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Arden's Day Blog

Arden's Day is a type I diabetes care giver blog written by author Scott Benner. Scott has been a stay-at-home dad since 2000, he is the author of the award winning parenting memoir, 'Life Is Short, Laundry Is Eternal'. Arden's Day is an honest and transparent look at life with diabetes - since 2007.

type I diabetes, parent of type I child, diabetes Blog, OmniPod, DexCom, insulin pump, CGM, continuous glucose monitor, Arden, Arden's Day, Scott Benner, JDRF, diabetes, juvenile diabetes, daddy blog, blog, stay at home parent, DOC, twitter, Facebook, @ardensday, 504 plan, Life Is Short, Laundry Is Eternal, Dexcom SHARE, 生命是短暂的,洗衣是永恒的, Shēngmìng shì duǎnzàn de, xǐyī shì yǒnghéng de

Novo Nordisk Summit

Scott Benner

Last week I traveled to Indianapolis to participate in a diabetes blogger summit held by Novo Nordisk. When I was invited Novo told me that we would speak about a number of issues revolving around living with diabetes. Initially, I wasn't thrilled about the prospect of flying, missing time at home and the rest that comes with business travel. But in the end the promise of having a conversation about insulin pricing got me on that plane. - commuter flights, bumpy.

The summit spanned two days. We spent our mornings in a conference room and the afternoons at the Indianapolis Motor Speedway where we meet with Charlie Kimble (T1D/Indy Driver/Novo Spokesperson). I even saw some of (had to get on a plane) a real Indy car race. - not a huge race fan but it was cool.

I arrived in Indy with my own incomplete thoughts and perspectives about insulin pricing. I believe that insulin should be affordable for all but I knew going in that I didn't fully grasp the complexity of the issue. My desire for this trip was to get closer to clarity on this big subject and I did in many ways. It was interesting to hear directly from an insulin maker and I felt that we were being spoken to rather candidly. But I'd be lying if I didn't tell you that there were moments in the conversation when I just wanted to yell, "make it cheaper". However, the more I learned the less realistic my primal urge felt. Make it cheaper may be what's right but wishing it so isn't how this is going to happen. One of the people from Novo, had what I considered to be, a complete grasp of the issue. I'm trying now to get him on the Juicebox Podcast because I want you to be able to hear what we all heard in that conference room. - so you can decide for yourself.

If you think that you have a commonsense idea that fixes the problem - I promise that you don't. The issue of insulin pricing, in my estimation, is a microcosmos of every political stalemate that I've ever considered. On the surface it feels like someone just needs to do the "right thing". Problem is, there are too many 'someones' and they all hold a different version of what doing the 'right thing' means. - no magic wand.

I left the summit with one concrete belief. This is isn't getting fixed anytime soon without a reimagining of the process. I saw a flow chart (available here) that proved to me that there isn't simply a "bad guy" that needs to be stopped. For example, it seems to make sense that Pharma should just drop their price. But when you look further you find that If they do PBMs (Pharmacy Benefits Managers) could and more likely would remove that insulin in favor of one that they (PBM) could make more money with. Every "fix" scenario that you can conceive, someone in that room floated that idea. They all played out the same way. "Hey what about this....". "That won't work because...". - defeating but enlightening.

takeaway. The world doesn't work the way it should. Right doesn't always win. But the good news is that once we understand the complexity of the problem we can actually find a real and lasting solution. Simply yelling, "make it cheaper" isn't going to help. I had an alternative idea in the room and I shared it. I talked about changing distribution, eliminating PBMs and removing the entities that scrape profit from your drugs. I don't know if that could ever happen but I do know that I saw some smiles on some faces and they made me think that I wasn't the first person to say that out loud. That made me feel hopeful, like someone was trying to find a new and better way. In my opinion the best thing that you can do as an outsider is to first understand the complexities associated with this battle and then speak up. Your voice will only ring clear when you are asking the right questions and pressuring the right people. I guarantee that just yelling "cheaper" isn't getting us anywhere. It can't. This mess is well beyond being righted by good thoughts and righteous sentiments. It needs new ideas, constant positive pressure from us and a willingness from Pharma to be the change that this paradigm needs. 

the rest. Novo Nordisk paid for my travel, lodging and meals. In return I sat on a rather uncomfortable chair in a florescent conference room and got to see pit row at Indy. My plane ride home was turbulent and I ended up exhausted on Mother's Day. Charlie Kimball is one handsome fella. Race cars are cool in person but racing is repetitive to watch. I hope to bring you more information with the relationships that I tried to foster during my trip. Oh also... a high up person at Novo has an Instagram about soup. In the end these are my thoughts untouched by any influence.

read this!

more - Novo offers a discount card that anyone can use to make their insulin cheaper. You can check that out here. They have also released their thoughts on insulin pricing with two blog posts. 1. Pricing Position and 2. Perspectives on Insulin Pricing


Contour Next One Meter

Scott Benner

A few days ago the makers of the Contour Next One meter reached out to see if I would like to join a webcast announcing their new app that accompanies the Next One meter. 

Here's why I said yes...

When the FDA approves Omnipod's new Dash Personal Diabetes Manager (PDM) there will be a bunch of improvements and additions coming for Podders. The new Dash PDM will be sleek, modern and you can hear all about it and other Omnipod news on a recent episode of the Juicebox Podcast featuring Omnipod's COO Shacey Petrovic.  The new PDMs modern look and eye on the future required one change that some Podders may find concerning. There is no more built in BG meter. Shacey and I spoke about the meters removal in the above mentioned podcast episode and I understand why the move was made. Don't get me wrong, at first I was not happy about the change but the decision will bring us more good than bad. Change isn't always fun but this was needed. 

Having two devices combined creates FDA issues, innovation slow downs and it ties the Omnipod device to meter tech the ages quickly. Omnipod searched for a meter to replace the one in the current PDM and they are confident that they chose well. After participating in the aforementioned Contour webcast... I agree. 

So when Omnipod moves to the Dash they will also move to the Contour Next One. The meter is small, boasts impressive accuracy and when combined with the Dash will actually take up less room in your diabetes bag then the current PDM with he built in meter. In all this feels like an improvement in meter tech that positions Omnipod and us for quicker future innovation. 

And that's why I sat through a webcast on a beautiful Friday afternoon...

Here is what I learned...

The makers of the Contour Next One are excited to be releasing the new app (pictured) that accompanies the Next One. Omnipod users should note that when Dash arrives your Contour will not require this app. Your meter will talk, via bluetooth, directly to your Dash PDM. The Omnipod device will use it's own app to show you the information coming from the meter. 

The rest...

Shown with new app (this is not the app Dash users will use).

  • Highly intuitive user-centred mobile app - easy-to-use, simple navigation, easy to use
  • Automatically syncs with the remarkably accurate CONTOUR®NEXT ONE/PLUS ONE meter to capture blood glucose results 
  • Ability to record events such as meals, activities and medication. Users of the app can also add photos, notes or voice memos to help put blood glucose results in context
  • Optional CONTOUR Cloud account for management and storage of data
  • List view and modal day view, activated by changing orientation of device screen 
  • Ability to set meal markers on the app or meter
  • Alerts and messages for critical low and critical high readings 
  • Adjustment of meter settings via the app including all user settings and targets

NEW APP FEATURES

  • My Patterns: Delivers actionable information at the right time to help users manage their diabetes using 14 smart patterns
  • My Patterns identifies patterns in blood glucose results that could affect the health of people with diabetes, prompts them to think about the causes, and offers easy-to-follow advice and helpful reminders
  • Testing Reminder Plans: 11 different test reminder plans that can help users optimize testing to provide a more meaningful and comprehensive overview
  • View Insulin and Carbs: Ability to view insulin does and carb intake alongside blood glucose readings in one simple view
  • Reporting: Easy-to-read Blood Sugar Diary that includes 1, 2, 4 or 12 weeks of blood glucose values, carbs and insulin, enabling more informed discussions with HCPs
  • Data Export: Data can be exported as a CSV file for use on multiple platforms

Ascensia (they make the Next One) feels that their app can help people living with diabetes to make more thoughtful decisions about their carbs and insulin with the tools the app provides. You can see and learn more in this PDF that they have provided.

You can learn more about the meter, their test strip program and really anything you want to know at http://www.contournext.com.

You can get the app on the Apple/iOS app store here and on the Android/Google Play store here.


A Perfectly Imperfect Diabetes Day

Scott Benner

imperfect.jpg

Arden's A1c has been between 5.6 and 6.2 for over four years and while those numbers are pretty amazing... they can also be a bit misleading. So I thought I would share what I consider to be a perfectly imperfect day with type 1 diabetes. 

This graph is from 9 am on Friday to 9 am on Saturday and it encompasses a ton of diabetes decisions and their outcomes. Some good, some not so good... all of them will lead to a 3 month A1c average of somewhere around 6. Let's break it down.

The 9 am incident...

Arden left for school around 7:45 am with a stable BG around 110. I gave serious consideration to changing her insulin pump before school because I noticed some inconsistencies with how the site was acting (read: I didn't like the action time of the insulin and though the site may be going bad a bit prematurely) but because of the stability of Arden's BG, I left it on. result, mistake

Here's how I tried to handled it..

After a few small boluses over an hour and a half I stopped trusting the pump site. At this point I wanted to venture to the school and change the Omnipod but I wasn't home. In place of a pump change I began to more aggressively bolus in an attempt to hold things in place. We used a combination of temp basal increases and small boluses. When the time came to pre bolus for lunch I figured that it was going to go one way or the other. Either not so bad or pretty bad. With that in mind, it was time to be extra bold. I prebolused all of the meal insulin plus an extra unit at 11:20 am for an 11:40 meal. You can see on the graph that it almost worked. Alas, Arden's eclectic meal of a bagel, grapes, chips, cookies, carrots and iced tea was too much for even an aggressive bolus (with a bad site). The spike reached 180 (normally there is no spike) but I was still out of town and wouldn't be back until after 1 pm. I guess in reality 180 with all of that food wasn't too bad and it wasn't like I didn't know what it happened or how to correct it. So when I arrived home I decided that instead of bothering Arden at school we would just keep pushing the BG and change her pump when she got home at 3 pm. result, ehh not bad

Pump change at 3 pm...

We swapped Arden's pump as soon as she got home and applied an aggressive bolus and temp basal increase. The idea was to get her BG back and stable as soon as possible. I was willing to add carbs to stop a drop if needed in exchange for a quick resolution to the elevated BG and that is exactly what happened. Two hours later Arden drank 15 carbs to stop the drop and then she went for a short bike ride with a friend. Her BG hung around 70 and so we used a temp basal decrease to help with the bike ride. The basal worked great for the excursion but would later cause a slight rise as we approached the movie theater. result, YEA!

Click to enlarge

Off to the movies...

We arrived at the theater around 6:50 pm. Half of our group went to find our seats and the other half stood in line for snacks. Arden was with me in the snack line. Her Dexcom G6 indicated that her BG was 120 and drifting higher. I bolused 4 units. Arden got a large popcorn to share with her friends, a slurpee and a box off Bunch A Crunch. We added more insulin when we got to our seats in the form of a bolus and an hour of increased temp basal. There was one more small bolus about an hour into the movie. Her BG hung around 165 with a slurpee and an unknown amount of carbs. I liked where we were and expected a BG decline when the snacking stopped. result, hell YEA but the temp basal should have been 90 min.

Bedtime...

Arden's BG settled around 114 as we left the theater and hung there nicely for two about hours. She needed a juice around midnight (still awake with her friends) and we used a combination of temp basal decreases throughout the night. She slept in the next morning and I continued to temp back her basal insulin so she could sleep. result, (after all that) BOHYA!

Perfectly imperfect...

If it's your intention to set a basal rate, count a carb and never think about it again diabetes is going to be a rough ride. But if you're willing to stay fluid, boldly attack problems and work to keep your insulin balanced with your body's needs... things can work out pretty well.

Conclusion...

Throughout the day I never once counted a carb, gave in to fear or considered adjusting our plans. The bike ride may have seem counterintuitive to some but I would never plan for failure. And that slurpee, well, you can eat anything if you time your insulin correctly. Be bold! To learn more about how we manage insulin you can check out the Juicebox Podcast at JuiceboxPodcast.com or on your fav podcast app.


Dexcom G6 APPROVED by FDA: All the pics and video are here

Scott Benner

The Dexcom G6 Continuous Glucose Monitor has been approved by the FDA!

I have so much media to share with you but before you dive in here are some things that you can look forward to:

  • Zero fingersticks  – No fingersticks needed for calibration or diabetes treatment decisions 
  • One-touch applicator  – Redesigned one-touch applicator that is virtually painless 
  • Low-profile wearable  – New transmitter with a 28 percent lower profile for comfortable wear
  • Mobile compatibility  – Compatibility with smart device apps to display and share glucose information with up to five people 
  • Alerts and alarms – Customizable alerts and alarms to proactively warn users of pending dangerous high and low blood sugars 

If you have any questions for Dexcom about the new G6 please leave them in the comment section. Okay, have fun with he pics and video!


WATCH: G6 Product Video


PICS: Scroll and smile

Excited? Get your Dexcom today!


Stunning admission by Aetna medical director

Scott Benner

CNN Exclusive: California launches investigation following stunning admission by Aetna medical director

from CNN

California's insurance commissioner has launched an investigation into Aetna after learning a former medical director for the insurer admitted under oath he never looked at patients' records when deciding whether to approve or deny care.

California Insurance Commissioner Dave Jones expressed outrage after CNN showed him a transcript of the testimony and said his office is looking into how widespread the practice is within Aetna.

"If the health insurer is making decisions to deny coverage without a physician actually ever reviewing medical records, that's of significant concern to me as insurance commissioner in California -- and potentially a violation of law," he said.

    Aetna, the nation's third-largest insurance provider with 23.1 million customers, told CNN it looked forward to "explaining our clinical review process" to the commissioner.

    the complete article can be found here