What changes would you like to see in diabetes devices/treatments?

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Some days, it seems like all I do is think about numbers thanks to my diabetes. But the truth is that even on those days, I’m mostly living my life and getting on with things despite (or even because of) diabetes. I hope that’s true for most of you. Yes, there are times when it’s all about the diabetes, but mostly it’s a temporary intruder that introduces hiccups while we get on with whatever we’re doing.


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I will be giving a presentation in a few weeks that’s focused on diabetes technology. I’ve got my own set of ideas about ways in which the devices we live with, and depend on, could be improved. Some are just minor tweaks on what we’ve already got, others are newer ideas that might take more work to implement.



What improvements would you like to see? If you could tweak the design of your insulin pump, or blood glucose meter, how would you do that? How would those changes benefit you?



I’d love to hear those suggestions. If I mention them during the presentation, and it’s not something I’ve already thought of, I’ll be sure to give attribution for the idea.



Happy Labor Day holiday for all of you living in the US.

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for the someone to buy the Cozmo technology… Jesse lives by his touch bolus by carbs button…

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Bernard,

I am not sure I can add anything to your thoughts as I know you are extremely well-versed on this subject.

Of course, you could start with Amy T’s open letter to Steve Jobs from way back in (gasp!) 2007.

From there, it is an easy jump to having apps available for iPhones, iPads and Android devices so we can ditch some of the myriad devices we must carry around with us (non-proprietary source code, please).

So here is a real quick list:

  • Integrate my meter/CGM/Pump control into my smartphone. Develop more accurate meters/CGMs (BTW, +/- 20% accuracy on meters and then using meters to calibrate a CGM has to strike someone as ludicrous doesn't it?) Pumps with Low Glucose Suspend (LGS) should be a minimal standard (hasn't anyone heard that insulin is dangerous?) Artificial Pancreas Pumps! Better infusion sets (longer lasting, less irritating, better sticking, etc, etc) Utilize design and engineering standards that will enable devices to get to market more quickly AND with more patient safety The US needs to re-think its approach to medical device safety and approval standards. There should be ONE agency tasked with overseeing medical device approval. Multiple agency approvals means devices get delayed and sometimes shelved, patients get denied, and costs (both direct and indirect) go up.

Cheers,
Mike

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I agree with Mike. Meter accuracy +/- 20% is joke! And a cruel one at that. Those of us that use insulin make dosing decisions every day based on meter numbers. Insulin overdose can and does kill. We need (and should demand) much more accurate meters.

Following better meter accuracy is better CGM accuracy. CGMs are better at trends than actual BG accuracy but I’m hoping the next generation will be more accurate too.

Faster insulins will also provide a much needed treatment technology boost.

In the end, what we all need is a cure!

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I agree with the others about meter accuracy. They have made meters smaller & faster from the old days, but I think the original meters were more accurate. The bells & whistles are nice, but I think accuracy should be at the top of the list for improvements.

Better alarms on the Dexcom. The first alarm automatically vibrates – that means you have to wait another 5 minutes to get a beep. Not everyone hears the vibrating – I missed a lot of alarms because of it. The alarms are impossible to hear at night for heavy sleepers.

If you have your low alarm set at 70 and drop below, you get a vibrate. If before that 5 minutes is up and you drop below 55, you get another vibrate. Now you are going on 15 minutes before you get an actual beep. I was having trouble with the alarms & Dexcom asked me not to respond to the alarms and write down what happened. I dropped below 70 and didn’t acknowledge the alarm (but did test and treat). Before it triggered the buzzer, I dropped below 55 so it vibrated again. Then I went above 55 but was below 70 so got yet a third vibrate. Had I been doing something I couldn’t feel the vibrating, I would have been in trouble.

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I really want to see a meter that reads your blood glucose using light or another non invasive techology. I am so sick of testing 8 to 12 times per day. Its bad enough doing MDI, but the testing is just salt on the wound.

We should have had something reliable that doesn’t rely on blood letting, long before now. I think the main reason it hasn’t been developed yet is that it would not need test strips, so the profit margins aren’t high enough for the big companies to have any interest in it.

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@Emmy, you’re not alone in this. But non-invasive is really challenging. I already pointed someone else today to the really interesting (PDF) document called The Pursuit of Noninvasive Glucose “Hunting the Deceitful Turkey”. It’s a broad overview of many attempts to accomplish non-invasive blood glucose testing. I don’t think this is just a question of profit margins, if someone figured out a way to do this they’d be able to make a profit from it.

@Kelly I know I’d like more accuracy. What if that meant a larger blood sample, or a return to 30+ seconds for a result. If that gave you 10% accuracy would it be worth it? I really want much better alarming for the Dexcom, I could write about that issue alone for pages. What about alarms that can be received remotely for parents. How about not alarming if I’ve looked at the Dexcom in the last 3 minutes? Unless the next reading is dramatically different, I don’t need to be woken up just after falling asleep to update me when I already know what’s happening. Alarms and alarm customization is worth a lot of attention.

@Terry faster insulins would be excellent. I was thrilled when Humalog was first made available, then I realized that it’s better, but still lousy compared to the real thing. In the end I think someone’s going to have to come up with some way to deliver it intravenously before we see big improvements. But I’m not a scientist, I hope it doesn’t take that long.

@Mike, I agree with you on all of those suggestions. Have you submitted any comments for the LGS proposal from the FDA?

Thanks all for your suggestions, please keep them coming.

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My wish is to see C-peptide introduced into insulin.

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Nothing to do with diabetes technology, but I would dearly like to see some serious research done on low carb diets for diabetics.

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I second almost everything already said, so won’t repeat.
I would love to see CGM technology that reads blood instead of interstitial fluid - an implantable sensor maybe?
I would like to be able to see my pump, CGM and manually entered data integrated in one application.
Yes, I’d be willing to wait longer for results in exchange for more accurate BG readings!!!
Why is so much of our equipment so boring? Black nylon cases? Come on!
Specific to the Ping remote - surely it can be made more easily readable? Maybe next year we’ll have a color screen. I do appreciate the intent of the FDA, but I know too much about how it works to do much but shake my head.

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@jrtpup: The Ping remote has a colour screen in Canada. It’s the same high-contrast screen as the Ping pump has. Not sure why it’s being held up in the U.S. Usually you guys get stuff ages before we do!

I feel like I’m on repeat when I say this sometimes, but what would help me the most is some sort of accessible pump/meter system for the visually impaired—ideally some sort of speech output. So many of the systems now are using meter remotes separate from the pumps themselves. I don’t see why they couldn’t make a “standard” remote plus an “accessible” remote. Or, better yet, make accessibility features (font size, contrast, speech output, visual/vibration alarms, etc.) that could be turned on or off depending on the user’s needs (a. la the iPhone/iPod Touch/iPad and Mac computers).

Also, it drives me crazy that it’s SO hard to share information between different diabetes applications! I really like Diabetes Pilot, but it’s such a pain to format the .csv files in the proper way to import data that I just don’t bother other than every few months. I wish programs at least allowed you to import/export from one another, even if they don’t use the same type of file format.

I also agree with the people who want faster insulin. And I wish CGMs would become a more standard treatment like pumps. I myself would REALLY benefit from a CGM but can’t afford to buy one (and my work health benefits don’t cover it, and the provincial health care most definitely doesn’t cover it—they don’t even cover pumps for adults yet).

I also wish pumps would incorporate some sort of exercise feature into the bolus calculations. It could ask if you plan to exercise in the next (insert user specified time period like 1-2 hours) and then, based on user settings, suggest decreasing a bolus by 10%, 25%, 50%, etc. Also, I wish the reminder alarms could be set in 15-minute increments so that they could be used for pre-bolusing each time I bolused (i.e., bolus, and then “after meal reminder” alarm goes off 15-30 minutes later, which is when I’d start eating). Of course, if we had faster insulin we wouldn’t need this!

This is kind of unrelated to diabetes directly, but I wish we could get meters that would measure hormones so that it would be easier to scientifically qualify (and adjust insulin to) things like stress and monthly hormonal cycles for us women.

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Judith, an Animas Ping - insulin pump.

Jen, I know about the vibe and the color screen, my complaint is that it isn’t here yet! Bah :frowning:

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So I wrote post a little while back on this which can be found here. The highlights of it are that there should be devices tailored to specific sizes of people and uses. like grow with you pumps tailored to kids from 3 to 12 in 3 stages. The have the same kind of things for cameras and cell phones. Why not medical devices? And no kid needs a 300u reservoir for 3 days. Most don’t even reach 75u.

I totally agree with the update to pump alarms. Users buy baby monitors and Macguyver coin collections to Dexcom receivers to make them louder. Can there just be a speaker attachment through the charging port?

Tracking and monitoring seem to be the biggest gripe/downfall of all techno-savvy or old school diabetics. I’d almost rather track the stock market. Inputting data shouldn’t be so difficult and their should be some sort of open med device alliance for putting data together. I can’t think of anything that exists now other than .csv, although some companies don’t even offer their data that way to the user.

Microneedles and faster insulin would be fantastic. I know there is hesitance to use dual chamber insulin/glucagon pumps on the FDAs part but I’m not low glucose suspend will help with the rebound high after. I definitely agree that all pumps should have them but I think some diluted glucagon mixture would be a better approach to the issue, but ultimately it returns back to CGM accuracy in accurately detecting glucose levels. (No solution on that one).

Also, why can’t we throw some pads with sensors on the bed to measure other signs of low blood sugar particularly while sleep like moisture (sweating), heart rate, temperature, etc. I know false positives drive everyone nuts, but with better lots of tuning or other tests, this might be the low tech intermediate solution to help lots of people. (Yes I know the downfall of noninvasive glucose monitoring but I’m only talking about one very dangerous extreme to solve for here). I know there are lots of other things that cause some of these but combined with CGM technology, it may help more than hinder.

I’d rather have a brick attached to my hip to take care of all of these things than a smaller device. But if you’re gonna keep everything in pieces, then yes, I’d like a smaller Dexcom receiver or at least one that isn’t shaped to be fumbled everywhere. The integrated app would be fantastic.

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@something_exotic, I like your idea about sensor pads to detect other hypo signs. And I totally agree with you about Dexcom alarms. That’s so big I don’t know why they didn’t do it the first time.

I need someone to draw me a picture of a Rube Goldberg device where a kid is sleeping in one room with their Dexcom receiver on a nightstand and the parents are in another with a speaker system connected using wires, ropes and pulleys to the an oversized ear horn hanging over the Dexcom receiver. Any volunteers? :slight_smile:

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I would so love smart insulin. You inject, but it is only used if needed. In theory, no highs and no lows. This has been in the research phase for years…not sure where it is at now.

This one is a littel “out there”, but I want value added or second use type of products. I want to stick my used stips in my houseplants and have them act as a fertilizer. See, I told you it was out there. But seriously…is there not something useful we can do with all these dead strips?

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@Bug74 no that’s an idea. I hate, hate, hate all the strips. I wish there was someone to put them to practical use.

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a glocometer thats easier to use by old people in AFRICA n cheap and easily available.one buys a meter 2day n tomorrow no strips.brand

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How about an infusion set that’s good for more than 3 days? It’s an expense and gets to be a PITA.

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I would like to see the Wizard Boulus feature of my insulin pump enhanced. I am a few years behind the times I guess, I have a Paradigam 722 but It’s my understanding that most “Wizards” act this way.

The truth as far as I know it is that the higher your blood sugar the more insulin you need to correct.

For example, when my sugar is between 100 to 200 I’m 1 unit to 25 for correction, but from somewhere around 200 I’m closer to 1 to 20 and over 300 I’m more like 1 to 10.

On my bolus wizard no matter what my sugar is it will spit back my 1 to 25 ratio calculation back to me. I’m not sure how much research has been done in this area, or if this has already been fixed in newer versions of Medtronic pumps or available in other brands but it would be great to see not only the technological development (which would be easy as sugar free cake) but I would also like to learn more about how to calculate these adjustments.

Decaff

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@Decaff The Mad: I totally agree with you. I’d also love to have variable Insulin to Carb ratios for things like before/after exercise, different types of exercise, sick days, etc instead of just times. I feel like it would just take a few lines of code in a computer program, but I also know that sometimes it’s a lot harder than we think.

@Bug74: Really awesome idea. I’m still rooting for glow in the dark strips so I don’t have to turn on lights to test at night but I think your idea is better. Could we do something similar for all the plastic that comes with new infusion sets/reservoirs?