The shifting paradigm of a “cure” for type 1 diabetes: Is technology replacing immune-based therapies?

Nearly 50 years after the autoimmune nature of type 1 diabetes was discovered, no therapy has been approved to alter the course of the disease at any stage. However, during that same period, technology has been delivering tools to help patients achieve better glycemic control and reduce the burden of the disease. With the imminent arrival of fully automated artificial pancreas systems that will continue to improve control and quality of life, it appears that we are on the verge of a major technological breakthrough that will significantly impact diabetes care. These devices have such a high degree of potential that they are, at times, mentioned as a virtual cure for the disease—a first for technology in this space. As such, these devices will undoubtedly alter the research landscape in a field that has predominantly been occupied by immunotherapies. This article reviews the history of type 1 diabetes and compares and contrasts the advancements that have come from the world of technology and immunology alike at this important crossroads in care that we are currently in.

View the full article here.


Recipe of the Month:Shrimp Scampi and Tomatoes

From the Kitchen of Chef Robert Lewis

A light and refreshing meal any time of the year!


What You’ll Need:

 1 large tomato

2 ounces feta cheese

4-5 sprigs fresh basil

4 tablespoon virgin olive oil

1 pound fresh or cooked shrimp

1 teaspoon olive oil

1 clove of garlic, minced

1/4 teaspoon freshly ground black pepper to taste

1 slice of lime (optional)



Wash the tomatoes and slice them crosswise into small slices, around 1/2-inch thick.

Arrange 4 tomato slices on a large salad plate. Sprinkle the feta cheese on top of each tomato.

Cut the fresh basil leaves into thin strips and sprinkle on top of the tomatoes.

Cook the shrimp in a nonstick pan, preheated and coated in olive oil. Add the garlic halfway through and saute until done. This will take about 3 minutes for cooked shrimp and 5-6 minutes for raw shrimp.

Place the cooked shrimp on top of the tomatoes. Generously drizzle the garlic and olive oil mixture over the top. For a final touch, garnish with a dash of pepper and a squeeze of fresh lime juice.


Nutritional Information:

Serving size: 4

Calories: 57, Fat: 6g, Carbohydrates: 1.5, Sugar: .5g, Fiber: 0.5g, Protein: 1g


For more delicious and nutritious recipes from Chef Lewis, visit happydiabetic.com.





Finding Your Starting Point with the Rock the Block Exercise

Not sure where to get started with your exercise program? Use this tool to help you find your starting point!

The appropriate level at which to begin your exercise program is where you’re at.

If you have exercised recently (if inconsistently) it’s pretty easy to figure out where you should start with your workouts. Pick a recent workout that felt somewhat challenging but comfortable. Figure out how long and how hard you worked out. This is your starting point. But what if you haven’t worked out in a while (or ever)? How do you know where to start?

Testing the Waters. How do I figure out what my body can and can’t do. The answer is by testing your limits. But you need to test those limits in a safe and rational way. It’s probably not a good idea to test your skiing aptitude by being dropped out of a helicopter in the Alps. And you probably don’t want to test your swimming aptitude trying to escape the jaws of a great white shark on the barrier reef in Australia. You should test your aptitude in a safe environment where it is easy for you to quit at any time. You should begin in an environment where you can spend time quietly checking in with your body and monitoring for signs of pain or discomfort. You may need to start and stop a lot at first. You need to begin gently and move ahead slowly. Don’t forget to watch out for your dashboard indicators (body warning signs like feeling dizzy, light-headed, tightness in your chest, extreme breathlessness, unusual fatigue, nausea, loss of muscle control or blurred vision). Needless to say if you experience any of these, you need to STOP.

Exercise 1: Body Awareness.

Your first exercise, is find a nice flat block with sidewalks and walk around the block for as far as you feel comfortable. Some of you won’t complete the whole block. That is perfectly okay. For some of you this exercise will seem hopelessly remedial. I assure you that it isn’t. The point of this exercise is not to see how far you can walk. The point of this exercise is to increase your awareness as you walk.

Get a bottle of water if it’s hot. Put on some comfortable clothes and nice comfortable shoes. Grab your cell phone—just in case. Before you start, write down the time here_______________.

Now go for a walk. Walk briskly but comfortably. Walk at a pace that you would take if you saw somebody really fascinating, like George Clooney on the other side of the room and he was getting away—I mean, leaving. As you walk, check in with how parts of your body are feeling. Note your breathing. Is it unchanged? Slightly deeper? Much deeper? Are you panting or significantly out of breath? If you are panting or significantly out of breath, this is one of your dashboard indicator lights and you should slow down or stop until you can catch your breath again.

Check in with your muscles. How do your legs feel? Are you feeling nothing at all? Do you feel slight tension or moderate tension in your muscles? Do you feel pain? If you feel pain, please stop and find a place to sit down. If you feel much better after a rest, you may turn around and head very slowly back for home. However, if you still feel a lot of pain, use that cell phone to call somebody to pick you up. There is nothing to be ashamed about. This is simply where you are, and we all need to start somewhere.

Check in with your other muscles. How does your back feel? How about your arms? Is your posture upright or hunched over? Do you feel any twinges anywhere? How do your feet feel as they hit the pavement? Try not to make any moral judgments about whether things are good or bad. Just open your senses and observe.

Whenever you finish and wherever you finish, right the time down here___________.

And the distance here__________________. (quarter-block, half block, 1 block, etc,).

When you are finished, sit quietly and breathe deeply. Allow your body to come to the same state it was in before you began. Once you feel that your breathing and heart rate are back to normal, write the time down here_______________.

Now write in your journal about how your body felt during the entire exercise. If you do this exercise correctly you should have at least an entire page of observations about your body and your feelings. Success in this exercise depends on the richness of your observations.

If you did less than a block, that’s fine. You have found your starting point. Pick a point in your walk that is just before where you experienced pain or were significantly out of breath. This is your activity target. Write your activity target here_________.

Every step forward, no matter how small gets you closer…

Checking in. How did it go? If you did the last exercise and found you needed to stop somewhere in the middle, then you have already found and written down your starting point. However, if you finished the last exercise, and were still raring to go, then you have a little ways to go in finding your starting point. This next exercise is for you!

Exercise 2: Rock the Block.

This exercise is exclusively for folks who finished exercise 8 and were still raring to go. Once again, find a nice flat block, grab a bottle of water and put on some nice comfortable shoes and clothes. Make sure you are wearing a watch and take note of your starting time. Also, take a look at your starting place for your walk. It might be the mailbox in front of your house, or the sign at the trailhead. This starting point is your home base. Start out walking away from home base around the block at a slow and steady pace. Swing your arms at your sides. Look up and be aware of your surroundings. Breathe deeply. Use the awareness skills you gained in exercise 8 to check in with your body. As you finish your rotation of the block and reach home base, check in carefully. How do you feel? Are you tired? Are you energized? Are you perspiring lightly or sweating like a sinner on Sunday? Are you breathing deeply or panting like a dog in heat? If you are sweating a lot or panting or experiencing any other exercise warning signs STOP. If you feel great, go ahead and go around the block again. Each time you pass home base check in with your body and see if you are ready to go around again. Continue until you are tired, or 40 minutes have passed—whichever comes first.

Now note your duration (how many minutes you’ve walked) here____________. And note your number of blocks completed here______________. This is your starting point for duration and distance. Please remember not to judge yourself, this is not a contest. This is not a moral imperative. It’s just information. And this information is an essential element in developing a fitness program that you can happily and safely enjoy for life.

Has the Block Been Rocked? The round robin exercise does a great deal to help you find your starting point. After this exercise, you should have a good idea of a starting duration and distance. The next step is to get a better sense of your exercise intensity. This is simply a way of describing how hard you are working as you exercise. Getting the right intensity level is critical to fitness success. If you work at an intensity level that’s too high, you risk injury and harm. You’re also more likely to quit. If you work at an intensity level that’s too low, you won’t receive as much fitness benefit from your exercise as you could. The next exercise will help you learn about fitness intensity.

Exercise 3: Managing Intensity.

Measuring your distance is one way of determining your intensity, but there is another important method called the Rate of Perceived Exertion or RPE. Now this is a fancy, ten dollar word for what I call the sweat scale. You can think of the sweat scale as monitoring your body to measure the intensity of your effort at any given moment. The sweat scale is a continuum that ranges from 1 to 10. You can think of level 1 as sitting on the sofa eating cheesy poofs. You can think of level 10 as ready to have a heart attack–please call 911. Obviously, you don’t want your workout to be at either extreme of this scale. Level 1 is far too little to get any training benefits. And level 10 is likely to land you in a hospital. Imagine level 5 as being right in between these two marks. Ideally you’d like your workout to land at about a 7 or 8 on the scale. At this level you can easily speak in short sentences, but you couldn’t sing or recite a poem. You are breathing heavier than when at rest, but you are not short of breath or panting. At five, you feel like you are moving at a pace you could do for a long time. At level seven you’re not entirely sure how long you could go for, but you are not begging to stop either. So go back into exercise 2. Do you remember all of those observations you wrote down about how you felt? How was your breathing? How long did you feel you could go on?

Now translate that number into a number on the sweat scale and write that number here______. This was also your intensity. You can use this as a basis of comparison. At this point, you can make a commitment to stay at an intensity of 6-8 on the sweat scale. Now we’re going to repeat the body awareness exercise, and walk around the block again (or to the distance you achieved if it was less than a block). Now as you walk, practice speeding up and slowing down. Try to experience how walking at a 2 or 3 feels. Now gradually pick up the pace experiencing the levels 4-8. What does a 4 feel like? How is it different from an 8? Try bumping it up to a 9. You may need to jog or run to experience this feeling, or you may get there by simply walking quickly. Whatever you do, don’t stay there too long. 15 or 30 seconds should be ample for you to get this feeling. And REMEMBER TO WATCH FOR YOUR DASHBOARD INDICATORS. If you are experiencing any of the warning signs, you need to slow down or stop! When you’re finished, pull out your journal and write your feelings in there.

All about frequency: TIn terms of evaluating your starting point, there’s one area we still need to calculate, and that is your frequency. Simply put, your frequency is how often you work out i.e. once per week or three times a week, etc. If you are already working out more than three times per week, great! That number is your frequency. If you haven’t been working out, then let’s aim for three times per week for now, okay? This allows you to have a rest day or even two between each workout, yet is frequent enough to help you maintain your training effects. If you want to aim for more days per week, that’s fine. But I strongly recommend that you start out at three days per week, experience success, and then bump your frequency up. In any case, I’d also like for you to have at least two rest days per week. This allows your muscles a chance to rest and rebuild as you ramp up your fitness efforts.

Exercise Four: Finding Frequency.

So based on your current exercise levels and the recommendations listed above, select your weekly frequency here: (circle one)

I will work out 3 4 5 times per week, every week. Okay, now that you’ve picked how many times per week you’ll work out, you need to think about how you will work this number into your schedule. Think about your week and think about your life. What days will work best for you? Is it Monday, Wednesday and Friday Mornings? Is it Friday Night, Sunday Morning and Wednesday afternoon? It doesn’t matter which days you will work out, just so long as the rest days and workout days are distributed relatively evenly throughout the week. Just pick a schedule that works for you and stick to it. Circle your Exercise Schedule:S M Tu W Th F Sa

Okay, so What’s the Plan? So with all this discussion of what you shouldn’t do to get fit you’re probably wondering, “So what DO I do to get fit? Was there a plan in there somewhere? Did I miss it?” No, you didn’t miss it. And believe it or not we had to go through ALL of that other evaluation stuff before we could be ready to formulate the plan. And now that we’ve done all that evaluation stuff (you DID do it right?) the plan is very simple. Review all the evaluation exercises you’ve done so far in this chapter. Now collect all the information and fill in the blanks.

Your Exercise Game Plan Duration: (copy from exercise 1 or 2)__________.

Intensity: Review Exercise 3. Pick between 6 and 8 on the sweat scale: _________. Or
Distance: Review Exercise 2. Write your distance here_____________.

Frequency: Copy from Exercise 4:_____________.
Schedule: Copy from exercise 4: S M Tu W Th F Sa

So one more time, let’s establish your personal plan:
I will exercise for ___________ minutes at a ____ on the sweat scale (or for _______blocks/laps/miles) _______x per week on the following days:_____________.

That’s it!  That’s your beginning plan.  Congratulations!  Now get going!

This article shared with permission from thefatchick.com, where you can find even more great articles, tips, videos and expert motivation from Jeanette!

What could Apple’s “super secret” diabetes project be?

News broke earlier today from CNBC’s Christina Farr that Apple, Inc. has a small team of engineers working on creating sensors that can “non-invasively and continuously monitor blood sugar levels to better treat diabetes”. The project is allegedly far enough along in development that Apple is investigating possible regulatory pathways and performing feasibility trials at clinical sites in the Bay Area.

The article suggests that the project is a wearable sensor (either inside or worn in conjunction with a future version of the Apple Watch) that can track blood sugar non-invasively with optical sensors, similar to how the current Apple Watch can monitor heart rate. Such a non-invasive continuous glucose monitor would undoubtedly be a “holy grail” for diabetes, but can Apple succeed where so many other companies have so far failed to deliver?

Just for fun, let’s brainstorm potential possibilities for what this secret Apple Project could be. We’ll sort them by order of plausibility.

Most Likely Possibility: Health-focused Apple Watch “Pro” with an Invasive Glucose Monitor Partner


One question underlying this whole scenario is whether or not Apple really wants to be a medical device company. As Tim Cook himself pointed out to The Telegraph in November, 2015: “We don’t want to put the watch through the Food and Drug Administration (FDA) process. I wouldn’t mind putting something adjacent to the watch through it, but not the watch, because it would hold us back from innovating too much, the cycles are too long. But you can begin to envision other things that might be adjacent to it — maybe an app, maybe something else.”

Interestingly enough, he does mention the possible for an Apple-made companion device or software to the Apple Watch that might be a health device.


That being said, systems that closely resemble non-invasive continuous glucose monitors exist or are on the horizon. The Abbott Freestyle Libre Flash is approved in Europe for continuous glucose monitoring in diabetes, and does not require any calibration with a glucose meter.  (A short-term version called the Abbott Libre Professional is FDA-approved in the USA).


Similarly, Verily (part of Google) has partnered with DexCom to work toward a penny-sized continuous glucose monitor that would be usable for both Type 1 and Type 2 Diabetes and not require calibrations.


Also, implantable CGM should be here soon (Senseonics is currently filing for FDA approval), which is inserted under the skin and worn for 90+ days.
The common thread with all these devices is that they are invasive and all require some sort of display/reader to receive the readings.

Apple could potentially create an FDA-approved Healthcare-focused (as opposed to just fitness) Apple Watch “Pro” that is more robust and can communicate reliably with such sensors. If the wireless connection and stability of the device were medical-grade, removing extra middle-man devices would be a huge boon to patients. Users of such a “Pro” Watch might sacrifice some other features (small size?) or not get a model updated every year, but it would be reliable enough for medical use. (Such a health-stable PRO Watch would be quite useful for Artificial Pancreas projects too).

Most Interesting Possibility: Consumer-grade Optical (or Microneedle) Glucose Monitoring for Everyday Use

Combining my theory that Apple does not want to become a medical device company and the fact that accurate non-invasive glucose monitoring is a feat of titanic proportions, perhaps their top-secret glucose monitoring project is not for medical use at all.

As society becomes more health-conscious and sensor-driven, it’s only a matter of time before the general population starts monitoring glucose. In the diet and nutrition communities, sugar and carbohydrates have become the enemy, and some athletes (without Type 1 Diabetes) actually use invasive continuous glucose monitors while training to optimize their diet and exercise regimens.

Companies like Sano have been working toward non-invasive CGM for everyday use, and Apple has acquired companies (eg C8 Medisensors) working on various forms of non-invasive CGM. Some of these companies utilize optical sensors, and others use an array of microneedles to sample interstitial fluid.

With consumer-grade CGM, people could observe rough trends about their blood sugar. They’d be able to see first-hand how quickly certain foods (eg. cereal, white rice) can spike blood sugars, and how avoiding carbs can keep blood sugars relatively flat. Furthermore, widely prevalent sugar monitoring might not be accurate enough to dose insulin or diagnose diabetes, but it could help raise awareness and promote screening for Pre-Diabetes.

As an endocrinologist without diabetes, I’ve had the opportunity to wear CGM’s in the past, and they have been very enlightening. If I had the choice, I’d wear quite often.

Moonshot Possibility: Medical-grade Non-Invasive Glucose Monitoring for Diabetes

Now this is clearly what the original source is suggesting, but I also find it the least likely. The article itself recognizes the immensity of this challenge:

“Accurately detecting glucose levels has been such a challenge that one of the top experts in the space, John L. Smith, described it as ‘the most difficult technical challenge I have encountered in my career.’ The space is littered with failures, as Smith points out, but that hasn’t stopped companies from continuing to attempt to crack this elusive opportunity.”

Much like Verily’s partnership to measure glucose levels via a smart contact lens, a non-invasive continuous glucose monitor from Apple would be mind-blowing. However, the diabetes community is well-aware of other longshots that have promised much, but never delivered. (Exhibit A: the GlucoWatch).

In addition to the technical challenges, I’m also not sure what Apple’s end-game with such a medical device would be. Would they try to carve out their own niche in the diabetes glucose monitoring space, taking on Dexcom and Medtronic? Would they license their technology to these companies? Would they try to market directly to consumers?

All that being said, I am extremely excited that Apple is focusing their efforts and resources on glucose monitoring and diabetes. I can’t wait!

A promising innovation in insulin delivery: the OneTouch Via patch

The pain of insulin injections is well-documented, and the diabetes community is always searching for better alternatives. One such promising technology is the long-awaited OneTouch Via, an insulin patch pump from Johnson & Johnson subsidiary Calibra Medical.

Designed for both Type 1 and Type 2 diabetes, the OneTouch Via is a very small (2 x 1 x 0.25 inches) patch pump that stores up to 200 units of prandial (aka fast-acting) insulin, which can be delivered by discretely pressing two mechanical buttons on both sides of the pump. It can be worn for up to 3 days, and would be used in combination with basal (or long-acting) insulin.

OneTouch Via Insulin Patch Pump

A replacement for Multiple Daily Injections

Both doctors and patients dread starting multiple daily insulin injections (aka MDI). It means more painful pokes, more potential for public embarrassment, and more opportunities to forget a dose of insulin. Thanks to new classes of non-insulin therapies (eg Victoza, Trulicity, Invokana, etc), starting mealtime insulin can often be prevented or delayed, but millions of people with Type 2 diabetes (and all with Type 1) will still require MDI.

Mealtime insulin usually requires carrying around insulin injection supplies (insulin pens and needles or vials and syringes) and injecting before meals, which can be embarrassing and/or cumbersome. Traditional insulin pumps present their own challenges, as most have long tubing and complicated electronic interfaces that are not user-friendly.

Similar to the V-Go from Valeritas, the OneTouch Via is an entirely mechanical, tubeless, and disposable patch pump. There is no screen or complicated electronics, which keeps costs down, and makes for an easy-to-use interface. The user just presses two buttons down at the same time to deliver mealtime insulin, in 2 unit increments. This can be done through clothing, so a user could easily and discretely take 12 units (as an example) with six button presses done through their fabric.

Another advantage for both types of diabetes is that the OneTouch Via allows users to easily take additional boluses, for small snacks or hyperglycemic episodes that would otherwise require a new injection.

In study data shared at the 2016 American Diabetes Association Meeting, users wearing the OneTouch Via reported injecting mealtime insulin 50% more often than they had previously done with pen or vial, and 88% of them reported that they worried less about forgetting insulin injections.

Unlike the V-Go, the Via can be worn for 3 days and stores up to 200 units (the V-Go stores only 36units and must be changed every day). Also unlike the V-Go, the Via only replaces mealtime insulin and should be used in conjunction with basal (long-acting) insulin.

The Rocky Road Ahead

As the marketing efforts for inhaled insulin and the Valeritas V-Go have shown, replacing mealtime insulin injections in market and mindshare isn’t as easy as one would expect.

While 75% and 100% of providers in the previously mentioned study preferred the Via over insulin pens and insulin syringes respectively, providers in the community can be slower to adopt and more wary of newer technologies.

Also, adhesive patches and wearable devices are not the ideal solutions for all people. Patients can develop skin reactions to the adhesive or feel burdened when a device is stuck to their body, no matter how small.

Perhaps in light of these concerns, the OneTouch Via had been previously slated for release in early 2017, but now might face delays in light of JnJ’s recent intentions to explore the sale of their diabetes division.

Devices aren’t drugs: Insurance companies should not dictate diabetes technology

The diabetes community has been set ablaze after UnitedHealthcare announced an agreement for Medtronic devices to be the “preferred” in-network, durable medical equipment (DME) provider of insulin pumps. Starting July 1, 2016, UnitedHealthcare patients will be funneled toward using a Medtronic insulin pump instead of offerings from manufacturers like Tandem and Animas.

Many diabetes advocates have eloquently voiced their outrage and have been rallying under the hashtags #MyPumpMyChoice and #AccessMatters, and I strongly echo their sentiment that this policy puts “profits before patients”. It’s unacceptable, and both UnitedHealthcare and Medtronic deserve any negative publicity that results from such a short-sighted decision.

To add another layer to the discussion, though, what I find particularly insightful about the controversy is that it highlights the distinction between medication and medical technology. I rarely blink an eye when my patient has to switch brands of insulin, so why is it such a big deal when they have to switch brands of insulin pumps?

Technology is Intensely Personal

Whether it’s Apple vs Samsung, Xbox vs Playstation, Nikon vs Canon, or BMW vs Mercedes, fierce loyalties are found among their users. Beautiful photos of phones and smartwatches adorn billboards across the city, evoking emotions such as envy and desire in a way that no medication can.

iphone 6s verizon billboard

When buying a new device, there’s a curious sense of satisfaction when finally choosing a model after poring over reviews and comparing individual specifications. Making that choice creates a personal connection before it even arrives in your hands.

On a personal level, many of my most touching diabetes patient interactions are due to technology. A recently-emigrated woman came to my office and was overjoyed to find that she could obtain an Omnipod pump, as it hadn’t been allowed by her previous nationalized health system. Additionally, I love watching the eyes light up in patients and their family members when they first learn about continuous glucose monitoring (CGM) and the ability to view their blood sugars on their phone.

In diabetes, harnessing technology to manage a chronic condition brings a sense of empowerment that medications alone can never do. Removing the ability to choose medical devices only adds to the sense of helplessness that underlies too many other aspects of diabetes.

Technology is Defined by Interaction

For medications, pharmaceutical companies create chemical compounds that elicit a desired physiologic effect. Their competition will create a slightly different chemical compound with a similar mechanism of action, and these medications are grouped into the same class (eg Humalog and Novolog insulin). For the most part, they are interchangeable to patients and providers, and insurances frequently prefer one over the other. No big deal — just swap out one pill (or pen/vial) for another.


But for devices, focusing on the desired outcome only tells a portion of the picture. For reference, choosing a smartphone is about more than making phone calls and browsing the web. As Apple’s success has shown, the overall user experience of gadgets often matters more than functionality. The iPhone was not the first smartphone (remember Blackberry?), but its intuitive and simple user experience expanded the smartphone audience from working professionals to college students, children, the elderly, and everybody in between.

When using an unfamiliar smartphone or computer operating system, even a simple task like sharing a photo can seem Herculean. With health technology, the stakes are exponentially higher as potentially lethal medications must be managed by complex user interactions with software dashboards and calculators. Being forced to switch between differing interfaces of insulin pumps and other diabetes technology creates confusion/frustration at best, and gaps in diabetes management at worst.

medtronic-tandemPut simply, there are no “class-equivalents” in the world of devices because they encompass a complex interplay between software and hardware. A Medtronic Pump is as similar to a Tandem Pump as a Blackberry (they still exist!) is to an iPhone.

Competition breeds innovation

To be clear, the outrage isn’t regarding the quality of Medtronic’s insulin pumps, or whether they are inferior or superior to the competition. Rather, the issue is that eliminating competition and choice in the insulin pump market stifles creativity and innovation.

We live in such an exciting time for diabetes technology. For insulin pumps alone, there are touch-screen pumps (Tandem), tubeless patch pumps (Omnipod), color screens (Tandem, Omnipod, and Animas), and cartridge-based pumps (Asante). Each of these features are appealing to different types of users. It’s not one size fits all.

Evidenced by Tandem’s 20% decline in stock after the UnitedHealthcare announcement, it’s hard to believe that such product diversity would exist in a world where insurance companies anoint a winner. Would Android and iPhones have come as far as they have if wireless carriers “preferred” Apple and required a prior authorization for any Android phone?


In the above timeline, notice that Medtronic Insulin Pumps did not noticeably upgrade their user interface for over 10 years… until after the 2012 release of the Tandem T: Slim. Now, the upcoming Medtronic 640G incorporates a dramatic redesign that seems to take some design cues from its competition. Had the Tandem never come to market, I suspect that the next Medtronic would look similar to the previous generations.

Deeper implications beyond diabetes

The digital health revolution is underway, and the future of health technology includes fascinating devices like wearable (or even implantable!) sensors and novel drug-delivery mechanisms, affecting specialties from psychiatry to pain management.

I’ve often beaten the drum that diabetes technology has been a harbinger of the future of health technology (continuous glucose monitors preceded the current infatuation with wearable sensors by about 10 years), and this week’s news suggests a bleak future where established, larger device manufacturers can outmaneuver innovative disruption by strategically partnering with insurance companies.

Free markets and capitalism have been serving the best interests of technology consumers for decades, and such interference by insurers would negatively impact health devices in all areas of medicine.

Call to Action

So what should we do? Make your voice heard, and raise awareness of the issue by sharing posts like this on Facebook and Twitter. Reach out to the pump manufacturers, tell your doctor, and vocalize your displeasure to the insurance companies. DiabetesMine has compiled a helpful list of action points here and will continue to cover the issue as it develops along with other advocacy sites like Diatribe.

As the world of glucose meters have shown, it might be a UnitedHealthcare-Medtronic partnership now, but what’s to prevent UnitedHealthcare from switching to a different pump manufacturer when their current agreement expires?

That’s why we must act now and make it clear that we will not take it lightly when insurance companies try to dictate which medical devices we use and prescribe.


Our Guide to Diabetes Apps for iPhone and Android

The App Store is crowded with diabetes apps for both iPhone and Android, but how do you know which ones to choose? That’s why we tested them out and created a list of our favorites.


MyFitnessPal (iPhone, Android) – For Tracking Nutrition/Carbohydrates

Count carbs with MyFitnessPalMyFitnessPal (Free) is the most popular health app of all time, and for good reason! It has the largest searchable food database, with over 5 million different items, from home-made recipes to fast-food chains and restaurants.

But it’s also one of the best diabetes apps available. Users can track their nutrition for the purpose of weight-loss and/or counting carbohydrates. It’s like carrying a Calorie King guide in your pocket, but it’s searchable and constantly updated.

To simplify the hassle of logging food, MyFitnessPal can even use your smartphone’s camera to scan barcodes and instantly record nutrition information!


MySugr (iPhone, Android) – For Monitoring Diabetes

mysugrBuilt by a team of people with diabetes, MySugr (Freemium) is an adorable app that helps users log their sugars, carbohydrates, and medications. This app features statistics and graphs, including an estimated hemoglobin A1c that updates as you record your sugars.

Like all the other diabetes apps in this article, MySugr includes support for Apple Health, meaning that glucose data can be imported automatically from newer wireless glucose meters like the Accu-chek Connect.

For $2.99 each month, Pro Mode adds reminders to check your blood sugar and the option to generate PDF and excel reports for your doctor’s visits.


Diabetes Kit (iPhone, Apple Watch) – For Monitoring Diabetes

DiabetesKit for iPhoneSimilar to MySugr, the creator of Diabetes Kit (Freemium for iPhone) built the app on his own to help keep track of all his various numbers such as sugars, medications.

The unique aspects of Diabetes Kit are its companion Apple Watch app and its number-driven user interface, with multiple useful graphs and dashboards to help learn from your data. Unfortunately, unlike the other diabetes apps listed here, Diabetes Kit does not include a feature to estimate A1c.

Also similar to MySugr, $9.99 a year unlocks Pro Mode, which includes reminders and the option to generate PDF reports.


Sugar Streak (iPhone, Apple Watch) – For Motivation to Check Sugars

Sugar Streak for iPhoneSugar Streak (Free) is great for people who have a hard time remembering to check their blood sugar. During setup, users pledge to check their sugar anywhere from once to four times each day.

By recording their sugars and fulfilling their pledge each day, users build a sugar streak! As their streak gets longer without being broken, they earn points more quickly, and the points can be redeemed towards small prizes like gift cards.

Meanwhile, the app creates a glucose logbook with real-time statistics like estimated A1c, and can generate reports to assist with future doctor’s visits. Unlike the previous two diabetes apps, Sugar Streak does not track activity/nutrition/medications.

Disclosure: I am the creator of Sugar Streak.


These are just a few of our favorite apps for managing the various aspects of diabetes. While using a diabetes smartphone app might not be for everyone, we think many of our readers will enjoy at least one of our suggestions.   The quality of diabetes apps have a come a long way from just a few years ago, and they should only continue to improve!

Dexcom finally adds Apple Watch support to G5 CGM

On March 14th, Dexcom users were pleasantly surprised to find a new software update availability for the Dexcom G5 Mobile app. The release notes mention that the Dexcom G5 fully supports Apple Watch compatibility for the first time. In addition, they added a Watch Glance view and a quick-launch Complication.

Prior to the software update, Apple Watch users had to use a workaround by using the separate Dexcom Follow app to view their sugars on their wrist.

In addition, the update brings a Today View widget for the iPhone, so non-Apple Watch owners get some goodness as well. See below for a description of these new features.

Apple Watch Glance View


For quicker access to view your blood sugar, the G5 Mobile Apple Watch app has a “glance view” so users can swipe up on their watch face to instantly pull up an instant look at their sugars. Having such valuable information just one swipe away is powerful.

Apple Watch Complicationdexcomcomplication

As complications often do (heh heh), the G5 Mobile’s Apple Watch complication disappoints. Unlike the watchSugar app which directly displays your glucose reading and trend arrow directly on the watch face, the official Dexcom G5 complication only has a static shortcut to the watch app. As such, it’s virtually useless because the previously discussed “glance view” is faster and more graceful.

iPhone “Today View” Widget


Similar to the Apple Watch “glance view”, the “Today View” widget allows users to view their live G5 reading on their iPhone by swiping down from the top of their lockscreen.

With the latest software update to the Dexcom G5 Mobile app for iPhone and Apple Watch, there’s a whole lot to like.

Feature Request for Dexcom: please add a live-updating watch face complication!