Congrats to Medtronic!

Posted on September 29, 2016 by Laddie

Unless you are living in an underground bunker, you know that Medtronic Diabetes announced yesterday that the MiniMed 670G hybrid closed loop system has been approved by the FDA with anticipated shipping in the spring of 2017. Here’s a link to the press release if you haven’t read it yet.

Am I excited about this? Absolutely yes!!! Will I purchase it? Absolutely not!!!

You may think that I won’t purchase this because I am currently a Dexcom and Animas user. You may think that I won’t purchase this because I’m mad about the United Healthcare/Medtronic agreement. You may think that I won’t purchase this because “The Cure” will be here in five years. No, those are not the reasons. What is preventing me from pursuing this device is my next pump and CGM is ⚡️⚡️⚡️⚡️

Those lightening bolts are supposed to grab your attention and make you sit on the edge of your seat as I explain my predicament.

My issue is that I am going on Medicare in April 2017 after having my current pump go out of warranty in December 2016. I long ago satisfied my deductible for 2016 and if I purchase a pump before the end of the year, it will be at no cost. The individual health insurance market in Minnesota is in chaos and I plan to purchase the cheapest insurance plan possible for January through March 2017. It will be expensive despite a high deductible. No way can I purchase a new pump in that time frame.

So my choice is to purchase a pump in early December or enter 2017 with an out-of- 110089 warranty pump and wait until Medicare. A naive advisor might suggest that I buy the Medtronic 630G in December knowing that those buyers will be the first in line for the 670G pump when it is released in the spring. But guess what! Once you get on Medicare, it is against Medicare law for beneficiaries to participate in upgrade programs. So if I purchase a 630G, that will be my pump for the next 4-5 years because I will not be allowed to upgrade to the 670G.

A Medtronic representative told me on Saturday that the 630G is now being reimbursed by Medicare. The sensors are not Medicare-eligible, but at least the pump is covered. If I wait hoping to purchase a 670G after April 1, the most likely possibility is that it will not be covered by Medicare for quite a while. Hopefully I am wrong on that.

I am excited that the FDA has approved the MiniMed 670G. Medtronic is not calling it an artificial pancreas, but it is an important step on the journey to complete insulin automation. That is good for all of us excited about the future of diabetes technology.

But for me, it is not in the game. My reimbursement scenarios just don’t fit the timing of this release. Anyone who reads my blog regularly knows that I currently use Dexcom after several unhappy years with Medtronic SofSensors. The Guardian Sensor 3 that is part of the 670G is many generations removed from that nightmare and I would be open to trying them. But it would be too big a leap of faith to move back to Medtronic without a trial run. Maybe that will be possible in the future when hopefully, hopefully, hopefully CGM/pump systems will be reimbursable under Medicare.

Today my options are too tangled and uncertain to make the MiniMed 670G part of my plans. But I will still camp out in the grandstands with other diabetes advocates yelling “Congrats!” to Medtronic. We live in a golden age of diabetes tech. Unfortunately we also live in a stone age of diabetes reimbursement for those of us who are approaching age 65 and older.

Moosh and Monsters: A Journal about mySugr

Posted on September 19, 2016 by Laddie

I am currently one of the beta-testers for the coaching module which has just been added to the mySugr Diabetes Logbook app. You may have seen a recent announcement about this feature which will allow users to receive virtual coaching from Gary Scheiner and other CDE’s of Integrated Diabetes Services. To learn about the program, check out “mySugr Coaching – your shortcut to great diabetes management” by Scott Johnson, the USA Communications Lead for mySugr. Another good source of information is this Diabetes Mine article by Mike Hoskins titled “A New Age of Mobile Diabetes Education and Coaching.”

I have been using the mySugr Diabetes Logbook full-time for two months. To best describe the experience, I am sharing my journal of insights, problems, and opinions. Please note that I am in the early stages of the coaching experience and will share that story in another blogpost.

Journal

Thursday 7/21/16: I saw Scott Johnson at an ADA seminar today. He asked if I would like some personal consulting sessions with Gary Scheiner of Integrated Diabetes Services. I have several times been a phone call away from calling IDS for help, but have never done it. So of course I said yes. According to Scott, the details of the project are still a little sketchy but will involve using the mySugr Logbook app to communicate virtually.

I like mySugr and have always thought that it is by far the best of the diabetes logging apps. But I have never been a faithful user. Too much data entry has always sidelined me after a week or two.

Friday, 7/22/16: I began using mySugr again. I have to admit that it has been a year since I last used it and it is much more functional than before. My Dexcom CGM data is my-monster automatically synced to the app through Apple Health. Most of the data entry is easy with icons and the ability to customize, rearrange, and delete line items. My personal monster whom I named Glukomutant is cute.

Friday 7/29: I am a week into logging and a day into using the Accu-Chek Connect meter provided to me by mySugr. The meter automatically sends BG numbers to my phone and the mySugr app.

The Connect meter makes mySugr infinitely easier to use because it is one more piece of data that I don’t have to type in. The hardest part of having my phone be a medical device is that I am using my sometimes-bad memory to coordinate data from the Dexcom app, the mySugr app, my pump, my meters, and my life. Scott showed me a couple of shortcuts and let me know what info he enters and what he ignores. He indicated that the app will “moosh” all data entered within 10 minutes into one entry. “Moosh” is Scott-lingo for “fetch and combine.” For example, I test my BG and enter a correction bolus. A few minutes later I decide I to eat and enter my food, carb count, and a couple of tags. It will “moosh” it all together into one log to prevent an unwieldy number of entries in the logbook.

Right now I keep forgetting bolus details the second the pump delivers the insulin and I have to go to the pump history menu to get the info. I’m sure that I will get better at remembering numbers and not get so tangled up creating an entry. Long term mySugr hopes to automate all data sources so that there is very little manual data entry.

Tuesday, August 2: Today I started a new Dexcom sensor. For the 2 start-up calibrations, I got the following numbers from the Accu-Chek Connect meter: 85 / 108. I did a 3rd test to get a better sense and got 78. This is why I use Freestyle meters. I will try to stick with the Accu-Chek meter for my trial and I did order a bunch of test strips. Out of curiosity I tested on my Freestyle Lite meter. I got 84 / 87. For consistency I used the Accu-chek to calibrate my CGM which interpreted the two tests as 96. Since Freestyle is often considered to test on the low side, the numbers aren’t too horribly different.

Saturday, August 6: The mySugr app allows basal changes by the hour or half-hour. When using half-hour, I would prefer that the basal rate still show the hourly rate because I have never thought of basal rates in half-hour segments although I often change rates on the half-hour. Does that make sense?

Saturday, August 6: I am used to reviewing my CGM tracings and feel as though I get a good overview of the “forest.” With mySugr I feel as though I am down in the trees with a lot of emphasis on average and deviation, both of which are highly affected by a single number. I think that once I have more weeks of data, the summary reports will be more helpful.

Saturday, August 6: Once again not thrilled with meter. CGM 145, Accu-Chek 118, Freestyle 138. Most of the time the meter is fine and aligns very well with my Freestyle. It syncs amazingly fast to my phone.

Sunday, Aug 7: Would like an icon for combo/extended bolus and maybe a way to log it besides using notes.

Although the ability to take photos of food is nice, I rarely do it. One of the most useful features is Search. Since I live in a rut and often eat the same foods every day, I can search by things such as “Lunch” and “Salad” and compare how I have bolused for similar meals in the past.

Thursday August 11: Love how the app learns words I use. For example: CGM, Oatmeal, Walking.

Wish pump bolus info was synced. I do everything on my pump and then enter it again on app. I have accessed my pump history more times in the last month than the previous four years. Wish I remembered it better.

Would like an icon for CGM calibration.

Sunday, August 14: I learn something new every day. When scrolling down BG numbers, I see that the ones from the Accu-Chek meter are marked with a “Verified” symbol while manual entry ones aren’t.

Saturday, August 20: I am definitely in the habit of logging, but am hitting the wall of data fatigue. It is quite horrible to see how many “interactions” I have with diabetes every day.

Wednesday Aug 24: Noticed that my step count from Apple Health is now included in the mySugr daily summary. I love data that I don’t have to enter!

Sunday, Aug 28: I need to learn more about the reports and graph. Would like to see the graph in landscape view.

Wednesday, Sept 7: When I activated the consulting module, I filled out everything. Then when I went to settings to activate the camera for a selfie, everything was lost. The perils of being a beta-tester. 🙁

Monday, Sept 12: Learned that I can swipe an entry to the right to see a menu of Share-Edit-Delete (I had been selecting the entry and pressing the Edit button). This is so much faster. Scott probably showed me this and I forgot. #OldAge. 😀

Saturday, September 17: My consulting request has been submitted and I am waiting to hear back from Gary. I usually think that my numbers are erratic and unexplainable. However mySugr reports show that my 7-day, 14-day, and 30-day summaries are eerily consistent. I am nervous about having someone review my data.

To be continued….

***

Fitbit Fun

Posted on September 7, 2016 by Laddie

In the spring of 2015 I wrote a couple of blogposts (here and here) about how much I enjoy using a Fitbit and how I find it to be a motivating addition to my diabetes toolbox. A year and a half later I am still using my Fitbit and participating in a regular challenge with members of the diabetes community. (Thanks to Sue R who invites me every week!)

Although I am a self-motivated Fitbit user and would tackle my daily step goal without DOC competition, I still enjoy the motivation resulting my daily interactions with other D-people. Recent thoughts include:

I have a good chance of beating Kerri of Six Until Me in a challenge for the first time ever because she had a baby by C-section two weeks ago. I wouldn’t be so stupid as to place a bet on my results once that “little tomato” “biscuit” “fourth chair” is a month old….

My trick of attaching my Fitbit One to my pump tubing is gaining traction as I recently witnessed Scott Johnson borrow an old-style Fitbit (Zip and One, unlike the more recent bracelet models) so that he could clip it to his pump tubing to track his steps on the basketball court.

David E has moved from being an “also-ran” to an unbeatable champion almost every week. I’m not sure that he is more active these days. I think that he is just becoming better at syncing his Fitbit so that his steps count.

Just so your know! On Monday Fitbit added a new do-it-yourself challenge called “Adventures.” If you click on “Challenges” from your phone/tablet Fitbit home screen, you’ll see a section called Adventures. This allows you to select a daily or multi-day hike to challenge yourself and receive the rewards of 180º photos at landmarks along the trail. Today I selected the Vernal Falls hike which requires 15,000 steps. (The options that show up in your adventures are based on your average steps.) Although my daily goal is 10,000 steps, my average is closer to 15,000 and that is why all of my adventure options require a lot of steps. As I type this blogpost, I am 331 steps short of my goal and I will walk around the house this evening to make sure I reach my destination.

Because I am a hiker, I enjoy the idea of “Adventures” and it is something different from my normal goals. If you need motivation to pull your Fitbit out of the junk drawer, check out Adventures on the Fitbit website and see if it interests you. If nothing else, you can download some new wallpapers from the Yosemite Adventure as seen below:

See you out on the Fitbit trail!

Countdown to Medicare with Type 1 Diabetes: 7 Months / Ducks in a Row

Posted on September 1, 2016 by Laddie

I went to court last month. Was I nabbed by the diabetes police? Nope. How about the regular police? Not them either. Was I dragged into the legal system for breaking the rules by dosing insulin off my CGM? Nothing like that. So what was I doing?

I was getting my ducks in a row.

What does that have to do with Social Security and Medicare? The answer to that is a lot.

As you approach your initial sign-up date for retirement benefits under Social Security, you need to be sure that you have the required documentation for your claim. According to the Social Security Administration (SSA) website, in most circumstances you will need the following documents:

•your Social Security card (or a record of your number);

•your original birth certificate or other proof of birth (You may also submit a copy of your birth certificate certified by the issuing agency);

•proof of U.S. citizenship or lawful alien status if you were not born in the U.S. [More Info];

•a copy of your U.S. military service paper(s) (e.g., DD-214 – Certificate of Release or Discharge from Active Duty) if you had military service before 1968; and

•a copy of your W-2 form(s) and/or self-employment tax return for last year.

My advice is to consider this list at least 3 months before signing up for Social Security so that you will have time to obtain any missing documents. Although I had a copy of my birth certificate, I chose to get a certified copy just to be safe. It took about 3 weeks to get the official document from the vital records department of my birth state.

Fortunately if you have any gaps in documentation, you can and should sign up for Social Security on time. From the Social Security Administration (SSA) website:

“Even if you don’t have all the documents you need, don’t delay signing up for Social Security. You can submit any documents you do have. You can provide the missing documents later or we may be able to help you get them.

In many cases, your local Social Security office can contact your state Bureau of Vital Statistics and verify your information online at no cost to you. If we can’t verify your information online, we can still help you get the information you need.

If you delay signing up, you could lose some benefits you may be due.”

So why did I have to go to court?

I had to get a court order for an official name change. Since 1976 I have had a discrepancy between the middle name on my driver’s license and the middle name on my Social Security card. When I got married I chose to keep my maiden name as my middle name and abandoned my previous middle name. Or so I thought. I went to Social Security and had a card issued in my new name. When we moved to Minnesota, the DMV required me to use the old middle name on my driver’s license. I don’t remember how my passport was handled, but it has always matched my driver’s license. So my two main forms of ID for the last forty years have not matched my tax information, bank accounts, and everything else that we own.

I should have fixed this discrepancy years ago, but it amazingly has never been a problem. Thinking of approaching Social Security and handling our assets in our senior years, I finally determined that it was time to resolve the issue.

Changing your name is not difficult. I didn’t need to use an attorney, but did so because a good friend was willing to help me. I filled out a lot of paperwork, seemingly the same thing over and over again. I signed a form allowing for a criminal background check by the FBI. I completed another form for a background check by the MN BCA (Bureau of Criminal Apprehension). More than once I signed that I was not changing my name for fraudulent reasons or to hide assets. On my scheduled court date, I went before a judge with two witnesses and received an official court order for a name change.

With the certified copy of my court order, I have applied for a new driver’s license and will apply for a new passport once the DL arrives.

It is possible that my name discrepancy might not have been noticed with my Social Security application. However in our increasingly ID-conscious society, it seemed to be an unnecessary risk to be a citizen with two aliases. Two aliases sounds so criminal compared to two middle names….

I don’t know everything about Social Security and Medicare yet, but at least I have my ducks in a row. Most of you won’t have to go to court to get ready for Medicare. However, you may have other things that should be taken care of as you enter this new stage of your life.

Now is as good a time as any to get your ducks in a row.