Monday, April 4, 2016

Investing in Cybernetics

By investing in cybernetics, I mean more the purchasing of medical devices to plug into your body, less so the buying stock in companies that make cybernetic components. Though I may want to do that.

This week, after taking care of a work project that had consumed a good share of my free time the last month or two, I finally got around to a number of the items on my to-do list that I'd been ignoring. One of which was plugging in my new Dexcom G5 continuous glucose monitor. Now I have not one, but two Bluetooth enabled devices that plug in underneath my skin. Woo! It's the 21st Century alright. Not long until my eyes glow and I can punch through walls, right?

I've been a type 1 diabetic for a little more than 24 years now. This is cause for a moderate amount of watching my diet, frequently testing my blood sugar via finger pricks, and adjusting insulin dosages five to ten times a day. For the most part it's an inconvenience, admittedly with a constant dread that my long term health will suffer. Frequently though the blood sugars do something unexpected, either spiking high and leaving me feeling like shit for hours, or crashing low and leaving me with less than full mental faculties, sweating profusely and stubbornly refusing aid while my friends have to consider wrestling me to the ground to stuff food into my mouth. Occasionally with the screaming seizures or sprinting off into the woods. Ah, memories!

Thank you all, family, friends, and loved ones who have dealt with me in those situations.

About four or five years ago, after one such attack, I made my first such investment in cybernetics, moving away from the traditional usage of syringes for insulin injections. I got a Medtronic insulin pump, and Enlite continuous glucose monitor. The insulin pump was a wonderful success, and dramatically improved my blood sugar control. The pump has the benefit of having a varying basal rate, that continuously drips a background level of insulin into me, that can be easily calibrated. It talks wirelessly with my blood testing kit, and calculates, based on the time of day and how much I tell it I eat, in order to give me a more proper amount of insulin.  Further, it remembers how much insulin has been injected into me. I had been doing this all in my head between the age of seven and twenty six, but the machine is a bit less prone to forget or overlook those important details.

Medtronic's Enlite CGM sensor system unfortunately left something to be desired. This was four years ago, and I'm sure Medtronic's tech has improved a good bit in the meantime, but the sensor then was so poor that I stopped using it after a few months.

For those of you not the most familiar with diabetes, a continuous glucose monitor is a system designed to, well, continuously monitor your blood glucose level. The ones on the market, both then, and now, do so with subcutaneous sensor that you implant in yourself for some number of days, and has a wireless/Bluetooth communication system, to beep out your blood sugar every minute or five.

As I was saying, the previous one I had left many things to be desired. Only lasted three days, had to be attached to the body with tape, easily fell off, and was inaccurate to the point of not being worth the trouble. I tossed it.

Over the years, the technology seems to have improved. Fellow diabetics recommended the newer Dexcom brand systems to me, and I finally took them up on their suggestion. The differences, though minor when describing them, add up to something that is exponentially better. The Dexcom G5 attaches without requiring additional tape wrapped over the top, and is a good share smaller and more comfortable. Most importantly, it has proved far more accurate, and to have less of a lag.

I have yet to see this Dexcom G5 be off by more than twenty percentage points or so, its alert system is timely, and in the week I've had it has kept my blood sugar in a much tighter range than I would normally be under. Don't think I've had a blood sugar above 190, and haven't had anything low without being awake and able to respond to it quickly.

The also checking while asleep is a significant benefit, one that of course existed in the previous CGM system I had, but with the added benefit of greater accuracy, and not waking me up without cause.

Managing blood sugars is a lot of dealing with lag. Insulin gets injected into your subcutaneous fat, and even with the quicker acting insulins, Humalog for me, it only starts to really have an effect half an hour after injection, peak effect perhaps hour and a half later, continuing effect out three or four hours. Eating food also has a similar lag time for raising your blood sugars. Non-diabetic bodies are a lot better with dealing with this, because pancreases are plugged in more directly to the arteries and veins, and can sense and respond to blood sugars much more quickly. Us diabetics though, with our putting insulin into subcutaneous fat, and with the continuous glucose monitors sensing the blood sugars in that tissue, we are on a delay.

Hence, once of the the great benefits of a continuous glucose monitor that happens to be accurate is that it can give you not just your close to current blood sugar, but the rate and direction of change. The derivative of your blood sugar, to think about high school calculus. Us diabetics are going to have the lag time in adjusting to our blood sugars, but being able to see the direction of change gives the ability to predict where it'll be in the next hour and to get ahead of it.

My other compliments to Dexcom are the very excellent UI, ease of viewing the data, and general ease of use.

Of course it's not perfect yet. Won't be perfect until we finally get around to curing diabetes, which has been promised to me as "five years away" since I was diagnosed in 1992. For more direct criticisms, I am irritated that there is software to access the data from the sensor for iOS devices but not Android. As an Android dev who often sees Android apps not started until a year or two after the iOS versions, I understand, but damn. Related, it's made by a different company than Medtronic, so it doesn't talk directly to my insulin pump, and I'm manually feeding data between the two. Sure be nice to have an open API for the two to plug into. Bloody corporate competition, and/or overzealous FDA regulation. Additionally, it's another thing sticking out of my skin, and I certainly can't do jujitsu with it. Then again, have to peel of the insulin pump insertion sight anyways to be able to do that, but now with two such peripherals stuck into my body, makes that sport less than practical. Some day, they'll either cure it, or it'll be subdermal. Then I'll get the Deus Ex future I've been hoping for since 2000.

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