First Hearing: Insulin Costs

Date: Tuesday, April 2, 2019 - 10:30am

Location: 2322 Rayburn House Office Building

Subcommittees: Oversight and Investigations (116th Congress)

The Subcommittee on Oversight and Investigations of the Committee on Energy and Commerce will hold a hearing on Tuesday, April 2, 2019, at 10:30 a.m. in room 2322 of the Rayburn House Office Building. The hearing is entitled, “Priced Out of a Lifesaving Drug: The Human Impact of Rising Insulin Costs.” 

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Dexcom Adds “Hey Siri, what’s my glucose?" and MORE!

DEXCOM G6 MOBILE APP version 1.4.0 released!

NEW IN THE DEXCOM G6 MOBILE APP:

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• “Hey Siri, what’s my glucose?”* – iOS device users will now be able to ask Siri to read Dexcom glucose readings aloud and display graphs directly on the lock screen, eliminating the process of unlocking the phone and manually opening the Dexcom app; the launch of virtual assistant integration is a first-of-its-kind innovation in CGM

• More followers** – Expanded Share function, allowing users to share glucose readings directly with up to ten people, versus five in the previous version; this update is critical for pediatric patients and others who rely heavily on their family and diabetes support network to help manage their disease

• 24-hour sensor expiration reminders – Automatically receive a 24-hour reminder before it’s time to replace a sensor, in addition to 2-hour and 6-hour reminders

• CLARITY app right at your fingertips – Launch the Dexcom CLARITY app directly from the Dexcom G6 app for more retrospective glucose reports. If a customer does not yet have CLARITY, they will be taken to the App Store to download and install the app

• Submit technical support inquiries – Submit technical inquiries through a browser launched through the app, versus the auto-populated email in the previous version

• Apple Watch Series 4 face complication – iOS device users are offered a new Graphic Circular complication specifically for the Apple Watch Series 41

• Integration with Google Fit – Android device users will have a new integration with Google Fit to display Dexcom CGM data on a 3-hour delay

Dexcom users can download the app update today from the iOS App Store and it will be available for download soon on Google Play. For more information on Dexcom G6®, please visit my link.

 For complete device compatibility chart visit dexcom.com/compatibility

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[1] Smart phone required to display readings on watch
[1] If your glucose alerts and readings from the G6 do not match symptoms or expectations, use a blood glucose meter to make diabetes treatment decisions.    
** Separate Follow app required
*Compatible with iOS 12

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Kris Freeman's Triathlon with Dexcom and Omnipod

Hello everyone! This is a guest post (sorta) from former Olympic Cross Country skier Kris Freeman. Actually, this wasn't written for Arden's Day - it's from Kris's Facebook page and I am posting it here with his permission. We talk on the Juicebox Podcast all of the time about how I use Arden's Dexcom data to make small adjustments to her insulin with settings that are available on her Omnipod. When I saw Kris's post I thought, "this is the next level of those ideas" and I wanted to share his process with you. Please visit Kris on FB or his blog, he's also been featured on Arden's Day a number of times and been a guest on the podcast twice.  -- #BoldWithInsulin

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Yesterday I competed in and won the Sea to Summit triathlon. The race traditionally starts with a 1.5 mile swim in the Salmon Falls river, continues with a 92 mile bike ride to the WildCat MT ski area parking lot, and finishes with a run up the Tuckerman Ravine trail to the Summit of MT Washington.

Unfortunately due to the heavy rains NH has had over the previous week, a lot of fecal matter has ended up in our waterways and the bacteria level in the river was above the safety limit. The swim was canceled and the event became a biathlon.

The swim would have taken approximately 40 minutes so I had to change my insulin dosing strategy to accommodate the slightly shorter race. My glycogen stores were topped off so I was running a 24/7 basal rate of 1.0 units per hour on my Omnipod. To cover race nerves, readily available glycogen stores and carb/calorie intake I settled on the following protocol. 

Hour 1 = 1.0 units per hour
Hour 2 = .7 units per hour
Hour 3 = .3 units per hour
Hour 4 = .3 units per hour
Hour 5 = .3 units per hour
Hour 5-5.5 = .3 units per hour
Hour 5.5- to finish = off

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It is very difficult to estimate how much insulin I will need in an event this long. I have to guess how insulin sensitive my body will become from prolonged exertion as well as how many calories I will need to fuel myself. The program that I used yesterday ended up being a little too aggressive and I had to force feed myself at the end of the race. On the bike I drank 60 ounces of Gatorade, 20 ounces of custom Cola/Coffee mix, and 24 ounces of RedBull. I had planned to take in solid food but I was sweating buckets and my stomach was not calling for it. 

The bike took me four hours and ten minutes and my glucose was 116 at the transition to running. I drank another 16 ounces of Gatorade during the first 40 minutes of the hike. At this point my glucose was 117. I decided to pull off the Omnipod that was delivering .25 units per hour as I did not want to have to overfeed to get to the top of the mountain. I was wearing two pods and the other one was delivering the minimum dosage of .05 units per hour. 

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I ended up having to overfeed anyway. I drank another 16 ounces of Gatorade over the next 20 minutes but my sugar dropped to 80. I had to pull out my emergency flask filled with 5 Untapped Maple syrup gels. The flask contained 105 grams of sugar and I finished it five minutes before winning the race in five hours and forty-four minutes. 

Every race is a learning experience. If I could do this race over I would reduce the first hour dosage to .7 units, the second hour to .5 and then I would have run .3 up until 4 hours at which point I would have suspended delivery. The attached picture is a graph of my glucose on a Dexcom during the race. It looks "perfect" but I really would have preferred to not take on over 100 carbs in the last 30 minutes of the race.

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UPDATED: Dexcom G6 Restart

How to Extend the Dexcom G6 Sensor Beyond the Ten Day Hard Stop...

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I’ve used this method multiple times using the code and once without the code, all with success. Original method is below.

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Original post below. Updated method above this text.

Reposted with permission from Diabetes Daily's David Edelman.

Some clever technologists have discovered how to restart a Dexcom sensor to extend its life beyond ten days. The process works by exploiting a bug in the sensor pairing process.

Katie DiSimon walked us through the process. Katies is involved in the community of people who are building homemade automated insulin delivery systems using current insulin pumps and continuous glucose meters.

1. In phone’s Bluetooth list, “forget” the Dexcom transmitter from the list.

2. Go to G6 app and stop sensor session. Click yes to end it despite all the warnings.

3. Then choose to start a new session. Choose the “no code” sensor session.

4. Wait 2 hours and 5 min. If any pairing messages come up for the transmitter during the wait, say no.

5. After the wait, restart the phone and open G6 app. This will trigger the phone to try to re-pair with the transmitter. Accept the pairing request.

6. You may need to restart the phone one more time, but then you’ll be greeted with two calibration requests and a new sensor session.

The directions above are for how to restart the sensor without using the receiver. During the restart process’ 2-hour wait, you will not be receiving current glucose readings, similar to any new session start-up process.

If you have the G6 receiver, you have the opportunity to use the receiver for the restart and continue to still receive current glucose values throughout the 2-hour wait. Here are the instructions in the video below.

Use your G5 or G6 receiver to bypass the 2 hour warmup (note: technically I filmed these from a couple different restart sessions, and then edited them in the correct order for a single video...so ignore timestamps on my phone in the video if you are nit-picking. LOL.)

You must start and finish the restart process prior to your existing sensor session expiration. Katie recommended setting an alarm on your phone for day #9 of your G6 session, so you can avoid rushing at the last minute. If you do miss the window and your session expires before you restart it, and the ten-day hard stop happens, you can still restart the sensor. This would just mean that you have to first reset the transmitter.

Instructions for all the options can be found on this page.

The Caveat to the Hack

The Dexcom G6 has not been tested or approved by the FDA for restarting sensors. There is no guarantee of sensor accuracy. Extend the sensor life only at your own risk.

A previous version of this post was updated to remove incorrect information. 

The text is from Diabetes Daily. The art is my doing. I have not tried this process with Arden's G6 and I'm currently not planning on trying. I am sharing the article with confidence as I have never know Diabetes Daily to share inferior content. Let me know if it works!

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Quincy the Koala uses Dexcom G6 (with video)

Koala with Diabetes at San Diego Zoo Receives Help from Dexcom G6

A group of San Diego based experts came together June 1, 2018 to help a koala with diabetes at the San Diego Zoo. The koala, a male named Quincy, has been diagnosed with type 1 diabetes.

Media release from the San Diego Zoo, Dexcom and Scripps Health

The experts, representing veterinarians, endocrinologists from Scripps Health, biotechnology professionals from Dexcom and San Diego Zoo animal care specialists took a course of action designed to better manage Quincy’s blood sugar levels through the application of a glucose monitor.

“Very few koalas have been diagnosed with and treated for diabetes. Quincy currently requires insulin injections, which are based on his blood sugar level.With a continuous glucose monitor, we may beable to monitor Quincy’s glucose levels throughout the day without having to disturb him. We are hopeful that thistechnology will work as well in koalas as it does in people, thus allowingus to optimize his insulin therapy while promoting his welfare during his illness.”

— Cora Singleton, DVM, senior veterinarian, San Diego Zoo Veterinary Services.

Learn more about Dexcom today!

 

The Dexcom G6 Continuous Glucose Monitoring System that Quincy is wearing is the latest innovation in diabetes management technology, which started shipping to people with diabetes earlier this month. The sensor and transmitter placed on Quincy sends his blood glucose levels in real time to a smart device monitored by his caretakers. With the new G6 technology, his veterinarians will no longer need to prick his skin multiple times per day to test his blood glucose levels. The Dexcom CGM also has built in alerts and alarms that will proactively notify Quincy’s caretakers before his blood glucose reaches dangerous levels.

A group of San Diego based experts came together June 1, 2018 to help a koala with diabetes at the San Diego Zoo. The koala, a male named Quincy, has been diagnosed with type 1 diabetes. Try a Dexcom CGM today - http://bit.ly/DexAd More at

“You can imagine what this technology means for Quincy,and any person trying to manage this challenging disease. Just like Quincy’s veterinarian, people with diabetes and their family or friends can monitor their glucose levels from a mobile device, providing around-the-clock safety and peace of mind.”

— Peter Simpson, vice president of advanced technology at Dexcom

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Koalas normally sleep during the day and are solitary animals. Animal care staff at the San Diego Zoo hope the new sensor will allow them to get more detail about Quincy’s glucose levels while also reducing the number of times they need to disturb him. "Quincy has an insulin deficiency type of diabetes, and needs insulin to control his blood sugar levels and ensure he gets the energy needed to help him build muscle, gain weight and stay healthy much like our human patients," said Athena Philis Tsimikas, M.D., corporate vice president of the Scripps Whittier Diabetes Institute. "Hypoglycemia abnormally low blood sugar is a safety concern, and the limiting factor to using the right doses of insulin, especially in an animal that can’t tell us their symptoms. The continuous glucose monitoring now allows optimal dosing to best manage Quincy’s diabetes." The application of the monitor went smoothly, and animal care staff said they look forward to having information that will help them develop a treatment plan to improve Quincy’s condition. Quincy’s diabetic condition was initially diagnosed by veterinarians at the Los Angeles Zoo, where Quincy was living at the time. He was transferred to the San Diego Zoo for continued advanced diagnosis and treatment. Diabetes has rarely been documented in koalas, and animal care experts do not know what may have triggered this condition in Quincy.

Click here to learn more about the Dexcom G6

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