The views expressed on this weblog are mine alone and do not necessarily reflect the views of my employer.
 Tuesday, September 02, 2003

My buddy Garrick just got a LifeScan UltraSmart meter and here's his detailed review:

I finally an UltraSmart meter (just before they started to give them away). I intended to get one sooner, but they were not available in mmol/L format, which is what I use here in the great white north.  I started using it August 1, and there is now about 230 data points in it now.

Most of what there is to mention about it has already been said, so I apologize if I repeat much.   I do have an AccuSoft Advantage Complete (also called a Manager) from several years ago, that does much of the same sort of graphing, though far less sophisticatedly. I had high hopes for the Complete initially, but I ceased using it because of the lack of precision and accuracy of the tests.  The Ultrasmart uses the same sensing system as the Ultra, so I assume it will have the same precision,  but also with an 8% low bias in the normal to high range.  [This helps to show better data than we really get, which makes us feel good.  I always add 8% to any reading I get that is not too low, and to my averages.] Unfortunate, considering it doesn't need to be inaccurate.

The Ultrasmart is larger than the regular Ultra, as is the carrying case, therefore it is more cumbersome to carry around, so I likely won't use it as a portable meter.  It does use easily available triple A batteries, not as cheap as double A, but far cheaper than button cells would be in a meter like this.

It looks nice, and can be easily confused for a PDA by strangers... as long as they don't see the blood spilling (:c>).

Every 25 tests, it asks for confirmation of the test strip code.  This is inconvenient and a possible waste of a strip if you apply the blood sample without noticing that it hasn't become ready yet.  I have wasted 3 so far. Lifescan has made a couple of extra bucks for J & J.

3000 test memory.  This is very practical for myself.  I don't download my regular Ultra meters, which have only a 150 test memory, to the Onetouch computer program regularly enough, so I have several large gaps in the stats.  Since this will be my most commonly used meter, there should be less gaps.  (I have 8 or 9 Ultras, altogether)

To turn the light on or off, hold the OK button down for at least 1.3 seconds.   Note that you can turn the meter on with the light, and also go straight to the Fastfacts menu, by holding the OK button.

The Ultrasmart is as easy to use as it possibly can be.  Very intuitive, even without the instruction book.  The Fastfacts button is my favourite.  It accesses graphs and averages, amongst other ways to observe the data.  The Graph of all results (push Fastfacts, select Glucose Analysis, push OK, push OK for Graph of All Results, push OK one last time or wait until the meter goes there on it's own) can only cover 3 days on the display screen, so it can be moved using the arrow keys, one data point at a time.  By holding an arrow key for long enough, you can get a 'flowing graph' that moves at about 8 data points per second.  Also, each individual point can be selected (push OK for the one that is flashing...hard to see especially without the light on) to view the 'comments' that were added to it... not something I will be doing.  The Graph by Time of Day works similarly, but can only include data points from one of the seven time zones (before and after each of three meals and one for night time).  You choose which one.  After you have seen one, you can use the back button to go back and choose another.

Average of All Results is also easily available.  (push Fastfacts, select Glucose Analysis, push OK, select Average of All Results, push OK)  The display shows the averages for the last 7, 14,30, 60, and 90 days all on one screen.  Quite useful for quickly spotting trends over the last 3 months, though not as inclusive as the 'flowing graph'.  Average by time of Day gives the you the averages for the seven time zones on one screen.  First, you have to choose how many days you want the averages to cover.  You have a choice of 7, 14, 30, 60, or 90 days.

One thing it lacks is the standard deviation (SD) of the data.  I consider the two most important numbers to be the BG average, but also the SD.  The SD tells me how tightly controlled I have been.  [It is available on the computer program though, however less convenient.]  SD isn't perfect of course.  The main problem would be having a lot of hypoglycemia.  Since hypoglycemia is not far from perfect, (compared to hyperglycemia),  having a lot of it would still show the SD to be quite low, and the average BG would also look very good, but I certainly wouldn't be feeling my best.

It does have hypo information, which is useful, especially considering that hypo level is customisable, as is the 'acceptable' bg range, both before and after meals.  For the post meal data to be reasonably accurate, you would have to eat at regular times.  I just use the same range for all times anyway so that is not a problem for me.  [My target is 4.7 (85), or my target range being 4 to 7 (72 to 125), which is the range for which if all is stable, I generally take no corrective action]

As usual with all things techy, there is more here than I care to use.  While I do agree that the exercise, health, meds/insulin, and food data buttons are useful for many diabetics, I find I can remember these things easily enough now (except for my medical records which are stored on good old paper), that I haven't any real use for  their accompanying programs.  As well, the calculations and protocols I've developed for myself are much more sophisticated than the Ultrasmart allows for.  [For instance, my insulin protocols for backpacking took me 3 days of hiking at various distances and elevation gains.  The result is a schedule that reduces my basal and bolus dosages, and also the lead time on the boluses, based on distance traveled and how many thousands of feet of elevation gain I have done and/or will do  ...BTW, it seems incredible to consume 700 grams of carbs in a day, and only need a total of 15 units of insulin, including the basal.]

The food data inputs capability may be suitable for type 2s, but are far too primitive for accurate enough calculating for tightly controlled type 1s, not to mention cumbersome.  I would however, highly recommend the food and exercise functions to new type 1s or type 1s just starting to use a basal/bolus routine.... partly because the meter provides some degree of fun.

One thing I consider lacking, is the choice of viewing the averages back farther than 90 days. Though 90 days nicely covers  HbA1c, with 3000 tests stored, it easily could go back 8 months or even years, depending on the frequency of one's tests.  From my own bg computer programs, I do know that December, July and August are my worst months. However, making use of that much data would presume this meter survives as my favourite for long enough.  In the present climate of ongoing improvements that are happening to meters recently, it may not. 

Garrick Neal

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 Thursday, August 14, 2003
The New Minimed Paradigm 512

I had lunch with a friend of mine, one of the Minimed Regional Consultants, who showed me the new Paradigm 512 Pump with the WIRELESS Glucose Meter from BD.  

In a word, yum.  

Having a pump takes getting used to, no doubt.  Everyone wants to ask "Do you sleep in it?"  "How do you, know?"

When you're connected to another device 23.9 hours a day that is basically acting as a surrogate organ for you, you grow attached (literally and figuratively) to it.  I can give myself insulin (called a "bolus") with my eyes closed.  I can use the Minimed 508 Remote Control, I can use the EasyBolus with Vibration for feedback. 

But it's the little improvements in my external organ that really affect my quality of life.  When I got a Blood Sugar meter (the UltraSmart) that had a backlight - WOW.  It made checking my blood sugar in a movie theater possible...more importantly, that improvement made me feel slighly less diabetic. 

The 512 is one such improvement.   I've long advocated and even predicted 3 years ago a wireless glucose meter/pump.  Why should I have to carry around two devices with screens, batteries, buttons, etc.  Well, I still need to have two devices, but with the Paradigm 512 the pump is told wirelessly what my blood sugar is right after I test it!  You don't even have to tell the meter, or press's transparent.

Then, the best part, on the pump you then run the Bolus Wizard.  Having previously programmed the pump with insulin ratios (multiple ones even, by time of day!) you enter in how many carbos you're going to eat, and the Bolus Wizard suggests how much insulin you should take.  It considers the ratios, of course, but also your current blood sugar AND the amount of active insulin!

For example, if you took 2 units to correct a high an hour ago, and now your blood sugar is 100.  Clearly you're headed toward a low.  If you tell the pump you're going to eat 30 grams of carbs and your ratio is 1:15, it might suggest 2 units, right?  WRONG.  You've already got at least one unit of ACTIVE insulin in you.  If it suggested 2units, you'd be right back where you are now, facing a low in a few hours.  Instead it might recommend 1.2 units (just an example) and get you back on target. 

It's THESE kind of improvements that get us one step closer to feeling normal.

I can't wait until June 26th, 2004 when my warranty runs out and I get the latest and greatest from Minimed.

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 Monday, July 28, 2003
Garrick Neal's Ten Commandments of Diabetes


1.  Lots of testing.  Lots.  At least 8 times a day, and preferably 10 to 12, or even more when things get astray.

2.  Disciplined diet. Maximal nutrition, aka healthy foods.  No snacking... there is no insulin available for small meals. Keep the meals to known quantities of carbohydrates, protein and fat.

3.  Stay well exercised.  Exercise provides all the usual benefits that it provides to normal people and maybe 2 times more than that for diabetics.  Including the ability to handle hypoglycemia better, and less bg exasperating illnesses.  One of the most important, to the quality if life issue, is that being fit means that during normal activity you are burning muscle glycogen, instead of blood glucose...

4.  Immediate correction of hyperglycemia.  The sooner hyperglycemia is corrected the less the amount of insulin resistance that sets in.... and hence continued hyperglycemia.  It varies for different people, but it happens at somewhere around 10 (180).  Find out, and avoid breaching it.

5.  Experimentation.  You must know your carbohydrate/insulin ratio.  Also precisely how much lead time you will need to take your rapid insulin, in any, prior to starting to eat.

6.  Watch the fat intake. Watch the protein intake.  Do not eat fat or protein based meals (or snacks) without carbohydrates.  Too much fat in a meal will make you insulin resistant for about 24 hours and too much protein will cause a 'protein spike' at some unexpected later time.

7.  Use glucose tablets.  Always keep them handy.

8.  Watch out for foods that may have high glycemic index values. The carbs will have as much as double the blood glucose effect as average carbs.  Watch out for over ripe fruit.  Again, eat consistently.

9.  Don't over basal.  Too much basal insulin will stuff the liver full of glucose,  and it will spill out... into the blood. 

10.  Never, never worry.  It's not fair that we are diabetics.  We don't deserve it.  We just have it, and we have to do what we can about it.  We cannot be perfect   (though for one whole day I once managed it. 

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 Friday, July 11, 2003
It's beginning...

Very soon my friends.  I'm on a MiniMed 508 and have been for 3+ years (spent the first 7 using shots up to 6 times a day).  I'm digging this new Paradigm 512...How do I get one???  It's such a great (and obvious) idea, it just might work!  It's not implanted, it's not automatic, but it's better that what we have now.  The real question is, how accurate can its suggestions be? 

It's quite a clever thing.  The Blood Glucose Meter "talks" to the pump wirelessly and informs it of your current BG.  Hopefully this happen totally automatically, it would be a shame if you had to "tell" the meter with some extra step/button press.

The meter looks a lot like an upside-down Ultra.  I'm not too excited about switching away from my beloved UltraSmart, but for wireless, I think I can be convinced. :)

Be sure to take a look at the Paradigm's Users Guide.  Often User's Guides can tell you more than the polished press sites will.

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 Monday, April 21, 2003
Glucagon-like peptide 1 (1-37) converts intestinal epithelial cells into insulin-producing cells.
Diabetes WebLog: Just wanted to let everyone know about a brand-new research result from a Japanese group, headed by Atsushi Suzuki: they have found that a fragment of proglucagon, the substance which breaks down to produce the anti-insulin hormone glucagon (which some of us use for hypos) will convert  gastric lining cells to insulin-producing beta-cells.   A really surprising and promising result......we all have an endless supply of gastric lining cells......but a very early step. - From my friend Malcolm

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 Tuesday, March 11, 2003
The New Lifescan OneTouch UltraSmart

It came out and I ran to Fred Meyer to pick one up for myself.  I'm talking about the new Blood Glucose Meter from Lifescan, the OneTouch UltraSmart.  (Diabetics who are also geeks MUST have all the new toys)

If you wanted a review, here it is: The UltraSmart is the BEST meter I've ever used.  Full Stop.  I love it.

If you want more, read on.  It combines everything that is good about the original One Touch Ultra with a very complete logbook.  Also, thank goodness, it finally includes a backlight.  I can't tell you how many times I've needed to check my blood sugar in the movies and have struggled with the non-backlit Ultra.

Here's all you need to know:

  • Uses the same Ultra test strips you use now
  • Results in 5 seconds
  • Huge temperature range
  • Blue "Indiglo" Backlight
  • Graphs and trending data
  • Logging of Exercise, Carbos, Hypos, etc
  • Connects to OneTouch Software

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The New Look for
In a rit of fealous jage and the inspiration of XML and CSS I updated my Diabetes Superstore  It's got a sexy new look and is dynamically updated by XML and XSLT taking the latest data and adding my review and comments of the latest books and information on Diabetes.  I've added new categories, I'm adding new books all the time.  If there's any desire for an RSS feed, let me know.  Enjoy!
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 Saturday, November 23, 2002

Sue has to go do a 2 hour Glucose Tolerance Test this morning (I'm going). She might have Gestational Diabetes with this pergancy too like with Jonathan. Man, she's pretty freaked and I guess I am too. Wish us luck. I had a GTT yesterday morning myself to see why I can't lose any more weight - I'm on the low sugar side.
[Sam Gentile's Radio Weblog]

I've been diabetic for about 8 years now, if Sue manages well, it will just be a few months again.  There are more tools to manage that situation than ever before.  God Forbid she is gestationally diabetic, which incidentally is incredibly common (about 5 percent of women, some say higher some say lower, but it's probably higher), I recommend (remembering I'm NOT A DOCTOR, just a DIABETIC):

  • Talk to an endocrinologist, or an ob who is VERY familiar with it
  • Take Humalog if you can and you doctor agrees, it's a great insulin - very fast acting, and leaves the body quickly
  • Use a One Touch Ultra - it's the fastest blood glucose meter, it needs VERY little blood and it's very small.  You can also check your forearms, and that saves wear and tear on your finger tips
  • Check blood sugar 4 to 8 times a day.  It will be a little more expensive, but knowledge is power.  You wouldn't check your plane's altimeter twice a day, why check your blood sugar similiarly?
  • Use some software management solution.  I recommend my GlucoPilot Diabetes Manager for the PalmPilot, but there's also InTouch, HealthEngage for the PocketPC, and others.

Be well, be positive, be strong.

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