Lantus 0.5 unit pen at last - Pendiq Intelligent Insulin Pen

Lantus 0.5 unit pen at last - Pendiq

I *love* the DOC.

No really.

I absolutely love, love, *love* the DOC.

Just a quick glance at Twitter and I can be cheered, encouraged, supported, made to laugh and occasionally brought to tears all at once. Other times you go looking for some lightweight wit and wisdom, or just to see what folks are up to and suddenly discover some weighty new piece of research, campaign to fight for or better still... everyone's favourite diabetes benefit an exciting-sounding new gadget.

Before Artoo became my constant companion a couple of years ago, I wrote quite a few posts about Lantus basal insulin. I spent quite a bit of time trying to wrestle Lantus into submission, and eventually we got to the stage where we muddled along bearably, but it's fair to say that one of my main motivators for starting pump therapy was to get 'proper' basal coverage, that accurately reflected the ebb and flow of my body's rhythms over a 24 hour period.

Comparing notes with other users it seems I was not the only person to be frustrated by Sanofi's rather less than enthusiastic approach to insulin delivery. Most of the injection pens that fitted Lantus were, frankly, nasty. And none of them offered doses in increments smaller than 1 unit. This might be OK if you are on higher doses, but many T1s are quite sensitive to insulin. I'm not quite sure how small children cope, for example. The minimum dose adjustment could well be a significant percentage of the total.

The other pen-related problem I had fixed around the same time related to my terrible memory. It may be hard to believe it you do not live with diabetes yourself, but after a few thousand injections they can become so automatic that you barely think about them. Sometimes you have absolutely no idea whether you have injected your dose or not. I changed bolus (mealtime) insulin to Humalog to get hold of a pen with a 'dose memory' the Humapen Memoir so that if I was ever unsure I had some means of checking that didn't involve me having to write something down, which I was just as likely to forget to do... Or possibly even to remember to write it down, but then forget the actual injection. See what I mean about my memory? Hopeless! Sadly the Humapen Memoir has since been taken off the market and it looks like its development has been abandoned. So now the only memory-enabled pen available on prescription in the UK is the NovoPen Echo.

But...

Thanks to a Twitter conversation I chanced upon earlier this week, I now know there is an alternative. And a very interesting alternative it looks to be too.

Enter Pendiq, the Intelligent Insulin Pen

Pendiq is a new breed of injection device from Germany initially launched in 2011 and relaunched in 2012. Such is the ruthless efficiency of German engineering that this pen boasts not just 0.5u accuracy but increments of 0.1u (from 0.5u upwards). Delivery is unlike any other pen I am aware of - dial up the dose on the display, press the button and a precision motor delivers the insulin at 2/u per second. The pen stores and displays around 2 months worth of injection doses and timings on an LCD screen and the website boasts all sorts of download opportunities and compatibility with logging software such as SiDiary. The battery is rechargeable and the device seems to be compatible with 'standard' insulin pen needles. The Pendiq is compatible with Lilly and Sanofi-Aventis insulins, which means that both Lantus and Humalog doses are now available on MDI in 0.1u dose increments. Heck you can even choose from five funky colours!

Unfortunately there is a snag. Isn't there always? It seems the Pendiq is not currently available on prescription in the UK. It looks like you can buy it via the website, but with the shipping/delivery it will set you back almost €185 (around £150). So not cheap... by any means. You would also probably be wise to speak to your DSN/hospital/clinic to get there guidance if you were tempted to spring for one before you part with any cash.

If you'd like more information, visit www.pendiq.com

Nano technology, non-invasive BG monitoring and smart insulin

There are some diabetes-tech buzzwords that always attract my attention. Thanks to a tweet from Nick Guerin (@Typeaware) I was treated to a triple-whammy this morning.

We have come painfully close to a 'non-invasive' BG monitor (or even better CGM) once or twice before, but it is good to see that the search continues. To be honest the breathalyser-style BG monitor (which still uses a single-use 'strip') interests me less than Smart Insulin, which I think is probably my most favouritest 'wildest tech fantasy come true' product of all time ever - see here.

"A team at North Carolina State University believes so. Prof Zhen Gu and his team are working on a couple of different systems which may achieve this ideal – effectively creating an artificial replacement to the beta cells in the islets of the pancreas, which would normally release insulin to counter high glucose levels.

"Our overall aim is to create 'smart delivery' systems for insulin provision," says Gu. "What I mean by that is that insulin is delivered at the right time, via a safe approach – avoiding too much or not enough dosage – and in a way which requires only small formulations."

One of the team's ideas in development is an injectable nanoscale sensory network, announcing earlier this year that such a system maintained normal blood sugar levels for up to 10 days in type 1 diabetic mice. The "nano-network" degrades to release insulin when glucose levels are high and the researchers are currently trying to optimise it to respond as quickly as pancreatic islet cells do naturally in the body, and to make it more biocompatible with human tissue."

And wouldn't you know it those pesky diabetic mice have beaten us to it again.

Full article is here:
TheGuardian.com - Nanomedicines set to revolutionise the treatment of diabetes

Do You Really Need a New Year's Resolution? Then Drink More Water...

Ask the average person to drink more water, and they'll make a face at you or come up with an excuse: "Water's so boring... it doesn't taste like anything."

I think that we're so used to eating, and overeating, that we don't feel right if we don't have something of 'substance' in our mouths all the time. We use that as an excuse and then it becomes so easy to avoid water, and get carried away drinking things like carbonated sodas, sports drinks, smoothies, teas, and coffee, etc., all throughout the day. We don't notice how these other beverages -- while sometimes possessing some benefits -- may be more detrimental than helpful, when they start replacing water. Some of them are even addictive, so much so, that leaving them may cause headaches or even migraines due to their caffeine content. Others are quite high in calories and sugar.

Now, don't get me wrong -- I don't mean anyone should drink X amount of water a day. The idea that we ought to consume x or y amount of water a day, came from an outdated notion of 'averages.' Today's wisdom is that people are all different, and as such, they should drink to thirst, to better meet their individual needs. It is a silly idea to suddenly make oneself consume so much water a day, as some kind of achievement -- as I have seen many fellow friends give themselves this challenge. Overconsumption of water depletes minerals and electrolytes which are necessary for a well balanced and healthy body, plus... it makes you visit the potty a lot more often than you really want.

Now, all this being said... it is not a bad idea to start adding more water to our days, and to start listening to those physical thirst signals. Here is something to know:  The feeling of thirst is very similar to hunger. If you are not having enough water in your day, and you are overeating -- it very well could be that you are not hungry at all, but simply thirsty. Try having a little bit of water, and wait to see if those 'hunger signals' are still there, or if they subside. 

Drinking a glass of water first thing in the morning will help your body get a kick start. Just like your body has spent the last 8 hours not eating, it has spent the last 8 hours not having water. The body needs to replenish fluids in order to perform its basic bodily functions, such as detoxing your system through urination, cell regeneration, and hormone production (which includes hormones which communicate hunger and satiety signals). 

Once you slowly add more water to your life, you may start to see some of these benefits: 

• A Better Mood. Being dehydrated can make us moody, cranky, even depressed. 
• Less Overeating. When you are well hydrated, there are less chances for you to confuse a thirst signal for a hunger signal, and will also feel your satiety signals more clearly. From personal anecdotal experience, I can say that when I have a diet soda with a meal, I will feel full and bloated on the carbonation, will then stop eating the meal thinking I am full, and then will start eating later out of feelings of hunger and lack of satisfaction. With water, I feel like I can fully enjoy a meal, and stop when satisfied.
• Better Glucose Levels. When we let ourselves get very dehydrated, our blood volume is decreased, and thus the concentration of glucose will increase. This can turn into a dangerous and vicious cycle -- especially if compounded with exercise, and higher blood glucose levels which also dehydrate the body even further. Water can help you sweat properly, release toxins, and keep a stable blood glucose level. 
• Younger Looking Skin. Simply put, when you're dehydrated, you look old and tired. Your cells don't have what they need to regenerate, or to have that healthy glow. Plus... you'll get dark circles under your eyes. Eww.  
• Less Swelling/Bloating. Swelling, bloating, puffiness... of the face, or of ankles, can all be defense mechanisms of the body to try to keep and retain fluids at all costs, because it's dehydrated. 
• Regularity. Water helps prevent constipation, and helps you flush out toxins. 
• Improved Muscle Health. Water can help our muscles and joints be more lubricated during exercise, as well as prevent them from cramping. After all, our muscles are mostly water.
• Less Headaches. One of the most common reasons for a headache is dehydration. Seriously. People just don't realize it. Do you know what a hangover is? DEHYDRATION. 
• Refreshment. When the outside temperature rises, drinking enough water can help our body feel refreshed, by keeping body temperature well regulated, through sweating. Drinking enough water can also help fend off heat stroke. 
• Better Sex!!!!! Yeah. You read it right. You can't perform right, if you're dehydrated. From erectile dysfunction to just losing steam in the middle of the action. 

So... as a baby step for being healthy, why not try having a a glass of water, just on its own, a few times a day? We can slowly wean ourselves from letting other types of beverages rule what we drink -- and soon the true refreshing nature of water becomes what we crave, without needing added flavors or additives, when we are truly thirsty. Trust me. It really does works. :) 

So if you're truly thirsty... put DOWN the diet Coke. Go have some water. You owe it to yourself, and to your health. 

Don't Fall for the New Year's Resolution Trap...

Every new year, I rail a little bit against the concept of New Year's resolutions -- that time of the year when everyone is suddenly dieting, ending bad habits, testing every day, taking all their medicines on time, and having a near heart attack after trying to jog for two blocks.

It's not that I don't want to see people succeed, but I feel that this time of the year isn't really ideal for making such changes. For one, our challenge becomes this public stage: all friends and family become aware of these resolutions, and we're expected to 'perform' like a good little child for someone else's praise. Often they might even police our behavior. On top of this, most people don't really have a basic grasp on how to approach these really big changes. People want to eradicate all unwanted behaviors, or install new ones, in one fell swoop. Considering that humans are creatures of habit -- and often, habits which have many emotional underpinnings, this is the stupidest idea that has ever occurred to anyone. And corporations LOVE IT, and feed on it -- and then constantly bombard us with New Year's resolution ads because we're sheep like that. This creates an environment where food, and the pressure to succeed and be perfect, is ever present on the mind: eating certain foods, and avoiding the foods we won't allow ourselves to have, being the size of that one skinny model eating yogurt, living on only cereal or soup, etc. It's a recipe for disappointment, and we really set ourselves up for it. Honestly, I'm surprised major women's groups have not denounced some of these ads as unhealthy, and gotten them off the air. I mean, are these corporations really suggesting I should live on nothing but cereal, or soup, to get skinny in a short amount of time? This is the root of anorexia right here, folks.

Now, do I think we shouldn't reevaluate anything in our lives, ever? No. But my perspective has always been that we ought to do more than just change some 'actions,' and instead change the emotional bonds and attachments behind ingrained behaviors. That we should first tackle the "bigger picture," if you would. For example: If we're having a problem with weight, perhaps we ought to focus for a while on not overeating (and all the reasons and emotions behind that, and what it entails), rather than drastically changing the particular foods we eat; or, if we're having a problem with being inactive, perhaps we ought to focus on finding enjoyment in some physical activity, like taking a walk around the block after a meal, and noticing how our body craves the movement, rather than focusing on meeting certain time limits and endurance levels; etc. Changing how we focus our minds around these challenges will allow us to address the problems at their root causes, and allow us to make further progress in establishing disciplined habits. Once we are focused on just eating the amount of food our bodies need (ie, eating to satiety signals) -- and not more than that -- we can perhaps consider trying new foods. Once we see that we enjoy walking, perhaps we can step up the pace.

So, really, when we look to make changes in our lives, we should be looking to slowly and completely change our state of mind, and not just some actions. Actions are simply the symptom of the deeper problem. The thing is... we can start this at any time of year -- we can start it whenever. And we don't have to let ANYONE know we're doing it. We can freely invite someone over to enjoy an evening walk after dinner, without ever having to let them know what we're doing. It is NOT about keeping ourselves accountable -- it is about finding enjoyment -- enjoying out body, the things it can do, and our lives.

So, in the New Year, resolve to give yourself the freedom to not resolve anything... but to give yourself and your actions, the love, respect, understanding, and attention which they deserve.

Happy New Year.

The consistency conundrum

Christmas is an interesting time of year to play at being your own pancreas.

The main Christmas Day meal itself is usually *ahem* relatively easy (especially since I adopt the traditional standpoint of 'no carbs count' for Christmas and birthdays). As meals go, it is big... it is rich... and it will probably involve a pudding the size of a bowling ball... But it is basically just a roast dinner and it is only one day - and you can't expect perfection all the time right?

However, on an alarming number of occasions either side of the 'big day' I find myself faced with my own particular food nemesis - a creaking table full of buffet nibbles. Each little carb-laden, high-fat morsel smiling sweetly up at me daring me to have a go. A festive tipple or two to blur my judgement and weaken my self control and you can see that these meals fall firmly into the 'high risk' category.

Which is quite an odd way to look at food really... But I've been doing it so long that I hardly realise I am doing it.

Over the years it has seemed logical to me that consistency in terms of food intake is likely to be a good strategy for Blood Glucose results. It makes sense surely? Eating similar quantities of similar foods should allow me to try out a number of dose and timing variations until I find one that works. Then I can eat that same meal any time, and get perfect results. Tried. Tested. Predictable. Easy! Other meals are much harder to calculate (read: wildly guess) and almost come with an inbuilt expectation of BG chaos. If you are going to enjoy these... you do so knowing that levels are likely to be less than perfect.

Except that it doesn't actually work like that. At least not for me, or perhaps just not all the time. And when it doesn't work like that... When an 'old faithful' lets you down catastrophically, while in the same week a 'wild stab-in-the-dark' guessfest comes out not too bad, you begin to wonder why you are bothering to make those careful choices in the first place.

When it comes to playing the BG boardgame (not so much Snakes and Ladders as Spikes and Hypos perhaps?), my diabetes, like some cantankerous elderly maiden aunt who hit the sherry early on is a big ole cheat. Not averse to completely changing the rules when it suits, or simply behaving in a completely baffling way. Even *if* I were to eat exactly the same items of food, in exactly the same quantities every single day. Even then, I still could not expect 'perfect' BG levels (whatever that means) to last for long. The consistency conundrum is simply that carbs, doses and timings are only a small part of the picture. There are a lot of other factors in play that can combine (or conflict) to significantly alter the outcomes for the most self-disciplined diet.

Douglas Adams summed up living with type 1 diabetes pretty well:

“The nearest approach the Guide makes to this matter is on page seven-thousand-and-twenty-three, which includes the words “expect the unexpected.” This advice has annoyed many Hitch-Hikers in that it is ‘A’ - glib, and ‘B’ - a contradiction in terms. In fact, the very best advice it has to offer in these situations is to be found on the cover. Where it says, in those now notoriously large and famously friendly letters, 'DON’T PANIC'.”
Douglas Adams, The Hitch-Hiker's Guide to the Galaxy.

In my heart I know that trying to reduce the number of variables involved in juggling my BGs is the 'percentage approach'. After a few days of winging it I usually have had enough misses for the illusion of SWAG invincibility to have worn off.

So I'm reeling my choices back in again, and aiming to lose some of the wilder swings I've seen over the past week or two. It will always be a balancing act. Along the line between complete dietary freedom at one end and monk-like self control at the other there is a place where each person with Type 1 Diabetes will feel comfortable, both with the food they are enjoying, the effort they are putting in and the results they are seeing.

Good luck in finding your own balance.

Don't Restrict Test Strips for People with Type 2 Diabetes

My fasting glucose at diagnosis,
versus currently.

All around us there are people who are struggling or living with challenging health conditions or diseases. Some are very visual, and apparent, and some are not. For those with apparent health conditions or diseases, we feel an immediate sense of empathy. However, it is not so easy for us to empathize with those whose needs we cannot openly see. We may assume a person is exaggerating (they really don't have it that bad), is being 'wimpy' (they should just shut up and 'deal with it'), or is simply lying.

Type 2 diabetes is one of these misunderstood diseases; it is a hidden illness and people with hidden illnesses often end up being judged as if they had no needs, or should be restricted in needs. These attitudes often end up in discrimination, particularly from employers, health insurance companies, and some health care providers and agencies. The problem becomes compounded because type 2 diabetes is also a silent disease. It is a disease which can remain silent (not showing very many outward signs of its presence) for many years, even decades. Hence, many people will often ignore their condition because they feel fine and healthy, and the condition does not seem real to them. Because there is NOTHING telling them they are sick, they feel a certain sense of invincibility... until they get their blood glucose level tested with a finger prick.  Persons with type 2 diabetes must check their blood glucose levels regularly if they are to be kept constantly aware that they a.) have a serious medical condition, and b.) that they need to adjust their food intake according to what their glucose levels are. A person with type 2 diabetes needs to be able to eat 'to their meter' in order to be able to manage their disease.

If the medical establishment (who are constantly preaching on the diabetes 'pandemic,' and how serious this matter is, and how the condition is costing our governments, worldwide, billions of dollars) had any inkling of the issue at hand, or indeed, if they believed their own warnings, they would realize that in order to reduce the risk of type 2 diabetes, and to control the health of those with current type 2 diabetes diagnoses, we need...

• Educated clinicians: Clinicians who are not trivializing the condition to their patients, but which strive to understand the condition, its potential risks and dangers, and who are committed to empowering their patients and properly educating them as to what the condition is; and
• Access to Proper Tools and Medicines: Sufficient glucose testing strips to make appropriate nutritional decisions, from day to day, to help control glucose levels, as well as access to necessary medications -- including insulin. 

How do we expect to control already diagnosed type 2 diabetes, in patients, if we will not allow patients to have an adequate amount of testing strips? Yes -- a testing strip should not just be a tool that is used to avert immediate danger (an extreme high, or an extreme low level of glucose.) A test strip is also a rudder to help a patient know to make the best, and most appropriate meal decisions, because we never know just how much glucose we have in our bodies at any given time. You can't just tell us to go eat whole wheat, grains, and fruit, and call it a day. I am sorry, medical establishment... Diabetes doesn't work that way. I have the RIGHT to know what my blood glucose is doing, and to be able to make educated decisions on what to eat, as to to reduce the risk of the potential long term complications of high blood glucose. It is my right, as a patient! You preach about the costs of diabetes, but something tells me you really do not understand how the game works. You see -- no one complains about the high cost of performing 3,000 mile oil changes on their vehicles; instead, they understand that if these are not performed, instead of paying $19.95 for an oil change, they'll end up paying over $1,000 for a new engine. But clinicians and insurance companies are practically telling people with diabetes that they'd rather they pay $1,000 for a new engine, than $19.95 for an oil change. I mean, isn't it cheaper, long term, to pay for some strips than to, oh, I don't know... have to pay for someone's dialysis, new organs, eye procedures, or amputations? 

Where is the common sense in the medical establishment, right now? I want to KNOW. I am SICKENED that people with type 2 diabetes who are on Medicaid  in Oregon, right now, are close to being severely restricted on their glucose test strip usage. According to diaTribe, 

Currently, the OHP provides 100 test strips every 90 days, but a new plan would severely restrict access to strips for type 2 patients unless they are newly diagnosed, take insulin, or meet a few other special requirements. For people not taking insulin – which covers the vast majority, about 70% of all type 2 patients – those with an A1c above 8.0% would be entitled to one test strip per week, while those with an A1c below 8.0% would not be provided with any test strips at all.

This is obscene!! One test strip a week tells NOTHING to a patient with type 2 diabetes! Tests need to be done in pairs so that we can see the cause and effect of things like meals, exercise, illness or periods, or even overnight sleep. Patients with type 2 diabetes are practically being PUNISHED for having good control, and being told that their health is not important enough to merit an educated management of their disease. Besides that, patients are supposed to work hard to keep an A1C which is at or below 6.5%. Telling a person that they will only get strips if they have higher A1C levels is not only not a good recommendation, but it is also unconscionable. It is the testing that keeps me at a lower A1C! I'm not psychic, for crying out loud. As of yet, there is no magical Glucose Level 8-Ball.

We need to stand together as a type 2 community against these kinds of things, or we will continue to be bullied by the medical establishment. If we are to stem the tide of unfortunate complications, and type 2 diabetes diagnoses, then we need to stand up for our rights as patients. We DESERVE education, quality treatment, tools, and medications, to manage our condition and lead healthy lives.

Really... whatever happened to the Hippocratic Oath?

DO NO HARM. 

We have very little time... Please sign the petition, here: Don't Restrict Test Strips for People with Diabetes.  

Top Ten Tips For Managing the Holidays with Diabetes

Happy Holidays, to you and yours! As my turkey slowly cooks in the oven, I've decided to take a moment to write a little bit. I've had a few comments from fellow sweet peeps, lately, in regards to traversing the holiday food extravaganza that is approaching, and there's much understandable fear and trepidation. 

So, I wanted to take a moment to reassure my fellow readers, especially newcomers, that, yes...

You Can Do This: 

1. DO count your carbohydrates. Think about your favorite foods for the holiday, and plot out your total carbohydrates through the day. For example, have some turkey and greens, if you prefer to have a small piece of pie later. Or... Have some turkey, some greens, and a small amount of mashed potatoes, if you're not much into pies. But... 
2. DON'T practice deprivation. Instead, practice moderation. Try eating just a tiny amount, of some of your favorites, instead of telling yourself you can't have anything. Besides, do you see the skinny people NOT eating anything? What do they do on a holiday like this? Some definitely pig out, and some others simply grab a few things, and taste here and there. But... 
3. DON'T feel like you have to eat everything there, out of obligation. Instead, you may find  it helpful to plan ahead of time which two food favorites you HAVE to have, and when the day comes, pick one extra item you'd like to try. If you have more things you'd like to try, you can always get a doggy bag, and eat them later.  
4. DO have some salad, leafy greens, and non-starchy veggies. Veggies are full of fiber, and because of this, they don't just help us with sensations of fullness and satiety, but also help keep our blood glucose levels steady throughout digestion. In other words, fill up on the broccoli on the snack plate, as it passes by... it'll help you absorb carbs, and digest and deal with any extra fat. Raw is better. But...
5. DON'T assume all veggies will be good. There are quite a few veggies out there that are high in their own natural sugars and starches. To help you navigate through the confusion, the American Diabetes Association has put together a list of non-starchy veggies, for your review. Assume that any veggie dishes which are slathered in various sauces have extra added sugar before consuming them. When in doubt, ask the host. 
6. DO make your own diabetes friendly dishes. Whether at home, or if going to a party, feel free to make one or two dishes which you know will be diabetic friendly -- whether that is a dish that is low carbohydrate, or a dish that is made with alternative sweeteners. Perhaps even have a favorite beverage with you, so that you can have something to 'nurse' through the day. This can be bringing your own diet tea, diet sodas, etc. But... 
7. DON'T forget to have water. Water is essential for your body. It helps control our eating signals of hunger, satiety and fullness. In many ways, water helps us appreciate the food we consume, and taste it better. When we taste food better, we can better focus on it, and we can better tell when we've had enough. 
8. DO try to practice eating with awareness. We go through life in such a hurry all the time, that we often eat incredibly quickly! Before we know it, the food is gone. Instead, really take some time to revel in the food you're about to consume. Notice its aroma, its colors, its textures, and flavors. Take each bite with slow, and deliberate delight. If you feel you need to put your fork down between bites, or have a sip of water, please do. Try to listen to when you're body has told you it's had enough, or even, if it is simply just satisfied. But... 
9. DON'T feel guilty if you overeat. It's a very food centered holiday. There is soooo much food, and people do tend to overeat, or indulge a little extra. It comes once a year, and we only live once. Focus instead on friends, family, loved ones, and being thankful. 
10. DO make it a family tradition to go for a walk around the block when you're done. A walk after eating a meal helps digestion, can bring time for conversation, and the focus AWAY from the table. If it's too cold outside, maybe it's time to break out the Wii Sports. 

Just remember, diabetes is NOT a life sentence because you 'messed up' being healthy, and active. It's simply a condition a few of us developed because we have the genes for it. Regardless of our past life choices, we can still live daily, healthful lives, and enjoy holidays and celebrations in moderation. So, kick back, and relax!