Set changes

Since I started with Artoo, infusion sets have been the weakest link in my pump experience. Around the time of the summer holiday I had noticed that I was getting some sort of set-based upheaval around once every 4-6 weeks, occasionally as much as fortnightly. This was clearly not right, and another 'no delivery' alert with attendant BGs in the 20s (360s) spurred me to contacting my pump DSN to investigate the options. Some of the failures I was getting were clearer than others, involving cannulas kinked at 90 degrees and 'no delivery' alarms. Others were less obvious - rampaging BGs which began to resolve after a set change despite there being no apparent problem with the old one. Still others involved multiple changes of reservoir and/or set in a single evening. Partly I am sure this is down to my own nervousness over the whole set business. One apparent failure, followed by a change which gives a 'no delivery' followed by another change can leave you feeling very unsure until you actually see your numbers begin to drop. Annoyingly, for me this can often take more than an hour - plenty of time to decide to do another full change 'just in case'.

In short I was very keen to experiment with alternative sets and see if I could find one which worked, change after change, for months rather than weeks at a stretch.

My DSN was able to give me several each of the shortest cannula length versions of Silhouette (angled Teflon), Sure-T (straight metal) and Mio (straight Teflon with self-serter).

Having spent most of September experimenting, on Friday I received my first order of Silhouettes which seem to work best for me.

I wasn't keen on the 'double sticky' extra loop business with Sure-Ts and while they were almost pain free to insert I found the 2 day changeover came around very quickly. I didn't get on well with the flimsy feeling Mio serter (though I know many love that feature). The first two Mios I pushed in manually, I actually dropped one which fell apart and deposited the 'sterile' needle part onto the floor (which would not have been ideal if I'd been changing on the run and had only taken one with me). The final nail in the coffin for Mios though was the last one which suffered a 'no delivery' cannula kink.

Silhouettes performed very reliably for the few I had to try, so I'll be interested to see what a whole box brings. I was impressed by the relatively compact box size. I'm undecided about the Silhouette kerplunker and may well try a few manual insertions which I suspect may be a bit more comfortable than spring-loaded ones. I did find that the mark on removal seems to be a little more noticeable than others, which might be to do with the angled nature of the cannula.

Fingers crossed I have a few months of clear space before I have to battle my next set-fail shuffle.

Glooko going spare

I was kindly offered the chance of trialling the Glooko meter sync cable and app early in August. Holiday madness rather overtook our household so it wasn't until last week that I was able to give it a go. the Glooko cable and app allow you to import data from one (or several) popular BG meters directly into your iPhone/iPod Touch. Once imported entries can have additional details (such as carbs, insulin dose, meal marker, comments) added. Subsequently nicely formatted data tables can be exported out as an email for printing or sharing with your healthcare team.

Unfortunately I can't really offer a 'proper' review or opinion because as it turns out the old blue Accu-Chek Aviva that I had intended to use for the trial is not compatible with the cable (though newer black ones would be).

What I saw of the app was straightforward enough. Unusually this logging app includes carb-lookup information which might allow you to have a better 'stab in the dark' guess at a meal than usual. This information (including nutritional breakdown) can be logged against your meal. From what I can see the app doesn't appear to offer graphing of your data, averages, SD or other analysis tools, opting instead for a simple table format with pre/post meal markers. Notes and comments are available either from a predefined list or can be typed in a box.

I would suggest that the Glooko cable would suit more occasional loggers, especially for users of Accu-Chek meters. The majority of meters it works with plug in via 3.5mm jack, but the optional Infra Red adapter (sold separately) requires you to line up the iPhone quite carefully, put the meter into IR transmit mode and then press 'sync' on the Glooko app. This is all very well if you want to import a day's or a week's worth of readings, but would take significantly longer than typing X.X into a box while hurrying so that your dinner doesn't get cold. Since the app is free, and the meter cable is what you buy, there is no way of adding BG values manually.

If you would like to try the iPhone BG meter sync cable for yourself the lovely folks at Glooko have suggested that I offer it to any of our readers who would like it (check Glooko.com for a list of compatible meters, and you would need an iPhone/iPod Touch, obviously). If you are interested, leave a comment below.

C8 MediSensors - A bright future for CGMs?

Some months ago I was made aware of a new piece of diabetes techno-gubbins in the pipeline which sounded really interesting. Any poor souls who have read these ramblings before will probably already know my interest in continuous glucose monitors (CGMs). So I was delighted to be invited by the lovely Andrew to a little round-table chinwag with various other diabetes bloggers, campaigners, movers and shakers along with a couple of people from C8 MediSensors who have developed an entirely new approach to CGM which has the potential to be a complete game-changer. A non-invasive, optical CGM. It is currently classed as an 'investigational device', so it's available for use in clinical trials, but not yet available for sale anywhere in the world.

In proper 'disclosure' style I'll mention at this point that my train fare was covered, they laid on some tasty sandwiches and I was offered a modest amount to cover attending the day. I wasn't asked or paid to write anything about it, but I wasn't forbidden from doing so either and as I say - this is already a proposition that interests me (and I suspect, some of you) very much.

What C8 MediSensors hoped to gain, I think, was some end-user input for the potential UK market. The device is not yet available anywhere (they hope to have European CE mark approval by the end of the year and plan to launch in the UK and Europe first). This wasn't a marketing push, or a sales pitch, not yet anyway - this was much more of a two-way dialogue. Picking our collective brains about what we thought would be important to UK punters, how well understood we thought the concept of CGM was in the UK. What potential attributes of app and interface we felt would be welcome and/or irrelevant.

What on earth are you talking about?
The device being developed is one of those rare things. A real first. It's a non-invasive continuous glucose monitor (nCGM). It measures glucose concentration not with an inserted sensor beneath the skin, but with a small beam of light. Let me say that again. No sensors. No sensor stabbiness every 3-7 days. No sensor cost. No consumables at all of any note. As someone who has looked into the challenging financial implications of self-funding a CGM in the UK you can see why this would attract my attention.

Essentially the nCGM is the world's smallest Raman spectrometer. Apparently the initial 'proof of concept' device was about the size of a sideboard, but you'll be pleased to hear that they have managed some ingenious Wayne Szalinski style miniaturisation since then and the current device and rechargeable battery are each roughly matchbox-sized and together weigh a little more than an iPhone. Not exactly nano-technology, but certainly viable. If you are interested in a bit more nitty gritty on the device itself we were shown a short video which shows the CGM in use.

There are still some wrinkles to consider of course. The 'belt' that holds the device against you is not the most beautiful fashion accessory you could imagine. You can't immerse the device in water. You can't really use it while running, leaping and turning somersaults (the light sensor needs gentle but consistent contact with the skin to take its readings every 6 minutes and might complain if it gets jiggled about a lot). There are even 'light screen'/dark shirt precautions that might need to be made if travelling alternately from bright sunshine to deep shadow since light can 'leak' horizontally under the skin. Currently the device is intended/tested for over 18s only, though young people and other user groups are certainly being considered for the future when research data/regulatory approval permits. Data display is currently only available via an Android smartphone, though an iPhone version is on the cards.

Crucially, with this CGM you just put it on and it begins collecting data within minutes. If you want a break, even for just a few hours, you can just take the whole thing off for a short while. It's still a CGM of course, so it's more 'trend' information than definitive BG levels and occasional fingersticks will still be part of the picture, but if you've looked into CGM before you'll know that already. Interestingly, the plan is to launch with a 30-day money back scheme allowing users to try it for themselves before they commit to permanent ownership.

I came away from the meeting very excited. After 8 years of development, and many clinical trials they have data that shows the C8 MediSensors Monitor to give results comparable in accuracy to 'traditional' CGMs, but without the ongoing sensor cost. In fact the suggested price point of the device ($4,000 or roughly £2,500 at the time of writing) is somewhat cheaper than one year's worth of full-time sensors, theoretically putting it within reach of many more people than can currently self-fund. In a clinic environment I would imagine this is a device that makes perfect sense. How many CGMs stay on clinic shelves, I wonder, for want of sensors to offer patients?

Encouragingly C8 MediSensors also seemed keen to build a relationship with users, foster something of a user community. Founded by a parent of a T1 child and his two college room-mates, they seem to have something of a patient's eye-view mentality. Essentially wanting to engage not just with Healthcare Professionals, but with the Diabetes Online Community. With us as end-users.

It will be very interesting to see what happens next. Whether CE approval is forthcoming, and quite how the launched device performs in the wild.

Hold on to you hats. This could completely change the landscape.

EDIT: C8 Medisensors announced that they had received CE Mark approval on 25th October 2012. Things seem to be getting a little more interesting!

UPDATE: Has the light gone out on C8 Medisensors optical CGM?