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

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There are plenty of things I’d like to see that require more R&D, most of which has been detailed below. But I’ll tell you what can be done right NOW, that - for some reason - just hasn’t been done. No new technology required, just some off-the-shelf electronic components or minor programming tweaks.

1: Add a small LED to light up the strip on a BG meter when testing in the dark. A backlight for the display is nice, too – some manufacturers already include this.

2: (Medtronic Revel Pump/CGM) Automatically suspend alarms during Reservoir Setup/Priming. I don’t need my prime to be interrupted by a “LOW PREDICTED” or a “METER BG NOW” alarm, then not knowing what was delivered. Alarms are queued up while delivering a bolus, why not during the prime process?

3: Automatically determine which BG values (from the meter) are good calibrations. If the CGM shows a relatively flat line for 30 minutes before and after a fingerstick, apply that value as a calibration seed. There’s no reason for us to look at the CGM output to determine if it’s a good time to input a calibration value (particularly with the ParadigmLink/UltraLink/ContourLink products); the machine should be able to do that.

4: Pumps offer varying basal patterns for periods of high or low activity. Why not bolus wizard patterns? The same should apply.

5: Tether pumps to a PC in order to input - and back up - bolus wizard values, basal rates, etc. It’s much easier, and less chance for error, if the data is entered using a real keyboard and full-size screen.

6: Improve packaging on the Medtronic Softserter. There is a rather long needle that must not get bent, but its only protection is a flimsy plastic bag. Given the failure rate I’ve had with these, I wonder if it’s because of the lack of protection on this needle, and when packing extra sensors for a long trip, it’s tough to protect these things. A formed plastic packaging with paper backing, like on the infusion sets, would be much better.

7: Reduce packaging on everything else. The boxes, the microscopic insert leaflets, the advertising. We go through so many of these, it’s just a pain. Since many people buy test-strips in 1-month or 3-month supplies and use ten per day, sell boxes of 300 or 1000 (with appropriate number of vials within). I shouldn’t need to tear open a new box every six days or 50 strips.

8: Insulin manufacturers sell insulin in vials and pre-filled pen-cartridges, why not in pre-filled pump reservoirs? I’d bet it would help with the air-bubble conundrum,

9: General note - don’t insult my intelligence (looking at you, Medtronic). If I just tested my BG by fingerstick and it’s 215, I know it’s high. The pump doesn’t need to sound an alarm to tell me it’s above my target. I know that if my BG is low that I should eat something and not bolus now. I know that if I’m high - and it’s unexplained - that I should check for keytones. I know that drops at the end of the tubing means the tubing is full.

  1. How about adding to pumps: a SuperBolus (pre-deliver the next 30, 60, 90 minutes of basal into the current bolus) or a Delayed Bolus (don’t deliver insulin for 30 minutes, since my meal is low GI or my BG is low to start) option.

  2. Using pumps is second-nature to us. Don’t change the keystrokes or number of menu options based on current situations, as we often do it by feel. Again, Medtronic: usually you default to normal bolus, but if I did a square-wave six hours ago, you default to that. Sometimes when feeding a calibration value you automatically go to the bolus wizard. Sometimes you don’t. I’ve missed boluses because you fool around with menu options and defaults.

OK, that was part-rant, part-suggestion. But these are all relatively easy fixes with no research required, and I’d love to see them implemented.

Where/when/what type of forum is this presentation? I’d live to be able to witness it if I can…

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Hi Bernard congratulations on the number of years you have fought the “good fight” and on behalf of all of us thanks so much for bringing your wealth of experience to the table (no pun intended). Remember testing your blood sugar with three drops of urine to twelve drops of water and putting this and a pill, in a test tube waiting to see if the colour was more blue than orange? We have certainly come a long way!!!

As far as any improvements go, I would have to say find a meter that will show you the MOST ACCURATE non invasive way(s) to check our sugars as possible. Whenever I discuss diabetes with anyone I say that if the front tire on your car or bike had a leak in it, you would out of necessity, carry a tire pressure gauge and some sort of compressor. You would leave the house a little early, check and make things right and drive or ride away without a problem. This is the kit you see in my picture and like Karl Malden and the American Express card "I don’t leave home without it. We don’t remember that commercial by the way, we are not old enough (ha ha).

In February I am fifty years old, thirty eight years insulin dependant and have no eye damage (whew). For those who have read this already my apologies for the repeats. I say this because I have worked very hard, had great support and at times, been very lucky. Yes timing is everything and when I got my first glucometer around 1986, this was a game changer bar none. For the first time in real time I could move and shake this beast. I almost heard it scream (ha ha).

The other bonus was Viagra and I wear that like a badge of honour. Lets be clear the mission of diabetes is to systematically destroy EVERY MAJOR ORGAN SYSTEM IN YOUR BODY (Dr Richard Bernstein/Diabetes Solution). Not only have the constant fingerpricks allowed me to be almost damage free, there is a large possibility I would be dead without it. The damage from a fingerprick I will tolerate, the rest I simply will not. Yes, the eyes truly are the windows to the soul, and your kidneys and everything else for that matter. Please do your best to keep those tiny blood vessels intact!

Yes it’s a great deal of work, but the rewards are massive and once complications set in, your STILL diabetic. At the present time, we have everything we need to move our blood sugar(s) up or down. The challenge is knowing just where it is, and anticipating where it is going to go, of course in real time. I believe these things do currently exist.

There are many emotional issues and rightly so. We can help squelch some of them with the correct data. At a buck a strip, I’m sure some folks like the status quo. I hope I have been some help, and thanks so much again.

Love Always
Anonymous Diabetic.

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Bernard,

Sorry, I have been away for a few days.

Yes, I gave the FDA 200 words (approx.) on LGS. You may find my comments over on Bennet’s YDMV site.

I think I have another improvement for you, and it is related to LGS and multi-wave bolusing.

How about the ability to have the pump stop delivering insulin when low at the start of a meal (or not deliver a bolus), but then ramp it up an hour or two later. This could also be helpful if you want a glass of wine/beer with your meal.

Exercise basal/bolus wizards could also be extremely helpful. I do some classes that combine cardio with weight-lifting. I initially need to lower my basal rate, but then need to raise it immediately after exercise.

Fair Winds,
Mike

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I really want a delayed bolus option. Kind of like a reverse dual wave. Or a triple wave.
How about insertion devices/site rotation? I need insertion devices that can be easily used by one hand. Having to use 2 hands to insert my infusion set limits where I am able to place it. This is why my abs, thighs, and hips are full of scar tissue.
Oh, and for the DexCom, can they add the serial number to the adhesive or the plastic clip that holds the transmitter in place? I shouldn’t need to hang onto my sensor packaging in order to get a replacement sensor if the original sensor dies before it’s 7 days are up.
And YES. Fix those dang Dex alarms. I keep mine in a glass cup because I don’t hear it at night anymore.

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Autumn, the SN for my dex is on the green sticky on the back. Almost unreadably small, but there.

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@Decaff The Mad. The increased insulin for higher blood sugars is a standard feature on Cozmo pumps. Unfortunately they’ve been taken off the market. Mine is out of warranty in October, but I’ll wear it until something better comes along.

@Autumn. I’ve wanted a delayed bolus FOR. EVER. So I can eat a meal when my BG is on the low side and have the bolus automatically kick in 30, 40, whatever minutes later. I guess you want one where the extended bolus is delivered immediately and the real bolus portion is delivered at later time, chosen by you. How would that help you? When would you use it?

FYI, the serial number is on the back of the Dexcom sensor in tiny letters. You can only see it after you remove the sensor.

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@Scott E, I’m not sure what you mean by a bolus wizard pattern. Can you explain that a little more?

@Everyone, thank you so much for all the valuable comments and suggestions.

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I vote for the three already suggested by others
:2) Delayed bolus option ( I use a Medtronic Paradigm 522, do not have that on this pump)
2) Increased insulin for nhigher blood sugar corrections ( I know to give more , but it would be nice if the pump automatically did this : would keep me away from injections in order to lower a really high (250 +) blood glucose
3) A c-peptide insulin mix as an option wouid be great, Gerri

God Bless,
Brunetta

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How about a sensor in the infusion set that is directly connected to the pump that signals an alarm if your BS is below 60 or above 180 with a msg displayed on the pump to tell you “Hypo” or “Hyper”. This would save many fingersticks/armpokes and money for those strips.

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Regarding the Bolus Wizard Pattern, it’s similar to the Basal Patterns that exist – at least in the Medtronic pumps. With the basal patterns, I have two patterns – one for work days when I’m sitting at my desk doing nothing, and one for weekends with lower rates, when I’m running around chasing after the kid (soon to be kids), etc. I’d like the bolus wizard to be set the same way, so that I might take 1 unit for 10 carbs during periods when I’m sedentary, and 1 unit for 12 or 13 carbs during times when I’m particularly active. With two (or more) patterns of I:C ratios and correction factors, I don’t need to manually lower or raise my units of insulin based on my activity level; I just specify which set of parameters to use. A bit hard to explain, but does it make sense?

That said, if I could only have one feature, the Delayed Bolus comes on top of the list!

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A insulin pump and CGM all in one fusion. More tubeless pumps. A cure!!!

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  1. a more convenient receiver (for those who don’t want to use integrated pumps). I can’t understand why in the age of ipods and smartphones does the Dexcom receiver have to be so big, round, with a black’n’white display and SO fragile! Why can’t it look like a ipod nano or why can’t it be optionally integrated with an ipod/smartphone…,
  2. colored transmitters? it might be silly, but kids might like it :slight_smile:
  3. CGMs approved for more than 6 or 7 days. I’ve noticed a publication on CGM system for dogs that’s approved for 10 days use. If dogs can have such a CGM, why can’t we?
  4. an opportunity to have an off-line application for downloading pump and cgm data. some companies offer only an online based software, which I personally find insecure - why would I wanna store my personal data on a server? I understand it’s nice to be able to share data with a physician or so, but I still find it a bit inconvenient and possibly insecure…
  5. bihormonal (or trihormonal) pump - that’s my dream. adding amylin and/or glucagon to the routine management of T1DM would be SO beneficial… ( in Europe we unfortunately don’t have an acces to amylin at all :frowning: )
  6. BG meters with an option to switch between mmol/l and mg/dl. I’ve read such meters were available some time ago but they stopped making them because it caused confusion to some patients. but i think it might be interesting for well-educated patients who are able to work with both systems to be able to switch the numbers…
  7. pump and CGM software working on Mac. Not all companies have a Mac-software available, which is a shame. I have gotten windows only because of my Animas and Dexcom apps and it is a pain in the neck to have to export all the data to pdfs to be able to view it on mac…
  8. I’ve been wondering about the possibility of making special cannulas for infants, toddlers and skinny children. Many children in our clinic have trouble with the cannulas or can’t use the pump at all because of lack of subcutanneous tissue to support the cannulas. Many of them deal with frequent high blood sugars due to a bent cannula or feel pain from the steel cannulas. If the pump companies provided shorter cannulas or some kind of cannulas designed for little kids or skinny people, it would be just great. Because CSII therapy is a great alternative for those who have to use diluted insulins on a MDI regime but the cannula-problem is definitely a setback…
    :slight_smile:
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A flat box for strips, the cylindrical one is too big to put in a pocket. Coloured insulin so a bubble could be seen easily.

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A color screen for my Animas Ping remote would be great...I hear they are available in Canada.

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