If I were to replace my imperfect pancreas with technology…
I would like a closed loop system. I suppose that goes without saying. It would have the ability to communicate via USB, Bluetooth and WiFi. An RF option should be available for those who like to swim and need it to be waterproof. I'd want my CGMS to communicate real-time trends AND bg numbers to the pump. I want an accurate meter that will communicate with BOTH the pump and the computer. I want trends to be analyzed by competent software with customizable reporting. I want integrated software tools that assist with D management. I'd like a food/carb database that actually assists me real time, perhaps with the likes of an iPhone app like Carbs Control that will feed into this software. I want seamless communication with all these pieces - at least most of the time - I really don't think it would be unreasonable.
What I don't want - communication errors, driver dysfunction, inflexible proprietary software and other such nonsense. I have enough going on in my life to deal with that stuff. Let me get to the business of managing, and get back to living life.
Much of this technology is out there already- but it's piecemeal. A feature here, and an improvement there. Insurance coverage is spotty at best. I would like to challenge legislators, insurers, software, pump and meter manufacturers, and all other decision makers to play nice, get their heads out of the sand, and listen and respond to the ever increasing D community. There are glimmers of hope - there are some improvements going on, and they should keep it up. For those not yet in the game, get on board. It's not too late. And it's worthwhile. I promise.
I'm sure there are hurdles out there that I have no idea about. I'm sure there are. But for heavens sake, I believe there are more creative minds out there. And I don't think I'm asking for too much.
Couldn’t agree more. Very excellent points! I too look forward to the day that all of these items operate seamlessly (or at least more so than the currently do) with each other. Nice post
as long as it’s a 1-way data transfer (pump only sends data, ignores any incoming data) i really couldn’t care less about someone hijacking or sniffing my pump’s data output as long as i have free access to it, although i would want secure 2-way communication - i’m not sure if the latest bluetooth spec uses anything beyond a 4-digit pin code to “secure” the datastream
I don’t think the meter connecting to the PC is as important - I currently wear a MM 722 with a CGMS, and the pump acts as a sort of central “hub” - it stores BG values and the CGM data. I do agree that i want open standards for data transfer, which would (hopefully) lead to more programs that had the ability to give you different outputs. I would also like to see the ability to do something like display CGM data + meter data simultaneously on the pump and an external receiver (such as an iPhone or similar)
(also, not to nitpick, but Bluetooth is an RF technology)
Nitpicking is certainly ok. Granted Bluetooth is an RF technology. The ping RF feature isn’t the most robust to say the least. Perhaps I’m looking for something that can make it see further than across the dining room table.
Also, perhaps there are others who would envision having more comprehensive medical info in the system, but I can’t see that for myself. I’m not really worried if someone knows about my bg # at lunchtime or my trending reports… more power to 'em.
just looked up the distance for the bluetooth spec - 3 different classes of device, class 1, 2, and 3. class 3 has a range of 1 meter, a bit less than the range on the ping or minimed. class 2 is what’s commonly used in cell phones, with a range of about 10 meters (33 feet) - this is what would ideally be used, since the Class 1 spec has a range roughly the length of a football field (100 meters), but also has 40x the power requirement.
I too am not very concerned with someone looking at my blood sugar or bolus information, but i’d want some sort of encrypted communication if there were to be 2-way communication (or at least some form of signed communication, so the receiver could verify the authenticity of what it is being told to do) - i’m not crazy about the possibility of either someone maliciously telling the pump to do something, or the pump receiving an errant signal and interprets it as “dose 40 units of insulin”
First of all bluetooth communication is encrypted. This is why you have to pair bluetooth devices before you can use them. At this stage they are exchanging public keys to be used for the communication. Second the distance of bluetooth is restricted for security reasons. Escpecially the pump controlling devices are restricted to prevent an abuse from the distance. Another reason for the short distance is the battery drain. The more distance the more battery power is consumed. Battery lifetime is still one of the biggest concerns for bluetooth devices. The available battery packages needed to fuel the meter, pump, controlling device, cgms are still to small to meet our expectation. To charge all of these devices every day is not very practical to me.
The integration of devices would be great. But without the willingness of the manufacturers this will not happen. They would have to standardize the data exchange as they did with bluetooth devices like head phones and printers. This standard has to be adopted and rigorously followed by all manufacturers. In general I do not see that todays manufacturers are following this road. Technology is mainly used for customer binding: convenience and test stripe revenue and so forth. Furthermore it could be legally dangerous to open the devices to be controlled. What happens in case of a security loopwhole or a serious dosage problem. Who is to blame? Who did not implement the interaction protocol correctly? Out of these reason I am very sceptical although I share your wish to improve the current situation. Time will tell…
Communications are the least of the problem. Continuous BG sensor accuracy would be required. We cannot inject the insulin into the blood stream as a normal pancreas does so we have a lot of pure time delay and dynamic delay both of which are poison to good control. Developing good control software would be a nightmare. Do I sound as a Luddite? I think a biological solution is a far better bet.
Biological solutions to me are a pipe dream for now. Admittedly, it could also happen in my lifetime, but I’ve been hearing those promises for years since I was diagnosed 20+ years ago. I’m still dreaming a little, hoping for everyone to start at least playing nicely in the technological sandbox.
i recently discovered (not by experience, thankfully) that it is fairly common for patients in the hospital (with diabetes) to receive insulin doses through their IV, since there is no absorption delay. i asked a nurse about this, and why home insulin therapy isn’t dosed IV, and she told me that it’s because of the risk of an air embolism.
In my opinion, we are still a long way from the fabled closed loop system - sensors are nowhere near accurate enough, nor are meters. I also have a feeling that a decent closed-loop system would not only reduce insulin output in the event of a low blood sugar, but would also inject glucagon (or, if it uses an IV infusion, possibly a dextrose solution)
