NovoPen Echo launches in the UK

Great news for forgetful diabetics in the UK...

Long-term readers (bless you, how ever have you managed it?) may recall that a couple of years ago I actually changed insulins (from NovoRapid to Humalog) because I was so fed up of my not being able to remember whether or not I had actually taken my mealtime insulin and/or which of the possible dose configurations I had finally settled on. At the time the only injection pen available in the UK which recorded doses was the Humapen Memoir. Had I lived in a different part of the world, there would have been no need to change insulins. The NovoPen Echo, which records doses and provides half units was already available at that time in the US. But not here. Cue general grumblings, outrage and sighing-and-rolling-of-eyes from a handful of discontented UK diabetics. Some even going so far as to launch that most effective of lobbying methods, a Facebook campaign-and-moan page.

Not without a whiff of irony, when I changed to a pump my DSN was a little wary of Humalog's reputation for crystallising in tubing so changed me back onto NovoRapid. It did strike me as very odd though that NovoNordisk would happily wave goodbye to any user of their insulin who wanted a pen with a memory in the UK, even though they had such a device available.

In the meantime Timesulin (a replacement cap which lets you know how long it was since your pen was last used) has launched and gone on sale in the UK. This tackles the main nagging worry of 'Erm... does anyone know if I jabbed before lunch?' and is compatible with a whole bunch of pens. Sadly though it can't track doses.

Well the wheels have turned. The Memoir pen has been taken out of circulation while Eli Lilly try to fix some battery problems and make other improvements. But it seems NovoNordisk have either a) come to their senses or b) jumped through whatever compliance hoops they needed to, because according to Kasper Kofod (Social Media Project Manager at Novo Nordisk A/S) the NovoPen Echo launched in the UK a week or two ago and is available from your local friendly DSN.

Hurrah!

Update/clarification: Initially the Echo was said to be available only for children. However I now understand that the NovoPen Echo is available to patients of any age. The NovoPen 5 (currently not available in the UK) which has the dose memory, a larger max dose but lacks the half unit may be released in the UK at some point in the future.

The placebo effect and insulin pumps

This may be complete nonsense, but...

In the unlikely event that you have read these ramblings before, you might remember that I noticed a slightly strange quirk about a week after starting on an insulin pump. The levels which worked perfectly for the first few days went completely out of the window and I had to start again. I would probably have ignored this had it not been that two other people who had started insulin pumps at roughly the same time with whom I was comparing notes had very similar experiences.

Nothing very earth shattering about it, but just a sense of, "Tch! Fancy that!". I was reminded of the experience though when we finally managed to catch up with an episode of the 'i' series of QI (almost certainly a repeat) which we had squirreled away on the TV recorder. One of the guests was debunker of Bad Science Ben Goldacre. He and national treasure Stephen Fry touched on the subject of placebos. The question being, "How do they work?". The answer, unsurprisingly, was that nobody knows (you'll have to do the booming voiceover in your own head).

What was quite interesting though (see what I did there), was that placebos do work. And they work even when people know they are placebos! Not only that, but in clinical trials (if you can clinically trial something with no therapeutic effect) it has been proven that two sugar pills are more effective than one sugar pill. And that an injection of saline is more effective than sugar pills. It seems that a sort of sliding scale of increasing medicallyness (technical term) operates.

The mind is truly an amazing thing... It's ability to effect physiological outcomes in the body astounds me.

And it makes me think about this in relation to diabetic control. How much one's state of mind might support (or scupper) a person's best efforts. I note for example that my levels were unusually good in the week I had using a pump with saline. Presumably connection to the pump was enough in itself to get my body to exercise a little self-control. Then during the first week I was able to achieve very good levels with a fraction of the insulin I seemed to need around 10 days after. I'm not sure why it didn't last. Perhaps I'd just got used to the tech and it became more normal and lost its medicallyness.

Now all I need to work out is how to convince my mind to provide long-term perfect BG levels using the placebo of bars of chocolate.

Playing golf on a blustery day

I was reminded this morning of something which struck me during a conversation with my parents last year. Some time ago they took up golf, and as with many sporting endeavours they have embarked on before they plunged into it headlong, devoting a huge amount of time and effort into improving their game. Taking lessons, trying new kit and clubs in the hope of finding some new 'magic ingredient'. And they got better. Much, much better - but never seem quite satisfied with how things are. Always want to improve a little more.

In this respect it resembles diabetes almost exactly.

Now I don't play golf, but from what I can see it appears to have been deliberately designed to be almost unimaginably frustrating on almost every level. For starters the equipment involved and physical practicalities of hitting a tiny ball long distances by whacking it with an unevenly-shaped weight on the end of a long stick almost guarantee that no two attempted shots are likely to yield the same results.

In this respect it resembles diabetes almost exactly.

And even if you could somehow miraculously steel your sinews to perform each swing with robot-like precision it would still not be enough. The nature of the playing field itself, with gusty inconsistencies of wind and constantly variable grassiness/sogginess/bounciness/sandiness of the ground (apologies for the use of highly technical golfer's terms there) could still turn yesterday's perfect delivery into today's disappearance into the lake.

In this respect it resembles diabetes almost exactly.

And then of course, there are those brave souls who venture far afield. Just sticking to the same course day-in, day-out is OK for a while, but soon there is a temptation to reach for a little variety. So rather than restricting themselves to a familiar course where their previous experience might at least count for something, they voluntarily put themselves in unfamiliar surroundings. Each shot becomes a wild stab in the dark based on little more than gut instinct and a laughable attempt calculate (hah!) the interaction of a myriad of contradictory variables.

In this respect it resembles diabetes almost exactly.

On Friday I woke to a BG of 7.3 (131). I ate two slices of toast and because I was going to the gym I reduced my bolus by 80% and set a TBR (temporary basal rate). At the gym I did my usual routine for the usual length of time. I had a measured small amount of fact acting carbs before and after. I tested when I got back and was 10.0 (180).

This morning I woke to 7.6 (136). I ate exactly the same breakfast. Exactly the same bolus and basal tweaks were made. I did the same set of exercises over the same length of time. Ate the same number of fruit pastilles. Got back to 6.4 (115).

Now I'm fairly happy with either to be honest, but the difference in the two days amounts to almost the entire 'range' that people living with diabetes are supposed to aim at. And I didn't change anything.

With Artoo I have a cracking set of clubs, it's just that I'm trying to play golf on a blustery day.

Rediscovering porridge

Someone I 'met' on a forum who started on an insulin pump a year or so before me said that in some ways she had to relearn much of what she thought she knew about her diabetes. Many tried and tested observations, and theories as to what was happening seemed no longer to apply. Switching to a pump so fundamentally 'changed the rules' that almost everything had to be evaluated from scratch.

I've had a glimpse of what she meant recently when I decided to retry porridge (oatmeal for US readers) as a breakfast choice.

I've always quite liked it in the winter and it has a reputation for being helpful cholesterol-wise. Mostly though it has a reputation for releasing its carbohydrate slowly and steadily which is very useful if you are trying to keep BG (blood glucose) levels after meals under control. For many years I ate cereals for breakfast, basing my choices on what I had been told - this is low GI, that is slow absorption, blah blah blah...

For many, many diabetic years I tested primarily before meals with ad-hoc other tests if I 'felt funny' or needed to drive. This was OK in its way, but never really let me see or evaluate what was happening after eating different foods. I didn't look at those choices critically enough for them to make any real sense. It was only really after 'meeting' folks with Type 2 Diabetes online who have food choices as their primary weapon in the struggle to control BGs that I realised how little I knew from testing about what to expect from different foods.

GI values are all very well, but they are only an average from a pretty meagre sample. And averages (as anyone with a BG meter can tell you) can hide a multitude of sins.

Having embarked on some after-breakfast testing a few years ago I quickly determined that all cereal is evil. There was just none that I found I could eat and remain in single figures (below 10.0mmol/L 180mg/dl) at 1-2 hours after eating. Porridge seemed a particularly bad example. I may as well have been eating jam.

So I concluded that for me porridge was not slow release at all, and stuck to Burgen soya and linseed toast with much better results.

I knew that at least part of the problem was a 'gap' in basal coverage that made breakfast particularly tricky time for me. I took my Lantus at breakfast time and while the last dose had faded and the next dose was still dragging its heels in 'onset' I had perhaps an hour with less basal insulin than I needed.

The pump of course, has fixed this. Continuous almost infinitely tweakable rolling patterns of basal insulin trickles can allow for the most challenging of basal requirements.

Once I had a basic basal pattern working OK I began to wonder whether I might be able to cope with a little porridge every now and then. The first few results are very encouraging. This morning I rose from 4.7 (85) before breakfast to 6.9 (124) an hour and a half later.

Porridge it seems is back on the menu. Score 1 for teampump.

Guest post: BG monitors for blind/visually impaired people

A few days ago we had a comment on our D-Tracker review from someone called 'Faulty Headlights' who was wrestling not only with diabetes but also with blindness. I can't imagine how hard that would be. As the conversation continued I became increasingly interested in the challenges faced by blind and partially-sighted people, especially in relation to available blood glucose monitors and their usefulness (or otherwise). Julie (Faulty Headlights) kindly agreed to write a guest post sharing her experience of the currently available options. If you have any experiences to share please add a comment below.

Three Blind M.... Monitors???

Living with diabetes can be challenging enough for some people, dealing with injections, blood monitoring, carb counting and so on.

I've lived with diabetes for 21 years now but 5 years ago I lost my sight do to bad control. If I thought it was difficult controlling it then, I was pretty darned puzzled as how I was going to manage not being able to see. I know I have help if I need it but I have always tried to be as independent as possible and didn't want my independence taken away from me just because I had lost my sight.

So not long after I learnt to use a computer I started looking into accessible products for diabetics with visual impairments. Mainly blood meters.

The first monitor I came across was the SensoCard plus (now discontinued), I liked this machine very much. Nice large display with one large tactile button on front and two smaller buttons on side for navigating menus, also. Clear speaking voice for reading results, a slot for easily coding machine and USB port for connecting to PC. Why oh why did they discontinue this one!

I asked around about another and was pointed towards the RNIB who specialise in audio products for the blind and visually impaired. They told me about the Clever Chek machine and there not seeming to be any other option I went for it.

Big mistake! It was awful! I’m sure there are other people using this machine who like it ok but they're probably all over 60 and still using phones like bricks too. Oops sorry, did I just write that?

The Clever Chek machine is bulky and has five buttons on the front, it has a large display and volume control which I guess would be good for people with hearing problems as well as sight. It has many features the same as the SensoCard plus but much much more difficult to use and there is way too much spoken information on start up which just isn’t necessary .If put in a pocket or bag it switches itself on with a merry little tune and tells you and everyone else in the vacinity thank you for using this product followed by date and time. Who ever designed this machine did not have the blind in mind. The strips seem to need more blood and I’ve been given so so many false readings in the past. I’ve compared them against my dad and sisters machines and readings were well off, maybe this is just my machine? I might have got a faulty one but I'll not be asking for another. One good thing about this machine is that it is codeless and... and... um? Nope, I'm struggling to think of anything else!

I was pointed towards the RNIB yet again and now they have a new audible blood monitor. It's called the SuperCheck2. It looks a bit like an mp3 player and has only two buttons. GREAT! It too has volume control, USB port for connecting to PC where you can store results and print for your doctor, large display, memory for up to 500 results and gives you averages over a week month and so on. It has a nice clear voice which reads pretty much everything a sighted person can see on their machine and is also codeless. Brill! On each of the three machines there is a 'dipped' area so you can feel where to insert the strip. The strips have one rounded edge and one flat edge so it's easy to know what end is inserted into the the machine.

What I like about this machine is that you can set alarms to remind you when to test your blood sugar and it doesn't look like a brick.

Technology has come on so so much over the years and it is good to see companies thinking about accessibility. One company I am pleased with is Apple who have made many of their products accessible to blind and visually impaired people with their voiceover.

I was recently told of new blood monitors called the BGStar and the IBGStar which connects straight into an ipod where your results can be displayed and stored. I don’t have a lot of information on these yet but am excited to see how it works and if it will be made accessible with the voiceover on iPod touch and iPhone. Technology really has come a long way, can you remember the old machines from many moons ago? Again, BRICKS!

I have now downloaded and tested 4 different iPod apps designed for diabetics to store their blood readings, exercise plans and carbs and so on. I was disappointed to find out that none of them were completely screen reader or voiceover friendly. Some of the icons were read aloud but others like time and date were not. I think apps like these are a great idea for both sighted and visually impaired diabetics, I mean, how many times have you shown up to your diabetic clinic with out your record book? Many of these apps also allow you to sync it to your computer or to email your results straight to your doctor. Nice one!

Julie.

UPDATE: See also the Caresens 'Voice' Blood Glucose Monitor for Blind/Visually Impaired people that I saw at the INPUT event in Truro