5 years mark

Sensotrend published the first launch page for its products on World Diabetes Day, November 14, in 2013. We estimated to launch our service in early 2014. Things have not quite gone as we then thought they would.

This business is really tough. Our peers, other diabetes startups in Finland at the time, were Mendor, Modz, Quattro Folia, and later Femma5. None of them are operational at the moment, we are the only one left. And we’re still waiting to launch our product big time.

Why is that? Where did the other companies fail and why we have struggled so much? Each of the companies can probably best answer for themselves. It seems the simplified version of the problem is that there just is no viable and sustainable business model for self care apps in today’s healthcare industry. We also haven’t seen any of our international counterparts finding the keys to success.

We do see some light at the end of the tunnel, though. A few new companies have risen from the ashes of the failed ones. Glucostratus continues the legacy of Mendor, working with the business model Mendor found to be at least somewhat profitable. People from the core team for Modz are now working with Dottli, a diabetes app that was included in the Top 10 diabetes apps by market share with the most recent Digital Diabetes Care Market report by Research2Guidance. (Yes, the market research company still keeps pushing diabetes as the most promising opportunity in digital health. Each report forecasts the final breakthrough for these apps to be just around the corner.)

The biggest light for Sensotrend came from the Finnish Ministry of Social Affairs and Health. We recently won an app design competition for the Finnish national PHR, and were awarded a 100 000 euros contract. That’s not enough to really develop and maintain a consumer grade product for a longer term, but when combined with our current revenue and other sources of funding is enough for us to finally bring our product to the wider market.

We see many other very promising signals as well, like how national PHR solutions are being launched on many markets, how big EHR vendors are opening their app stores with clearly defined business models, how mobile PHR solutions like Apple Health and Google Fit keep evolving, and how all the players are converging on a common technical specification, the HL7 FHIR.

We also finally see self care data being used by healthcare organizations on levels beyond just the primary care and patient appointments. This data plays a crucial part when organizations digitise their care paths, when they profile and triage their patients, and when they seek to improve the quality of their care and customer satisfaction. All of that seems to be slowly turning into a business opportunity.

What currently seems even more promising is how big of a buzzword Real World Data currently is for the big pharma companies. We see their interest in the data as a key ingredient in forming a sustainable business models for self care apps.

So, perhaps the final breakthrough for digital health and diabetes apps really is just around the corner. If it is, we feel we’re as ready as we’ll ever be to ride the wave. Even if that time is not just yet, we feel it’s now our turn to contribute big time, and to try and push the industry forward to where we all know it needs to go.

Uploading Medtronic pump data to Carelink with Mac OSX Sierra

I have heard people have had increasing difficulties uploading their data to Carelink.

Some times the site is just slow, for sure, but another thing seems to be the new permissions for Java applets in Safari web browser. In the Sierra version of OSX, Safari hides the "Run in Safe Mode" selection by default. You need to hold the Option key pressed down when selecting the permissions for the Carelink site in order to see it and to toggle it off.

Access the Security settings from Safari -> Preferences, then select the Security tab. Then select Plug-in Settings...

Select Java from the list on the left. Select the Carelink site, and hold the Option key (alt) down when accessing the On/Off selection.

You'll see the Run in Safe Mode selection on the bottom. Just untick it, and you're done.

Let me know in the comments whether you still run into issues with the upload. I'm happy to help you further.

This guide is mainly aimed for people who used to be able to upload their data to Carelink, but can't do it anymore. If you have never uploaded your data, there's some more effort involved. You need to get Java enabled in Safari in the first place. Even then, I hope this guide will be beneficial in assuring people that yes, it really can be done.

MedAngel One Monitoring the Temperature of My Insulins

MedAngel kindly sent me a new kind of a diabetes related gadget to try out, on the condition that I'd share my experiences with it. This gadget keeps me safe by guarding the temperature of my insulins.

I got the device just in time for a trip to the United Arab Emirates. That was just perfect, as I had been thinking of the temperatures. Finland, where I live, is currently quite cool, with temperatures usually below freezing point (0 °C, 32 °F). It's winter time in the UAE too, but it can still get quite hot there.

Extreme temperatures are bad for your insulin

I have had my insulin damaged by temperature a couple of times. I can't directly see it from my insulin, it remains a transparent liquid. I notice it when that liquid loses it's capacity to keep my blood glucose levels down, even when I change the cannula of my insulin pump system, when I dose more and more of it, and my glucose levels still keep rising. When I then finally refill the cartridge of my pump with fresh insulin, and my glucose levels finally start to come down, I know there was something wrong with the old insulin. And when I think back, I recall being outside at a park, for instance, where my pump may have been exposed to direct sunlight (in which case the black device absorbs the heat and becomes warmer than the surrounding air). Or I may have been out in Finnish winter, with temperatures well below freezing point, and some of that cold may have reached my pump, even though I try to protect it.

The insulin I'm carrying in my pump is one concern, and I wish the pump itself would have a thermometer and warn me if it gets too hot or cold. The other concern is with my reserve insulin, the vials I fill my pump cartridges from. When I travel, I need to keep that reserve insulin with me, and I need to protect it from extreme temperatures as well as I guard my pump. But it just may happen that the reserve insulin is in a bag that I leave to the car when stopping for a lunch, and the temperature in the car when I return from the lunch may be quite cold (Finnish winter) or hot (in the UAE, or even in Finland in summer time). Unfortunately, it's quite easy for me to make that error and leave the reserve insulin in the car. Most of my internal processing power when stopping for lunch is targeted to what I'm going to have for lunch, how much insulin I should dose to that, and when.

When something like that happens, I'd like to have a device like MedAngel One, next to the insulin. So far I have been lucky if I have even noticed my error. And even when I have, I haven't had a good idea about whether the insulin has really suffered.

With MedAngel One, I can see what temperature the insulin has been exposed to, and for how long.

Lessons learned

In the UAE, it never gets hot indoors. Every place is air conditioned, very efficiently. And not just indoors. Even bus stops outside are air conditioned, keeping the local atmosphere at the bus stop cool even when the air just a few steps away exceeds the human body temperature (around 37 °C, 100 °F). This lead me to not think about the heat too much.

When driving 2 hours from Abu Dhabi to Dubai on a nice, wide motorway it was really quite comfortable on the driver's seat. However, my luggage in the trunk was positioned so that the reserve insulin inside was on the top, and the top of the luggage was exposed to direct sunlight throughout the drive. Again, a situation I would have paid no attention to without the thermometer next to the insulins. But when I checked the MedAngel app later that day, I noticed the insulins had indeed been exposed to some moderate heat.

I'm a big fan of learning. So next time I'm loading the luggage in the trunk, I know to think of the positioning of the luggage, and of the position of the placement of the insulin within the luggage.

The MedAngel One could have helped me even better, if I had let it. It could have alerted me in real time when the temperature within the luggage started to rise. However, the smartphone app that talks with the thermometer was only available on Android during our trip, and my primary phone was iPhone. I had an Android phone with me too, but during that drive it was packed in the same red luggage, and turned off. So I missed the opportunity to learn how it feels like when a guardian angel warns you before something threatening is about to happen, but I'm sure I'll get to learn that sometime in the future.

Back at home I learned yet another thing. When I unpacked my luggage, I left the small bag with the reserve insulin on a table in our bathroom. I know it's our hottest room, and should be warm to help keep it dry. But I had no idea it was actually warmer than 25 °C, and therefore not a good place to leave my insulin into.

Right now the gadget is in the fridge, guarding the storage temperature of my reserve insulins. The temperature there may drop too low too, as I learn happened with the founder of MedAngel. And there may be a power blackout while I'm away, in which case it will be super nice to be able to check whether that has potentially affected my insulins.

Final words

I really like the device and the app. I had no trouble taking them into use, found every feature I was looking for with ease, and had no problems or hick-ups during use. This is what I call good design.

I know there are some similar products available too, like the Likelle containers with a premium look and price point. But for my preferences just a simple small gadget I can slip in with my reserve insulins works better.

I'm keeping mine, and am considering ordering another one. You can learn more about the device at medangel.co.


Besides getting my own device for free, I have no affiliation or other ties to MedAngel.

Diabetes data platforms need competition

I received the recent news of Diasend and Glooko merger with mixed feelings. My main concern is the openness of the joint platform. Will it be possible for other apps to use the data? Ultimately, will it be possible for people with diabetes to upload their data once to a safe location, and then use the apps and gadgets they choose to make sense of that data in a way that best supports their individual goals?

@smansonsmith Timing is uncertain unfortunately, but an API is part of our plan and we hope to come to an agreement with relevant partners.

— diasend (@diasend) November 22, 2014

Diasend have discussed opening an API for third party applications and developers for some time now. I have assumed they just lacked resources to make it available (although they never explicitly stated they would make that API open for anyone). Glooko, on the other hand, have never made any promises regarding an API. They do refer to a platform, but that's a much more vague term.

In their take on the news, Tidepool state that they don't consider themselves competitors to Diasend and Glooko. In a way, I'm disappointed. Competition is one of the key driving forces of innovation. We definitely do need that in the diabetes data management market. We need companies, nonprofits, and independent developers competing, for instance with the following:

• Who will be the first to build an open platform for all the data people with diabetes need to see together?
• Who will be the first to release a truly universal uploader, supporting all the different hardware we use?
• Who will create the best developer experience, attracting all the best apps to be connected with the platform?
• Who will build the best architecture, combining security and privacy features while enabling easy sharing of data between stakeholders.
• Who will build the best user experience, making it easy to use the above mentioned tools?

We've seen how Nightscout, the open source project lead by independent developers on their free time, has helped commercial vendors bring their products to the market faster. Having the technology out there both validates the need for it and puts pressure on the companies to introduce their own solutions in order to not miss the train. In the case of Nightscout, it also put pressure on the regulator to approve the new commercially available technology in an accelerated procedure.

We do need the same with the diabetes apps ecosystem, with the data management platforms. I do believe that once we see the first platform that really enables upload from the most used glucometers and insulin pumps, and makes that data available for all third party applications, we see a quantum leap of innovation. We see that data actually being used. Used in many ways we currently dream of, and also in ways we cannot yet even imagine. I see the lack of such a platform as the biggest bottleneck of innovation currently.

At Sensotrend, we've from the beginning seen our own offering as a service that runs on Personal Health Record (PHR) platforms. On generic PHRs like Apple's Health and Microsoft's HealthVault, but also on PHRs focused on diabetes. We would really like to see Glooko, Nightscout, and Tidepool becoming such platforms. And we'd like to see them competing on who's the first one!

So long, Sports Tracker

Last week, I had the privilege to attend to the Sports Tracker Innovation Night. The event was targeted to people like me, with a CTO role in startup companies, or something close to that. I went there with great expectations. Is this the moment they finally open their API?

The first time I asked Sports Tracker for an API to access some of the exercise data was at Slush 2013, almost three years ago. I could hear from the answer that many other people and companies had asked for that too, and plans are currently being made for making an API available. I’ve repeated the question occasionally since then, and the answer has always been that the API is being planned, designed, or even built.

During the event, it became somewhat evident that an API is not being built. The presentation I saw (there were several presentations running in parallel) was about digital transformation, but mainly presented ideas on how to market and sell more goods to consumers through digital sales channels. The current owner of the Sports Tracker app is Amer group, the owner of many great brands like Atomic, Patagonia, Salomon, Suunto, Wilson, etc. It’s understood that within the group there’s a lot of know-how on how to market and sell goods.

I’m writing this on my way home from the MyData2016 conference. In the conference, there were numerous presentations on how the society is changing, and many on how consumerism is changing, too. People of today don’t want to be sold to. They want to get personalised experiences matching their values, and they want to be involved in creating value on initiatives and activities that matter to them. I see this as a really welcome development, and really want to believe in it.

Almost all other sports and wellness apps have already understood and are embracing the API ecosystems. When you expose access to data through publicly available interfaces, you no longer need to worry about offering that personalized experience to each and every different user or user group. The data produced by a sports app may be a key ingredient in something more meaningful, like in an athlete learning to train better or a person with chronic illness being able to manage his condition better. But the sports app cannot produce all the value alone. Especially not to both the athlete, and the chronically ill, and the myriads of other people with different needs, life styles and preferences. On the other hand, the value of the data from that app increases exponentially, when combined with data from a nutrition diary, smart scale, and perhaps medical devices.

Today, building an API should not be a big task. The first step for a wellness app would be to integrate with HealthKIT and Google FIT. In case that’s inconvenient for some reason, the app most likely uses and API already, to communicate with a cloud server. Opening that API for third parties requires little more than an OAuth2 implementation, for which there are plenty of implementations available. Of course, there’s the added cost of documentation and support. To get around that, an alternative is to open the API to aggregators, such as Human API, Validic, W2E, or Wellmo. You can even get the aggregator really interested by making an exclusive offer. It would be more limiting to developers wanting to use the data, but at least there would be a way.

Among Sensotrend’s current users, and among the potential users we have interviewed, Sports Tracker seems to be a really popular application. This may be due to it’s long history, and due to Nokia being so dominant in the Finnish handset market at one point in time, and Sports Tracker being the most highly acclaimed sports app at that time, on that platform. We’ve gotten many requests to support Sports Tracker in our app. This far, we have asked those users to be patient, and wait until the API gets released or the app gets integrated to HealthKit and Google FIT.

From today on, we’re changing that message. It’s evident that an API is not coming in any foreseeable future. People who are interested in seeing their data in our service, or in any other service for that matter, should instead select Endomondo, Strava, Runkeeper, Moves, or almost any other app that gets the value of open APIs.

I’m a long time user of Sports Tracker myself, and changing to another app requires some effort. Just selecting the right one from the ones listed above needs some research. However, the longer I keep using Sports Tracker, the more I feel I’m being left out of opportunities to learn, and to use the data in meaningful ways. And the bigger the effort to transfer the data manually to another platform, if I ever choose to.

It’s supposed to be my data. I should be able to use it in the ways I want to.

Frustration with Enlite

I just disabled all alarms and the SmartGuard feature of the pump.

I have great trouble getting the Enlite sensor to be accurate. Maybe it's just me, maybe the sensor finds my tissue hard to read, maybe I'm not calibrating it right, maybe there was something off in the manufacturing or transportation of the particular batch of sensors. The sensors just keep giving me numbers that are way off from what my glucose meter says.

At 10 am, when I woke up, the pump told me the sensor reads my glucoses at stable 3.8 mmol/l and the SmartGuard feature has been activated to save me from going too low. I did not feel low at all, so checked with the meter. It said 9.9 mmol/l. And 10.4 mmol/l when I measured again. And after washing my hands carefully, still 10.2 mmol/l. The real glucose level was clearly around 10 mmol/l. I dismissed the SmartGuard to resume the insulin flow, and injected some insulin to bring my glucoses down. I did not calibrate at this point, as I was sure the calibration that far from the sensor reading would be rejected by the transmitter. I felt a bit frustrated, as I thought the SmartGuard action of the night was likely the reason for the high level. It may also be that my glucose levels had really been low and then bounced back up due to my liver releasing some glucose into my bloodstream just before I woke up, so the sensor just did not have time to catch the change.

An hour later (at 11:12), just before breakfast, my meter told me I was at 6.9 mmol/l, so I bolused accordingly. Again I did not calibrate, as although the meter reading was now much closer to that of the sensor's (5.2 mmol/l), there was an downward arrow in display, so I knew my glucoses were still dropping, a bad time to calibrate. Shortly after, the pump buzzed and told me that insulin delivery had been stopped again, to save me from going too low. I needed to dismiss the SmartGuard again, as I knew I wasn't that low, and was currently eating, which would rather bring my glucoses up soon. In addition to that, it took me a while to find the amount of bolus insulin that had been injected (only 0.15 units -- the bolus delivery rate of the 640G is really, really slow!), and even longer to find the real amount that should have been injected.

While I can understand the logic the sensor and the pump used, and acknowledge I'm not yet familiar with the menu system and that's why it takes me time to get around and perform some actions, I became frustrated. It felt I was just fighting an enemy, rather than working together to treat me in the best possible way.

I have used the Dexcom G4 CGM for more than a year, on and off. Before that I occasionally got a CGM (either Dexcom or Medtronic one) from my clinic for a week. Throughout this time, I've gotten better results from the Dexcom. 90% of the time, it shows what I expect when calibrating it (that is, within 15% of the reading of my glucose meter). And 90% of the time it's off, it's easy for me to see, in retrospect, the point when it got off the track and also back on track. Either I calibrated when my glucose levels were changing rapidly, or I probably slept on it, causing the so called 'pressure low'.

With the Enlite, I have never gotten the same feeling. I have no idea why it behaves the way it does.

When searching the internet, I find I'm not the only one with these issues. See for instance the end part of this review: http://www.healthline.com/diabetesmine/medtronic-minimed-connect-review.

I also had a short discussion about the issues in Twitter.

@scottleibrand @mrinnetmaki I've heard some people say the new Enlite is dramatically better, some claim worse than old. Which is odd...

— Sulka Haro (@sulka) December 29, 2015

Anyway, for a couple of days, at least, I don't let the Enlite sensor interfere with my treatment. I keep wearing the sensor, and keep watching its readings. I hope I can better learn the ways it works, so we can work better together. I already got some advice from both a local representative and a peer support group:

• Calibrate at least 3 times within first 5 hours after inserting the sensor.
• Only calibrate, if bg/ISIG is above 0.14 and below 0.44, applies when bg is in mmol/l).
• Pay attention to the insertion site.
• Try inserting the sensor first, connecting the transmitter hours later.

I really want to learn to trust the sensor and the system. For me, the SmartGuard feature of the Medtronic Minimed 640G is a really promising step towards an artificial pancreas. A system that would eventually do all the micro management required to control my glucose levels for me. But there's no way I'm giving that responsibility to a system I don't fully trust and understand.

Finally, I ask you to remember that in this blog I share my experiences when and as I face them. I may be totally in love with the system next week.

Will I use the bolus calculator of the Medtronic Minimed 640G?

I have been using the Accu-Chek Spirit Combo pump system for five and a half years. I have been really happy with its bolus calculator feature.

When I first started pumping, I was offered a choice between Accu-Chek, Animas, and Medtronic pumps. I chose the Spirit Combo as it's meter could be used as a remote controller for the pump. This means whenever I measure my blood glucose, I can immediately also dose the right amount of insulin, without having to reach for another device. I still think this is a winning feature.

After having used the system for some time I came to appreciate the embedded bolus calculator too. Without the bolus calculator, I would often get too much insulin when correcting a high blood glucose. For instance, if in the morning my sugars would be high, I'd take some additional insulin for my breakfast bolus, to bring them down. Then I'd measure my blood glucose again in one and a half hours, and see that it's even higher. So I'd inject some more insulin. One and a half hours from that I'd measure again, and find that my sugars are still high, so I'd start to wonder whether there's something wrong with either the insulin or the cannula, but inject some more insulin to make sure. Less than an hour from that, my sugars would come crashing down, and I'd be trembling in an episode of hypoglycemia.

I did not really notice that pattern back then. But the bolus calculator taught me patience. When I'd check my glucose one and a half hours from breakfast, it would tell me "OK, your sugars are still high, but that's to be expected after the breakfast, remember? There are still many units of insulin in effect in your body, the situation is being taken care of." And an hour and a half from that, when I'd be frustrated again, it would remind me that yes, the insulin I have taken to lower the high reading is still working and already bringing the glucoses down, I don't need any extra insulin.

Here the bolus calculator reminds me that I still have 1.2 units of insulin on board to bring that 8.9 mmol/l down to target level, I only need 0.2 units more (added to the 6.9 units I need to cover the 55g of carbs in my meal) to make it perfect. Without that reminder I would most likely be frustrated that the reading is still high and dose some more correcting insulin that would then cause a hypo later on.

The bolus calculator has really helped me to avoid many lows, and to be less frustrated when waiting for the insulin to take effect. I would really like to continue using it.

In the Medtronic 640G, the pump system I'm currently trying out, there is no bolus calculator in the meter. The glucose meter does work as a remote controller, meaning you can set a bolus with it, but when you do that, neither the pump or the meter know how much insulin you took for the meal you were about to eat, and how many units of the total were dosed to correct a high. So after one and a half hours, there's no tool showing you that everything is going on just as planned, no need to panic and adding more insulin to the system does not benefit at all.

This is one of the things I'll be paying attention to when considering the switch. Will I get used to handling two devices (both the meter and the pump)? Or is it just too convenient to set the bolus with the meter? Do I really need the help of the bolus calculator anymore, or have I learned my lesson already and can think things through before stacking a dose after dose of insulin?

When to test a new pump?

I was originally supposed to start with the Medtronic pump just before Christmas. Christmas is a challenging time for people with type 1 diabetes, with plenty of food we only encounter once a year and therefore don't necessarily know how it affects our glucose levels. And more sitting and lying around than usual. With more than just one occasional treat. So it would have been a good time to challenge the new pump, see what it can do under those circumstances. And, I would have had plenty of free time to play around with it.

However, Medtronic Finland did not get the pump on time. There had been a software update to the pump, causing something in the product code to be changed, which caused some hiccups to the delivery.

Medtronic kindly asked whether I'd like to get a demo pump for Christmas time, so I could play around with it and learn the features, but not yet fill it with insulin and connect it to myself. I thought this to be too much of a hassle, as I still needed to operate my old pump. I'd rather make the switch once the real pump arrived.

So we started after Christmas, when I returned to work. It's kind of fair too. It may be easier for the new pump to convince me of its capabilities under more regular circumstances.

Medtronic 640G

I'm now connected to a new pump, the Medtronic 640G.

And here's the disclaimer: I signed a blogger contract with Medtronic.

Signing the contract was not really required of me to get the pump. I have discussed my need for a new pump with my doctor, and she has indicated I have a choice between the three pumps they can offer: the Accu-Chek Spirit Combo, Animas Vibe, or the Medtronic 640G. However, I wasn't sure which pump I'd prefer.

So I asked Medtronic whether they could provide me with a sample so I could get to try it in real life. They said the easiest way would be to get it under the blogger contract, which actually sounded good to me, since I've felt I should be more active with this blog. Now there would be a reason to write a post every once in a while.

So you may consider any upcoming posts about the Medtronic 640G as advertisement, if you wish. However, I'll do my best to record both the good and the bad experiences.

Two years later...

The first "Hello World" post in this blog was published exactly two years ago. Personally, I face this day with mixed feelings.

Two years ago, I thought we'd be much further by now. I imagined us launching the first version of our service early in 2014, then focusing on customer acquisition and growth, and by this time already playing with big data algorithms on all the data we had helped collect and bring together. However, due to challenges with growing the team, financing, the healthcare market, and demonstrating true value from our service (all nicely intertwined), we haven't even publicly launched our service yet.

On the other hand I think we have been extremely lucky and successful. After all, two years is a long time for a startup to even survive. And in this time, we've received an incredible amount of support and positive feedback. We've learned a ton about running a company, about the startup scene, and about healthcare market, and made dozens and dozens of really valuable connections.

Most importantly, with the little resources we've had, we've managed to get our service in trial use in a public healthcare institution. Today, we're taking in the second batch of trial users.

Our service will help them, and their nurses and doctors, in viewing all relevant data from their medical devices and wellness apps together, and in making sense of diabetes trends.

Continuing Connections

The topic of this last day of Diabetes Blog Week, Continuing Connections, reminds me of my last post of last year's week, the
Diabetes Thought For the Day.

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.

At the end of last years Diabetes Blog Week I implemented a simple web page that redirects the visitor to a random post of all the posts from all the participants of the week. I have been using the service myself, and found many new voices within the community. I'll be updating the contents with this year's entries soon, and welcome you all to try it out at sensotrend.com/ThoughtForTheDay/, whenever you feel like you could use some peer support or want to see diabetes through someone else's eyes.

Favorites

Today's Diabetes Blog Week topic is Favorites and Motivations.

If you have been blogging for a while, what is your favorite sentence or blogpost that you have ever written?  Is it diabetes related or just life related?  If you are a new blogger and don't have a favorite yet, tell us what motivated you to start sharing your story by writing a blog?

My own favorite is the one from very early on, the post on whether to Compete or Collaborate. The main message is still the way I see diabetes technology needs to be developed. There are so many people with diabetes, and so many different needs. We need a lot of different devices and apps, so that each of us can choose the tools that best suit our individual lifestyles. At the same time, we need cooperation and open interfaces, so that all those different apps can use the data from glucose meters, insulin pumps, and continuous glucose monitors, enabling the best possible combination for their users. All of this is nowadays further emphasized by the #WeAreNotWaiting movement.

What about your favorites then? The most read post of this blog is The Exciting State of Diabetes Technology in 2014.

Changes

Today's Diabetes Blog Week topic is Changes.

Today let's talk about changes, in one of two ways. Either tell us what you'd most like to see change about diabetes, in any way. This can be management tools, devices, medications, people's perceptions, your own feelings – anything at all that you feel could use changing. OR reflect back on some changes you or your loved one has seen or been through since being diagnosed with diabetes. Were they expected or did they surprise you?

My first thought was, of course, to write about the tools and devices, and all of #WeAreNotWaiting that's currently happening. And all the development that has happened in one year after I wrote about The Exciting State of Diabetes Technology in 2014. But then again, that would have been too easy for me.

Today, I'll rather write about my relationship with, or attitude towards my diabetes. There have been some noticeable changes.

As I wrote in one of the earliest posts in this blog, I first saw diabetes as a friend, telling me to take better care of myself. Later on, our once happily intense relationship cooled down a bit, as I concentrated more on other things in life.

Right now me and my diabetes are closer than ever. I'm the founder of a startup creating self-care tools for people with diabetes, and I think about diabetes very intensely, literally each and every day. You might say diabetes and the best possible treatment for it has become my life's purpose.

I think it's very important for all of us to understand that the relationship between people with diabetes and their condition is changing continuously. That is yet another reason why we need to have a wide array of tools and methods for our treatment.

We have different priorities and different challenges at each point of our lives. No one solution fits all.

Clean It Out

This is by far the most difficult topic of Diabetes Blog Week for me this year.

Yesterday we kept stuff in, so today let's clear stuff out. What is in your diabetic closet that needs to be cleaned out? This can be an actual physical belonging, or it can be something you're mentally or emotionally hanging on to. Why are you keeping it and why do you need to get rid of it?

To get some inspiration, I read through the entries already posted for this topic. Surprisingly many of those are about all the supplies us people with type 1 diabetes need to store and use. Actual physical things in an actual physical closet.

My supplies take up space too. I put some effort into keeping them organized, and rarely have problems with the sheer volume of the supplies. What gets to me, however, is the way they are packaged. One thing in particular, are the user instructions. I get my tests strips in a package of 10 containers; one container of 50 strips lasts for around a week. Why does each one of them come with its own user instructions? And my infusion sets too, for each pack of 10 I get 2 different booklets.

All these instructions I just throw away immediately. It's just so much waste, over years and years of use. Couldn't they rather make some beginners set that's available when you first get your pack of certain type of supplies? And then all the subsequent packages would contain just the essentials.

Yes, I am aware of some of the regulation that's in place for patient safety. But in this particular case, with consumables I use day in, day out, for many years, I don't really see the benefit of having to immediately discard so many user instructions.

We often demand a lot more. Better devices, more accurate test strips, sensors for CGMs, etc. When someone asks me what I could do without and where would it be possible to save some cost, I say the user instructions for the everyday consumables.

Nurses Day

Today is the second day of Diabetes Blog Week, with the topic Keep It To Yourself:

Many of us share lots of aspects of our diabetes lives online for the world to see.  What are some of the aspects of diabetes that you choose to keep private from the internet?  Or from your family and friends?  Why is it important to keep it to yourself?  (This is not an attempt to get you out of your comfort zone.  There is no need to elaborate or tell personal stories related to these aspects.  Simply let us know what kinds of stories we will never hear you tell, and why you won't tell them.)

Since this is also the International Nurses Day, I'd like to express my gratitude to all the diabetes nurses and certified diabetes educators (CDE's) who have helped and continue to help me achieve the best possible treatment, and at the same time encourage me to lead a life that's not all about treating my chronic condition. You have all been so amazing!

So, I wish nobody will ever hear me brag that I've achieved any good treatment results just by myself. The support from my loved ones, from my nurses and doctors, and from the technology I have access to are the key ingredients that I couldn't cope without.

I Can

It's Diabetes Blog Week again!

This year, the topic for the first day was the empowering I Can.

Lets kick things off this year by looking at the positive side of our lives with diabetes. What have you or your loved one accomplished, despite having diabetes, that you weren't sure you could? Or what have you done that you've been particularly proud of? Or what good thing has diabetes brought into your life?

The first thing for me, obviously, is all that I have accomplished with Sensotrend this far. Both myself and my wife have worked for our startup company full time for over a year already. I feel incredibly empowered, being able to create tools that can help me gain better understanding of how my body works, and better treatment outcomes.

I've written before about the change that using a Continuous Glucose Monitor brought to my life as a diabetic and to my attitude towards treating myself.

For the first time, I was able to see how my blood glucose really behaved. No more shotgun charts. The resulting chart was rather a roller coaster, showing the glucose go up and down, sometimes fast, some times slower. Very far from the ideal curve, but providing so much more insight than the isolated dots of the meter.

I had been told I can control my blood glucose by simply calculating all the carbs I eat and taking little less insulin when I'm exercising. But for me, it was not so simple, and I could never really explain all the variations in the values of my isolated blood glucose measurements. The CGM curve showed me how the values changed, and prompted me to find out what was causing the different ups and downs.

That's what changed my attitude completely. I had already given up, found good control of my blood glucose values to be beyond my capabilities. Getting more insights from the CGM curve was the ground breaking change I needed, to get the sense that there is a way to learn what exactly affects my blood glucose levels and how, so I can start to keep it better under control.

A Case for Wearables

Wearables have been getting a lot of bad reputation due to studies revealing that people abandon them after 6 months. I’d like to defend them, and offer a different view.

I hit that critical 6 months mark with my Polar Loop in July. I suddenly noticed I just wasn’t wearing it anymore. Also, I started to get annoyed with having to charge the band every few days. Something had clearly happened in our relationship.

Wearables provide information

I originally started tracking my daily activity with the Moves app, over a year ago. I had heard a lot about the 10 000 daily steps required to stay fit, but I had no idea how many I was taking myself.

With the Moves app, it took me a few months to learn what it takes to reach that goal. My daily walking commute gets me half way through, and my other activities vary so that I sometimes pass the 10 000 mark, often times not. What was really important for me to learn, however, was how much variation there is. Some days I just stay at home, programming. On those days, I may take less than 200 steps. On other days, I may have several meetings taking place at different locations, and I may take over 15 000 steps without really noticing being involved in any physical activity.

Wearables do help people with chronic conditions

The main reason for me to track my daily activity is not to get fit. I have type 1 diabetes, which means my body no longer produces the insulin hormone, rather I must inject it myself. I really must pay attention to that variation in my baseline activity, as it directly affects my blood glucose levels and therefore also my insulin needs, both during that day and over the following night.

Moves app already helped me get some of that understanding, and the Polar Loop added more details. I’m able to track my heart rate at the gym as well as during football games and practices, and learn the effects different levels of exercise have on my blood sugar levels.

Wearables do facilitate behaviour change

I never expected an app or device to motivate me to exercise more. For me, it has always been more about learning the effects. Still, tracking my daily steps changed my perspective.

Before, my engineer brain optimized my walking routes for efficiency, for the least amount of steps. Once I started tracking my steps and had that magical number 10 000 in my head, I suddenly started to optimize the routes so that I could get to that goal or exceed it. I ended up selecting routes that would actually increase my step count, instead of getting somewhere in the fastest way. I feel that change in perspective is permanent, even if I end up abandoning my wearable device.

Wearables get abandoned for a reason

So, my precious wearable had taught me to better manage my chronic condition and helped me be more active, and I was still about to abandon it after that 6 months mark. Had it failed me in some way? I would say, quite the contrary! My wristband has provided me with a wealth of information, and I’m immensely grateful for that. It’s just that after 6 months I’m not learning that much anymore.

Now, I still wear my Polar Loop almost daily. Partly because it’s a nice visual aid when I explain what our startup Sensotrend does, combining information from medical devices (I point to my glucose meter or insulin pump) with data from activity trackers and other wellness apps (I point to my wrist band). But also because I really want to take the data I gather to the next level, make it more actionable.

For instance, I’m currently implementing an app on my phone that reminds me to set my insulin delivery overnight to a lower level if my daily count has exceeded 15 000 steps, or increase the rate in case I’ve recorded less than 5 000. This kind of personalized and actionable notifications are the direction I’m hoping many wellness apps will evolve in.

Human touch enhances the effect of wearables

Finally, let’s not forget the importance of some human interaction. For instance, my wife followed my tracking with interest for a long time, but only started tracking her own steps after I installed a pedometer app to her phone. Installing an app seems trivial for me, but she never got to do it herself. Now she’s way beyond her 6 months mark, and still tracks her steps daily.

Doing things together certainly also helps with the behavior change. The first time ever I myself recorded 10 000 steps on 7 consecutive days were the days immediately after I had installed the tracker to my wife’s phone.

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This post was originally published in the HealthSPA blog.

Using Accu-Chek Smart Pix on Mac

The official system requirements for Accu-Chek Smart Pix software don't list OSX as supported, but you can use the reader and the software on Mac, quite easily.

The official system requirements indicate only Windows is supported.

This is how I do it:

First, I install the reader to the USB port on your Mac. I get a notification of an error, but I just ignore it.

The light on the device flashes and then starts blinking, indicating the device is already open for reading your meter or pump.

First a flash

Then blinking

I then open the SMART_PIX device and launch the START.HTML file.

And there it is, Smart Pix software on my standard Safari browser.

The software is immediately ready to read a device, so I just put my meter in data transfer mode and set it in front of the receiver.

Once the transfer is complete, I get a notification...

... and can then access the information from my meter.

The same works with the pump. I click Read Device, set the pump to data transfer mode and put it in front of the receiver.

After the transfer is complete, I can see also the pump data in Smart Pix.

As I explained in the previous post, all the data from before the change from daylight saving time to standard time is unaccessible to Smart Pix, so here I only see a short period of data.

I can then examine the data with all the views and graphs Smart Pix has to offer, and also generate the report.

If I want, I can 'print' the report and save it as a PDF file to be sent to my healthcare team to look at.

So, works for me!

On my Windows machine I use a different version of Smart Pix that actually preserves all my data in an internal database, and therefore allows me to view data from an even longer period of time. But apart from that, the software works pretty well for me also on my Mac.

Please feel free to let me know in the comments if your Mac behaves differently.

Update: Please note the response from Accu-Chek. The software has not been certified to work with Mac, so you're using it on your own risk!

@mrinnetmaki TY for the mention pls note the SmartPix is not approved/cleared in the manner you've described in your blog.
— Accu-Chek US (@accuchek_us) October 29, 2014

Device data and Daylight Saving Time

Last year I lost a few months worth of data from my insulin pump, due to poor software.

When I downloaded the data to my computer on November 3rd, I could only see it back to October 27. When examining the raw data, the data available at the cutoff point was:

<BASAL Dt="2013-10-27" Tm="10:24" cbrf="0.75" profile="3" remark="time / date set (time shift back)" />

There was no data going back from that time. The previous time I had downloaded the data from my pump was at the end of August, so I ended up losing two months worth of data.

That data contained all the information of my temporary basal settings, and was really important for me. As I'm figuring out the correct basal dosing related to my exercise, I want to take a look back every now and then to see which rates have worked best during exercise and after it.

I really wanted to save the data from all the football matches from one season, where I had used different settings for different games and practices, to be able to analyze the results and also share it with my healthcare team and other people with diabetes. Now I could not do it anymore.

I explained my problem to the pump support team and they confirmed this is a flaw in their software. The pump actually preserves all the data, but the software used to read it gets confused when there are overlapping entries or gaps in the records. And this happens each time you change the time on the pump, whether due to daylight saving time or traveling to another time zone. They also explained that this is a well known problem and they are working on getting it fixed. As for now, there is no fix available.

So if you're using the Accu-Chek insulin pump and care about your data, make sure to download the data before changing the time on the device!

Our path to Slush 2013

There are just a few days left to register your startup to Slush, in case you're interested in the early bird price. Note the comment!

Post by Slush.

And then there's the registration form.

When we filled the form a year ago, we really didn't have much clue on what to write there. We did the best we could, submitted the form, and waited. And waited.

Then, just two weeks before the event, we got an email announcing that our company was not among the 100 companies selected for the pitching competition. They recommended that we concentrate our efforts on networking during the event.

We were devastated. It felt that mail destroyed everything we had been working for over the past months. We were very disappointed with the application process, that was just a black box. Had we known what kind of info they expect in each of the form fields, we could surely had filled it out better. The world seemed to be a very unfair place for a moment.

But after a day or two, we got a new mail, saying we had been selected to be present on the Health Track and we'll get a demo booth for one day. So instead of pitching for one minute for a random audience, we'd have the chance to present our service to many people interested in healthcare services, without time limits - and we got the stand for free! Things were looking very bright again.

A week before the event we got yet another email. We were offered 5 minutes stage time to launch our service on stage as part of the Health Track program. This was just superb. So much better than the pitching competition would have been for us. Of course, there was only a week left and we had all of that week already scheduled for other preparations. But we just had to take this opportunity as well.

So we quickly created a launch campaign and the presentation. We couldn't get everything done in time, so we were probably one of the only companies with a booth but without a rollup (we used a screen instead). Free tip for you, startups, get your rollup ready in time. You're going to need it.


During the event, there were some last minute changes again and a bit of hassle, but that feeling of creative chaos is just part of what makes Slush so great, I guess. Our booth was busy the whole day and the launch was received with a lot of love and plenty of registered users.

In the end, there was one more nice surprise, when Slush featured us in their blog. We ended up getting so many good things. For us, this still is perhaps the most striking experience of what it means to be an entrepreneur. We lived through the initial disappointment and through every new positive turn so fully and with so much emotion. And it taught us that even in desperate times there are amazing things ahead.

This year, we still don't know exactly what to write on the registration form. But we do know there will be ups and downs on our path to Slush and beyond. And we'll most likely be devastated and depressed at some point again. But this time we'll face all obstacles with a new kind of confidence.