device was adult-insecurity-proof. Hold it flat against your stomach. In the sensor goes straight down at 90 degrees after on button press. Press and hold to pull the inserter off. So simple you could do it with one hand - I found that gimmicky. Seriously, when am I going to do this one handed especially considering the cost and lifetime of a single sensor. Using two hands is not the end of the world. Pulling the needle out and having it retract into it's personal housing was a spring-loaded cool and painless. Medtronic gets my props for designing that.

One of my old gripes about MM's previous CGM sensor was that the little seashell transmitter never stayed still. The eventually started selling seashell-shaped backing tape individual of the sensors but I hadn't stuck around long enough for that. The Enlite comes with backing automatically attached to the portion under the transmitter. That along with a special overtape (to go over the sensor but not over the transmitter unless you want a second piece) helped everything stay in place. Add one more short piece of tape to hold the seashell down and the sensor was pretty secure (wayyy more than the old one). The trainer told me that all the adhesive that MM selected was pressure sensitive so holding it down for 5 or 10 seconds would help the sensor stay on longer. Of the fours sensors I've worn, only one came off early and honestly that may be my own fault for getting caught on a door way (really, who's surprised).

I was happily surprised to see that charging the transmitter wasn't as big of a deal as I made it sound in the last post. Not eight hours. More like 30 minutes between each 6 days of wear. I only spaced on that once (with the sensor that came out early) where charging the transmitter slowed me down from running out the door, but I managed to keep myself busy with other things in the meanwhile. I imagine that taking a sensor out and putting the transmitter on the charger becomes second nature after you've been wearing it long enough so no reason to fuss.

After the initial sensor placement, there's a 2 hour warm-up period after which you put in a calibration (same as Dex). For a Dexcom, you actually need to put in two readings after the warm up and I usually do two immediately (aka I use the same value twice - shocking I know). For the Enlite, you need to enter another calibration within 6 hours. You should only put in one calibration in every 30 minutes. You must calibrate once every 12 hours or the Enlite sensor stops providing data. The way that the MM algorithm works is based on weighting the last four calibrations in order to translate from ISF to blood glucose. So if one of those calibrations is sub-optimal, then your accuracy is off until you get rid of the bad value in your log.  None of this weighting nonsense exists with the Dexcom G4 system.

One of the big claims that I kept hearing over and over again is that you can calibrate the sensor whenever you want, with few exceptions. DEFINITELY a sales gimmick. For the previous MM sensor, you could only calibrate at times when your blood sugar is stable. I NEVER understood this. If I knew my blood sugar was stable, why would I be using your device? There are a ton of unreasonable assumptions: your blood sugar is stable when you wake up, when you go to bed, and before meals. Is it true for a lot of people? Sure. Does it work for me? No way. When I get up is the only real guaranteed stable point in 24 hours. After that, I'm running around like a madwoman, eating bits and pieces of healthy and unhealthy crumbs all day long, with nothing that resembles a schedule between two adjacent days. I'm in graduate school and everyone knows that college-life is not a steady well scheduled thing. I will eat ice cream before I go to bed. I will snack through my two-hour post prandials.

Different people will tell you different things. One rep told me it was okay to calibrate with one arrow. One told me never. A technical rep told me not to calibrate when I saw the sensor and meter values were far apart even when my blood sugar was stable at a high or low number. I could only calibrate when I was within a happy range. Another technical rep told me that I needed to get up and get my body moving to get my interstitial fluid (ISF) moving when that happened (to which I asked, I REALLY have to get our of bed in the middle of the night to stretch???). Coming from a Dexcom where you can ACTUALLY put in a blood sugar whenever you want, I couldn't handle this only calibrating during "stable" times especially since accurate calibration is what seriously affects sensor accuracy.

Another thing that is a little bizarre to me is the insistence that I use the Next Link Meter. Supposedly, this Bayer baby has better accuracy than other meters. I didn't notice a difference between it and my one touch mini the few times I did double fingerstick experiments. The 530g system was FDA approved with the meter, even though you can't bolus with it just transmit fingerstick values. No real complaints about the meter. The case is weird. The strips are a little harder to insert. I found myself looking down to see that the new strip hadn't registered even thought I had already splashed blood over. It is kind of nifty though that you can add blood afterwards if the sample is too small.

This accuracy issue goes right to the Low Glucose Suspend (LGS). I actually like how the LGS is designed and demonstrated. Basically, the pump turns off for 2 hours if your blood sugar is low. If you don't respond it basal insulin stays suspended and the alarm keeps hollering. There's a nice message on the display that says something along the lines of I'm a diabetic and I need help. Great for non-responsive situations. If you are responsive, you can chose to suspend the basal insulin for two hours to resume the basal activity. Let me say this again: I LOVE that this feature exists. I LOVE how simple it is to use. I LOVE the way it was designed. However, I cannot stand it when combined with bad sensor accuracy.

Every time (4 times total) I put in a new sensor I had the same problem: surprise LGS in the middle of the night when my blood sugar was fine. I verified that with finger sticks twice. I assumed the other two with good reason (::cough cough:: my Dexcom). The first time, the low alarms and LGS just kept me awake all night. The second time, the LGS went off and I slept through it, I never got the high alarm because the sensor was out of range, and I woke up high at 250ish. The third time, the LGS went off and and I slept through it, I got the high alarm as I woke up saying 186 mg/dl when my meter was saying 290ish. The fourth time, I kept getting low blood sugar and weak signal alarms, and I didn't get any sleep.

Accuracy when compared to my Dexcom was reasonable after 48 hours. Those first 48 hours ranged from atrocious to mildly irritating though. The Enlite sensor did much better on day six than day one. The Dexcom G4 sensors take about 12 to 18 hours before being a trustworthy accurate for me. However, their warm up period never quite reaches mildly irritating because I can always pop in a calibration ans see semi-immediate alterations in the blood glucose calculations. Also, an awkward comparison since the G4 sensors are good for seven days.

This brings me to my last few gripes. Sensor range. The range of a MM sensor should exceed my body. Getting a weak signal alarm when the sensor is in my left hand pocket of my jeans when my transmitter is on the right side of my stomach is asinine. There's no better way to say it. I shouldn't be getting weak signal alerts or lost sensor alerts when I'm in my bed. This is 2013. We can transmit things across countries. Bluetooth works at greater range. What kind of low grade tech are you putting into the transmitter that prevents this? Oh right, you didn't upgrade the transmitters. Just the sensors...

Alarm volume? Comparable to the Dexcom. However, I can amplify the Dexcom alarms in a low tech way (glass with coins next to my bed). I cannot sleep with my pump next to my head, because of the weak signal problems. My sheets and comforter muffled the alarms so much that I had no idea a LGS was going off til I peeled them down. Not cool. The vibration isn't all that strong either. I've had a whole lot of phantom pump alerts trying to keep an eye out for them.

Battery life? Well I guess you can say this was low because of the number of alarms. But really? 2 weeks before my first battery change is kind of sad, but I don't really know how to compare it since my Dexcom is only checking my sugar...

After the fourth sensor (and the 10th or so night of not sleeping), I decided to stick a fork in my diabetes tech experiment and ask for a return. You can't tell me I can calibrate whenever I want and then tell me I'm calibrating at inappropriate times. I also did not enjoy being treated like a child when I said it wasn't for me. I don't think medical devices should be a hard sell. My trainer put me on the verge of tears because they blamed my D-control was the problem when I blamed sensor accuracy and they almost had me believing it, which is super uncool with a condition that comes with as much of a mental burden as a physical one. I did break down on the phone with the continuing care representative a little bit. I all out bawled afterwards out of exhaustion, frustration, and high blood sugar. That said, all in all the customer service was much better than I was expecting. Lots of follow up. I know that they are people too. They get judged on who stays and who goes. I'm sure the everyone's under pressure with this new system.

So now, MM is processing the return. Two weeks minimum before everything is sorted out from the device end. No idea on how long refunding the insurance claim will take. I'm crossing my fingers that it won't be longer than mid-December so that I don't have to pay through the nose for a new pump and a new transmitter for my Dexcom because of deductibles (ironically the battery on that died this Sunday before I decided to return the MM system). What am I getting next? Still keeping my options open and doing way more research before I take the plunge again...

TL;DR
Pros :-)
Ease of sensor insertion
Adhesion of the sensor
One device
Low glucose suspend
Mehs :-|
Transmitter charging
Battery consumption
NextLink Meter
Cons :-(
CALIBRATION!!!
Sensor accuracy (and therefore low glucose suspend)
Alarm volume
Transmission range

My recommendation: Only use the system if you're comfortable with MM's CGM tech already. Otherwise Dexcom rules.

If there's anything I didn't discuss and you're curious about, leave me a comment!

Before the Return of the Shell

Since I've been on an insulin pump for several years now, I have been lucky enough to see some of the diabetes technology devlop. All in all, I think (because my memory is too fuzzy to really remember) I've had at least 3 different Medtronic Minimed (MM) pumps. The latest and greatest 530g just came out as the successor to the Revel. I never got to experience the Revel first hand but one of the improved features was predicted alerts for the continuous glucose monitoring (CGM). I'm going straight from the MM Paradigm to the MM 530g, who's updated features included the linked CGM that allowed you to see your bloodsugar on the screen of your pump. If I'm wrong about this, I'm sure someone out in the DOC interwebs (because we're usually brighter than the average bears) will correct me. The funny thing about this whole experience is that while the Paradigm had the CGM ability, I only used it a handful of times before being so frustrated that I nearly pretended it never existed in the first place (which is saying quite a bit for someone who has the patience of an educator).

Regular readers will know that I've grown very attached to my Decom CGM that I lovingly call Eggy. I switched from MM to Dexcom two years ago because of that silly shell shaped transmitter. The transmitter would never stay put even with the assistance of every type of tape under the sun (that I could get my hands on at the time). The sensors were also crazy innacurate, and I could never get the calibration to work with my insane college schedule (really, who is stable for two hours when there are hormones and caffiene raging through you?). I held out for 4 months before deciding not to order another 3 month supply.

One of the other major things that bothered me was that the transmitter need to be recharged for EIGHT hours once a week. Add on the two hour calibration for every new sensor and replacing a sensor every three days. There goes 12 hours of glucose monitoring for your week.

In my mind, I expected that Minimed would change this as the technology improved, because this continuous monitoring thing was too new still. Or at least realize that they should send people two transmitters for the investment. That kind of logic is entirely false apparently. Even with a newer sensor that is FDA approved for SIX days of wear (the Enlite), you still lose eight hours of calibrating (ten if you add the two hours of calibration). This is all extremely perplexing when you add in the benefits of CGM plus low glucose suspend. If I chose those ten hours to be overnight while I'm sleeping, there goes the necessity of that feature. If I chose those ten hours to be during the day, I lose the ability to track my meal bolusing. I know that we're still miles away from "true" continuous monotoring but losing eight hours to charging the shell shaped transmitter seems asinine especially when compared to Dexcom system. All you lose is two hours a week for new sensor calibration if your efficent. Switching over has been a hard sell, my friends. But for aomeone who's struggling with perpetual hypoglycemia, I couldn't say no to a system with low glucose suspend and the timing for an upgrade just worked out.

I'm being adventurous and faithful to a company that  has served me for over a decade. I'm also trying to keep an open mind. Maybe it won't be as bad as last time. My CGM training is tomorrow afternoon so hopefully I can throw in a new sensor before bed. I will try the dual Dexcom and Enlite for a little while since I've got the mother load of Dexcom sensors left...

If you have any specific questions about the system, let me know in the comments!

Wordless Wednesday: Birthday by the Pictures

Thank you to everyone who made yesterday an awesome kick off to the next (fantastic) year of my life!

Lemon Laws

I spent my Friday morning waiting for three hours to find out what was wrong with my car. The waiting rooms at automobile dealerships kind of remind me of the waiting rooms of doctor's offices. It's especially bad when medical issues arise while at a car dealership but more on that later...

In the United States, the have laws to protect consumers who buy new cars from manufacturing defaults. No process is perfect. With thousands of parts going into creating one machine, there's just an inherent chance for something to go wrong because of part defects when putting something together on a factory line. They're called Lemon Laws. They vary from state to state but essentially covers any performance problems in a new car in the first few weeks.

Now I've been having some issued with a evaporation purge valve in my fuel line. It's been going on for about a year. It just decides to not play nice once in a while. Doesn't seriously affect the car's performance (as far as I know) but it does keep the car from passing the NH state inspection next week. Usually they test this valve and it tests out fine. Every dealer I've shown it to has said if it keeps acting up, to replace it. Me being stubborn, I won't replace it until the tests definitively say this part is broken. Much to my chagrin, the test on Friday declared this valve broken. Unfortunately, my car is well past the lemon law stage.

Apparently, there is no Lemon Law for body parts. I'd gladly swap my pancreas out but I guess I'll just keep rocking my pancreas impersonation skills.

Technology Failure

My poor little laptop is officially dead. It croaked its last breath on Tuesday night at 8:16pm. I stuffed it into a well packed box and shipped it back to the company yesterday afternoon. Now, I have to wait 4-6 business days for it to return...

In the meantime, I have all these little snippets of posts waiting to be written into full fledged awesome stories. I guess I'll just keep writing myself little notes until I can find some time (and technology) to put them together.

Keep on holding steady.

Focus on the Forward (Not the Backward)

I can't start a post about the future without touching upon the past.

This past year, I've made real connections with more diabetics (type whatever) than I ever have before. I've gone from being relatively alone (minus those silly voices in my head) on this tireless journey with my friend, diabetes (I'm thinking she's gonna have to be nicknamed Bete soon) to trying to remember who is in which time zone. I met more and more new friends with diabetes that have inspired and supported me. Just rattling off names and numbers (like a good engineer?) wouldn't describe the type of connection and hope that each person has given me through a few simple moments. I was also very lucky to get my hands on my (relatively) unbreakable Eggy who has helped me bring me a little more control. I've been blessed on all these accounts.

So the one diabetes-related thing I'm looking forward to for 2012 is building more of those relationships. Meeting more people I can lean and more people who can lean on me. Getting out into the real world a little more. Teaching one more person that people with diabetes can do whatever we set our minds to despite a paperweight for a pancreas. Showing one more person that we all have our moments of weakness and struggle. The diabetes community is vast and diverse. Sometimes it is really difficult to believe that there are so many of us doing so many amazing things. And sometimes that amazing thing is just saying hello.

Now that I'm here and now that I've found you, I can't imagine going back. Back to fighting this on my own. Back to fighting this silently. Back to fighting this just for me.

This post is my January entry in the DSMA Blog Carnival. If you’d like to participate too, you can get all of the information at http://diabetessocmed.com/2012/january-dsma-blog-carnival/.

Vacations, Bad Luck, & Emergency Baking

It's weeks like these that make me feel like Diabetes isn't going to kill me. Stress on the other hand...

I apologize for the impromptu hiatus in blog posts. I'm a little disappointed for not making a goal I set to post regularly. Honestly, I'm burnt out on responsibilities at the moment. I needed to take a real break from everything for a little while, which was amazing while that feeling lasted (and unfortunately it was extremely short lived).

So what have I been doing? I took the week after Christmas to sleep out the exhaustion from my first semester and the crazy holiday/semester-end celebrations. There was quite a bit of driving around. I think I spent 14 hrs in a car over a 48 hr span of time. Every day that week began with many hours of sleep and a few enjoyable hours on the couch watching bad television (because really, it's the only kind).

Unluckily, my laptop crashed the day after I returned to New Jersey after only functioning for about 45 minutes. It was a serious blue screen of death followed by a "I won't boot regardless of how nicely you ask me" tantrum. Two system restores, many phone calls to HP tech repair, and 48 hours later my laptop was mildly functional. I just recently (as in the last few hours) installed Windows 7 and restored its functionality (read: it's no longer a very expensive paperweight).

This past Saturday, I managed to have my cell phone and One Touch Ultralink meter lost (and probably now stolen) in a public restroom. That lead to a very unpleasant 24 hours where I was relying very heavily on my continuous glucose monitor (EGGY TO THE RESCUE!). Needless to say, I have had multiple moments of undue stress, unclear thinking, and reckless panic. I still haven't slept to make up for all of it.

It proved to be a fairly (but not insanely) expensive mistake. I bought a new phone from AT&T and a One Touch mini from my favorite pharmacy. To try and unwind a little, I googled a quick recipe for my favorite (and mildly famous) chocolate chip cheesecake cookies since all my recipes are hiding in the backed up files on my external hard drive somewhere. Whipped up a batch as speedily as I could. I'm all sorts of discombobulated still. But indeed a delivered pizza and baked goods do ease large quantities of stress, in case you thought otherwise.

I'm sure you'll see upcoming posts that were intended for well before their actual post date. I hope they haven't hit their expiration dates.

Endo Visits and New Forgetful Starts

So. I saw my endo before I left my parents place to start my life at grad school with a "clean diabetes" record. Everything is up to date for a while and my HbA1c?

Pictures don't lie. I'm doing okay. There were somethings I should have probably asked about (primarily about my stomach) but I was to enamored by my great stats with less lows. I'm as healthy as I could be. More exercise wouldn't kill me but in terms of numbers and diabetes, I'm doing good.

My first day of classes went fairly well despite being exhausted from lots of driving with an 8:40 am class. I think I've talked about having diabetes quite a bit to my new classmates enough that they won't forget I have it. (Yes, I can eat that but no, I don't want some now; Yes those are glucose pills and yes I eat them for almost every one of my many lows; No I don't need some orange juice. I'm just annoyed with this homework). However, I will forget some of my diabetes essential and non-essential devices in random and sometimes untraceable places.

We decided to have our first study group on campus in one of the student dorms since they have much larger living rooms than my apartment. We eventually traveled from one room to another and finally figured out our homework woes. When I was getting ready to leave, I realized I didn't have Eggy (my Dexcom reciever) anddddd the panic sets in. Freaking out, I retraced my steps and unpacked/repacked my bag between 3 and 30 times. I was just about to give up when my classmate picked up his phone, let us into his dorm, and found it on the floor of his kitchen.

The lesson I learned? I need another SPIbelt. With Two Pockets. And preferably a clear window for both of them. Which I think is a dream. Or maybe a very expensive CUSTOM hope. One of these days I'll figure out how to walk around without losing/forgetting one of my many diabetic accoutrements somewhere. Til then, I'll keep my fingers crossed and keep patting my pockets

Bad Sites

I feel like putting in an infusion site nowadays is like digging for gold: Random and nonsensical.

A few weeks ago, my CDE and I discussed potential alternates from my stomach. After having an insulin pump for about a decade (2 upgrades later, that seems crazy) and recently acquiring a CGM that actually works for me, I feel like I need to give my tummy a break. There are little white scars everywhere on my brown skin that make me feel like I'm artificially giving myself reverse freckles.

Anyway, now the outside edges of my tummy (aka my lovehandles [eww]) are reserved for the Dexcom and the infusion sets are wandering. I've been comfortable enough to try the back side of my hips. I was afraid mostly because I didn't think I was flexible to comfortably get the site in with the sil-serter (makes me think of soft serve ice cream for some reason [#takethatwendell anyone?]). It's awkward but I've gotten to work for me with one very large caveat.

I can only use my left hip. Every site I've tried (I'm up to 4) on my right hip has ended up being a vampire infusion set. After putting one in that seemed fine for the 10 minutes I was watching it, I went shopping today and found the following image awaiting for me in the dressing room mirror.

It's a little hard to tell, but basically that's a lot of blood that's crusting around somewhere where there should be any. That's definitely an infusion site fail. The little dot to the left of it is one of the earlier ones that bled out and left my blood sugar running high for about 8 hours overnight (reasons not to change infusion sites before bed). I thought human bodies were supposed to be relatively symmetrical. I just want it to work. I hate having to change them early. I also don't want to be worrying about not hitting a vessel in addition to worrying about not hitting scar tissue. Some part of my body has to play nice, right?

Feel It Coming

Funny tidbit: Blogger only let's me update html post from my phone. Weird but I'm just happy to be writing despite no "real" broadband internet til Friday.

Anyways! Today is day one of unpacking into my new place. Let's just say that I'd rather be anywhere else doing anything else. So I kinda chalked up my lack of motivation to distaste for the task instead of low blood sugar.

Normally, I'm as bright eyed and bushy tailed as everyone else (and sometimes more so). Today, I experienced that slow, losing steam at the cracks sort of feeling. Arms that felt like lead made me think that maybe I just needed to relax for a few minutes on my bed and troll the web for something exciting to read. Somewhere, the better half of my conscience said, "It could be a falling number." But I looked at my CGM and saw a flat arrow at about 90 and decided it really was just too much moving stuff around.

Gradually, I became more and more tired, like a gradual fog settling in on the folds of my brains. I said to myself, "This kind of feels like a mild low. I should test. Where's my meter?" That notion was immediately battled by my inner child with a very whiney (sans cheese), "I don't want to. Please don't make me get up. I'm comfy."

That should've been my sign. But no. I kept reading and putzing. Meandering from site to site until I got really sleepy and suddenly Eggy buzzed loudly in my ear. 52 and slanty down arrow. Got up and tested to find a 49 waiting for me. I actually ate 6 glucose tabs (21g), set an alarm for 15 minutes for the recheck, and started to wait for that feeling of preparedness to come back.

Instead, I started zoning out while thinking of bookshelves and grocery lists. Luckily, I set a 15 minute timer on my phone because apparently I fell asleep on my comfy little airbed otherwise I would've missed the second reading of 49 on my little black OneTouch Mini.

I worry about my meter and my sanity when I see the same number. I always question myself as to whether I really ate those glucose tabs or whether that was low bg hazy delirium. And if it's a high, I ask myself, "Did I really push the ACT button?" and immediately pull out my pump to check the last bolus. The worst cases are late at night but sometimes it happens between meals and really freaks me out, because I know my body. I know there's no way my sugar levels have been at a constant for 4 or 5 hours after eating sometime. Is there such as thing as diabetes coincidences? Or does my meter just have an affinity that day for that particular number? This post makes me think that might just be a possibility.

Traveling & Surprise Vacations

I hate being all over the place. Scatter-brained checklists everywhere and anxiety laced with panic setting in.

I don't do well with living out of bags. Especially because I always like to be prepared and look appropriate for the destination. Which means that I have no idea how to pack light. I'm always thinking about pouring rain and cold breezes or bug bites and emergency situations. I wanna have six of everything but I know that impossible to carry that much stuff around comfortably. As it is, I always get looks of worry from lugging around and overstuffed duffel bag plus my school backpack (which houses my laptop and other random things). Regardless of the situation, I always end up with one too many "emergency" outfits and things that I don't touch at all, but in the same token, I ALWAYS forget something I wish I had brought.

On my latest excursion to no where terribly exciting to see family, I managed to forget to bring along an extra Dexcom sensor for Eggy mostly because I assumed, I'd get at least the extra 3 or 4 days that I needed to survive the extra 3 or 4 days I was out of town. Unfortunately, traveling makes me sweat and fidget with seatbelts which coincidentally makes Eggy's sensors peel. And that peeling was what led to the stingy feeling in my side that comes from the sensor coming a little bit out and then going back in a little bit (because those things are dull yet extremely sharp all at the same time). So I pulled it right out thinking I had an extra one.

I panicked for exactly 3 minutes. And then I breathed a great big sigh of relief. Because, yes, despite how much I love my CGM, I love my time without my CGM. One less D-tech thing I have to carry around. Plus, no serious fears of losing it (leaving it in the bathroom, slipping out of my pocket during a walk in the park, running out of my car, taking out the trash, and the list goes on). I enjoyed my Dexcom vacation a little longer than I had to and now I've got a new sensor in about 5 days later.

The alerts are nice. The Dexcom 7+ Sensor System is way more fun than I had I with 6 months of Minimed's shell-shaped Guardian/Paradigm sensor. It works better and is more functional for me when I can hold onto/remember where I put Eggy. But yea, sometimes it stresses me out and sometimes I bolus/eat without actually doing a finger-stick. Not all technology is good and useful (ESPECIALLY if you overreact to it). And even when it is good or useful, sometimes few days without it makes you remember to smell the roses, or the alcohol wipes on your finger tips, more often. I enjoyed my vacation so much, I think someday probably not until winter break I may want to take a full technology break: no Dexcom, no pump, no smartphone (GASP, could be hard). Of course that silly meter has to come along, but hey I can have my dreams right?

Technology: Benifits and Drawbacks

So I'm a biomedical engineer (BME). When I started college, I really wanted to be playing with stem cells, but I picked the school who's BME program was all biomechanics, aka movement analysis and prosthetics, because they gave me lots of money to go there. As I took more and more classes, I realized I really enjoyed bioinstrumentation, aka fancy medical devices, because on any given day, I can be found carrying at least three of them on my person.

I was psyched when I saw that the DSMA (Diabetes Social Media Advocacy) was hosting a discussion week about medical devices. Unfortunately, because my social life is sideways and upside down in the summer, I haven't been able to join in to any of the convos. but I read the transcripts and try and listen in on at least some of the radiotalk on Thursdays. Then, I found out that it was this month's blog carnival, and I've been scheming about what to write about since I saw it. **I go back and forth with a lot of these issues because while I understand why they exist, I still think it sucks**

Because I'm on the up and up (I think) on how device development works, I know that bringing serious innovation forward to existing devices is hard. Partly because of how the FDA approves changes and partly because of how big business works. After that comes all the cool stuff I'd like to see happen with our current D technology.

Regulation of medical technology is hard. Period. It's a little backward in the US but it's not always better in other countries either. EACH country has different approval mechanisms. Some are easier and believe it or not some are harder to gain regulatory approval. So yes, while I'm jealous about the Animas Vibe coming out in the UK, I understand why they started there.

Regulatory approval is like those car seatbelt alarms. While they annoy the daylights out of you and they're pesky, the ONLY reason they're there is to help keep you alive. They're not really trying to hold back innovation and cool new technologies. They exist to keep us safe from medical fiascoes like the Pinto (read car that burst into flames) for the car industry. Also keep in mind, while some of what they do and their procedures make no sense, NOTHING in the medical or political world is close to perfect.

So the big bad world of big business makes it really hard for a basement tinkerer to come up with something really cool in terms of D-technology. They have lots of money and lots of resources. When larger companies absorb smaller companies, sometimes awesome things happen and sometimes awful things do. This goes back to the previous point but it's really tough and expensive to win regulatory approval as a small firm between the amount of money for the trials and the amount of paperwork to ensure you actually thought the idea through. A lot of times people have to sell their ideas to bigger companies so that they make it to the hands of everyday people like us. I was a little sad when I read the Deltec Cozmo pump (pump with meter attached) was going out of business because I was so psyched at how different it was from the other major pumps in the market. While I don't know their reasons, I do understand the pressures from a very competitive market.

As far as my hopes for D-technology, I'll break it up in 2 ways: Near Future and WAYYY out there. Everyone thinks that smaller is better when it comes to technology (see anything about cell phones and mp3 players). While smaller is cooler in some cases, bigger is also better too (especially for the older peeps with D). There are some populations of people with D that don't get as much attention as they nearly need. The two in my mind are the uber-technophiles like me and those kids who are diagnosed early on (because if I see a commercial selling my diabetes supplies with medicare once more, I may scream at the TV about how I'm not old enough for that by decades).

As far as technophiles, there's tons that we wish we could do with our D-technology. 1 integrated device to carry around instead of 3 or 4 would be awesome (are there security concerns? sure, but can't we decide our data risks personally?). Looking at our data in different forms and playing with it find trends that important to us. Customizing our devices sometimes plays a big role (see bg meter via iphone). I think someone brought up the incredible point of putting a light where the strip goes and the blood gets sucked in so we can test in the dark (think movie theaters, bedrooms, camping trips). Even some fluorescent or glow in the dark action on strips (I know you're supposed to keep them in a cool dark place but still) would be cool. It amazes me that not all pumps come with remote controls and there aren't smartphone widgets for inputting d-numbers to track. I HATE that I have to put carbs and bgs into my pump and then my dexcom. If tracking is SO important, why do they make it so impossible? I want more options. Can't we decide how complicated or simple we want our medical devices to be? I can get a less powerful version of an iphone for less money than the brand new one, but I can't do that with my medical devices? Can't I upgrade the processor or order more software to tinker with it myself at MY OWN RISK? (Although to be honest, I think that's more the FDA then the companies)

For kids? It's been a while and I was diagnosed close enough to puberty that I've always been pretty much the same size. But I met a d-dad at an interview who was telling me about how disappointed he was that his son couldn't live with an insulin pump because it's too big for him. With all of these miniaturization and customization skills that companies have, they haven't figured out how to make pumps and devices sized for kids. Ones that have smaller reservoirs and fewer options than the regular-sized adult ones would make their lives that much easier. They've started coming out with cellphones for kids that can gradually be transitioned to real phones. Why don't they have grow with you insulin pumps targeted to the ages of 0-12 years?

There are also things that most diabetics are disappointed and confused by. Like the accuracy of our testing devices. Why can two identical meters be so far off? (Variables. Temperature. Test strips. Tolerances in device specs. Testing locations. Blah blah blah. Seriously?) If we can send people to space, why can't I test my blood sugar when I'm snowboarding because my meter is too cold or at the beach because its too hot?

As far as the future, I'm right there with everyone for a cure or at least an implantable pump. I understand the difficulties with reservoirs and batteries as well as scar tissue and glucose monitoring physiology. I just would love something that would make me worry less 24/7. I'd be happy to forget that I have diabetes for more than an hour (most days, not even that).

I know that technology isn't instant like microwave noodles. It takes time and money and a lot of innovative minds. But I can't lie and say that I don't want more. More accuracy. More options. More simplicity. More sizes. I want more, and I want it soon.

This post is my July entry in the DSMA Blog Carnival. If you’d like to participate too, you can get all of the information at http://diabetessocmed.com/2011/july-dsma-blog-carnival/