Author: Gordon Hannan
I have been using the Dexcom G4 Platinum for just under 2 weeks now and I can say that it has made a big difference. I love that I can quickly glace at it to see where I'm at and see where I've been. Although I haven't had any lows while using it, I have had a few highs and I love that the alarm goes off, or vibrates depending on the settings, to let me know that something is going on. I'm still getting used to it but it has already lead to better control in the short amount of time that I have worn it.
The only negative thing about it is that the sensor doesn't want to stay stuck. My first sensor came off at just 6 days. Since they are guaranteed to last 7 days, all I had to do was call Dexcom Technical Support and they replaced it for me for free.
Aside: For what it's worth, it is important to record the lot number on the sensor packaging before tossing it out. I was required to give them the lot number in order to process the replacement. Luckily I had ordered a pack of 4, which were from the same lot, so I could read it off of a different sensor. If you were to just order a single sensor, had a single replacement sent to you, or were on the last from the pack of 4 you might not be able to give the the lot number.
The technical support team recommended using Tegaderm adhesive, cutting a sensor-sized hole in the middle, to stick overtop of the normal adhesive. I bought a pack of eight 10cm x 12cm patches for sticking overtop of my second sensor. After shaving the area, wiping with rubbing alcohol, and applying the sensor I then stuck on the cut out Tegaderm. It seems to be a lot more secure. Unfortunately the 10cm x 12cm isn't quite large enough to cover completely the edge on the left/right, but it is sticking much better than without.
Some users on Reddit suggested using Skin Tac (http://dsmrtr.com/K) adhesive and getting the adhesive remover (http://dsmrtr.com/L) to see if that works better. I've also found generic version of Tegaderm in a 10.97 meter by 10.6 cm roll (http://dsmrtr.com/N) that I am going to try as well. That way I can cut to the size that need. I'll update this later with whichever version I find is better.
The Dexcom Studio software offers more in depth access to the data, but I haven't delved into it much. It does provide a lot of data (view a redacted screenshot of main info page)!
I also ended up ordering, from https://pumppeelz.com/, "Pokeball Inspired" vinyl wraps from my Verio IQ, Dexcom receiver, and Dexcom transmitter. They look pretty awesome! The first picture is of the sensor/transmitter with the wrap installed with the tegaderm added. It is the "wavey" clear stuff.
Disclosure: The product links to Amazon, not Pump Peelz, are affiliate links. It doesn't cost you anymore to use them, but I make a small commission on the sale and would appreciate it if you would use those instead. Let me know if you find anything better and I can put a link to that as well!
I decided to order a CGM to help me achieve better control of my levels. I ordered a Dexcom G4 Platinum on Monday July 25th, and waited impatiently for it to arrive. On my wife and my's 3rd anniversary, the 27th, it arrived and I've been innodated with tons of information and insight ever since. I will be doing a full review shortly!
Today, we in Canada, celebrate the founding of our nation and of our independence! As Canadians we like to brag about how we make the best hockey players, maple syrup, whiskey, and beer. We have the Great Lakes, our cottage country, milk in bags (photos: in store, in pitcher), and are known for being polite—sorry for bragging!
Canadians like myself also have an excellent health care system which covers the majority of primary care, specialist, and emergency room fees. This means that we don't have to think about whether our illness is "severe enough" to warrant the cost of a hospital visit or if our insurance will cover the visit. I can visit my primary care physician, endocrinologist, diabetic educator/nurse, and get my blood work done without having to spend a dime or file any paperwork. It really is a great system! While there are some drawbacks in what it doesn't cover for people with diabetes, I'll leave that for another day.
I am not one to visit the ER for minor reasons. Back in November 2015, I had a blood test done Friday afternoon. I got the results at 10 pm that night and was told over the phone that my blood sugar was high, but I had no idea what 28 mmol/L (504 mg/dl) meant. After being told that the normal range was between 4.0 mmol/L and 6.0 mmol/L, a family member offered to let me borrow her spare glucometer so I could keep an eye on it until I could meet my family doctor during the following week. I started feeling slightly more sick during the middle of the week. If I had to pay for my visit or worry if insurance was going to cover it, I would have definitely waited longer before visiting the ER. In doing so, I would have become more sick before heading in too, which would have made my treatment much worse. If it wasn't for this coverage I would also have large health care bills from when I was first diagnosed and even more continuing on.
This is just one of my many reasons to be grateful and proud to be a Canadian!
Happy Canada Day!
A few days ago I finally received a response back from the makers of Dario! While it did take 14 days to hear back, I'm glad they responded.
It seems like, based on their email, that the Nexus 6p will not be supported in their future updates. While this is disappointing, it isn't all that surprising. Looking at their USA/International site, it shows only photos of iPhones, and only lists iPhones under their models (screenshot here from http://mydario.com/the-app/). Although they said they would be "[updating their] list of supported phones for the Samsung and LG families," updating could mean removing entirely instead of adding new models.
I guess my next step is to take them up on their offer the speak to their professional support services to see if I can get a refund.
You can read their full response below:
Thank you for taking the time to give us your feedback. It is important to hear back from our users and to understand the needs of our customers.
In our next app upgrade, which is currently being verified for release, we will update our list of supported phones for the Samsung and LG families.
We would like to make the Dario Smart Glucose Meter system as widely available as possible, but we also want to ensure that we can responsibility validate all the phone models that we proclaim to support. Please take into consideration that there can be a great variance between the hardware of each Android phone and how it interacts with our meter and app. Our device was tested and approved by the relevant regulatory authorities. The device accuracy meets all standards. The inaccuracy, presented in the movie posted in your blog is related to the unsupported phone that was not verified. We advise potential and current users to review the list of supported smartphone devices as stated on our packaging and website.
Dario understands and takes very seriously the need for our users to have a glucose meter that they can rely on when using it with one of our supported phone models. We are continuing to upgrade our app and have team members who are dedicated to developing and maintaining the Android version of the app.
We are welcome you to contact our professional support services for any needed assistance or refund request.
I've been recently learning how to calculate bolus insulin based on my insulin to carb ratio and correction factor. Using a calculator works, but it isn't the quickest method. I decided to make my own calculator app. You can find it here: https://play.google.com/store/apps/details?id=appinventor.ai_digitallysmarter.InCalc&hl=en
The app takes your current blood glucose level, what you're correcting to, numbers of carbs you'll be eating, your insulin to carb ratio, and your correction factor. It then calculates the base insulin, correction factor, and adds them together for your total. It rounds to two decimal points so that you are the one who makes the decision whether to round up or down.
This is very much a 1.0 version, so I'd consider it to be beta. It currently only accepts blood glucose in mmol/L (mg/dl will come later).
Main Screen Unfilled
Main Screen with Calculation
Feedback and suggestions are welcomed and appreciated! Please send to insulinCalc@digitallysmarter.com.
I have sent LabStyle Innovations, at email@example.com, the following email. I have also tweeted it here https://twitter.com/diabeticdotlife/status/741741305051500544.I will update the article with any response that they provide. Until then, I'm stuck with ~ 250 strips that I can't use.
For those unfamiliar with the Dario Glucose meter here is an older photo of mine:
Dario glucose monitor plugged into an LG Nexus 5 phone with a unused test srip inserted.
Subject: Open Letter Regarding Lack of Proper Android Support
Dear Dario Staff,
Up until recently, my favourite glucometer of choice has been your Dario. I liked your smart glucose monitoring system because is portable, compact, and convenient. It's great that it works with iPhone or Android by using the universal headphone port. This was a great system when I was using the LG Nexus 5. I recently upgraded to the Huawei Nexus 6p, which isn't officially supported by you. The fact that the most recently supported Android phone is the Samsung S5 (screenshot here) and iPhone 6—which was released over 2 years ago and just under 2 years ago, respectively—has diminished my faith that you will continue Android development. You also don't yet list support of the 6s or 6s Plus either, although this is of less concern for me.
On my Nexus 6p, sometimes it will work fine, other times it will take 3 or 4 strips to actually take a ready. At ~$0.75 a strip, the software bugs make the testing cost-prohibitively expensive. I would have expected an official flagship phone, especially a Nexus series phone, to be supported—especially when the company is getting about $100 a month from my personal testing alone.
I did a screen recording of the app malfunctioning and have uploaded it to YouTube, you can watch it here:
The most worrisome thing about the testing in the video, was that the readings varied wildly. Once it finally worked I got a reading of 13.9 mmol/L (~250 mg/dl) then immediately after the next reading was 5.2 mmol/L (~93 mg/dl).
If the test strips weren't expensive enough, it is worth noting I had to pay an additional $40 plus shipping for the meter. Most companies will give you the meter for free since they're making money off of the test strips long term. Apart from research and development costs (which appear to have been a one-time investment), the Dario seems very cheap to manufacture. The parts are likely cheaper than any other glucose meter since they usually have an LCD screen and on-board ASIC calculator to measure the blood glucose level. The Dario instead utilizes your smartphone for the display and its CPU for any kind of computation.
I have posted this article at http://thediabetic.life/2016/06/11/an-open-letter-to-labstyle-innovations-corp-mydario/ and will update it with whatever response you would like to provide.
My main question is this: Are you going to continue with Android support for new models or will you refund the strips that I purchased that I can no longer use?
Gordon Hannan (from www.thediabetic.life)
Update: Labstyle Innovations did send an email response, you can read it here: http://thediabetic.life/response-from-labstyle-innovations/
Whenever possible, I have included citations and links to my sources. If you spot an error, want to suggest a topic, or want to chat, please send me a message on the contact form, and I'll respond as soon as possible.
As I learn more about Diabetes, I am also learning about different complications thay may arise from it. One of the more serious complications is a type of eye damage called Diabetic Retinopathy.
According to the Canadian Diabetes Association (CDA) and the American Diabetes Association (ADA), Diabetes is the leading cause of blindness in Canada1 and the United States2. Symptoms of Diabetic Retinopathy include blurred vision, vision loss, flashes of light in the field of vision, blotches or spots in vision, and floaters.
Diabetic Retinopathy has two forms that it can take. The first is Non-Proliferative Diabetic Retinopathy (NPDR). NPDR occurs when diabetes damages small blood vessels within the retina. These vessels leak both fluid and blood. This gradually causes the retina to thicken or swell. Overtime the swelling, or edema, thickens the retina. This causes the vision to become blurred. The second form is Proliferative Diabetic Retinopathy (PDR). PDR occurs when new/fragile blood vessels grow abnormally and extend into the vitreous.3 According to the National Eye Institute, the vitereous is "a gel-like substance that helps the eye maintain a round shape."4 The abnormal growth of the blood vessels into the vitereous can cause bleeding, scarring, and contraction of the vitreous. The contraction of the viterous can, in severe cases, lead to retinal detachment. PDR can cause severe vision problems, including blindness.3
PDR can be treated with a laser treatment, called photocoagulation. The focused lasers are used to help seal the areas with abnormal blood vessels by creating small burns. The American Optometric Association have some excellent videos, created by Eyemaginations, Inc, that you can view here: http://www.aoa.org/patients-and-public/eye-and-vision-problems/glossary-of-eye-and-vision-conditions/diabetic-retinopathy?sso=y.
The best way to prevent retinopathy is by:
- Get your HbA1C tested every 3 months and know what it is at (check with your healthcare provider for your target level, most people with diabeties aim for a 7.0 or less). Check out these charts for a guide to interpret your HbA1C.1 For International System of Units, SI, mmol/L click here. For Conventional Unit (USA) click here.
- Maintain good glucose levels, blood pressure, and cholesterol levels.1
- Visit an optometrist at least once per year. Follow optimetrists recommendations for more frequent visits, if necessary.1
If you meet the following conditions, according to the CDA, you should be screened for retinopathy:
- Anyone over 15 with type 1 diabetes (T1D) should be screened yearly after five years from diagnosis of diabetes
- People with type 2 diabets (T2D) should be screened when diagnoses
- Women with T1D or T2D who are planning to become pregnant should be screened prior to conception, during their first trimester, as needed during pregnancy and within the first year post-partum.
Eveyone with T1D and T2D are at risk for diabetic retinopathy. The time between optometric appointments will vary between individuals. Based on the severity of the retinopathy, the frequency will likely increase. For people with no or minimal retinopathy, the recommended interval is one to two years. Please consult your optometrist and health care team to determine what suits your health best.
1. "Eye Damage (Diabetic Retinopathy)." Eye Damage (Diabetic Retinopathy) | Canadian Diabetes Association. Accessed March 07, 2016. http://www.diabetes.ca/diabetes-and-you/complications/eye-damage-diabetic-retinopathy.
2. "Complications." Complications: Diabetes Forecast. Accessed March 07, 2016. http://www.diabetesforecast.org/diabetes-101/complications.html.
3. "Diabetic Retinopathy." Diabetic Retinopathy. Accessed March 08, 2016. http://www.aoa.org/patients-and-public/eye-and-vision-problems/glossary-of-eye-and-vision-conditions/diabetic-retinopathy?sso=y.
4. "Facts About Vitreous Detachment." Facts About Vitreous Detachment. August 2009. Accessed March 08, 2016. https://nei.nih.gov/health/vitreous/vitreous.
A patent — filed on May 28th, 2014 and published December 3rd, 2015 — reveals a design for "A system for needle-free drawing of blood". This patent is exciting for anyone who needs to regularly test their blood for any reason. One of the common reasons people need to check their blood would be to monitor glucose levels. The patent mentions that one application of the new technology could be diabetes:
In a typical scenario, a person's blood is drawn and either sent to a lab or input into a handheld testing device, such as a glucose meter, where one or more tests are performed to measure various analyte levels and parameters in the blood. The frequency and regularity of such blood tests can depend on the type of test and the nature of the condition or conditions being monitored. For example, testing for blood glucose concentration for a person with diabetes may be performed relatively frequently. 1
The biggest advantage that the patent mentions is that the "the micro-particle can be small enough, and can be accelerated fast enough and to a high enough kinetic energy, to imperceptibly pierce the dermal tissue."1 Many would surely switch to their needle-free micro-particle system if the blood draw was imperceptible as the patent promises! The patent also elaborates on a system where "the device could be wearable, for instance attached to a wristband, and comparable in size and form factor to a small electronic device, such as USB flash memory drive."1 They go on to mention that other form factors designs would also be possible.
This is a diagram from the patent of the conceived needle-free apparatus and wearable:
According to The Verge, Google replied to one of their emails asking if diabetes patients would be able to specifically made use of this, Google's response was that "[they] hold patents on a variety of ideas — some of those ideas later mature into real products or services, some don’t. Prospective product announcements should not necessarily be inferred from [their] patents."2
Here's to hoping this makes its way into the hands (pun intended) of diabetic hands soon instead of never surfacing!
1 Peeters, Eric, and Peter H. Smith. NEEDLE-FREE BLOOD DRAW. US Patent US 2015/0342509 Al, filed May 28, 2014, and issued December 3, 2015.
2 Duhaime-Ross, Arielle. "Google Wants Your Blood." The Verge. December 03, 2015. Accessed December 06, 2015. http://www.theverge.com/2015/12/3/9846088/google-needle-free-blood-draw-patent.
Sung, Jenny. "Google Files Patent for 'needle-free' Blood-drawing System." Global News Google Files Patent for Needlefree Blood Drawing System. December 04, 2015. Accessed December 06, 2015. http://globalnews.ca/news/2381215/google-files-patent-for-needle-free-blood-drawing-system/.