2014 Year in Review

It's December 31st and I've been spending a lot of time recently thinking about how to make Arden's Day better for you. As we head into the eighth year of my little blog's life I'm looking at ways to make the blog more informative, social, easy to consume and worth coming back to. In the process I've been reading a lot of old post from 2014 and found a few that are worth revisiting before the ball drops. I hope you read to the end of this long post, I'd like to share something very personal to me before the calendar flips. 

From January 2014

It baffles me, but one of the most popular things on the blog this year was a photo of me looking tired, How to Spot a D-Parent. It was even reposted on Diabetes Daily and become one of their most popular post of the year. Of all the things I wrote, shared and talked about this year, you liked seeing me looking ragged the best. Tells me we are all pretty damn tired.

From February 2014

Dexcom was approved for pediatric use, one of my non D storIes blew up on Huffington Post and Miss Manners was all the buzz but all you guys wanted to see was pictures of Kris Freeman's abs. Parents still read this post every day when they wonder if their child is too lean for pumps and a CGM. Kris's abs turned out to be quite the public service.

From March 2014

My blog titled, Pitstop Fail won Best of Betes Blogs for March - a huge thank you to the person who nominated it and voted!

From April 2014

A Forgotten Wallet Buys a BG of 25 and I got yelled at a little bit in the comments. BTW, Kris Freeman could have easily been mentioned here too, you guys sure love abs.

From May 2014

I changed my expectations for what 'in range' means and lowered Arden's a1c, Living Between the (Diabetes) Lines. 

From June 2014

June brought the lowest A1c Arden has gotten to date, A1c Countdown: It's Endo Time.

From July 2014

This was the month of #ShowMeYourPump but Arden's Day readers were more interested (By just a few hits) in Arden's Sudden Needle Anxiety. 

From August 2014

In August I tried with all my blogging might to get you to believe that Diabetes and Fear don't have to go together, Guts over Fear was written, the hashtag #DiabetesandFear was tweeted and my quest was underway. 

From September 2014

I traveled to the Dominican Republic to deliver a speech to a group of D parents during the summer but wasn't able to share the video of my talk until September. My time in the D.R. led to a very popular post, my first invitation to give a keynote at a JDRF event (Info coming soon) and a whole lot of new understanding about the rest of the world. 

From October 2014

Hello Dexcom SHARE you are the remote monitoring I've been waiting for.

From November 2014 

Arden changed her first OmniPod without any help from me while she was at a sleepover, I'll Take Insulin Pump Change for the Win Alex.

From December 2014

I shared our experience with getting an insulin pump in the hopes that it would give you the freedom to speak your mind because, Don't Let Doctors Push a Pump on You, that's why. 

I can't thank you enough for reading about Arden's day. I hope you have time to check out one more post from 2014, it's one I wrote today about what diabetes blogging means to me, you can find it here. Have a happy, healthy 2015... you are all in my thoughts. Best, Scott

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Dexcom's New 505 Software Review and How To

The (Algo) Rhythm is Gonna Get You!

Last week the good folks at the FDA approved Dexcom's latest software for use in your G4 continues glucose monitor. Let's talk about what you'll need to know about installing the software on your receiver and if I saw a difference after upgrading. 

What you need to upgrade?

A Dexcom G4 adult receiver (The company has announced that they will submit the software to the FDA in 2014 for approval in their pediatric receiver). 

A Windows computer with Internet access

The charging cable from your Dex, minus the electric adapter, so USB to Dexcom

A few minutes

What to do...

Go to Dexcom's website and click on the "Download NEW Software 505" link. You will need to login to the Dexcom site, if you do not have an online account on their site, you can quickly make one.

A downloader program is installed on your computer. After launch it will ask for you to connect your receiver to the computer and the rest happens in short order. Please note TWO important things. The process will revert your receiver back to it's factory specs. Make notes of all your settings and be prepared to reconfigure the receiver (takes a few minutes) after installation. Also, you will have to restart your sensor session after the update, so you won't be getting any of that good BG data during those two hours - plan accordingly.

You don't have to wait until it's time to put on a new sensor to upgrade! Just choose 'Stop Sensor' on your receiver's menu and then restart the receiver after the software upgrade has finished. You DO NOT have to change your sensor site to do a sensor stop/start.

Should I do it?

Yes, here's why...

Dexcom is reporting that the MARD (mean absolute relative difference) will increase by 4%. In plain language, your Platinum G4 without the new algorithm has a 13% MARD , the new software clocks in at 9% MARD - a lower MARD is more accurate.

Did you know? The new 505 software is the version currently being used in artificial pancreas trials!

What did I see after the upgrade?

We upgraded Arden's receiver and have been running it for a week in conjunction with another G4 receiver that is using the previous software. My in a nutshell review -- the new software has been consistently closer to our finger stick checks than the previous software. We use the OmniPod meter with Freestyle strips. This is not to say that the previous software is always farther off then that of the newer version - at times it has been and at times it hasn't. The newer version (505) has been consistent with my prior expectations or better, never worse. But when it is appreciably better, it is 20 - 30 points more accurate and that's worth upgrading for in my opinion. It also seems to deliver more accurate fall and rise rates that don't linger after the change in BG has leveled. 

Here's some side-by-side pics...

The first four images show a BG rise (I confirmed with a meter not pictured). You can see that the previous software lagged behind the rise and never reached the actual BG which topped out at 213 (on meter). The fifth image is an example of no significant difference between 505, previous and meter. The last image shows a metered 68 that registered as a 6o with the new software but an alarming 46 with the previous version. After testing and calibration the previous version adjusted to 60, the new version adjusted to 66.

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Conclusion...

Obviously my observations are just that, observations. Nothing very scientific was done and I am not a doctor as my disclaimer mentions. The upgrade is fast and simple but Mac users will have to bum a Windows machine from a friend.

The 505 software is currently not approved for the pediatric version of the G4 but Dexcom announced that they will be applying with the FDA in the last quarter of 2014 - that's any day.

The upgrade is free, better and the next step toward CGM data that perhaps one day you'll be able to dose insulin from - might as well do it... I don't see any downside.

Managing type 1 Diabetes just got a little bit easier in my opinion and I expect to see a difference in Arden's A1c after a full three months with the new software - time will tell. 

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First Impressions: Dexcom SHARE

I'm a bit of a pragmatist so when asked the question, "What would make the Dexcom continuous glucose monitor better?" - my simple answer was that I would like it to be able to send information to a remote location. I don't need it to power Iron Man or transform into a hover board. I just need to not have to get out of my bed and walk into Arden's room when it alerts. After eight years with type I diabetes, that is what I need more than anything else – pragmatically speaking.

It's my assumption that future iterations of CGM devices will do more. I'm hopeful that sooner rather than later, the device will be able to broadcast it's signal without the aid of a cell phone so we will be able to receive alerts on our phones or our futuristic cerebral implants without having to attach the Dex to a transmitter. But really, once cerebral implants are a reality, whose going to need a cell phone? 

Back here in reality

For the moment the technology that exists has limits. First the signal from the Dexcom transmitter has to be sent to a device that can read it. The current transmitter, per the Dexcom website,  has a useful distance of 20 feet.

After the transmitter sends the signal it must be captured and translated into data you can use. That's where the receiver comes in and now with the advent of SHARE, your iPhone can act as a secondary receiver. 

But how does the signal get from the transmitter to your iPhone?

When Arden goes to bed she places her Dexcom receiver into the new SHARE cradle. The cradle takes the data that the receiver has gotten from the transmitter and sends it, via Bluetooth, to Arden's iPhone running the Dexcom SHARE app. That iPhone, using it's cell or a WiFi signal, sends that information to Dexcom's cloud. My iPhone running the Dexcom FOLLOW app, gets Arden's data, alarms and graphs from the cloud. It sounds convoluted I know, but it is actually very simple to set up (minutes), seamless in its execution and just plain works. In my opinion, that's when technology is helping you, when it's easy and reliable. 

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setup

To complete the cradle setup, plug it into the wall and pair it to your Dexcom receiver. You are finished.

To set up the transmitting iPhone (the one that needs to stay within Bluetooth distance of the cradle) download the Dexcom SHARE app from the iTunes app store. 

Setting up the iPhone that you will view the data requires the Dexcom FOLLOW app.

Follow the onscreen directions to set up both apps. I've captured the SHARE and FOLLOW setup screens so you can get a look at them.

SHARE app

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FOLLOW app

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Using the SHARE

I use the SHARE in a few ways but mostly for sleeping hours. In my mind the device is perfect because I don't want or need it to be everywhere that Arden is. I believe that much of Arden's growth and the process of her maturing in a way that allows her to care for herself during most hours of the day, are a direct result of the situations and problem solving that is created by my not being able to constantly see her BG. 

Despite what you may imagine, safety is not my first concern when I think about overnight hours and type I diabetes. Safety is important but much of the A1c success that we have is a direct result of managing overnight BGs (texting from school is a close second). These sleeping hours are free from eating and often very manageable. I monitor and manage Arden's BGs at night more with her long-term health in mind than short-term. Still, getting out of bed over and over is exhausting and why I have longed for the SHARE to come to market.

SHARE has also stopped me from having to run back and forth to Arden's room in the evenings while Kelly and I are hanging out in the living room. Big plus!

I was able to run to the store the other day in a moment that I normally wouldn't have. Arden's BG was good, stable but on the low side. I left the house confident because I could see her data. The FOLLOW app works perfectly with my cell signal.

The FOLLOW app has customizable and rather loud alarms that are difficult to ignore. They have so far woken me at night with no trouble.

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Would I pay $300 for the SHARE?

In my mind, if you have the money...  it's worth it just for overnights and the occasional sleepover.

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Check this out!

I know that many of you want to use this technology differently than I do and so I experimented with making the cradle portable (read: without an AC outlet).

I used a portable cell phone charger that I bought on Amazon and the results were very encouraging. The cradle ran constantly, powered only by the battery source for 17 hours and 40 minutes. 

If you wanted to make SHARE portable, put it in a dugout, under the bench at a basketball game, etc... you easily could but remember that you would be limited by the 20 foot restriction of the Dex transmitter.

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All the rest...

• I was given this SHARE by Dexcom as a gift. You can read my disclosure of how that happened on the SHARE unboxing post
• The cradle isn't sexy but it's solidly built and will sit stably on a table top
• The Dex receiver's mini connector looks to be protected from wear and tear by the specific and tight way that the receiver is slid into the cradle
• iPhone and iPod only, "currently not available for Android"
• Cost is listed as $299 on Dexcom's site, it is not covered by insurance
• No prescription is required
• For sale in the US only
• Dexcom suggests a different cradle for each person in your home that needs the product. I'm trying to find out why from the company in more detail than their site indicates.

Tidbits directly from Dexcom

Development work is happening now for "Android, iPad and other iOS devices"

The Bluetooth low energy required for SHARE was not available on Android when the system was being developed - Dexcom is "actively working on it"

Book Review and Giveaway: Dealing with Diabetes Burnout

Dealing with Diabetes Burnout: How to Recharge and Get Back on Track When You Feel Frustrated and Overwhelmed Living with Diabetes - A new book from Ginger Vieira

Buy on Amazon

Ginger Vieira's latest book is geared mostly toward adults living with diabetes, but I found it to be a wonderful resource just the same. As the parent of a child living with type I diabetes, I often find myself wondering what it feels like to live with the disease. I do my best to imagine what Arden is thinking, feeling and experiencing, but I know that I'll never be able to fully comprehend. I'm happy to tell you that after reading 'Dealing with Diabetes Burnout' I'm closer to understanding than ever before.

The book is very well written and presented, Ginger's voice, humor and wisdom is apparent throughout. There's a wonderful section that offers advice to D-parents that I found helpful and tons of contributors from all over the diabetes community. 

We can work, hope and pray that our children don't go through bouts of burnout, but lets face it, they probably will. Ginger's book helps to prepare you for those moments and gives sound advice on how to combat and live well through them.

You can enter below to win a copy from Arden's Day or if you can't wait... pick one up today in stores or online.

a Rafflecopter giveaway

Winner of the book will be chosen at random. Book will be shipped directly from Ginger's publisher, DemosHEALTH. There are many ways to enter, just login to the Raffelcopter app for details (It's super easy). -- Buying through my link will help to support Arden's Day.