Hope For A Better CGM

I have no idea how Abbot will use my user feedback in the further development of the Navigator. Although the idea of having the potential even the smallest voice in the development process makes me feel like this blog is potentially accomplishing something. I even included some of my thoughts on sustainability in future generations of the Navigator. And who knows who else might come along the below view points; because I think we're all striving for the same thing - a better, easier way to manage our blood sugars that is more integrated into our daily activities. Here are my hopes for the next generation Navigator:

1. Adhesion, although I have used several different types of external medical tape I have continued to have a problem keeping the sensor attached to my body. This has been in part due to the size of the transmitter and the lack of adhesive tape attached to the sensor. Often after a simple shower or a 1/2 hour in the pool the sensor will fall off, sometimes without my knowledge. Would love to see future versions of the sensor have extra adhesion.

2. The 90 degree cannula neither stays in my body as well nor is as comfortable as a 45 degree or variable angle cannula, like the Minimed Silhoute. When speaking with diabetic educators about which insertion set to go with for my insulin pump they unanimously suggested the variable angle type. A longer cannula would also give me piece of mind that the sensor is staying in place, and actually provides more comfort because its further below the tactile nerves in my skin.

3. A universal insertion device would achieve two goals. From a sustainability perspective, a "gun" similar to the one Medtronic uses for their insertion devices reduces the amount of plastic required for each sensor. This reduces the environmental impact of each sensor as there would be less waste material; additionally this may provide more consistency for insertion as a "gun" is much easier to handle than the bulky automatic inserter. Secondly, this could provide a huge cost savings to Abbott; less plastic means lower manufacturing and shipping costs. The production line for the mold of each automatic inserter could be removed, by removing the plastic automatic inserter each shipping box will be smaller, a smaller and lower weight shipping box means lower shipping costs for Abbott - a win, win for consumer and producer.

4. A smaller transmitter and smaller receiver. In a perfect world the receiver would be the size of a Garmin Forerunner watch. For training purposes wearing a watch that displayed my blood glucose and trend at all times would be a gift from heaven. The watch would allow me to view my blood glucose more easily and require less effort than the current receiver does. Additionally, the lower bulk of a watch makes it a more practical solution - for my needs communication distance is much less important than size. Both the Polar HRM and Garmin Forerunners are great models for product innovation.

5. Although you are serving two consumer bases, the menu options on the receiver are a bit limited. Because it is produced for such a generic audience I understand that you need to keep it as simple as possible. However, I think the simplicity at times makes it more complicated than it needs to be. Additionally, I would like to see my glucose number always displayed; and the backlight automatically come on when I hit a button; rather than having to hit a button to display glucose and a second button for the back light.

6. Battery life and battery recycling is another main concern. A shift to a rechargeable battery or a longer life battery would help a ton. Too often the battery in the transmitter goes dead without my knowledge; having a rechargeable unit in place would allow more frequent use of the device and ensure that the device does not go dead mid-cycle.

Having A Voice

For some time now I have been frustrated as a diabetic with a ton of ideas but no one practical to share them with. Sure, I blog about some of my ideas that can improve blood sugar management, but there is a world of difference between blogging about ideas and applying ideas. I'm reminded of this in my Leading Strategic Change course as we analyze the knowing - doing gap.

With that, I can't begin to express my excitement when I received an e-mail from the product manager of the Freestyle Navigator!!! Jonathan had come across my blog through researching consumer opinion on the product; and reached out to me in part because we went to the same undergraduate institution. He was excited about my ideas (which I'll list in a later post) and shared alot of my desires. Even better, he told me that anytime someone calls their help center, the suggestion or complaint is logged so that data can be incorporated into newer versions of the product.

Anyway, it's nice to know that sometimes when we share our thoughts someone is actually listening.

When it works.... Its Awesome

Day 3 of the Navigator Experience has been going great. Unlike the troubles I had during the Charlottesville Marathon and unlike the SNAFU on Monday, I've been getting accurate readings and great comfort from my over sized bundle of blood glucose readings. Having the Navigator in my pocket during a meeting or on the bus ride home gives me peace of mind that I'm not going to bust into a spontaneous sweat because of a low. So for that I give the Navigator huge props for actually working over a 48 hour period! PROGRESS!

Amazingly enough the sensor stayed in place during my charging rhino impersonation on the track last night. I'm currently performing new threshold tests for my new triathlon coach (more on that tomorrow and hopefully a big announcement on Monday) and had to do my 6 minute run test last night. I ran .93 miles in 6 minutes with an average heart rate of 173 and a max heart rate of 179, I have no idea what any of that means, except I thought my lungs were going to explode when I had finished. I continued to cough up whatever badness accumulated in my lunges since IMLP until about midnight last night. So I'm pretty sure I reached my threshold. What was really cool and relevant, was the Navigator was able to immediately sync back up with the sensor when I was done with my run (no idea how the blood sugar was during the run) and continued to be accurate for the rest of the night.

Additionally, the CGM has identified a basal rate that is too high at 2am, too low at 3:30am and just right from 7 am to noon. That's the real beauty of a CGM, to see what the trends in a basal rate are, especially those little trends that can creep up on you and turn a 110 into a 250. Anyone can adjust either a basal or bolus rate for blood sugars that go really high or really low, but the blood sugars on the margin of good and bad are the ones that wreak havoc on an A1c. Hopefully the Navigator Experience continues after my swim test tonight!

Off To A Better Start

Last night I inserted my second Navigator sensor in as many days to continue my attempt at getting my CGM to work right. This time after insertion I was met by a nice gushing of blood which dripped all over Kim's bedroom floor - she has to be thrilled I'm living with her for the summer! Between the random test strips she finds all over the apartment, to my bleeding on the floor and piles of triathlon equipment (although she has that too) I don't know how she puts up with it!

Anyway, unlike yesterday after the 10 hour warm up period I tested my blood sugar and was greeted with a bs of 101 - perfect! Since that point the CGM has been pretty much spot on; I just did a check to compare the results of the CGM with my Ultramini; the CGM has me at 173 and the ultramini at 191 - not bad after some falafel for lunch about an hour ago.

The real test will come tonight when I test my heart rate thresholds in a 6 minute all out track workout. If the sensor stays attached through my charging rhino act the Navigator may have promise after all; if not its back to the drawing board where I need to figure out how to get the sensors to stay in my skin.

Thankfully I'm Not Lost

Because the Freestyle Navigator has about as much ability to lead me out of the darkness as Mr. Magoo could lead me through the Amazon. Having gotten into the swing of my summer internship I decided to give the freestyle navigator another try, hoping that my dismal results with it during the marathon were an aberration. However, after today I'm about ready to go to town on this device with as much vengeance as Peter and the boys had for the office printer in Office Space. I don't know if John Connor has as much loathing for Skynet as I do my Freestyle Navigator!

Last night I inserted the oh so well designed infusion site as Kim watched in horror. She also very logically asked, "you mean to tell me that thing is held on by that small amount of tape." Yep, they clearly designed this thing with the end user in mind - great job Abbott. Finally at 9am this morning the blood drop icon shows up on my Navigator so I go to calibrate, my blood sugar was oddly high at 180, so the test results weren't valid for calibration. An hour later I was below 160 and was able to calibrate.

Then the real fun started, even though my blood sugar was below 170, my CGM was showing my blood sugar to be above 220. As the day progressed my blood sugar on the CGM continued to climb above 300, but from finger pricks I was never above 270 (it was a really weird blood sugar day). After seeing my blood sugar at 340 on the CGM, but 220 as a finger stick I went to the gym. Upon returning from the gym my blood sugar was in the 60s - but wouldn't you know, the damn sensor failed already.

Less than 5 hours, my new sensor lasted less than 5 hours!!!!!!!!!!!!!!!!!!!!!!! The rip off Cabbage Patch dolls of the 80s that spontaneously burst into flames were designed better than this thing. But don't worry, I have a whole box of sensors so I'll keep trying, I swear one time I'm going to get this thing to work or its as worthless as Crystal Pepsi.

Day 2 With the Navigator

Yesterday I took my Navigator for a long run to see how accurately it could predict a low. One of the main reasons I wanted a CGMS was to have a way to monitor my blood sugars during exercise without stopping, to have an alternative to finger sticks in the pouring rain (like IMLP) and to have a trend predictor of an impending low.

The plan was to run for 40 minutes yesterday at a recovery pace at then do hill repeats for 20 minutes. I knew my cumulative carbohydrate total was a bit lower than it should have been for the amount of exercise I've done over the past 2 weeks and thought there was a small chance I'd have a low, but was confident I had enough in the tank to finish the run. However, as I looked down at my Polar RS800 I noticed maintaining a 10:30 pace was WAY harder then it should have been (normally I run at an 8:40 - 9:20 pace), which is normally the first sign of a low. After struggling along for 3 or 4 minutes my navigator started vibrating, I took it out of my sleeve pocket and saw the vertical downward arrow and a blood sugar of 106 - it worked!

Yesterday, without the Navigator I would have kept running until my blood sugar was in the 60s since I normally test every 30 minutes while running. The Navigator predicted my low 4 minutes before I would have tested and allowed me to safely walk the rest of my route home - rather than having to sit down with an energy gel waiting for my blood sugar to rebound. The Navigator worked perfectly yesterday and prevented what could have been a dangerous low - exactly what I wanted the device for.

Freestyle Navigator - First Impressions

Wow! Before writ ting about the technical details of my first calibration I wanted to immediately write about my first 24 hours with my navigator. Like I said, Wow! As annoying as the sensor is to wear, as frustrating as some of the device settings can be - this device is incredible.

As you saw from my packing for Costa Rica I'm pretty neurotic when it comes to diabetes management and want to have as complete information as possible. While sitting in class I often worry that the warmth of the room is due to a raising or falling blood sugar rather than well the actual temperature. Yesterday at any moment during class I could look down at my navigator and see that the room actually does have big temperature swings that my bs had nothing to do with.

I was able to identify a few trends in my blood sugar and identify the general time that I had some basal rate discrepancies leading to some blood sugar highs around 2pm (for the past week). And on the treadmill the thing was incredible!! I wanted to run in a controlled environment yesterday and was able to see how my effort affected my blood sugars - totally cool. But more importantly the navigator gave me the peace of mind to run as hard as I wanted.

I know that the navigator has a time lag, that the information isn't perfect and that it will never truly replace finger pricks. But only doing 5 finger pricks yesterday versus 15, seeing general trends in my blood sugars and having the extra confidence to just go about my normal day make the positives of this device far outweigh the negative characteristics.

It's Here! It's Here!

While up in Boston I received an e-mail from my neighbor that said "Ed I noticed a huge box outside your door, so I brought it up to my apartment, let me know when you're back in C'Ville." Once I sadly left my gorgeous girlfriend and beantown I was excited to find out if this package was my CGMS.

Once I arrived at my apartment I contacted my neighbor ASAP and was thrilled to pick up a huge box (not from Medtronic.) I quickly opened the box and was greeted by my FREESTYLE NAVIGATOR!

Unfortunately my first attempt to link the sensor to the receiver didn't work so I need to wait until I get in touch with my trainer as I don't want to waste a second sensor. But I can't wait to test this thing out and save at least a couple finger pricks a day. More to come......

HUGE NEWS!!!!!

Today I received a phone call that I've been awaiting for nearly a year. I checked my voice mail after class today and had a message from Angela of Abbott Pharmaceutical, normally the conversation with her would have me complaining about Abbott's lack of communication regarding the freestyle navigator with me - but today was different. Today when I called Abbot back I found out I've been APPROVED FOR A CONSTANT GLUCOSE MONITOR!!!!!!

I haven't had alot of diabetes related information to blog about recently, unless you would like to hear about bolusing during 9 case studies a day, there just isn't much to share. But now I have a new blood sugar management tool! Now, I don't have to worry about pouring rain during a workout! Now, I don't have to worry about it being too cold for my meter to work! Now I can feel like a normal person during exercise - I'll hopefully never fly blind again!!!!! Today was the best diabetic news I've ever received and I'm so freaking excited to figure out how to use a CGM and let you all know how it goes. Now I'll have real data to analyze, now I can compare my blood sugar movements with my heart rate, now I have the ability to see exactly how food affects my system!

Tomorrow I also meet my new endocrinologist, thanks to a classmate who was a doctor at UVA prior to coming to Darden - he pulled some string to get me in. In the coming weeks Ring The Bolus should be back and I invite you all along for the ride again. Q1 is over, I made it through the hardest part of my academic career at Darden and now it's time to return to my commitment of sharing my battle with diabetes with all of you.