Mechanical Exhaustion

cables-3-1243182-639x852“Where’s the damn cable that works with this? ARGH.”

John hands me one after another as I clumsily attempt to connect the correct USB charger to my Dexcom receiver. We’ve got lightning cables, USB micro cables, USB 3.0 and 2.0 cables strewn all over our house. We’re a wired family. We even have a cable “coffin” where older, no longer needed cables reside (but we won’t throw them away, because you.never.know.).

My diabetes exhausts me sometimes and not just physically or mentally. With the technology available these days to us, I have now added mechanical to my list.

The mechanical tools I use to manage my diabetes include: iPhone, iWatch, insulin pump, continuous glucose monitor and glucose monitors. I’m like an electrical junkie that’s always looking for a fix. (My friend, Briley, once snapped an image of me after I got out of my car. I was charging my Dexcom through the car adapter and forgot to disconnect, shutting the door on the cable.)

Much like our community’s desire to have a universal uploader and standard operability for our devices, I wish that the world would just settle on one charging method. My phone connecter won’t charge my watch and the watch connector won’t charge my Dexcom and my Dexcom charger won’t charge one of my glucose monitors…

I am on a constant quest for power to charge/recharge these devices and when a get a notification that one of these devices are low on juice, it triggers a tiny anxiety that grows until I get connected to a power source again. These tools help me to manage my diabetes but along with alarm fatigue (when you hear the beeps and buzzes so often that you begin to ignore them, to your own detriment), I’ve come to realize that these  devices are also creating a type of exhaustion that I can’t seem to quit. It’s mechanical.

Of course, you’re telling me that I could just stop using the devices. Sure. That’s an option. And I also know that the next generation of devices may have better battery reserve capacity and my quest for power may not send me into a tizzy. I made the choice to use these devices, but sometimes the side effects include exhaustion. They don’t list “mechanical exhaustion” on the warning label.

But I know that I’m not alone. It’s much like the feeling you get when the alarm on your pump tells you that there’s a finite amount of insulin left in it. You’ve got to add that to the list of other things in your life.

What would you do to help keep the mechanical exhaustion at bay? I’d love to know. In the meantime, I’ll be carrying around four different cables, looking for a place to plug in to stay healthy and on top of my diabetes.

Please excuse the insensitivity of this rant, as it’s full of first world complaints. I recognize that for many individuals, access to these devices are impossible, improbable, or downright unaffordable. As a family, we’ve made decisions to pay for these tools, eschewing other “luxuries.” These tools are my family’s luxury, as John feels that having me healthy is a necessity. 

 

Two Minute Diabetes Advocacy: CGM Medicare is Back and FDA Goodness

708615_95129272It takes two minutes to make a difference for people with diabetes. Here’s the latest on how you can help.

CGM Medicare Bill: It’s Back!

Want the back story? It’s here.

Right now, Medicare does not cover CGM devices, leaving seniors with diabetes without access to this technology. Among the most important goals of our advocacy and education efforts is to ensure that those entering the Medicare program at age 65 do not experience disruption in their diabetes management. (None of us with diabetes is getting younger. If you are, please let me know your secret!) I don’t want a single person to be denied coverage of this device simply because of their age (or any other reason for that matter, but first things first, right?) and we have an opportunity to make a difference for our entire community.

Remember that this bill will also help when artificial pancreas technology comes to fruition. We need everyone to get involved.

The Medicare CGM Access Act has to be reintroduced in both the House and Senate in order to move forward. (New Congress = sort of starting from scratch, but this is a good thing, in my opinion…)

Representatives Tom Reed (R-NY) and Diana DeGette (D-CO) just re-introduced the bill in the House. Senators Susan Collins (R-ME) and Jeanne Shaheen (D-NH) are expected to drop the parallel legislation in the Senate very soon.

57 members of Congress co-signed the bill last year. This is a great start, but we need your support and the support of your communities to drive more co-signatures.

Here’s what you can do RIGHT NOW:

Contact your representative (for the first time – or again!) about supporting and co-sponsoring this bill. 

Yes, you may have done this last year, but you may also have a new representative in your district or your representative may not have heard you the first time. Every. Voice. Matters.

FDA Goodness:

Clinical Considerations of Risk in the Postmarket Environment

If you care about the medical devices that we use each day to manage our diabetes (think insulin pumps, CGMs, blood glucose meters) and the risks that we take (and how to mitigate those risks), then sign up to be a part of this workshop. This will be webcast, so you can participate from the comfort of your home or office, but sign up ASAP. Registration will close on April 13th. Those in the DC area should know that you can attend this in person on the FDA Campus. Here are the details:

The FDA has announced a public workshop entitled “Clinical Considerations of Risk in the Postmarket Environment.”  The purpose of the workshop is to provide a forum for an interactive discussion on assessing changes in medical device risk as quality and safety situations arise in the postmarket setting when a patient, operator, or member of the public actually uses the device.  For details and registration, please see: http://www.fda.gov/MedicalDevices/NewsEvents/WorkshopsConferences/ucm436365.htm

Date, Time and Location:

This meeting will be held April 21, 2015, beginning at 8:30 a.m. at the following location:

FDA White Oak Campus
10903 New Hampshire Avenue
Bldg. 31, Room 1503 (the Great Room)
Silver Spring, MD, 20993

Get some knowledge and take the world by storm. We can do this together!

Two Minute Diabetes Advocacy: MDDS

Tick-tock, y’all. 708615_95129272

This is a last minute push to get comments on the FDA docket currently out for medical devices. You have until 11:59pm ET Monday, August 25th to get this done.

Two minutes. That’s all it takes.

What is MDDS?

Medical Device Data Systems.

These are systems that, in the FDA’s words, facilitate

“the electronic transfer or exchange of medical device data from a medical device, without altering the function or parameters of any connected devices.”

 

Think about your Dexcom information on an iPhone or a tablet or a computer or a smart watch. Think about seeing boluses in real time. Think about being able to view medical data NOT on the device itself. For parents of kids with diabetes… kid is at school and mom or dad can see BGs in real time.

FDA thinks that this type of technology doesn’t introduce much additional risk, so they want to lessen the regulatory process (i.e. red tape) for these devices.

We totally agree. 

However, FDA isn’t clear on the topic of “active patient monitoring”, so our goal is to encourage the FDA to

  • Specifically address the importance of giving patients access to their own health data on multiple devices/screens (the more access the better), and…
  • Clarify whether CGM-related technologies will be included in the MDDS relaxed regulatory process. (We believe they should be.)

If you want to read up on this, you can get it from the source (FDA) and you can get additional information over at Strip Safely.

This is what you can do RIGHT NOW:

1. Copy the information below. 

I am encouraged by the FDA’s draft guidance on MDDS. I support the FDA’s position that technologies that transport data, without changing values, are low risk. I believe that access to medical data should be available on multiple platforms that are accessible to both medical professionals and patients. Access to this type of data is becoming increasingly essential in healthcare, with the potential to reduce costs and improve outcomes – in fact, not having timely access to needed data poses a far greater risk. I strongly support access to this type of data and am pleased to see FDA recognizing its importance.

People living with diabetes depend on data in order to minimize the chance of life-threatening complications that can arise with very little warning.

Suggestions:

The draft guidance seems to be focused on data provided by MDDS to healthcare professionals. It should be modified to also explicitly state the value of access by patients, particularly for chronic conditions like diabetes where patients need access to their own data to manage their own care as safely as possible.

Real Time:

The draft in section V-B seems to precludes active patient monitoring. Specifically how or if this impacts diabetes is unclear. A clear definition of active monitoring should be included in the guidance. I strongly suggest that real-time access by patients to their own data *not* be defined as active patient monitoring. I strongly support including in this guidance more open access to information from continuous blood glucose monitoring for patients with diabetes. The appropriate risk of device performance is regulated through the device PMA, and shifting CGM data to secondary screens does not in any way increase risk. From a patient perspective, secondary screens significantly decrease risk by making information more readily accessible to the patient. This is particularly relevant for those of us who may be unaware of early stages of hypoglycemia.

ER and Hospitalizations:

Geller et al estimate in JAMA (JAMA Intern Med. 2014;174(5):678-686. doi:10.1001/jamainternmed.2014.136.) that almost one hundred thousand Americans a year are treated in the Emergency Room for insulin related hypoglycemia and that about one third of those are admitted. Timely access to real time sensing data may help prevent many of these ER visits. This suggest real opportunity to mitigate risk through secondary device display of CGM information.

Multiple Data Sources:

Existing regulations state that ‘Accessories to classified devices take on the same classification as the “parent” device. An accessory such as software that accepts input from multiple devices usually takes on the classification of the “parent” device with the highest risk, i.e., class.’ (http://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/HowtoMarketYourDevice/PremarketSubmissions/PremarketNotification510k/ucm142651.htm ) People managing diabetes often use multiple devices to provide the data needed to follow care instructions. Bringing that data into a single application would improve patient understanding. For example finger stick measured blood sugar, CGM trends, amount of insulin infused, and the time of each are all information that patients juggle. A dashboard displaying all relevant diabetes data would improve safety and reduce risk, compared to forcing the patient to consult multiple devices and displays.

FDA’s Dr. Courtney Lias offered promising comments on diabetes and mobile devices at the Keystone 2014, “Practical Ways to Achieve Targets in Diabetes Care” sessions. Closer Look reports that Dr Lias, in comments on artificial pancreas, spoke of a strong FDA interest in consolidating devices through mobile technology to facilitate better diabetes care. She reportedly spoke of “component artificial pancreas system,” where patients could choose component devices of a system. I fully support the vision Dr Lias shared. This proposed MDDS guidance can encourage logical, safe and incremental steps towards that future by opening multiple diabetes devices to display on a mobile devices.

Conclusion:

Diabetes patients implement the individualized care programs created by our doctors based on real-time data from multiple FDA-approved medical devices. Easing the accessibility of data from those devices improves our ability to follow our care team’s instructions. I support the FDA’s adoption of MDDS guidance that incorporates a nuanced appreciation of the low risk and incredible value in using MDDS to transmit and display diabetes data.

2. Click here and paste the copied comment into the comment box. Wanna get fancy? You can add why this is important to you. There’s a 5,000 character limit, so you’ll need to delete some of the copied comment, but they’ll get your gist.

3. Then do this. 

  • Fill out your information. You’re commenting as an individual so UNCHECK the box that says:
  • “I am submitting on behalf of a third party”
  • Click the Category, “Individual Consumer”
  • Click continue.
  • Review, check the confirmation box
  • Submit your comments. You even get a receipt to confirm your comments were posted.

4. Do a little dance and high five yourself. You just raised your voice for diabetes advocacy. You rock.