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Craft Forum / Wood/Metal / Metalworking / July 2009Diabetes
Relating to content in a recent thread: http://health.usnews.com/articles/health/healthday/2009/07/27/tight-management-o f-type-1-diabetes-worth-the.html [ By carefully controlling blood sugar levels and taking medications that lower blood pressure and cholesterol, people with type 1 diabetes can significantly reduce their risk of developing the most serious complications associated with the disease, new research shows. In a study appearing in the July 27 issue of the Archives of Internal Medicine, scientists report that people who intensively manage their blood sugar levels have less than a 1 percent chance of becoming blind, needing a kidney transplant or losing a limb. ] > By carefully controlling blood sugar levels and taking medications that > lower [quoted text clipped - 3 lines] > with > the disease, new research shows. My better half lives with type 1 diabetes. Her glucose had become extremely hard to control a few years ago. Medtronics had just developed a continuous glucose monitor. Takes a reading every five minutes 24 hours a day. alarms for low and high glucose. Insurance wouldn't cover it, but we got it anyway. THIS DEVICE IS LIFESAVING!!! The improvement in control is unbelievable. We have since got insurance coverage. If you know someone with a difficult case of type 1 diabetes, have them check this out. Karl >> By carefully controlling blood sugar levels and taking medications that >> lower [quoted text clipped - 18 lines] > > Karl I have the Medtronics pump that can use that same monitor technology, in a closed loop, but I didn't go for the monitor part. But I don't have any control problems. It's a neat device, though, for people who need it. -- Ed Huntress > I have the Medtronics pump that can use that same monitor technology, in a > closed loop, but I didn't go for the monitor part. But I don't have any > control problems. > > It's a neat device, though, for people who need it. its not closed loop. The technology isn't that good. You can get erroneous readings from the monitor at times. But still a great help. Julie got her A1C results down from 10s to 7s with this unit. Karl >> I have the Medtronics pump that can use that same monitor technology, in >> a closed loop, but I didn't go for the monitor part. But I don't have any [quoted text clipped - 7 lines] > > Karl I'm not sure what she's using, but it sounds like the interstitial-fluid monitor, right? Medtronics has that monitor integrated with the MiniMed Paradigm insulin pump. When you use the two together, you have a closed loop: the monitor controls the output of the pump. I have the pump but not the monitor. It sounds like Julie has the monitor without the pump. Correct? -- Ed Huntress > I'm not sure what she's using, but it sounds like the interstitial-fluid > monitor, right? Medtronics has that monitor integrated with the MiniMed [quoted text clipped - 6 lines] > -- > Ed Huntress She has both units. You have the model names correct. The pump takes readings from the monitor and plots results either by 3 hour or 24 hour. (can also download all the data to a PC and analyze the heck out of it) It alarms for hi limit, low limit, dropping too fast. So, Julie Beeps all the time<VBG> Twice a day, or more, you take a standard blood meter result and recalibrate the monitor. You also enter the carb count for each meal and the pump will bolus insulin. Other than that, the pump runs at basal rate. She looks at the reading chart often and bolus another 1/2 unit or takes a small glucose tablet. The pump does NOT do anything closed loop, only what you tell it to do. There is a learning curve to getting the most out of this technology. If you, or anyone else, get one contact us off NG for a lot of detailed information. Karl >> I'm not sure what she's using, but it sounds like the interstitial-fluid >> monitor, right? Medtronics has that monitor integrated with the MiniMed [quoted text clipped - 17 lines] > takes a small glucose tablet. The pump does NOT do anything closed loop, > only what you tell it to do. Aha. That isn't the way they explained it to me. Thanks for clearing that up. > There is a learning curve to getting the most out of this technology. If > you, or anyone else, get one contact us off NG for a lot of detailed > information. > > Karl I appreciate that, and I'll keep it in mind. So far I'm in the low-6's using the MiniMed/One Touch radio-transmitting conventional meter and the MiniMed Paradigm. But I'm keeping my eye on the attached monitors. -- Ed Huntress >>> I'm not sure what she's using, but it sounds like the >>> interstitial-fluid monitor, right? Medtronics has that monitor [quoted text clipped - 21 lines] > Aha. That isn't the way they explained it to me. Thanks for clearing > that up. There is a good reason for not closing the loop, test accuracy and liability. If the sensor, I'm assuming a skin patch sensor rather than actual blood sample, becomes contaminated, loosens, or fails in any way then, in closed loop operation, would give the patient potentially a lethal (or at least harful) dose of insulin. I worked on a system very similar to this measuring lactate acid in the bloodstream while our sister company did the glucose version. Our sensor, using essentially the same polymer, required body fluid to measure so we sucked a blood sample into a valved manifold which routed the sample to the polymer sensor. After readings stabilized the sample and a calibrated saline/lactate solution was flushed back to the patient. I designed in seven different fail-safes yet the emotional, legal, and liability burden was overwhelming. And we weren't even injecting a drug, just saline. I'd be very leery of automated insulin injection under closed loop control even if it were being sold. I can see where statistical averaging, tight bounding and multiple sensor redundancy might work but "might" isn't good enough when a life hangs in the balance. >> There is a learning curve to getting the most out of this technology. >> If you, or anyone else, get one contact us off NG for a lot of detailed [quoted text clipped - 5 lines] > using the MiniMed/One Touch radio-transmitting conventional meter and > the MiniMed Paradigm. But I'm keeping my eye on the attached monitors. What is the sensor, skin-patch?  SignatureRegards, Curly ------------------------------------------------------------------------------ I Love Republicans, They Taste Just Like Chickenhawks ------------------------------------------------------------------------------ > What is the sensor, skin-patch? interstitial-fluid monitor. Or a small needle about 1/4 inch under the skin. If you hit a small artery, you just wasted $50. The monitor will fail in a very short period. Karl >> What is the sensor, skin-patch? > [quoted text clipped - 3 lines] > > Karl Ah, thanks. Do you insert the probe yourself? Where and what is the lifespan of a probe/sensor? That would work for glucose, not for lactate. It would also have a significant latency and averaging effect depending on fluid flow and mass. Now you have me curious as to how much filtering is going on in the instrument vs. sensor. SignatureRegards, Curly ------------------------------------------------------------------------------ I Love Republicans, They Taste Just Like Chickenhawks ------------------------------------------------------------------------------ > On Tue, 28 Jul 2009 15:38:42 -0500, "Karl Townsend" > [quoted text clipped - 20 lines] > I Love Republicans, They Taste Just Like Chickenhawks > ------------------------------------------------------------------------------ Probably more than you want to know, but here are some details: Paradigm Real Time manual: http://www.minimed.com/pdf/x22_user_guide.pdf Sensor: http://tinyurl.com/m37ytn (Guardian RT = monitor alone; Paradigm RT = monitor/pump combo, both use the same sensor) The probe is inserted by the user and its lifespan is about 3 days. >> On Tue, 28 Jul 2009 15:38:42 -0500, "Karl Townsend" >> [quoted text clipped - 17 lines] >> -- >> Regards, Curly ------------------------------------------------------------------------------ >> I Love Republicans, They Taste Just Like Chickenhawks ------------------------------------------------------------------------------ > Probably more than you want to know, but here are some details: Paradigm > Real Time manual: http://www.minimed.com/pdf/x22_user_guide.pdf Sensor: > http://tinyurl.com/m37ytn > (Guardian RT = monitor alone; Paradigm RT = monitor/pump combo, both use > the same sensor) 262 pages, that's an interesting evening's read. Thanks. A cursory scan answers most of my questions. How much does the thing cost retail? Not a difficult design but I can see an eventual unit which is pretty much automatic and closed-loop. If the liability issues can be resolved. > The probe is inserted by the user and its lifespan is about 3 days. Where do you stick it, abdomen or limb? Fatty tissue wouldn't give good real time readings, limbs could be contaminated. SignatureRegards, Curly ------------------------------------------------------------------------------ I Love Republicans, They Taste Just Like Chickenhawks ------------------------------------------------------------------------------ > >> On Tue, 28 Jul 2009 15:38:42 -0500, "Karl Townsend" > [quoted text clipped - 45 lines] > > - Show quoted text - Expensive retail (without insurance): http://www.google.com/products?q=paradigm+insulin+pumps&aq=f One lawsuit over pump: http://seattletimes.nwsource.com/html/localnews/2003481742_medtronicnew17m.html Auto-off feature turns off pump if no buttons are used in 10 hrs – feature was disabled and/or not explained to new user. Typically it's used in abdomen tissue. Appendix A in the manual shows a study that Medtronics did demonstrating that the glucose measured by the sensor in interstitial fluid closely mimics that of blood glucose measured by test strips, etc -- when the sensor is fresh/viable. You still need to calibrate with test strips because the sensor degrades with use and not necessarily in a predictable fashion. Probably uncontrolled variables with the electrochemistry needed to make a tiny nA signal. (I don't know all the details). >> > On Jul 28, 3:45 pm, Curly Surmudgeon <CurlySurmudg...@live.com> >> > wrote: [quoted text clipped - 19 lines] >> >> -- >> >> Regards, Curly ------------------------------------------------------------------------------ >> I Love Republicans, They Taste Just Like Chickenhawks ------------------------------------------------------------------------------ >> > Probably more than you want to know, but here are some details: >> > Paradigm Real Time [quoted text clipped - 16 lines] >> -- >> Regards, Curly ------------------------------------------------------------------------------ >> I Love Republicans, They Taste Just Like Chickenhawks ------------------------------------------------------------------------------- >> Hide quoted text - >> >> - Show quoted text - > > Expensive retail (without insurance): > http://www.google.com/products?q=paradigm+insulin+pumps&aq=f Yow! That is insane, or maybe I should blame liability lawyers. In a competitive market, without the lawyers, that would be a $1,500-$2,000 instrument... > One lawsuit over pump: > http://seattletimes.nwsource.com/html/localnews/2003481742_medtronicnew17m.html > Auto-off feature turns off pump if no buttons are used in 10 hrs – > feature was disabled and/or not explained to new user. Heh, RTFM. My wife has the same problem. Get a new car and she has to ask me how sh.t works instead of reading the f.cking manual... > Typically it's used in abdomen tissue. Appendix A in the manual shows a > study that Medtronics did demonstrating that the glucose measured by the [quoted text clipped - 4 lines] > uncontrolled variables with the electrochemistry needed to make a tiny > nA signal. (I don't know all the details). Makes sense except for the sensor degradation in an unpredictable fashion. I'm still astonished at the markup. Assuming that FDA certification might add even 50% to the price, that's still a 600% markup over commercial parts/fabrication cost with 200% sales/distribution markup. If you liken it to a printer, printers are often given away below cost with profits being made on the toner/ink cartridges. I'd bet the probes are unreasonably expensive too. Of course I'm not a bean counter or lawyer and believe that some things shouldn't be profited upon but sh.t, 600% over normal industry price? SignatureRegards, Curly ------------------------------------------------------------------------------ I Love Republicans, They Taste Just Like Chickenhawks ------------------------------------------------------------------------------ >>> > On Jul 28, 3:45 pm, Curly Surmudgeon <CurlySurmudg...@live.com> >>> > wrote: [quoted text clipped - 61 lines] > competitive market, without the lawyers, that would be a $1,500-$2,000 > instrument... You mean, in a competitive market without *patents*. They have it sewed up pretty tight. And their interstitial meter is the first one that's been accurate enough to get FDA approval. Others have tried. I've been tracking them for almost 20 years. >> One lawsuit over pump: >> http://seattletimes.nwsource.com/html/ [quoted text clipped - 19 lines] > over commercial parts/fabrication cost with 200% sales/distribution > markup. I've looked my pump over pretty carefully. The mechanical part is quite simple (although very precise) and the electronics probably are trivial compared to a fancy cell phone. I figure that at cell-phone production rates, it ought to sell for less than $200 or so. > If you liken it to a printer, printers are often given away below cost > with profits being made on the toner/ink cartridges. I'd bet the probes > are unreasonably expensive too. Of course I'm not a bean counter or > lawyer and believe that some things shouldn't be profited upon but sh.t, > 600% over normal industry price? See if they build a cheap copy in India. <g> -- Ed Huntress >>>> > On Jul 28, 3:45 pm, Curly Surmudgeon <CurlySurmudg...@live.com> >>>> > wrote: [quoted text clipped - 19 lines] >>>> >> -- >>>> >> Regards, Curly ------------------------------------------------------------------------------ >>>> I Love Republicans, They Taste Just Like Chickenhawks ------------------------------------------------------------------------------ >>>> > Probably more than you want to know, but here are some details: >>>> > Paradigm Real Time [quoted text clipped - 16 lines] >>>> -- >>>> Regards, Curly ------------------------------------------------------------------------------ >>>> I Love Republicans, They Taste Just Like Chickenhawks ------------------------------------------------------------------------------- >>>> Hide quoted text - >>>> [quoted text clipped - 40 lines] > compared to a fancy cell phone. I figure that at cell-phone production > rates, it ought to sell for less than $200 or so. The cell phone scenario doesn't apply as the production numbers are vastly smaller. Small numbers require amortizing costs over smaller sales volume ergo higher prices. Plus cell phones don't have electro- mechanical interfaces, the fabrication and test is more complex. In small volume I'd price it at $1,500-$2,000 even with overhead and distribution costs included. Certainly not worth $10k! >> If you liken it to a printer, printers are often given away below cost >> with profits being made on the toner/ink cartridges. I'd bet the [quoted text clipped - 3 lines] > > See if they build a cheap copy in India. <g> Or China. But the FDA is pretty protectionist. SignatureRegards, Curly ------------------------------------------------------------------------------ I Love Republicans, They Taste Just Like Chickenhawks ------------------------------------------------------------------------------ interfaces, the fabrication and test is more complex. > In small volume I'd price it at $1,500-$2,000 even with overhead and > distribution costs included. Certainly not worth $10k! Oh, but you're forgetting the most important part. Its also a watch. I tell my better half she's outdone Rolex for most expensive time piece. Karl >> In small volume I'd price it at $1,500-$2,000 even with overhead and >> distribution costs included. Certainly not worth $10k! [quoted text clipped - 3 lines] > > Karl Heh, my wife loves watches. I buy a dozen at a time at the local swap meet for $5ea. I put a long strip of hardwood on the wall with 50 little brass hooks. Much better than her previous collection of sewing machines and she thinks I'm spending a fortune... It's cheaper to buy new watches than to bother changing batteries. SignatureRegards, Curly ------------------------------------------------------------------------------ I Love Republicans, They Taste Just Like Chickenhawks ------------------------------------------------------------------------------ >>> I'm not sure what she's using, but it sounds like the interstitial-fluid >>> monitor, right? Medtronics has that monitor integrated with the MiniMed [quoted text clipped - 30 lines] > using the MiniMed/One Touch radio-transmitting conventional meter and the > MiniMed Paradigm. But I'm keeping my eye on the attached monitors. Small frequent meals, yo! 200-300 cals each. Bear in mind that a single yogurt is in this range (not rec'd, btw, the fukn sugar is just outrageous in almost all non-plain yogurts), a slice of bread from 100-200 cals. Of course, low glycemic is better, but fats help greatly with this as well. In principle, a disciplined and optimal diet regimen would obviate testing, altho I'm not advocating this from the gitgo. I've seen simple walking drop glucose 40 points. Timed exercise with meals could likely regulate glucose to your whim! And is probably equally as effective in type I as in type II, but proly in different ways. wrt to the OP, the hbp makes sense, the cholesterol is just a fukn ruse. Big Med/Big Pharm has stooped to ads, such as, If yer cholesterol is just *a little* above where you would like it to be, consider xyz.... give me a fukn break, ferchrissakes.... They even link high cholesterol to ED.... Sheeit, let me tell you, I have cholesterol 250+, and half the time I ride a bus or a subway, I miss my stop cuz I can't stand up.... at least not without getting slapped..... or propositioned..... well, south of 14th St, anyway..... SignatureMr. PV'd Mae West (yer fav CongressShill) to the Gangster (yer fav Lobbyist): Hey, Big Boy, is that a wad (of cash) in yer pocket, or are you just glad to see me?? Experiment on Homo Sapiens -- CEOs, Lawyers, and Politicians, in particular. Spare the animals. Click here every day to feed an animal that needs you today. www.theanimalrescuesite.com/ > -- > Ed Huntress >wrt to the OP, the hbp makes sense, the cholesterol is just a fukn ruse. >Big Med/Big Pharm has stooped to ads, such as, If yer cholesterol is just *a [quoted text clipped - 3 lines] >They even link high cholesterol to ED.... >Sheeit, let me tell you, I have cholesterol 250+, You need to see a doctor & get treatment then. Low enough LDL & high enough HDL seems to be able to reduce plaque in the arteries of the heart over time. Probably other places as well. Remember gummer ... SignatureCliff >>wrt to the OP, the hbp makes sense, the cholesterol is just a fukn ruse. >>Big Med/Big Pharm has stooped to ads, such as, If yer cholesterol is just [quoted text clipped - 11 lines] > > Remember gummer ... It's not the rodents that he eats. It's the Big Mac remains that the rodents live on. Moral: If you're going to eat rats, don't get them out of the dumpster. -- Ed Huntress >In principle, a disciplined and optimal diet regimen would obviate testing, Kind of depends .. but for those needing Insulin I doubt it. BTW, All have been on type-I so far ... would not the pump & etc. help type-II insulin dependant folks too? SignatureCliff >>> I'm not sure what she's using, but it sounds like the interstitial-fluid >>> monitor, right? Medtronics has that monitor integrated with the MiniMed [quoted text clipped - 33 lines] > -- > Ed Huntress I'll ask Kaiser about this, sounds cool! Today would have been the first day in weeks I was going into the shop and my alternator quit about two miles from home. My meds/activity level is just starting to stabilize, I'm back on Codeine. I sure remember Codeine and the un-fun side effects but, the devil you know... >>>> I'm not sure what she's using, but it sounds like the >>>> interstitial-fluid monitor, right? Medtronics has that monitor [quoted text clipped - 36 lines] > > I'll ask Kaiser about this, sounds cool! Watch the costs. If your insurance won't pay, it adds up in a hurry. > Today would have been the first day in weeks I was going into the shop and > my alternator quit about two miles from home. My meds/activity level is > just starting to stabilize, I'm back on Codeine. I sure remember Codeine > and the un-fun side effects but, the devil you know... Ugh. I hope you're not stuck on that stuff for long. -- Ed Huntress |
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