Have you voted in the US Primaries today?

February 5, 2008 by Bernard Farrell

Today is the presidential primary day for many states in the US. And my good friend Manny has issued a challenge to the presidential candidates. Are they prepared to make funding for research and treatment of diabetes a National Priority.


This may not seem too important if you don’t have diabetes. But remember that a recent study(PDF) showed that in 2007 the US spent over $174 billion dealing with diabets.

How much is that? More than was spent in Iraq supporting the military and dealing with situation there. Or about $580 for every person in the US, that’s $2,320 for a family of four. For one year’s treatment.

If you’d like to make your opinion heard on this, please complete the Diatribe survey about diabetes and its importance.

Oh, and do please vote in the primaries. It’s important to make your opinion count.

David Lazarus on living with diabetes

February 2, 2008 by Bernard Farrell

I just spotted this Marketplace interview with David Lazarus of the Los Angeles Times. He was diagnosed with diabetes in November 2007.

The title of the interview is ‘Living with (and paying for) diabetes‘. When he was asked about what he’s learned about the costs of living with this chronic disease, he answered

They’re extensive. In some cases, some diabetics tell me the spend about $10,000 a year on this thing. You’re talking about your blood glucose meter, you’re talking about the test strips that are required for that (and I do as many as seven to 10 tests a day), but there are other things as well: you’ve got you’re insulin, you’ve got your needles, you’ve got the lancets you need to poke your finger — again 7 to 10 times a day — and so you have a lot of fixed costs attached to a chronic disease.

He also talks about the $1 per strip cost. Maybe with his focus on publicizing the costs something may happen.

One of these days some company will wake up to the idea that they can provide accurate strips for $0.50 each and capture a big share of the market. I can’t wait for that to happen.

First Impressions of the SymlinPen

February 1, 2008 by Bernard Farrell

I saw my endo today and I was given a sample SymlinPen 60. I’ve blogged previously about my experiences with Symlin. So in this post I’ll just talk about the pen itself.

When I got home I snapped some pictures before using it.
Symlin Pen size comparison

As you can see the pen itself is a little longer and thicker than a large ballpoint. It’s an awkward fit in my shirt pocket, only about a half-inch of the clip is actually holding it in place. I’ll definitely keep it in my diabetes kit.

I had planned to use the pen at lunchtime. When I opened the box and took the cap off I found…no pen needle in place. That’s right, the sample cannot be used immediately. It’s like a Christmas toy that has no batteries and all the stores are closed.

Luckily I had some 10-year old pen needles left from when I used an insulin pen, and once I got home I grabbed one of these. It fit perfectly.

Symlin Pen

The pen has a dial at one end that lets you choose to dispense Symlin in doses of 15, 30, 45, or 60 micrograms (mcg). For comparison, 10 units of insulin is equal to 60 mcg of Symlin. Many people with type 1 diabetes will use 45mcg or less per meal. If you have type 2 diabetes and are taking insulin then the Symlin 120 pen is probably more useful, it will deliver either 60 or 120 mcg.

To start with I attached the pen needle, dialed up a 15 mcg dose, pulled back the end to prime the pen and dispensed the dose into the air. This was to fill the needle. I repeated this several times until I saw a stream of Symlin.

Symlin pen standingThen I dialed up my regular dose of 60 mcg and was able to inject it using the wonderfully small pen needle. If you put the needle cover back on, you can replace the pen cap with the needle still in place.

There’s an interesting design feature, where you can stand the pen on end. I’m not sure what the benefit of this is, or whether it’s just a side-effect of having a built-in plunger.
SymlinPen Plunger
There are markings on the barrel of the plunger that help you determine whether it’s pulled back far enough. This is especially useful when the cartridge is almost empty and there may not be enough Symlin left for the dose you want.

Note that once you’ve pulled back the plunger the only way to undo this is to dispense the dose. If you dial up too small a dose you can choose a larger number and pull the plunger further back. If you’ve dialed up too much, you need to just dispense the Symlin into the air.

As you push the plunger there are soft clicking noises. I didn’t count these, but there seems to be one click for a 15 mcg dose and three or four (I didn’t count carefully enough) for a 60 mcg dose.

Once you’ve started to use the pen, you can store it at room temperature up to 86 degrees F (30 degrees C). Unopened pens must be stored in a fridge.

Overall I think this is going to be a lot easier than carrying around a vial and syringe. I wish the pens themselves weren’t disposable, but that seems to be the way these things are made nowadays. I think I’d give the pen design a score of 7 out of 10.

To improve the score Amylin would need to include a pen needle with their samples and reduce the size enough for this to fit in a normal shirt pocket.
I think I’ll find this

Is this a better way to treat diabetes?

January 28, 2008 by Bernard Farrell

I was reading Forbes magazine this evening and noticed a full right-page advertisement that started with this statement.

3rd Law of Healthonomics
Soaring healthcare costs are only the symptoms. You’ve got to start treating the disease.

The remainder of the advertisement reads.

Most employers are rethinking their responses to escalating healthcare costs. Why? They recognize chronic diseases are the root problem. Example: An employee managing his diabetes might cost $5,000 per year. An employee not managing his diabetes could cost up to $45,000. The win-win here is that by providing employees incentives to lead healthier lives an helping them to manage their chronic diseases, you reduce your healthcare costs. And you’ll have healthier employees. Sure beaths the alternative.

The advertisement points to a website to ‘learn about lowering costs‘. That site leads to the Diabetes Ten City Challenge (DTCC) site.

The DTCC FAQ page includes the following summary of how the DTCC works:

The Diabetes Ten City Challenge establishes a voluntary health benefit for employees, dependents and retirees with diabetes, provides incentives through waived co-pays for diabetes medications and supplies, and helps people manage their diabetes with help from a pharmacist coach in collaboration with their physicians and diabetes educators.

I like the idea of waiving co-pays for meds and supplies to help with better diabetes management. I just wonder whether this program is aimed at people with all forms of diabetes, or just those with type 2? Given that one of the sponsors is GlaxoSmithKline, I’ll bet I’m right. Will is lead to better benefits for insulin pumps and continuous glucose monitors, or will the focus on cost reduction mean these important technologies are less covered?

This program is being tried by a number of employers in the following cities: Charleston/Spartanburg; Cumberland; Chicago; Colorado Springs; Dalton; Honolulu; Los Angeles; Milwaukee; Pittsburgh; and Tampa Bay.

Have you been enrolled in this program and can you give any feedback on how it works for you? I’m interested in seeing if this is the start of a new approach to diabetes care across the country. And I’d love to know whether or not it includes all types of diabetes.

Walking barefoot

January 25, 2008 by Bernard Farrell

If you’ve got diabetes you already know that one of the big challenges is loss of feeling in your feet. This is caused by peripheral neuropathy and it often leads to foot damage because you can’t feel the pain of an injury to your feet.

So those of us with diabetes are taught early and often to protect our feet. “Don’t walk barefoot” is a standard mantra.

Today I was doing my random walk through the internet and I came across a product called Vibram FiveFingers. I’ve not bought a pair and I have no connection to the company.

These things look very interesting to me. And the thought of having a barefoot experience of sorts is intriguing. I really like the look of these, someone has clearly put some thought into the design (diabetes product makers take note).

I’m blessed with wide feet, but according to the FiveFinger FAQ (I had to use this alliteration it was too tempting) the material accommodates wide feet. So that removes one obstacle for me.

Have you ever heard of, or bought a pair of these? I’m tempted, but at $70 and more for a pair I’d love to know before I invest in them.

Stem cells found in mice pancreas

January 25, 2008 by Bernard Farrell

An article in today’s Washington Post reports on research that has found stem cells in the pancreas of mice. I’m not sure whether it matters, but it appears these were regular mice or NOD (non-obese diabetes) mice.

“This demonstrates a stem cell repair mechanism in the pancreas that, if we understand it more, then we can help develop more cures with either transplantation or with drugs that can increase the body’s own stem cells and beta cells,” said Paul Sanberg, director of the University of South Florida Center for Aging and Brain Repair in Tampa.

The full technical article was published in the journal Cell.

I think this is another example of research that can contribute to thinking differently about how our pancreases truly work. It may be a long time before this research leads to human treatment, but it’s another step in the right direction.

Briefing on the Toll of Diabetes

January 23, 2008 by Bernard Farrell

Today, January 23rd 2008, the American Diabetes Association (ADA) and the members of the congressional diabetes caucus will hold a briefing to announce the annual diabetes cost estimates for 2007. Maybe if you’re in Washington you can drop by and listen to the briefing.

During this briefing, speakers will release staggering new figures about the direct and indirect costs of the disease, and reveal the devastating expense incurred by Americans.

I’ll be interested to see how much the incidence and cost of diabetes has increased. And also whether any new legislation is proposed during the briefing.

Update: The final estimated cost(PDF) for diabetes in 2007 was $174 billion. The US Population last year was about 300,000,000 people. That means the toll of diabetes was about $580 for every person in the US.

If a cure is ever found that would mean that huge amount of money could eventually be put to better uses. Hey, I’d happily take mine as a tax break!

America’s Giving Challenge

January 23, 2008 by Bernard Farrell

I got an e-mail from the Juvenile Diabetes Research Foundation (JDRF) about America’s Giving Challenge.

PARADE Magazine (which comes in some Sunday newspapers) is holding this contest where the 8 charities that attract the most individual donations will receive $50,000 and be featured in PARADE magazine article. This is a great opportunity to raise visibility for diabetes research.

To help you donate to JDRF through the Network for Good organization. Your donation can be of any size. You’ll have to register with Network for Good to do this (I just did) and then you can donate via Paypal or with a credit card.

To me, this seems like a relatively inexpensive way to raise awareness of the importance of diabetes research and the search for a cure. I hope you’ll agree because right now JDRF is not even on the top 10 list for this contest.

Maybe an artificial pancreas IS possible!

January 22, 2008 by Bernard Farrell

I’ve had type 1 diabetes for a long time and I’ve spent much of that time hoping for, and thinking about, a possible cure for diabetes. But I’m also very interested in the research that JDRF is doing on an artificial pancreas.

I can understand how a closed loop between a continuous glucose monitoring system and an insulin pump could work to control my basal (background insulin) rate. But I really didn’t see how it might also be possible to effectively give boluses (larger doses for meals or BG correction) with such a system.

Yesterday I stumbled across a short paper in Diabetes Care, Detection of a Meal using CGM. The authors describe a Meal Detection Algorithm that allows them to detect a meal about 30 minutes after the person has started eating!

It’s not perfect – but we already know that’s true for most of diabetes care. Uf this brings the Artificial Pancreas a little closer and make diabetes treatment a little easier, I’ll take it.

Insulin is not a cure. But automatic insulin delivery is a step in the right direction.

Random links for Thursday

January 18, 2008 by Bernard Farrell

I came across a report much earlier in the year that I forgot to tell you about. It’s published by the New England Healthcare Institute (NEHI), and is titled Continuous Glucose Monitoring: Innovation in the Management of Diabetes(PDF). Although it was published in 2005, the contents are still very relevant.

Don’t be put off by it’s length, the real information is within the first 40 pages. It’s a readable and informative document. And the Significant Barriers to Adoption that are covered starting on page 35 are still here today. It’s worth reading.

If you’re a regular reader, you know that I created the Diabetes Search Engine that uses Google technology to let you search over 800 sites that are all related to diabetes.

I add new sites to the engine list many times a week. And I decided that I’ll occasionally post a list of the ten sites that I’ve most recently added. If you haven’t already tried the engine out, I think you’ll find it very useful. All advertising raised goes to support Dr. Faustman’s research for a Type 1 diabetes cure.

I hope you’ll check out some of these sites. I had a hard time stopping at the first ten!

InsulIndependence.org is “a worldwide project aimed at changing diabetic lives through adventure travel, educational outreach, and web-based community support.”

so much sweeter is a fairly new blog from Carly. She’s a graphic designer from PA, and she’s the proud wearer of an OmniPod.

The Biggs Picture is a blog from Angela. Like many oph us she struggles with diabetes and technology. She seems to like kitties.

D.A.D. Innovations is a startup company that makes and sells diabetic driver car window decals and other handy products. The company was founded by Lisa, who’s dad has diabetes.

Trying To Be Human is a blog from Araby62. “Various and sundry thoughts on living with type 1 diabetes from a thirtysomething wife, daughter, sister, aunt, friend, and lady-in-waiting to a certain feline.”

The Diabetic Domestic Diva is a blog from Windy who has type 1 diabetes and also wears a Dexcom.

Dodging Diabetes Charity Dodgeball Tournament. I think the name is obvious. This is the 3rd annual one and it happens in Bethesda, Maryland. They’re looking for participants and sponsors.

Confessions of a Starbucks Addict is a blog from Aurica in Kent, Washington.

The Diabetic Runner Challenge is a site that challenges you to run and raise awareness of diabetes and the upcoming 2nd World Diabetes Day in November.

Camp Possibilities is a camp for “children with diabetes between the ages of 7 and 15 who, due to the complexity of their disease, often do not get the chance to go to a summer camp”. It’s in Darlington, MD.

If I don’t talk with you before then, have a great weekend!