iLet

One of the most interesting and exciting things I saw last weekend at DTreat was the Skype presentation by Scott Scolnick from Go Bionic.  Fresh off the introduction of the iLet at FFL we got a sneak peek at the new device as well.  I'm a bit of a geek and very seldom do I get to feel like I'm seeing new things as they are breaking, so it was very cool for me.  I have to admit that I haven't followed any of the artificial pancreas stuff to closely.  I know its out there, I have read peoples experiences and been jealous, but I don't really know the difference from one to the next.  And I was pretty surprised by how close to market the team at Go Bionic seems to be.  They are awaiting FDA approval for their trial and are hoping to have approval by 2018!

I first wanted to share a couple of things from the trials that have already been done.  The thing that stands out the most to me, more than the change in average blood sugars and highs, is the dramatic change in time spent with blood sugars below 60.  That is a huge deal that I don't think most people think about.  In the outpatient trial from 2013, in 20 adults over 21, the mean blood glucose of participants went 159 to 133.  In the control arm participants had blood glucose below 60 3.7% of the time and over 180 34% of the time.  Those on the bionic pancreas dropped to 1.5% of the time below 60 and 16% over 180.  In the next trial in 2014 the control arm showed a mean blood glucose average of 162 with 1.9% of the time spent under 60 and 20% over 180.  While those using the bionic pancreas had a mean blood glucose average of 141 with .6% of the time being under 60 and 20% over 180.  While the average blood glucose averages don't show a huge drop, the control that participants saw, with time spent between 60 and 180, was pretty outstanding.  A1c's on the bionic pancreas averaged below 7, the goal for people with Type 1.

The information was great, but the most exciting part was seeing the prototype of the iLet!  While we didn't get to see a live model or anything like that, getting to see what it was all about was enough.

Introducing the iLet!

I was furiously trying to write down notes all the way through the presentation but had troubles keeping up at times so some of my info may incomplete but here is what I've got.  The previous trials for Go Bionic have consisted of 4 parts.  A Dexcom CGM receiver to track blood glucose levels, 2 Tandem pumps to supply insulin and glucagon, and an iPhone to put numbers through the algorithm.  Not exactly ideal for real world application.  The new prototype is one standalone unit to do all of these things.  It takes two pen cartridges, one with insulin and one with glucagon, receives data from a Dexcom CGM transmitter and has all the information to run the algorithm on board.  The touchscreen interface can display bg levels, insulin micro boluses, and glucagon micro boluses.  There are screens to show the life of the Dexcom sensor, infusion sets, battery life, and cartridge levels.  Users have the option of pre-bolusing for meals.  The iLet will give 75% of the amount of needed insulin up front and then monitor and adjust from there.  The system is always using previous information to determine needs based on meal, time of day, carb counts, etc.  The more information that goes into the algorithm, the more it can learn and adjust.  The system learns over time and adapts to the user.  All that is needed to start is the users body weight.  The iLet will also come with a bluetooth enabled meter that communicates with the receiver for calibrating the CGM as well as entering blood sugars if the sensor is not active, for example during the two hour warm up period. This eliminates the chance of incorrectly entering a blood glucose value. The system can still be used without a sensor, it just tends to let averages run a little higher and will not administer glucagon.  During those times the user can use the carb count entry menu and the bluetooth meter.  Another new feature is the G-Burst.  This allows a burst of glucagon to raise blood sugars before disconnecting from the iLet.  

Of course the iLet is only as good as the accuracy and performance of its individual parts.  We are still waiting on a more stable form of glucagon, CGM and meter accuracy can always be better, and currently insulin with a fast acting time would be ideal.  The Go Bionic team is working with three companies who are developing new glucagon formulas, one of which is a liquid glucagon stable at room temperature for 2 years.  They are entering animal trials and are hoping to start human trials in about 6 months.  If this is not ready at the time the iLet is released to consumers, the system can be ran as an insulin only artificial pancreas and ready for dual hormone use later.  And as the numbers show, even using the current insulin available use of the bionic pancreas can lead to much better control.  I don't know about you, but I'd sign up for that in a heartbeat.

Disclosure:  I was in no way compensated for this post.  I attended DTreat 2015 in Boise as a facilitator where this information was presented.  I'm just ridiculously excited about it.

DTreat 2015

I got the opportunity to attend and help facilitate at DTreat 2015 in Idaho over the weekend.  If you don't know what DTreat is, it's a retreat for young adults with Type 1 diabetes.  There are a range of topics covered like dealing with burnout and stress, college life, insurance, diabetes in the workplace, and a lot of fun things going on as well.  But most of all it's great to be able to get together with a lot of T1 peers and just have a good time while not feeling different.  Kind of like summer camp for grown ups.  This was my second year attending.  Last year as a participant and this year as a facilitator.  Sadly, this will be my last year participating, as next year I will be outside of the 18-30 year old spectrum (#old).  I am hoping that they will call me back as a speaker or helper in some fashion next year (hint, hint).  It's impossible to cover everything that goes on here, and putting it all into words is something I don't think I can do but I wanted to cover what the highlights were for me.

It was great to see this years DTreat grow some from last year.  There were over 40 T1 young adults in attendance.  A lot of attendees were from the local area with ties to Hodia from being campers previously.  But there were also a lot of attendees from other places; from Virginia, California, Washington, Ohio, Georgia, Michigan, Iowa, and Arizona.  It is exciting to see the event grow and reach more areas of the country.

Every syringe represents someones hometown

The first day was all about getting to know everyone.  As everyone showed and got settled in there was a vendor fair to get lots info and free goodies.  We played some ice breaker games to learn about all the things we have in common and the things that make us unique.  After a few dinner and a few other activities to get the group settled it was time for Game Night!

Pictionary!

Jenga!

Day two kicked off with a great presentation with Annie Schultz who works for TrialNet, and has also worked for JDRF and took part in one of the artificial pancreas trials at Benaroya Research Center in Seattle.  Annie is great and hearing her story was so amazing.  You can see a little of Annie's story here.  She talked about a few other research things going on as well.  The AP trials throughout the country and the encapsulation trials by ViaCyte are definitely something to get excited about!  After that the group broke into guys and gals groups for some more personal conversation.  The afternoon included 'speed dating' where the participants were able to choose a handful of topics they were interested in and rotate through stations in small groups to ask questions about those topics.  I got to man the insurance station.  I'm certainly not an expert but having dealt with buying insurance for 10 years I hope I was able to provide a little assistance to those that needed, mostly students still on their parents insurance who want to know what's coming when they are no longer able to do that.  The day closed out with presentations on getting older and preventing complications and stress and burnout (something near and dear to my heart).  That night we were scheduled to attend a block party concert/fundraiser but we were rained out.  Instead we went to a local sports bar/bowling alley/arcade.  I think it was a good break from all the diabetes talk and a good chance to the participants to bond and have a good time.

Some of our speakers from day two

Our final day kicked off with a Skype session with Scott Scolnick from Go Bionic.  Go Bionic is developing a bionic pancreas, theirs is the only dual hormone system  being trialed in the US.  They also just unveiled their prototype of the iLet at FFL.  I believe we were one of the first groups to get to see this presentation.  I for one was totally geeking out over this.  They are gearing up to start trials for FDA approval very soon, which is SO exciting.  I'm not going to go into too much detail on this because I think it's worthy of its own blog posts which it will get.  We had a couple of attendees from CDN, Dan and Mindy, who gave a great presentation on Diabetes and your rights in the workplace.  Dan and Mindy were great and I'm super jealous that they both get to make diabetes their careers.  Dan works in stem cell research focusing on diabetes, and Mindy is working with the College Diabetes Network.  I'm extra jealous of her because she has gotten to attend FFL and meet awesome people.  We closed out with Taylor leading the group in making "Jars of Happy".  I don't think a lot of the group grasped how great these could be if you ever find yourself battling through some depression.  I still have mine from last year and its great to get a reminder that there is more out there than diabetes and that life can go on even when it seems you don't want it to.  We had one more closing activity and even though it seemed like it had just started, it was over.

Dan and Mindy from CDN

Jars of Happy

I had very good time and I'm sad that it's over now.  I feel so lucky that I was able to be a part of it the past two years and if you are, or you know someone who is 18-30 living with Type 1 diabetes I encourage you to look into this event.  It will be back next year and it is just an amazing experience for young adults.  Taylor and Sydnee did a great job of bringing this event to Boise and have put so much hard work into getting it going, along with the rest of the committee, Gabby and Natalie.  I have already seen so many pictures and connections on Facebook in the day since DTreat ended.  And that's really what it's about.  Building connections and a support network.  And I'm incredibly grateful that it's there.

Adventures in Introverted Parenting

I haven't really been active around here since DBlog week.  There just isn't really a whole lot happening in life on T1 front.  Things are more or less stagnant and I feel a little stuck.  My most recent visit to my Endo showed a slight drop in my A1c bringing it below 8.  While I have been disappointed in my results the last few visits, I am slowly accepting that my A1c really isn't that terrible.  It's higher than I'm accustomed to but could be a lot worse.  The doctor seems to agree with that.  He's asking me to focus more on testing at least a couple times a day 3 or 4 days a week than he is seeing my A1c get lower so we can get some good results to go off of for dosing adjustments if need be.  But diabetes isn't really what I want to talk about today.  In fact its completely unrelated.

When I was a kid I was definitely an introvert.  I was more content being in my room alone or with my brother digging through a pile of Legos, or wandering through the bushes behind our house hunting for lizards than I was going to friends houses or joining a large crowd of people.  I had friends that I associated with school and occasionally had sleepovers or play dates but overall I was happy to entertain myself and more often than not I spent my free time alone.  In High School it was the same.  I had a core group of friends that I would do things with.  But I was never the type to be at someone elses house everyday after school or going out every weekend.  And as an adult, little has changed.  I still need time to myself to recharge.  Some days at work I just want to lock myself in my office and tell the world to go away.  My wife and I have friends over for dinner or go play games with people and I enjoy.  But 9 times out of 10, if given the option, I would probably choose a night in reading or watching a movie over a night out.  I am content being alone or with a small group of people, large groups of people tend to stress me out, and interacting with new people is incredibly awkward for me.  My son, The Boy Genius, on the other hand is the complete opposite.  He is the epitome of an extrovert.  He loves to be around as many people as possible.  He like to be the center of attention.  He warms up to new people quickly and LOVES to talk.  We joke that he is going to be a lawyer one day because he can talk circles around you and will continue to argue his point long after it's been made, even if it's clear that he's wrong.  At least 5 times a day he asks if he can go to a friends house.  I try to impart on him the joys of spending time alone but that just doesn't do it for him.  It's hard for me to understand his need to always be accompanied by another person.  When we're at home, he wants me to be present for whatever he is doing.  If he is watching a show or playing a video game, he wants someone there to watch with him.  If he is reading, he wants you to lay with him while he does.  Meanwhile, I am wanting to sit alone and do whatever I am doing.  Don't get me wrong, I love spending time with him and I'm happy that he wants me involved in what he has going on.  But it can be hard sometimes when opposite things make us happy.  When he wants to go see a new friend, meeting new parents is an interesting experience.  Several of his friends have parents who would like to sit and talk for hours while I am trying to inch closer and closer to the door so I can make my escape.  I'd much rather text to make plans than make a phone call.  I can only imagine what some of the parents think about me.  That I'm stuck up or anti social.  But in reality I'm just super awkward and don't want to embarrass myself.  So each day is an adventure.  Trying to find the balance between his extrovert qualities and my own introverted ones.

Anyone else have this experience?  How have you made it work when your qualities are the opposite of your child's?

"You Won't Know"

"Now even if I lay my head down at night, after a day I got perfectly right, She won't know..."

Those song lyrics seem to ring so true for life with diabetes sometimes and came to mind last night as I lay on the couch waiting for things to level out after a 2 AM low.  The evening before, we went to a neighbors house for a game night with some friends.  There was a lot of beer and a lot of delicious snack foods, including some amazing cookie dough truffles and tater tops, stuffed with cheese, wrapped in bacon (sooooooooo good).  At first I had told myself I wasn't going to drink because I didn't want to have to deal with continually taking insulin for each beer I had throughout the night.  But as the night wore on and everyone else was enjoying their beer and I had finished my diet Dr. Pepper I decided to have a couple.  Typically in this situation I would bolus for the first, then forget about any others and end up high later.  This time though I decided I was only going to have the two Angry Orchard ciders that were left in my fridge.  They are a favorite of mine so I knew they had 24 carbs a piece so I bolused for both as well as an estimate for the snacks I had eaten.  I always err a little on the low side when drinking so I tested when I got home late that night and was at 224.  I corrected with 4 units and went to bed.  Then a couple of hours later I found myself waking up sweaty and shaky so I stumbled down the stairs to find myself at 55 and eating Sour Patch Kids in the middle of the night.  That's where the frustration comes in.  Even though I did everything correctly tonight I still wound up low in the middle of the night.  I counted my carbs for dinner and bolused.  I took insulin for the drinks I had and limited myself to the amount of drinks I had planned on.  I even bolused for my snacking which is a rarity.  Then I double checked when I got home and corrected the high from my bolus coming up a little short, which I expected because I would rather be high after wards and enjoy the evening than go low in front of a bunch of people I've just met.  And the rarest thing of all is that I limited myself to about 16 carbs to fix the low.  Even though I was tired and all I really wanted to do was eat the entire box of candy and go back to bed.  I checked again before heading to bed and was 113.  After waking up this morning I was at 143.  These kinds of times are not uncommon.  Even when you feel like you've done everything right you still end up with this off the wall number, be it a high or a low.  You do exactly what you should.  Treat the low with minimal carbs and still end up high again later.  You've put in all this work and if someone were to look at this number or maybe a high A1c they wouldn't know that you even tried.

Intro to D-Traveling

The Pretty Lady in My Life and I are about to embark on a new adventure in our life.  Because she is a great person she has decided to be Gestational Surrogate.  For those of you who don't know, (which is probably everyone because I had no idea previous to this), there are different kinds of surrogates.  A Gestational Surrogacy means my wife will carry a child but will have no genetic relationship to the child.  An embryo created from another couples egg and sperm will be transferred to her uterus where it will "cook" for a few months and then get to go home with his/her wonderful parents.  Pretty Lady has been matched with a couple in Los Angeles, California.  This means we will be taking a few trips to LA, the first of which will be next week for her medical evaluation.  This is foreign territory for me as I haven't flown since my T1 diagnosis.  In fact, my last trip on a plane about a week before being diagnosed, for our vacation where I realized "Holy crap, I'm peeing a lot," and took to Google to find out what horrible thing I might have wrong with me.  I have taken a few short road trips, and one very long one before starting on insulin, but this will be my first air travel.  It will a be a quick trip, arriving in LA at about Midnight and leaving at 5 PM the next day.  I've read a lot about other people's experiences with airport security, carry ons, and the like.  I don't currently have a pump or CGM so I won't need to worry about security in that aspect.  I'll likely only be needing a carry on bag so all my D goodies will need to be in that one bag.  That will be my meter, a couple vials of insulin, some syringes and low supplies.  Enough to last about 36 hours tops.  I'm a little unclear on what to expect with all of this going through airport security.  Do I let them know ahead of time that I have these things in my bag or let wait to explain it if they ask?  Do they need to be in a clear zip lock bag?  Help! All you D travel experts.  Any tips, tricks, or advice I should be aware of before heading out on this little adventure?

DBW- Continuing Connections

This is my post for Day 7 of DBlog Week.  Interested in more?  Check it out here.

"The very first inspiration for Diabetes Blog Week was to help connect our blogging community, and that continues to be the most important reason it's held every year.  So let's help foster and continue those connections as we wrap up another Dblog Week.  Share a link to a new blog you've found or a new friend you've made.  Or pick a random blog off of the Participant's List, check it out and share it with us.  Let's take some time today to make new friends."

I have to admit that I have not done a great job of reading others posts for Diabetes Blog Week.  There A LOT of posts and I sit down with the intention of reading through them but always seem to get pulled away.  After all I still have a real person life on top of diabetes (weird right?) that requires me to take care of things as a parent, spouse, employee, employer, and human being (you know, eating and stuff).  I have given up on emptying my Feedly reading list for the next several month and have just been going through the topic list for each day.  I love seeing all the different perspectives and  I have read several posts and a lot from blogs I have never read before though.   And one of those was Kim at Confessions of a Deniabetic.  The first post of hers I read was for Day 2- Keep It To Yourself and it resonated with me on a huge level.  Kim is new to blogging but definitely not to diabetes and she started her blog for many of the same reasons that I did.  To help deal with a lot of the feelings that diabetes brings up.  I find so much of what she says very relate able.  I look forward to reading what she has to share.

Want to see what blogs everyone else loved?  Check out all the other posts for Continuing Connections!

That ends Diabetes Blog Week 2016 for me!  I officially survived my 2nd one, and I actually managed to get a post up 7 days in a row.  I think that's a record!  Thanks for reading everyone and thanks to all of the bloggers who participated for posting.

DBW- Favorites and Motivations

This is my post for Day 6 of DBlog Week.  Interested in more?  Check it out here.

"The very first inspiration for Diabetes Blog Week was to help connect our blogging community, and that continues to be the most important reason it's held every year.  So let's help foster and continue those connections as we wrap up another Dblog Week.  Share a link to a new blog you've found or a new friend you've made.  Or pick a random blog off of the Participant's List, check it out and share it with us.  Let's take some time today to make new friends."  

Of all my posts my favorite line still comes from my second post on the blog.  "This is not MY diabetes, this is OUR diabetes."  Try as I might to compartmentalize things and keep them to myself or keep things from effecting those around me it's just not possible.  Diabetes does not just alter the life of the person who is diagnosed, it is life changing for everyone around them as well.  When I child is diagnosed the parents become live in nurses, sacrificing sleep and social activities to ensure that their child is healthy.  They become an external pancreas for their children.  And then there is the financial impact.  For the siblings it means that one child in the family is likely receiving a lot more attention as Mom and Dad fight to keep them healthy.  For those diagnosed as adults like myself the rest of the family undergoes a lot of changes as well.  For the Pretty Lady in My Life it meant a lot of worry.  Not knowing what this diagnosis meant and seeing me suffer through low and high blood sugar fluctuations.  And the mood swings...oh the mood swings.  My kids don't always fully understand what is going on, they have to deal with Dad not always feeling up to playing or having mood swings.  And they have all had to deal with mental aspects of this disease and the depression it sometimes brings on for me, right along side me.  I often forget that while I'm the one checking blood sugar, dosing insulin, fixing lows, and whatever else diabetes throws at me I am not alone in the fight.  I have my loved ones going through it right along side me.

Check out everyone else's posts about their Favorites and Motivations!