About Lorraine

Mom of Colin, Caleb & Lila. Caleb was diagnosed T1D in January 2007 at the age of 3. Thank you for sharing this journey with us.

Investor Bit | Insulet Q4 2015 Call

Screen Shot 2016-02-26 at 9.03.10 AMFull transcript on Seeking Alpha.

In Insulet’s earnings call for the fourth quarter of 2015 yesterday, positive financial results with several performance records were heralded, and strong growth is expected for 2016.

– We were reminded of the divestiture of Neighborhood Diabetes to Liberty Medical to allow for focus on OmniPod and Drug Delivery (think using the Pod for cancer drugs) products.

– They are working with Eli Lilly to gain approval for use of concentrated insulins which would effectively increase (double or more) the capacity of the Pods for users with higher insulin needs. This is expected to hit the market in the next two to three years.

– Digital Insulet is the term used for all things mobile and artificial pancreas. In the first half of 2016, they expect to launch their first app which will allow for product ordering and accessing training tools. Further, quoting directing from the transcript:

In addition, later this year we will submit a 510(k) for our Bluetooth PDM and mobile app that will display key real-time data on a customer’s mobile device, including CGM integration with Dexcom’s G5 sensor. In fact, this will enable CGM integration in a manner that ensures that our users will always have the latest and greatest CGM sensor with the latest and greatest OmniPod.

-Insulet has entered into a licensing agreement with Mode AGC for an Artificial Pancreas algorithm. Clinical trials are expected later this year.

There was much discussion about the robust market opportunities in both type 1 and type 2 markets and why OmniPod is believed by management to be a superior choice for insulin delivery, as well as big improvements in customer retention and customer service. I will leave it to you to read those details in the full transcript.

Investor Bit | Dexcom Q4 2015 Call

Screen Shot 2016-02-24 at 10.30.31 AMFor the full transcript, please go to Seeking Alpha.

Dexcom had an encouraging earnings call yesterday from both a historical financial perspective as well its prospective outlook. In addition to record-breaking financial results for 2015, I found the following noteworthy:

  1. A new G5 receiver and insertion device are expected for the second half of this year. Not mentioned on this call, but heard from a key exec from an interview conducted on Discuss Diabetes – the insertion device is expected to be MUCH simplified, and with automation will eliminate hand shake at insertion and reduce pain.
  2. Gen 6 will require 1 calibration per day, an advanced algorithm and be labeled for 10 day sensor use. Gen 6 IDE will be submitted in the next two weeks and there will be more information on the next investor call.
  3. Dexcom expects an FDA approved insulin dosing claim during the later half of 2016. G5 in Europe is currently thus approved – fingersticks are not required for dosing decisions; 2 daily calibrations are required.
  4. G5 Android app is expected for later this year; Follow app is already available on Android.
  5. A note in the financial overview that struck me references a charge recorded in Q4 relating to a potential increase in warranty expense for an issue with the speaker on the receiver. We’ve had two receivers whose audible alerts completely stopped and had to be replaced.
    • We also note that we recorded a charge in Q4 relating to a potential increase in warranty expense resulting from an important customer notification we have issued related to the speaker component in our hand-held receiver.

  6. The Life Sciences Google partnership is now the Life Sciences Verify partnership and is moving forward according to plan.

There’s lots more in the transcript including discussion of pump partners, international expansion plans, and a more detailed financial review. Find it at Seeking Alpha.

 

 

 

 

Clamdiggers

IMG_9526For at least a couple of years, I felt like we settled. The peaks and valleys of diabetes were smoother, less frequent, easier to handle. Nights provided the best interrupted sleep I’ve ever had. Years of experience and technological advances were paying off. It felt good and it felt earned.

These last few months have been a bit more rocky. High blood sugars reaching points I haven’t seen for years out of the blue for no explainable reason. Historically reliable corrective approaches having no effect whatsoever. Nine years of experience coupled with a subject who is exponentially more mature and capable have made these loops bearable, but no less surprising and bewildering.

Dance competition season is approaching. To me this means costume making. Caleb competes in jazz, lyrical and his favorite, tap. The depth of options for costuming for males is as minimal as it can get. I work with Caleb’s dance director to design his costumes to coordinate and complement his teammates’, and sew them myself.

In sorting through the options for Caleb, I asked him to try on a pair of pants from last year’s annual dance recital – just seven months ago. My immediate reaction was a mixture of amusement and relief. The pants weren’t merely short, they looked as though they were intentionally made to be of capri length. I knew Caleb seemed taller, even thinner, but the inches of flesh that appeared under his hem was astounding.

I don’t know that growth is the reason for the blood sugars we’ve been seeing. Knowing that most everything else is about the same, it certainly is a viable option in my mind, making the means to the end all seem okay.

Podcasting with Caleb

IMG_4458.jpgCaleb joined me on the most recent edition of DSMA Live: ‘Rents, only this version wasn’t live. In our first prerecorded show, Caleb and I talk about his diabetes tools and how his role in his care has changed over the nine years with which he’s been living with type 1 diabetes.

I hope you enjoy the show, and thanks for listening!

You can listen here.

 

#DPodcastWeek benefitting #SpareARose

15-MS-071DiabetesWeekLogo_r1The first Diabetes Podcast Week kicks off on February 1. I will be taking part as cohost of DSMA Live: ‘Rents.

Since August of 2012, Bennet Dunlap and I have been hosting ‘Rents, interviewing fellow bloggers, medical professionals, diabetes device executives, people living with and caring for people with diabetes, to name just a few. We’ve covered topics from Nightscout, The Artificial Pancreas, Spare a Rose and so much more. We’ll be airing our 75th episode live on February 1.

Our DPodcastWeek show will feature fellow Podcaster, Christopher Snider, and we’ll be talking about Diabetes Secrets. He hope you’ll join us live at 1PM EST, when we’ll Screen Shot 2016-01-20 at 8.57.27 AMbe happy to accept your calls.

Please check out all the participants of DPodcastWeek and consider supporting the Spare a Rose Campaign. Buy one or two less roses (or skip them altogether) and donate that money to Life for Child and bring life saving insulin to children in need. For more information, please visit IDF, or listen to our podcast with Kerri Sparling mentioned above. Donations will be accepted started on February 1, when DPodcastWeek kicks off!

For a complete listing of all DSMA Live: ‘Rents episodes, please subscribe on iTunes!

 

The Answer for Overnights…

Screen Shot 2015-10-27 at 5.46.10 PM…I don’t have it.

I’ve been working hard towards learning it though experience for nearly nine years, or 3,200 trials and lots more errors. I’ve searched and asked many questions regarding it, but no clear direction has been discovered.

Overnight care is the final ugly beast of diabetes that wedges itself between Caleb and his full autonomy. There are other things that he doesn’t do – he hasn’t changed a Dexcom sensor by himself, he doesn’t call customer service when there are issues, he doesn’t manage basal program or sensitivity adjustments independently – but these are things I know he can learn and don’t present imminent danger. This overnight thing is different.

Sleepovers and extended field trips – these include periods of sleeping. Caleb is on the ball when he is awake. When he is asleep, well, he’s asleep and does it for numerous hours at a time. Diabetes works in 2 or 3 hour cycles. Sleeping in increments of 2 or 3 hours or even 4 hours is not healthy. I haven’t been able to balance these opposing needs after more than 3,000 attempts.

This is not to say that every night for the past nine years I’ve been up actively managing his blood sugar every 2 or 3 hours. Particularly with the use of Dexcom G4 Platinum, there have been a number of nights when I wake to just check the CGM number and go back to sleep until morning. But there has not been a single night that I have slept through uninterrupted. Over the past year I was lured into a feeling of safety because it was more the norm than exception that I could just do that eyeball thing at 1 or 2 am and all would be well. These past couple of months have rattled me back into the fear of how ugly overnights can be – highs that don’t correct and lows that won’t rise.

This isn’t new. It’s not pleasant, but I can handle it – or handle it well enough.

I don’t know the best way to prepare Caleb for these nights. The ones after long days of varying levels of activity that show up in overnight lows to an extent you cannot reasonably predict. The ones after uncommon and fatty foods are consumed in quantities that vary from the usual routine that release seemingly never-ending gushers of glucose into his bloodstream.

We’ve been able to normalize so many things. Special trips are the hardest to deal with and present the biggest danger because there are so many variables, yet are the times when he should be able to stretch his wings and leap and fly and learn from his mistakes.

It’s the fear of the magnitude of the mistake that has me on edge.

How do you manage overnights?

iPhone Medical ID

Apple Medical IDThis is not new, although it’s new to me. As soon as I saw Meri post about it, I got this set up on my phone and Caleb’s phone.

Caleb has just about every form of medical ID there is. Caleb is not consistently compliant with wearing any of them. I know – it’s important. I can’t think of many times when he is not with people who are acutely aware of the fact that he is T1D, but there are times where the awareness is more general, and there’s the fact that he has the peanut allergy thing as well, not to mention if we crash and are all unconscious. He’s aging as a middle schooler; high school is just around the corner. He’ll continue to become more and more independent, so he’s got to become more compliant…

Caleb’s phone is with him always. The iOS health app allows for you to set up an emergency medical ID page that is accessible even if your phone is locked (there is the option to disallow) and first responders are becoming more and more aware of this. In addition to checking for bracelets and necklaces, they are checking phones.

Setting this up allows for you to be detailed about medical conditions and treatment – things that don’t always fit very well on a jewelry charm – and the ability to directly call emergency contacts listed.

For more information and instruction check here and here, and also note the mention of weighing the risk of privacy.

#Dexcom CLARITY | #Diabetes Management App

Dexcom CLARITYWith the announcement of G5, Dexcom CLARITY reporting was introduced and I completely overlooked it. I assumed the enhanced reporting wouldn’t be available until I had the handy dandy new G5 transmitter in my hands.

I was looking for the new G5 app in the App Store, saw Dexcom CLARITY, downloaded it, logged in, got nothing, thought it didn’t apply to me, moved on.

Then I asked about the G5 mobile app in a TuD conversation and my eyes were opened!! I see now that Diabetes Mine caught it and reported on in in their original newsflash.
Upload Dexcom CLARITYYou can download this application on your computer now, and it’s Mac compatible – HUGE!!!!. Download data from your receiver and, just like that, a new world of reporting is open to you!

Go to your phone (iOS only right now), download the app, sign in to your account and a PDF report is generated. You can also  generate a code to share info with others – specifically medical professionals. They can enter the code as a healthcare professional and view all your reporting, including summaries, trends, etc. Here is a USER GUIDE with tons of more detail.

I find this reporting so much more intuitive than the reports from Dexcom Studio. I loved having all the data and reporting that Dexcom Studio provided, but found myself using only the one hourly stats graph, and only going to the trouble (finding a PC) of getting it just prior to an endo appointment.

Dexcom CLARITY Summary Low Trend Dexcom CLARITYDexcom CLARITY has a more streamlined feel and isolates data interactively for you right before your eyes. There’s less to manually sift through, but still all the data there and presented in summary or detailed format at your choosing. For example, it notes a trend of lows for Caleb after dinner – something I was aware of, but seeing it in front of me like that really makes me focus. This seems like friendly reporting that can be used with little effort, which means it has a greater likelihood of actually being used.

Sleepovers | Type 1 diabetes in tow

Brothers SleepingIt’s something we did early on with family, when Caleb was four years old and newly diagnosed. It proved to be an overly stressful situation. Invites were few and then non-existent.

Eight years later, Caleb is a tween in middle school and is invited for the first time ever to a friend’s house for a birthday party sleepover.

As with other milestones in his diabetes care, I took the cue from Caleb. He wanted to go. He developed a close group of friends in his new school and was excited about the party. Most notably, he did not even mention diabetes.

It’s often the first thing he thinks of, and a factor in choosing whether or not to do something. I see it in his face as the questions form: “who will be there, what kind of food will there be, how will I know if it has peanuts, how will I count carbs, what if I’m high, what if I’m low, what is this event about anyway? oh, who cares, it’s too much trouble, no thank you.”

This time the only question he had was, “Can I go, PLEEEEEEEZE?!?!?!?”

So he went.

There were a mountain of variables complicating blood sugar management, and by “complicating” I mean “bringing hell to earth”. He went to the party straight from a baseball game. Games vary in intensity and there is often some kind of blood sugar clean up needed on the other side. He arrived to ginormo pieces of ice cream cake – he was a late arrival because of the game and they were kind enough to hold off so he could be included. I’m not kidding when I say these pieces of cake were huge. Caleb often sends pictures of food with his hand in it as a point of reference for carb counting. His hand was dwarfed by the size of the piece of cake. And did I mention it was ice cream?  “Happy birthday to yous” transitioned to an intense and seemingly never-ending match of manhunt. Movies, snacks, chatting and at some point in the wee hours boys were starting to fall asleep.

Blood sugars were all over the map. Gus, juice boxes, sugar tabs, correction boluses, extended boluses – they were all in play. There was a period of about 45 minutes where Caleb and I were texting each other while everyone else was asleep because we needed to be sure he recovered from a low and was safe to sleep.

It was a nuisance and it was disruptive, but Caleb did not complain once. He rolled with it. He was responsible and attentive to his diabetes, but he did not worry about it. He was in communication with me, but also made decisions on his own. Not all of them worked out, but he took corrective action as he needed.

All I could think of the next morning was what a mess his bgs were and how tired he must be. When I picked him up, all he had to say was what a great time he had, and filled me in on a litany of details of tween-boy, fun activities.

CousinsTwo months later, he’s invited to his cousin’s new home for a sleepover with his brother and sister. Variables are fewer and blood sugars are much more cooperative. Caleb, who never ever wakes up to Dexcom alerts, blood sugar checks, or screaming sirens in his ear, set an alarm on his phone to wake and check at 2am. And he did! Bg was a magical 150 and it’s right back to sleep for him, nothing else to talk about until morning.

Sleepovers with type 1 diabetes – it seemed like the one “thing” we hadn’t yet dealt with and it was a gloomy cloud hanging over me, pulling at me, giving me angst. Although I’m not worry-free about the prospect of future sleepovers, Caleb has shown me he can be responsible and do what is needed to fit diabetes, the thing he can’t leave behind, into the fun he doesn’t want to miss.

#DexCom G5 Mobile CGM Approved

DexCom G5

The next generation of DexCom has been approved and is expected to begin shipping in late September. With this system, the need for a dedicated receiver will be eliminated if you use a compatible mobile device. One less thing to carry. Receivers are still a part of the system, but now they are optional.

What’s equally exciting is the enhanced app that will be used with G5. Alerts and the ability to log events right in the app sounds like we may finally have meaningful reports to help us best use all this information for better diabetes management.

More photos and information at dexcom.com.