The Sugar Finger

Sticky fingers. Finger lickin’ good. Finger food. Wrapped around your finger. Can’t put your finger on it. Fingers crossed. Finger on the pulse. Butter fingers. Point the finger. Finger on the button. Slip through your fingers.

We have a lot of finger phrases. I have a new another one to add to the list:

Sugar finger: the finger that when checking your blood sugar with a finger stick, results in a consistently and significantly higher blood sugar reading than the other fingers.

I saw one definition online calling the middle finger the sugar finger, which is also fitting because I definitely wanted to give my meter the middle finger. Twice now, I’ve checked my blood sugar on one finger and was shocked by the high number. Something in my gut told me this wasn’t right (and of course this happens when my sensor is updating, or warming up, or already at the top of the graph so it couldn’t be counted on). So I washed my hands and checked another finger on the other hand. Sure enough it was at least a 100 points lower. So I check a third one just to be sure that the lower reading is accurate. Yup, it’s confirmed. I’ve had fingers be off before, but never so drastically, and two different days. I’m just glad that I didn’t correct based on the higher, inaccurate reading.

Right hand, index finger. The sugar finger.

Taking that finger out of rotation for a little while.

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Meet the Dario Smart Meter

About a month ago, the company Dario contacted me and asked if I would be willing to test their new diabetes management system and meter. Always interested in trying the latest and greatest, I happily agreed. Dario supplied me with the meter and a limited supply of test strips and I downloaded the app on my phone. So here is my honest review of the meter from my experiences over the past couples weeks.

The Packaging

imageLet’s just say, the meter makes a damn good first impression. I’m someone who appreciates the artistry of a well packaged device. I love opening Apple products for that very reason. All my past meters have just come in a normal box, nothing special. The Dario meter was not like that at all. Every piece had a place, the packaging was slick and sophisticated. It was a pleasure to unpack this medical device, and that says something.

The instructions and reading material was conveniently hidden within the box while the lancets were cleverly stored in a neat compartment next to the meter.

The All-in-One Device

There are 2 things that make this meters and management system so unique. The first is that it turns your smartphone into the meter (more to come on that later). And the second, is that the lancet and test strip holder are combined into one, well designed and easy to use device.

Holding the device, it doesn’t look anything like past glucose meters I’ve used before. Without knowing what it is, I never would have guessed what it was used for, which is great if you like to keep things discreet.

The Lancet

The needle is housed on one end of the device. To access it, you just snap off the top orange piece. You can set the depth of the needle, and then you follow the arrow and pull down on the black piece to load the needle before pressing the orange button to release it. Super simple.

Test Strips

They’re stored on the other end! How awesome is that?! No need to carry around multiple pieces. The cartridge of 25 test strips just snaps into place. You just remove the white piece at the end. The box of test strips came with two 25 test strip cartridges.

The Meter Attachment

The Dario system turns your smart phone into your meter by plugging in a small attachment into the headphone jack. The attachment is also stored in the all-in-one device.

The Meter

The packaging on the box clearly explains how to download and set up the app on your phone, walking you through the set-up. To test your blood sugar, you plug in the attachment and open the app. If the attachment is in correctly, it will prompt you to insert a new strip and then place a drop of blood on the test strip. The meter counts down by filling in a circle before displaying the glucose number. It uses a color coding system to visually show if it’s within range, borderline, or high. It then immediately takes you to a screen that allows you to indicate if its pre-meal, post-meal or a bedtime reading and then insert additional information related to carbs, insulin, physical activity, and even tags.

The App- Tracking and Analytics

Overall, I’m impressed with this app and how intuitive and easy to use it is. I think it does a really good job of logging important information and then displaying it in a meaningful way to the user. You are able to set up a personal profile which includes your blood glucose thresholds, hyper/hypo warnings, and then the type of basal/bolus medication you use.You can sync fitness apps, track food, and set reminders in the app.

Logbook and charts

imageThe app automatically stores every reading in the logbook and you can decide if you want to view it more as a list, a timeline or a chart. The chart will graph up to the last 14 days. You can also easily share your logbook either as a PDF or CSV with your phone contacts or by entering an email address.

The statistics tab gives you a great summary for the day, or the last 7, 30 or 90 days. It will tell you how many readings you had, the lowest and highest and then breaks it down by how many were in range, below or above range and then how many hypos/hypers you had based on your settings. If you click the summary box, it will show you all the readings that fell into that category. It also shows on the website that the app estimates your A1c.

 

Things I like and Areas for Improvement

What I love:

  • I love how everything fits together into one device. Instead of carrying around my pouch with all the separate pieces (meter, test strips, lancing device, etc), all I really need is the one device and my phone
  • It’s great at logging everything and makes it super convenient to share
  • I don’t have to worry about charging my meter, as long as my phone has battery, the meter will work

Some drawbacks/areas for improvement:

  • It’s a slightly slower process. Maybe I’m just used to my old meter, but I find that the whole process takes a little longer to test. Since it’s an app on my phone, I need to unlock my phone, open the app (sometimes it takes a second to load), insert the attachment and then test. Don’t get me wrong, it’s still a relatively fast process, but I found that when I was in a hurry, I resorted back to my old meter
  • It doesn’t sync with any other diabetes devices. This might be the biggest drawback. My other meter at least would send the reading to my pump. This meter doesn’t. So if I’m correcting or bolusing, I have to manually enter my bg number in my pump.
  • My summary feels misleading. I have a CGM that I use in addition to my meter.  Most often it’s when my CGM says that I’m high that I test to get a more accurate number to correct and give insulin. For that reason, high blood sugars are over-represented in my logbook on the app and isn’t really capturing the whole story. If the app was able to integrate with my CGM, it would give a much more accurate picture of my blood sugar history.
  • Greater integration. This is not only with diabetes devices, but also other apps. It’s great that you can link a fitness app like runkeeper, hopefully the list of apps or wearable devices that it links with will continue to grow and include some food tacking apps as well, like MyFitnessPal. It would be great if the app could be used as a one stop shop for diabetes health more generally, including fitness and healthy eating. Also, it would make entering data related to fitness easier. Currently it asks you to enter physical activity as calories burned whereas entering the amount of time would be easier.

 

2015 Diabetes Blog Week Day 4- Changes

Diabetes Blog Week

When I think about diabetes and what I’d like to see changed, one word comes to mind. Well maybe 2, a cure would be a nice change. But the word I’d like to focus on is integration.

Integration. I could yell it from the rooftops. Integration would make diabetes so much easier to manage. It would make communication so much more effective. It would make our lives in general a little less burdensome. 


What exactly am I talking about?

I want diabetes devices talking to other diabetes devices. I want my pump, my meter, and my CGM to all communicate constantly. And while I know this is unrealistic, I wish that this communication could happen across companies so that my dexcom CGM could talk to my Medtronic pump or a Bayer meter could talk to an animas pump. I want numbers and data flowing freely from one to the other, whether it’s then used in a calculation, helping to inform a decision, or just being stored for later retrieval.

I want diabetes devices talking to non diabetes devices. I want my CGM numbers and my pump talking with my phone, presenting my data (carbs, boluses, blood sugars) in an easy to read and accessible manner in an app. I want their data showing up on a graph on my computer or tablet. I want other apps that I’m using to integrate in a platform with my diabetes data, whether it’s food tracking that I do or exercise tracking. How great would it be for one app that would have my carb and bolus information from my pump, graphed against my blood sugars that are collecting from my meter and CGM, informed by my Fitbit tracker active minutes and steps, and integrated with the food that I tracked during the day in My Fitness Pal?! Think about how much easier it would be to see a trends and potential causes for highs and lows. Based on the food you ate here, it looks like you gave too much insulin and that’s why you dropped low here.

I want ALL of these devices talking to my doctor. I want to be able to walk into my endocrinologist’s office or even my primary care physician, or eye doctor, or really any doctor’s office and have all of this information available to them. I want the information from all of my devices to be consolidated into a format that is integrated right into my medical record. Then when I go to the endo, they aren’t making suggestions based off of just my CGM, they are looking at the complete picture with little burden to me since all of this uploading, syncing, and integration happens automatically. 


I’m hopeful that these changes are coming soon, that this is the future of diabetes self-care. Integration will be a requirement, not just a nice feature. 


This post is part of the 2015 Diabetes Blog Week. Today’s topic: 
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? You can read more posts on this topic here

Mission: Secure Lost Meters

I sat in the car with that satiated, content feeling you get after a particularly satisfying meal. However, I was feeling extra thirsty, which was odd since the beer and multiple glasses of water should have been sufficient to quench my thirst. Tuning into my body, I realized it was the symptoms of a high blood sugar that I was experiencing.

I started digging around in my purse, looking for my CGM. I felt around in the endless abyss that is my work bag, but nothing was feeling familiar. My searching became more frantic. “Where is it?!” I thought. “It should be here!” Okay, well if I couldn’t find my CGM, I would at least test my finger so I could tell how high I was.

My hand went back into my bag, but again came up empty. Gigi AND my glucose monitor, both gone?! How could this be?? I started to panic slightly. I felt lost. Rarely am I without both my meters, no way to tell exactly how high I am and how much insulin to give. I could guess, but if I was way off, the consequences could be serious.

“I don’t know where my meters are, either of them. They should be here! I need them. What if I lost them?” Eyes wide, I dumped everything out of my purse, searching the surrounding area. But the search was futile.

“Relax,” said the voice of reason sitting next to me. “I’m sure they’re not lost. They probably fell out in your car.”

Yes. Yes, that would make sense. They’re probably in my car. But I don’t remember taking them out of my bag. But maybe they fell out without me noticing. I’m sure they’re there. Where else could they be?

“Yeah, you’re probably right.”

The 10 minute drive back to my car seemed to drag on forever. I tried to enjoy the music and the company, but my mind was focusing on only one thought: finding my meters.

We arrived back at my car. I wanted to run and fling the door open, but I kept my composure. Of course they’d be there, what was the rush?

I opened the passenger door and picked up the coat on the seat. They weren’t there, either of them. I looked on the floor, in the back seat, between the seats, nothing. Defeated, my mind pictured Gigi abandoned on the side of the road. Who would find her? How would she be returned to me? Was she gone forever??

“I’m going to go check my office. Maybe I left them there.”

It wouldn’t have been the first time that I would have left Gigi under a pile of papers, out of sight and out of mind. We loaded into my car and drove across town on a mission to return my meters home safely. We pulled up to my darkened office, it was 10:30 at night and the only light was from the cleaning people finishing up for the evening. I walked inside, making my way through the darkness to my office. I lifted the papers scattered across my desk. Gigi! My beautiful CGM! I was so relieved. But where was my other glucose meter? I looked in the drawers, on the floor, and all around. It wasn’t anywhere.

I returned to the car, perplexed. It’s happened before that I’ve forgotten my glucose meter at home on my nightstand, where it sits over night. And it’s happened before when I’ve left my CGM at the office. But both in the same day?? I suppose it was possible, I needed to believe it was.

At this point I was feeling mad. I was mad at myself for being so forgetful. I was mad that my diabetes was being so disruptive, and in this case, I was to blame. Rather than being able to relax and enjoy my evening, I instead spent it in an anxious, sour mood driving across town. I was feeling bad for the guy I was with who insisted on accompanying me and for inconveniencing him as well.

“I’m sorry, I know this isn’t how we imagined spending the rest of the evening. Thank you for coming with me.”

“You don’t need to apologize. We got to go on an adventure together. I know you’ll find the other meter too.”

I drove home, ran up the stairs, and went straight to my bedroom. Sitting on my nightstand where I left it was my other meter. Relieved, I alerted my mission comrade that it had been secured and that all was well (except for my blood sugar).

Looking back, I’m still upset that I managed to leave both meters separately in different places, but that’s not what I’m going to choose to focus on. Instead, it was the attitude of the person that I was with that has stuck with me.

There are lots of times when my diabetes has ruined or altered plans that I had. Maybe it was a low that made me stop what I was doing, maybe it was forgetting supplies and having to drive back and get them, maybe it was running around trying to find a battery because my pump had died, or maybe it was just having to make different arrangements to accommodate my schedule or needs. It can be annoying, frustrating, and upsetting. But as I was reminded, you can’t let it ruin your plans, or your mood. Every cloud has a silver lining, a forgotten meter is a chance to go on an impromptu adventure. I’m just glad this mission ends with a smile.

Integration

“What is it?”

The devices gathered around, peering inquisitively at the band that lay in the middle of the circle.

“I don’t know,” B.G. Meter replied, inching closer.

“Don’t touch it! We don’t know what it does! It might be dangerous!”

Meter gently tapped on the black surface and a series of bright white circles bounced across a mini screen.

“Look it lights up!” Gigi exclaimed.

“Why hello there,” the band stretched out, springing to life. My name is Fitbit Flex. And who are all of you?”

“Oh um, hi. My name is B.G. Meter and these are my friends Insul N. Pump and Gigi CGM. We didn’t mean to bother you, but we noticed that the Human started wearing you and we were curious what you were doing.”

“Oh how lovely! It’s always a pleasure to meet new devices. I’m a tracker. When the Human puts me on her wrist I can tell her how many steps she takes each day, how many calories she’s burned and even how well she slept!”

“Oh wow. You must take a lot of blood to figure out all that information. Where is your lancet hidden? Not that I was checking you out or anything, but you have a rather sleek design.”

“You’re making me blush, Meter. I actually don’t need to take any blood to figure out those numbers.”

“Whattt!? No blood? But you’re still under the Human’s skin right, like Gigi or Insul?”

“Nope. I prefer to stay away from bodily fluids and functions.”

“Crazy! How come you can’t do that, Gigi? So how does the Human know how many steps she’s taken? I noticed you don’t have a very big screen.”

“Yes, bigger is not always better, Insul. When the human lightly taps on me, my dots show what percentage of her goal she has completed. One dot is 20%, two is 40%, etc. But more importantly, if the Human takes out her phone and opens my app, she can see all these numbers and graphs right on her phone.”

“Wait, let me get this straight. You send your information right to the Phone, the thing that the Human always has with her?! And she doesn’t have to type anything in? We’ve been trying to get our numbers on the Phone for ages, but it will never take it from us!”

“Well that seems rather silly to me. The app also lets the Human keep track of other things too like her weight, calories eaten, and how much water she drinks. She can even cheer on or taunt her friends to reach their goals.”

“How can we get our numbers on there?? I know that the Human can manually type in that kind of information, but she’s kind of lazy. It would be perfect if her blood sugars and units of insulin delivered was wireless sent and synced right in your app. With your information about steps and activity and food logging and our information about glucose numbers and insulin, we could really help the Human understand the big picture!”

“You know what, Gigi, that’s a great idea. Hopefully someone smart is working on figuring that out right now.”

I sure hope so.