Why There’s No Cookie-Cutter for Managing Diabetes

Ann Bartlett

Ann Bartlett has lived with type 1 diabetes since she was 5 years old—over 35 years. As an expert in balancing traditional, non-traditional, and lifestyle health choices, she has been a practicing massage therapist for 24 years for clients ranging from terminally ill to professional and world-class athletes and is owner of the Body in Balance Center, an integrated wellness practice in Alexandria, VA. 

Ann’s father was a founding board member of JDRF. A pilot for TWA, he used his international travels to find Type 1 researchers from around the globe and engage them in collaborative sharing.  He successfully fostered relationships in London, Tel Aviv and Milan and helped create the first international Type 1 diabetes symposium in the mid 70s.

In addition to speaking at conferences as a patient advocate, Ann is an expert patient blogger at HealthCentral.com, and serves as a consultant for Sanofis US diabetes.

You’ve seen the evolution of diabetes technology from the 1970s to today, which developments in diabetes technology do you think have had the most significant impact on overall patient well-being? 

For me personally, the best development has been the CGM. In 1970, we had to use urine and test tape. It was never immediate information, so we had to really know “how we felt” in order to catch a low blood sugar.  I can remember a handful of times waking up to my mom holding my head trying to get orange juice down, also being partially paralyzed for an hour after and trying to work on getting my hands and feet on one side of my body back to functioning normally. Blood glucose meters helped to give immediate information, but it is the CGM that tells you trends and that’s been very helpful to cutting out a number of lows and highs. I have always said, it’s like having eyes to the inside of my body and being able to follow the trends within your body is one of the most successful tools we have.

What aspect(s) of patient care (and wellbeing) do you feel are still being under-addressed through technology, doctor’s appointments, and overall diabetes education?

Under addressed?! Where to begin….as someone who has had diabetes 45 years, the education process blows.  Because I had a solid below 7 A1c, the healthcare system assumed I was an educated patient. In fact, my education was from my years as a pediatric patient, but as an adult, the system assumes that patients will figure it out.  I was always offered nutrition, and only 10 years ago I had my first visit with a CDE, but there was an immediate jump to “you need to start on a pump for better control.” Two problems with this, 1) the RD root was not a fit for my needs and 2) jumping to a pump had explanation for why. The advice felt cookie cutter diabetes care. Where were the steps that needed to walk me to transitioning to a pump?

It wasn’t until I landed in Gary Scheiner’s office at IntegratedDiabetes that I had a full year of working with his team to I understood why I needed to consider a change in my system of care. In my first appointment with Gary, he went over all my diabetes management and said, “Your diabetes management is about 20 years old and it would be wise to upgrade your system of management.” From there I worked with his RD/CDE to update my nutrition education, and then we modified tactics for exercise, daily routine and refreshed things like sick day management. After we had a few months we looked at the blood glucose patterns to talk about where a pump may level out the inadequacies of my current system and we spent another couple of months talking about pumps. Also, Gary’s team was on board when after 4 years on a pump, I was struggling with a rising A1c and I wanted to change to injections. Again, they were on board with helping me make the right choices for me, and the next step was CGM.

I have had diabetes for 35 years and as an adult I had never had this kind of engagement from a doctor’s office. Adult education and refreshers are necessary education and without them we will inevitably fall into complacency in our management.

You have worked hard to stay on the forefront of diabetes research development, sharing that information with your blog readers — what current studies in cure research do you think are breaking the most ground and perhaps holding the most potential?

I love all research and, in particular, I love to understand research that did not meet its end point. Many people like to claim that the cure is out there, but I believe it’s so complicated and we still have holes in theories that looking for a cure is a bit like watching a horse race. I have found that looking at research that didn’t make it, tells us a story about diabetes we didn’t understand and creates new innovation. Let’s take antiCD3 trials, all three failed to meet their endpoint, which basically means that there is a missing factor in how diabetes develops and affects the body.  I often wonder if the same hole that affected the outcome of antiCD3 is what causes a couple of other current projects to have to continually increase the dosages to create a cure. I’m watching Faustman Labs and Insulin Independence to see if they run into the same problem.

I love reviewing all research for new iterations of technology and insulin.  For example, I’m eyeing the work being done by Merck on the polymer-based insulin known as smart insulin. I love the fact that the Artificial Pancreas will help to drive technology and insulin to new levels of efficiency. To breathe life, the AP will require an insulin to have faster uptake, like 5 minutes compared to the 20 minutes available now and redundant sensors for the CGM to keep the sensors from wondering. These advancements will prove invaluable to me, whether I choose to wear an AP or not.

People ask me if I am frustrated that we don’t we have cure, yet. In honesty, I never get tired of learning what research is revealing.  It keeps me motivated and teaches me things about my own body. It’s an endless cycle of learning.

If you could make any one aspect of daily diabetes care simpler (for you, for everyone) what aspect would you choose? 

In a word: data.  Diabetes is so driven by our data and we walk around with a ton of it hanging on our bodies, or in our purses, it’s ridiculous how much we are accumulating daily. I would like to see better integration of that data.  I know Medtronic is working to create a platform for pumpers to see data streams side-by-side, but I also think that data collection needs to vastly improve for all people with diabetes, so that includes type 2 population, who barely have basic access to tools and good education. So we need platforms that will give people who are on injections similar opportunities to look at data streams. That may involve combining something like a fitness wearable to help with data uploading. Technology is certainly going to move us in to new levels of self-management and better outcomes.

At Dario, we certainly understand the need for not only great data but the ability to analyze that data and share it with our healthcare team! The Dario app definitely strives to sync all of that data into one easy-to-use platform! (Read more here…)

Thank you, Ann!


Pediatric Endocrinologist Says, “First, We Listen”


Dr. Jennifer Shine Dyer is a pediatric endocrinologist, social media enthusiast (@EndoGoddess) researcher, blogger at EndoGoddess Musings, and mobile technology entrepreneur at Ohio startup Duet Health and creator of the app, “Endo Goal.” She is focused on implementing engagement platforms with compensated feedback loops for chronic diseases such as diabetes.

Dr. Dyer is a board-certified physician in both Pediatrics and Pediatric Endocrinology previously at Nationwide Children’s Hospital affiliated with The Ohio State University College of Medicine in Columbus, Ohio where she recently earned her MPH degree in health behavior studies.

What are a few aspects of the patient experience that you wish more endocrinologists could learn about?

I am really proud to be a part of the diabetes online community…one of the largest and most active of all online healthcare communities. I wish that endocrinologists would recommend the diabetes online community as an important resource for support and information to their patients. In general, endocrinologists are afraid that the online environment will provide misinformation to their patients. What they don’t understand is that the community itself, particularly when there are a lot of voices involved like the diabetes online community, polices itself with regards to misinformation and mischief by those without the best of intentions. In other words, the diabetes online community is a democracy where the intention is to provide accurate and helpful information to its participants. Thus, endocrinologists should not worry but rather embrace the diabetes online community.

Where are today’s diabetes technologies falling short?

Data management interoperability is a major flaw of all of our technologies currently: no universal cord or software program for each of the glucose meters and insulin delivery devices (pens, pumps) at one time. Furthermore, there are no glucose/insulin/carb data management solutions that allow wireless cloud-based data updates in real-time without manual entry or manual downloads to a central platform. In our clinic alone, we have a huge mess of cords that we must sort out to download data from devices at an appointment…a universal cord would be a start in the right direction so that valuable time at an appointment is not spent trying to locate the right cord.


When working with a patient who is struggling with the demands of diabetes management, how do you as a healthcare provider focus on their emotional state in their life with diabetes and the support that they may or may not be able to find from diabetes technology?

In our clinic, we are constantly trying to find the best ways to support our patients that are struggling. We are always learning and changing our approach as we learn more. However, currently, the first thing we do is listen. Listen to what the patient is saying…or not saying. In other words, what is the biggest problem that they are facing in their life unrelated to diabetes. The first priority is to have each patient create a diabetes goal and to help them to see how that that diabetes goal can help whatever problem that they are having in their life. The second step is to help formulate some easy answers specific to that problem for the next several days that the patient feels that they can be successful at. Finally, if the problem that they are having requires specific psychological support such as in a case of bullying or teasing at school about their diabetes, we have a wonderful psychologist in our office that can see them in conjunction with their diabetes appointment.

What can the diabetes online community do to help alleviate fears of misinformation that endocrinologists have?

Endocrinologists are always listening to the results of studies and improvements in outcomes so anytime the diabetes online community can be studied and improved outcomes published in medical journals, then endocrinologists will eventually lose their fears. In the meantime, all of us in the diabetes online community must continue to inform those who don’t understand about its power and natural policing of information. It’s up to us to keep up the effort until everyone understands.


Thank you, Dr. Dyer!

Actor Jim Turner On Getting to Diabetes Acceptance

Jim Turner was diagnosed with type 1 diabetes in 1970 as a teenager in high school. Glucometers didn’t exist. Pumps, CGMs, and even a steady long-acting insulin didn’t exist. But Jim is also a well-known actor whose starred in TV shows such as Arliss back in the late 80s, and more recently Granite Flats and Anger Management. He’s known in the diabetes community for his true-to-life videos at dLife that are always a charming mix of both humor and serious aspects of living with type 1 diabetes.

Can you imagine going back in time to the 1970s during your first few years of life with type 1 diabetes, and how different things would have been if you had had today’s technology like glucometers that give results in 5 seconds, insulin pumps, and continuous glucose monitors? Do you feel as though the technology would have impact far more than just your overall blood sugars, but any parts of your life or emotional wellbeing as well?

I think that, of course, my blood sugar management would have been better. But emotional well being; I’m not so sure. I think the initial diagnosis is such a shock that having more stuff to learn how to use doesn’t help things. I’m a fairly simple guy. I have many reasons for not going on the pump but a main one is that it seems like a giant mess of stuff to figure out and frankly, I don’t want to. I’ve seen perfectly intelligent people struggle with how to simply test their blood sugar. I think it would have slowed my acceptance of my diabetes initially.

Where do you feel, in your own personal experience living with diabetes, diabetes technology is still falling short?

Right about the time that I started testing my blood sugar in 1980 with the old Chem-Strips (no meter, just an eyeball guestimate based on the color the strip turned after being dipped in urine) I had this idea for a thing about the size of a dime that would be surgically inserted into your bloodstream and then somehow cordlessly forwarded to a device you carried around. This was during the heyday of the cordless phone. Wireless was not a thing yet. We now have the CGM that works the same way, but I still kind of like the thing inserted in your blood stream. As far as actual things, I’m not much of a visionary. I love my CGM. I don’t mind taking shots. I read about the artificial pancreas and it just makes me nervous — what if it reads your BG wrong and pumps you with insulin. I know this is silly but that’s where I am. If it was left up to me, diabetes technology would probably wither and die right where it is. I’m awful.

You’ve shared a great deal through dLife episodes and interviews about hypoglycemic episodes during work and home-life and how supportive your family and coworkers have been…do you have any tips or suggestions for helping people educate their friends and family about diabetes and get the support they need?

Oh jeez. I think just talk it up. Talk about it all the time. I think people are pretty bored with my diabetes stories by now. The main thing is not feeling any shame about it. Talk, talk, talk. I got really mad playing golf the other day. Really mad at myself. I threw a club. The first thing my friend asked was if I need something to eat. Like NOW. I said no, I’m just mad that I suck at golf. He said, are you sure, why don’t you test? I did. It was my golf. So… find a way to accept it (the diabetes) and yourself and let people know. If people want to get educated about it, there’s a lot of wonderful books — your book “Your Diabetes Science Experiment” is a great way to understand it. But the person has to make the commitment to read it. I don’t expect my friends or family to go reading about my diabetes. That’s why I continually talk about it.

You have a wonderful way of talking about diabetes with both a lightness and a serious respect for how overwhelming it can be…do you have any personal mantras or philosophies that help you face diabetes each day?

I used to meditate and I think even though I don’t anymore, I think that continues to help me deal with the moment I’m in. I try to stay in the moment instead of racing off into the future to deal with things that haven’t happened yet or running back into the past to fix things that can’t be fixed anymore. A character in the movie, The Adventures of Buckaroo Banzai, says something to the effect, “wherever you go, there you are.” Man, is that the perfect diabetes guideline, or what!

Thank you, Jim!

Life as a Type 1 Mom

Moira McCarthy is first and foremost, a mother to daughter Lauren, who was diagnosed with type 1 diabetes at age 5. She’s also a writer, author, and public speaker who has shared her experiences and knowledge on raising a child with type 1 diabetes through books and on her blog, DespiteDiabetes. McCarthy is known for her intense combination of straight-forward and stern yet continuously compassionate advocacy and wisdom on raising a child with diabetes. You can learn more from with her latest book, Raising Teens with Diabetes: A Survival Guide for Parents.

Your daughter was diagnosed with type 1 diabetes more than 17 years ago…what would have been different for you as a parent taking care of a young child with diabetes if today’s technology (pumps, CGMs) were available and readily used in kids like they are today?

Wow! Back then we had NPH and Regular insulin, meters that took a minute to count down and required a “hanging drop of blood.” I feel like when I tell people that I should also say “and we had to walk barefoot in the snow uphill both ways to get it!” But … things really have improved. Yet, I have what may be a surprising answer for you: I think if I had today’s technology, I’d be pushing from the start for the newest and the coolest — pump and CGM and whatever else comes down the road. And here’s the thing: I’m not sure that’s best for the parent or the child. There is something about having to learn the physiology of shots and checks and how insulin works in the body that I think gives you an excellent foundation for living life with diabetes on board … and I am not quite sure parents of newly diagnosed kids get if they go to a pump that tells them how many carbs something has and estimates the insulin on board for them.

I also think a CGM (continuous glucose monitor) — which my daughter loves, by the way — can be a confusing tool that leads folks to overreaction if they are not yet in tune with how their body works with diabetes. Heck, my own daughter, who really knows her diabetes has found herself having more lows from overreaction when she was first on her CGM. A really famous diabetes researcher who has had T1D most of his life told me the first time he ever had a low requiring assistance was after he went on a CGM. Now, he and my daughter reminded themselves that there are certain things about their diabetes that they just know, and that they are smarter than even the CGM. But how is a newer parent to diabetes supposed to know that?

I am not saying tools that do great things are not awesome — they are — but sometimes I worry that newbies are getting too technologically advanced too quickly. Maybe it should be like driving a car. You start with a learner’s permit and someone has to oversee (or you start, really, by riding a bike as a kid and getting to know the roads etc.).

I also think another piece of technology is wonderful yet tricky: the internet and Facebook. I’m telling you, it would have been amazing to have the instant support you can find out there back when my child was diagnosed. But it might have confused me and scared me. I tell parents of newly diagnosed kids all the time: Be very selective about what you read on the internet. It’s not all true, and some of it is people looking for attention. Life with diabetes is very hard and extremely challenging…but it’s not the dire, sad, horrid life some post about out there. I think I might not have had the same vision of “It’s going to be okay!” I had back then thank to our endocrinology team, had I been able to cruise the internet.

How did you go about balancing or dividing the responsibilities of your daughter’s daily management between you and your husband?

Oh, that’s kind of funny. Divide? Ha! Let me start by saying: this was all my fault and let what I did be a cautionary tale to all. Because I was pretty sure from day one that no one, even my husband, could take care of my daughter’s diabetes the way I could. So I owned it. And kind of pushed him away from it. And it was so easy for him to just let me (heck: I would too if someone tried to push me away! Diabetes is hard work!). So it very much became my job and role — and I worked full time just like my husband! But there was the thing: I travel for work. And this was back before cell phones and even pagers for a while. So when I went on the road, it had to be his job.

At first I’d come home and freak out because he had not color-coded the logbook the way I liked. And then her endocrinology talked to me about it. Here is what he said: “Moira? It’s his right to have his way of doing things, and your way is not the only right way. So long as I am okay with things, you need to be too. And I am. Let him do it his way. And when you get home, just move forward. Don’t go back and review to “test him.”

So I did. It took a lot of self-control from this control freak, but by changing my goal from “the logbooks aren’t color coded etc. etc.” to “She’s alive and smiling,” it allowed my husband to reclaim his equal role in my daughter’s life. And now as an adult she and her dad are BFF’s, so it’s all good.

What aspect of parenting a child with type 1 diabetes do you feel is still under-acknowledged or under-addressed healthcare professionals? Where can they improve how they support parents of children or teens with type 1?

I have two answers:

1) FEAR. From what I see and hear (and lots of parents reach out to me for information and help, so I see and hear a lot from others, too), we are improving our tools, our insulin and our data, but parents are getting more afraid than ever in the past. I honestly feel it is the #1 “Complication” facing parents of kids with diabetes now, and it spreads into the kids. Moms tell me their children are afraid they are going to die in their sleep. Parents are afraid to let their kids go off and play or sleep over or anything. I’d love to see healthcare professionals address that in both a one-on-one and a large scale way. Help parents — and patients — see that they really are going to be okay; that T1D is not going to kill them in an instant (or that it rarely, rarely does that). Maybe do some true studies on deaths and show real stats as well as causes to help ease minds. It breaks my heart, and kind of makes me glad my daughter was little before this kind of terrible fear was gripping so many, because I know if we were new to this I’d be right there in that fear.

2) Transitional care. I think we are really great as a society at treating kids with T1D, and are really great at treating adults with T1D. But that shaky time in between? We need to focus on it. I know some practices already are — Dr. Jake Kushner at Texas Children’s is all about finding the solutions to this. So is Dr. Howard Wolpert of Boston. The teen and transitional years are tough anyway; we need to find a way to treatment that makes it better for all. I’m quite passionate about it and doing my best to help make that happen.

What piece of diabetes technology do you feel is the most life-changing for your daughter today? If she had to choose only one device to keep, which would it be?

My daughter was the first young child in the Boston area to go on an insulin pump back in the day, so we are big technological folks. She also went on the very first Minimed CGM (anyone remember it? Not the shell but the big two-piece thing. I still have it in a drawer!) and then was one of the very first to go on the “shell-shaped” MM CGM when it first came out. I feel like Kip at his wedding in “Napoleon Dynamite:” “I love technology…lalalalala” (extra points if you get that).

But I also learned as time went on that technology was only as good as her embracing of it. So when she came flouncing out of her endocrinology appointment three years ago waving a pen at me and saying “guess what? I’m on shots!” I did my best not to freak out. She’d been pumping for 12 years (she’d only stayed on that first CGM for a year, by the way) and said she just needed to “shake things up.”

And you know what? It turned out fine. She was in her own transitional time and she — smart girl — realized that all she really ever knew was the pump. She decided if she went back to basics somewhat, she’d be forced to pay more attention to her diabetes and learn (or as I said above — build her own foundation). It all turned out fine. She did go back on a CGM and is quite happy with it now, finding it helps her fine tune things with less stress. And since she is a young adult, it also gives her some peace of mind after nights on the town.

So while I’m a huge pump advocate, for now I’d say the CGM.

There is one other piece of technology though that folks take for granted today that was incredibly transformational for us when it came out: Ketone meters. Wow. The difference in knowing what ketones are during sickness up to the moment instead of a few hours off literally changed our lives. I’ll never forget using it the first time. It’s an incredible tool and insurance should better cover strips for it for all.

The Four Most Important Factors in Building Successful Diabetes Software

Hope Warshaw, MMSc, RD, CDE, BC-ADM, though not a person with diabetes, has worked in diabetes care and education since the late 1970’s. “To say I’ve witnessed a lot of change in technology and care is an understatement,” says Warshaw. She says she vividly remembers the first glucose monitors. Portable? Not! Time consuming? Yes! We’ve come a long, long way, but when it comes to technology we always want smaller, sleeker, and speedier.

Fast-forward 35 years, Warshaw spends the bulk of her professional time consulting with diabetes and nutrition-related companies and writing books and articles for people with diabetes and their caregivers. Warshaw is the author of several best-selling books published by the American Diabetes Association including Diabetes Meal Planning Made Easy and Guide to Healthy Restaurant EatingLearn more about Warshaw at her website. Warshaw recently joined our Scientific Advisory Board to help ensure we achieve our mission of helping people with diabetes thrive.

There are a lot people building software to help people with diabetes. Where do you feel like we are coming up short? What do we need to be focusing on that’s not getting enough attention?

Hope: Four words capture my thoughts – connectedness, stickiness, simplicity and management-enhancing. To an extent, these concepts overlap. Let me explain. Keep in mind, though I don’t use these devices several times a day, I’ve observed the marketing blitz and glitz for many devices over the years.

Connectedness: People with diabetes and caregivers who do a lot of daily monitoring are clamoring to not have to re-enter their results, whether glucose results or grams of carbohydrate, either into a device or to record on paper. That’s downright annoying! As a RD, CDE, a frustration I’ve had over the years has been the disassociation between the quantity of carbohydrate (and other nutrients) consumed and glucose results. I think back to the early (and still used) glucose monitoring booklets. They only allowed space for glucose results and medications. This essentially disassociates the impact of carbohydrate (and food in general) on resulting glucose results, particularly post eating.

Stickiness: People are often enamored with a new device, app, or technology and will use it a lot when they first get their hands, or fingertips, on it and start to use it. But what about six months, a year later? Are they still using the device…has use of it stuck and become an appendage, of sorts? What matters most in diabetes care is consistently using a device to help you manage diabetes day in, day out.

Simplicity: To achieve stickiness, noted above, a device needs to be simple to use, quick to do a test and easy to carry.

Management-enhancing:  Here’s where I believe the rubber meets the road when it comes to monitoring and thus tight control. Research shows us there’s no benefit in diabetes management to test, test, test and generate lots of results if you don’t know how to or just don’t translate these results into improving care and/or you don’t have a provider who uses them. It appears that monitors (and other diabetes devices, like pumps integrated with CGM, are moving towards helping people take actions based on results to improve care. Think about the first baby steps towards an artificial pancreas with threshold suspend on a pump or the meters which give advice about insulin dosing. We have work to do in this area! I’m often disheartened that even very smart and diligent people I work with who generate lots of glucose data have never really been taught pattern management – how to see glucose patterns and use the numbers (whether from a meter or CGM) – to change medication dosing (particularly insulin). Don’t get me wrong, I well realize people with diabetes are trying to live life to the fullest and are just trying to squeeze diabetes management into their busy life.

What role does connecting people living with diabetes to each other play in improving outcomes?

Hope: From my observations (and engagement) over the last few years, as the Diabetes Online Community (DOC), has grown exponentially – A LOT. But that’s simply from listening and observing. Because social networking, and specifically social networking among people with diabetes, is still in its relative infancy, there’s not been a lot of objective research to study how this engagement can impact and improve outcomes.

There are a few bits and pieces of research, conducted in people with diabetes specifically and in people with other chronic diseases, which is starting to show that for those who regularly engage (get and give support), social networking can be advantageous. Keep in mind this is always going to be hard to measure objectively and advantageous is not just the impact on clinical measures. Quality of life matters, too!

In that case and on a purely observational level, I’m overwhelmed and heartened by the valued relationships that have been formed thru the DOC and how these connections have grown into jobs, organizations, relationships, and advocacy initiatives to improve diabetes care and technology. How can that not all be great stuff for people dealing with this really tough 24/7 disease?

How do you see technology changing the way educators support people with diabetes in the decade to come?

Hope: Ah, the crystal ball question! If there is one thing we know from research study after research study, which in my world is diabetes research with an overlap of weight control research, it’s that people need constant and continuous SUPPORT. With the notion that support is essential to positive outcomes, health care systems will be developed to dovetail our technological capabilities with systems to deliver the needed care and support.

From the vantage point of “diabetes education” or “self-management training” as it’s called today, we’ll need to break down barriers and create new successful models, many which should be virtual, of delivering the education, management support and psychological support that we know is crucial for successful outcomes. Yes, we’ll need new reimbursement models and will need to figure out payment models to deliver telehealth. I’m confident we’ll get there and I believe this will all be good for people with diabetes.

Support & Smart Devices Are Key to Success According Educator & T1D Mom

Elna Narula is first and foremost, a mom of a type 1 daughter, and second, an RN, CDE. Ever since her daughter Svati was diagnosed thirteen years ago, she has worked as an advocate for diabetes research, lobbying on Capitol Hill and in the national media with her daughter, organizing Research Summits, and setting up a nonprofit to fund researchers to give them a voice and get funded.  Elna is passionate about disseminating information on advances in type 1 research and technology, and spreading awareness about resources available to those who are newly diagnosed.  Currently she works as an independent contractor providing diabetes education, developing programs, and consulting for diabetes biotech and research companies.

What got you interested in supporting people with diabetes?

I was an RN working in the field of gestational diabetes when my daughter was diagnosed at age 9.  Suddenly I really “got it” about just how different type 1 is from GDM and type 2 by living with it 24/7 in our family. I took off a month of work to find out what was being done around the world to cure this disease and met a lot of wonderful people in the process.  I ran a support group for families in the area, because it was apparent that this was such a help—everyone having support and sharing the best resources out there, to get through this.  Families and kids (…and actually anyone diagnosed with any form of diabetes) need one another, particularly when first diagnosed.  Sharing knowledge about one’s own experience, education, the latest in technology and research, benefits everyone.

What skills or qualities lead do you feel lead to patient success?

As I just mentioned, having a good support network is huge. Feeling that you are heard by members of your healthcare team, is also very important. It doesn’t matter whether you are a child or an adult—what does matter is that you have as much control as you can over this disease.  That means feeling empowered and armed with good info about what’s out there to help you cope, and being valued and understood, surrounded by people who “get you”  – hence, the tremendous value of the greater diabetes community—through online websites and support groups, diabetes camps, Children with Diabetes conferences, JDRF and ADA walks, the blogs, the books—making good use of the resources available—that’s key.

Receiving good diabetes education from the onset is also very important.  It is sad, but not everyone has access to quality diabetes care or education—or know where to find it. As a CDE, I strive to meet people where they are mentally, emotionally, physically—and to teach and help them meet their immediate goals.

I have found that those living with diabetes who keep physically active do better all around.  Those who excel in spite of their diabetes, whether as a diabetes advocate of some kind, or doing something else in another field—whatever it is, if you live your passion, you will be successful no matter what you do.

Having a proactive, can-do attitude works wonders.

As a parent of a daughter with diabetes, how do you want technology to help you connect with and support her?

My daughter is an adult now so she no longer needs to report blood sugars to me, and update me on everything diabetes-wise.  If you prepare your kids well, they will, hopefully, do well when they are older and managing on their own—that’s the goal, right?  However, that’s not to say that I don’t still think of things that can happen or worry, or that my cell phone is not with me all the time, because that’s just how it was these past thirteen years living with this thing—being there in case of a call about a hypo or something.  Once a mom of a type 1, always one…

It was the cell phone that made all the difference for us—so I am grateful that we had that when she was diagnosed. (It wasn’t always the case with those who came before us…)  It was the connection to the school nurse, to her when she was at a slumber party or away at a track meet.

We are entering an era when mobile health is fast accelerating and already there are other ways to share data beyond a phone call or text message.  Having the ability for BG data to automatically be sent to other mobile devices is wonderful, and it is only going to get easier and better.  Parents want to be able to see what their child’s blood sugar is, to be able to see what is happening in real time with their CGM, to know how much insulin one bolused from a pump or gave via a pen.

There are a number of apps out there and devices in development that will make a real difference. How nice it will be to have an insulin pen that sends dosing info to a smartphone and has other features like a pump or a bi-hormonal device that mimics what your pancreas can do—that makes decisions for you so you don’t have to think about how much to bolus and correct as you go through your day.  (My daughter participated twice in Ed Damiano’s trial and we have seen firsthand how well it works and how rapidly this technology is progressing.  It will have cloud-based support and remote monitoring capability as well, so that will be great for a parent, significant other, or healthcare provider to be able to see what is going on, too.)

What kinds of mobile technology could help educators better support patients?


Having diabetes devices such as pumps, meters, and glucometers that automatically transmit data to a mobile device will make it so much easier.  Not having to use cables or have patients come into a clinic or office to download the data is ideal.

The Dario is one such example of a smartphone-compatible meter but what is also neat about it is that it is sort of like a Swiss army knife.  It is an integrated all-in-one device where you can simply pull out the lancing device or the strip needed to test, rather than having separate components.  Put it all together and you have one smart meter!

What I hear most from those living with diabetes is that they want simpler and smarter solutions. Endos and CDEs want the same—open, agnostic systems that work for all devices, not just one for one company and its particular products. I think we will get there—just don’t know when.  There is a lot of exciting development going on in this field today.

Until there is a true cure, it’s all about making life with diabetes less time-consuming, less complicated, and less of a daily hassle.

From Color-Coded Blood Sugars to the Data Age, a Talk with Sarah Kaye, T1

Sarah Kaye is a type 1 diabetic, diagnosed in 1988 at the age of 4. Known in the diabetes online community as the “Pump Queen,” Sarah has used or trialed most insulin pumps available, from her first pump, the Disetronic H-Tron+, to the Accu-Chek Spirit, Omnipod (old and new), Animas Ping, Medtronic Revel and 530G, Asante Snap, and her main love, the Tandem t:slim. In the end, though, she is truly just a diabetes tech geek at heart. She’s been a blogger for just over 5 years at Sugabetic with topics ranging from overall diabetes management to other things like pregnancy, hypothyroidism, and various opinions about diabetes-related products and gadgets. She’s also a mother to her amazing son!

Looking back at the technology that was available when you were first diagnosed with type 1 diabetes, in what ways would your life be different today if you were still using those same forms of technology, types of insulin, etc.?

Sarah: Oh, gosh. I was diagnosed in November of 1988. We only had an old Accu-Chek II glucometer (see image below).

Accu Chek !!

There was no fancy logging machine that downloaded all your numbers into a fancy graph on your computer. Instead we just had an old account book that mom wrote her notes in, and we kept glucose readings and carb-exchanges in for our future diabetes appointments.

The meter used strips that could either be used in the machine or could be used alone and the colors of the strip after the blood was wiped off could be discerned against colors on the bottle to get a rough estimate of what your glucose was. Since we were on a sliding scale (an old method used for determining insulin doses), this wasn’t that much of an issue to get the exact number. Insulin delivery was as technical as using a calculator occasionally, but most of the time it wasn’t needed as foods were exchanges and insulin was simply drawn up in a needle with one unit for a certain number of exchanges or one unit for a glucose reading between one range, and two units for a readings between another range, and soon.

It was more simple back then, but things also weren’t as accurate as they are now. If technology hadn’t progressed, I don’t know if I may have had more complications by now or not. I know I probably wouldn’t be as dedicated to my control as I am now because I like to see my data and I like to be able to fine-tune as much as possible.

In so many ways, the technology we have today for managing diabetes reduces stress and anxiety, but with any technology there are malfunctions…what are the most frustrating glitches and malfunctions you experience?

Sarah: The most frustrating for me now is how everything I have has to be charged: my pump, my meter, and my CGM (continuous glucose monitor). Add that on top of having an iPhone and computer that has to be charged as well, that’s a lot of things to be charged. With everything going so “green” now, sometimes it would just be nice to go back to batteries where one battery lasted a whole month in a pump or 6 months in a meter, not a charge that lasts one week.

Also having pump failures like occlusions are never fun because you have an interruption of insulin—whereas with shots, you have insulin working all the time, which in my mind is good but frightening as well. I like being able to know I can disconnect or stop my pump at anytime. Of course, you also have things like site failures you have to watch out for too. Having a pump does help a lot in the grand scheme of things, but at time, it can cause just as much stress as having diabetes itself.

I rarely have glitches or malfunctions with my meter, and usually, if I do, I just pull out a backup meter. That is one good thing about technology progressing as much as it has – most meters don’t cost as much as they used to. Some, when they are new on the market are upwards of $100 or so. Now, they’re roughly $20. So, if your meter messes up, you can likely get another one cheap. It’s the strips that cost so much more.

You are known as the Diabetes Technology Queen for your experience with practically every insulin pump and glucose meter out there…what do you feel is still lacking in the world of diabetes technology?

Sarah: Well, I don’t know if I’d call myself that, but I have had a lot of experiences with insulin pumps and meters as well. Right now, what’s lacking, in my opinion, is a valuable and fully intuitive way to actually use all of this data you’re collecting.

Almost every meter and pump are designed to be uploaded, but most of the software is proprietary, so you can upload your meter in one place, and your pump in another, and your CGM in another, with the exception of Medtronic who has the ability to upload all of theirs in one place, provided you do use their entire system.

For those who don’t, they’re still faced with the mismatched reports. And, for the reports, most aren’t user-friendly. It’s one thing to have the best fit of diabetes device for you, but if you can’t understand or use the information in the reports or have to have a degree to decipher it, then there’s really no point in having it, in my opinion. Patients need to be empowered, and the right technology can help that in a big way if it works in every aspect of care.

As we both know, diabetes is 24/7 and there are no days off! In your own life, what helps face diabetes each day?

Sarah: You know, some days, I don’t even think I think about it. It’s a sort of autopilot thing that I know it’s something I have. Other days, it’s a pain in the tail. Sometimes, I want to scream and complain. But then, I think about it and realize that it’s okay to get frustrated, but it’s not okay to stay frustrated. So, I go and have my pity party for a bit and then I clear my head through walking or singing and then come back to whatever upset me to begin with and try to tackle it with a clear mind. Sometimes it’s the next day before I even try to figure whatever it is out.

Overall, it’s my knowing that if I don’t take care of my diabetes, I’m not just letting myself down, I’m letting my family down. They should never have to pay for how I feel because of diabetes through my actions or attitude, so I do my best to keep it in check, and ask for help if I need it.

Thank you, Sarah!

“Know Yourself, Know Your Diabetes.”

Leann Harris has lived with type 1 diabetes for 14 years. As a Positive Psychology Coach, working with people with diabetes across the globe, at Delphi Diabetes Coaching, she focuses on the mental fears and emotional challenges of thriving with diabetes. She is passionate about helping others learn resilience skills, counteract shame and blame, and overcome diabetes burnout. Her motto is ”Know Yourself, Know Your Diabetes.”

As both a patient living with diabetes and a Positive Psychology Coach, what aspects of daily diabetes management do you feel spark the most anxiety and stress?

I feel it’s all the daily mental choices I make. I want to make the best choices for my health, but I want to avoid lows, avoid going high, avoid feeling hungry, avoid being disrupted during a work day to check my blood sugar, avoid complications, and avoid feeling as if all I do is act like a pancreas. I have competing avoidance desires and sometimes that’s what makes me stressed out. Anxiety is fueled by being trapped in this avoidance loop. We work ourselves up trying to be in control or trying to be perfect. We become frustrated in a day filled with: “Oh, look at that 326 mg/dL,! Arugh! I forgot to give insulin for lunch,” It’s a wonder we don’t ask for crystal balls alongside our meters.

If we feel out of control and the need to DO SOMETHING, we shame ourselves when the right answer isn’t apparent. Our actions follow our beliefs. If we believe we are incompetent, dumb, or lazy, we behave like someone who is incompetent, dumb, and lazy. Alone, it’s hard to see where this pattern begins and ends, which is why it’s so difficult to change our beliefs and our behavior and stop blaming ourselves. It’s my job as a Coach to help people see that their judgments aren’t facts and that life can be better.

What could help a patient go from a place of anxiety and stress around their diabetes to a more confident, empowered place?

The Positive Psychology approach is to step back and try and see our lives for what they really are. The main goal is to cultivate the conditions, processes, and beliefs that allow for someone to embrace their unique approach to life and to thrive. As a Coach, I help people understand the negativity bias we’re born with and how take steps to see the reality of life, which has both positive and negative pieces. It’s actually when someone takes in all of reality — the good, bad, and neutral — that people make progress. We are more than our blood sugars and more than what we ate today. We are even more than just people with diabetes. We don’t usually allow ourselves the freedom to maximize the skills we were born with and, with this broader perspective, to savor the pleasures, strengths and values that have nothing to do with a disease. Every person has a unique set of talents that, when revealed and put to work, make not only diabetes self-care easier but give a new meaning to our lives as a whole.

In what ways could a caregiver or physician help to not only support a person struggling with anxiety around diabetes but also be sure not to add to it or trigger it through their interactions with that patient?

For starters, remember that knowledge does not equal change. Patients need your expertise, but when only facts and fears are discussed in a visit, most people can’t change their beliefs and behaviors. Think about how many people smoke with full knowledge and the desire to quit. Instead of a cigarette, many people use food to self soothe. Unless you replace that food with a different form of comfort, they don’t have a viable path to change. Help your patients find alternative behaviors. Clinicians are human too, so it’s easy to become frustrated with people’s lack of response to the facts. Believing in someone’s capability, even if it’s hidden by circumstance at the moment, will do more to motivate than fear ever does. Compassion wins in the long run, every time.

I truly believe that the more self-aware of a clinician you are, the better care you give because you have examined what things actually helped you. Unless you start treating aliens, what helps you will certainly help another human being. You have more knowledge than what’s just in your head, and patients need your knowledge tempered with understanding and wisdom.

Focus on what does work for each person. I realize in an 8 minute visit this might be hard to do. But just as it’s easy to point out the 456 blood sugar, look for patterns that went well. Say things like “I see for 5 days that week your pre-lunch blood sugar was under 130 mg/dL. How do you think you accomplished that?”

In what ways do you think the newer developments in diabetes technology both relieve and/or trigger those stressful emotions in day-to-day diabetes management?

Being a geek long before I was a diabetic, I welcome our new electronic overlords. I have mostly Christmas-morning-type feelings when I think of new technology, and the only time I’m stressed is if the battery is dead. My hope for technology is to take over some of this churn from task switching inside my head. That’s why I’m really looking forward to any version of the artificial pancreas: I haven’t forgotten what it’s like to have something act like a proper pancreas and let my brain be normal and not a brain/pancreas hybrid. In the meantime, anything that is small, lightweight, and works with my existing devices is a complete win.

I also want my technology to mine my data for me. I want software to alert me to trends and tell me the statistical significance of a proposed change to my care plan so I can discuss the idea with my doctor. I want to harness the power of the data to lessen the mental stress of how to make the best choice with the information available.

Remember, knowledge is empowering – that’s why we developed the Dario glucose meter. Dario combines a glucose meter that plugs directly into any smart mobile device with  personalized information and support to make life easier for people with diabetes.

Supporting College Students with Diabetes

Christina Roth, living with type 1 diabetes, is the President and CEO of the College Diabetes Network, a national non-profit organization she founded after realizing how little support there was for students with diabetes during their college years.

The College Diabetes Network is focused on supporting the college students with type 1 diabetes through the challenges they may face at that time of their lives, such as finding a community that understands their disease to ensuring they have proper health care resources. The College Diabetes Network’s mission is to empower and improve the lives of students living with type 1 diabetes through peer support and access to information and resources.  

Balancing diabetes in a college environment (and trying to fit in with the traditional college lifestyle) could very well be deemed one of the most challenging times in life with diabetes…in what ways have the most recent developments in diabetes technology helped improve life for a diabetic college student?

I think that the most recent, most significant advancement in technology for college students with diabetes is the continuous glucose monitor. College students have more on their plate now than they ever have before – classes, homework, studying, competitive internships, student clubs, sports, jobs, and friends. When you’re on the go so much, something like taking out your meter and checking your blood sugar can be difficult to remember. Having a CGM allows college students to see what their blood sugar is at the touch of a button. Because student schedules are so sporadic, CGMs also help students to see trends and give them more context than just checking their blood sugar.

Of course, CDN is the second best development in the lives of college students with diabetes in recent years.;)

What’s a piece of knowledge or strategy has really improved your success over the last few years?

It might sounds cliché, but connecting with people through CDN has played a huge role in my success in many different parts of my life. While I was in college, connecting with others on campus kept me motivated and supported in everything I had to do to balance diabetes and college. After graduating, CDN’s network has supported me professionally, making it possible to grow and develop the organization, as well as my own professional development, with many in the community serving as mentors and friends.

What aspect of technology or support is still missing that would truly improve life for a college student with diabetes?

A viable telemedicine option for college students would be hugely beneficial to their diabetes management and well being. Students sometimes move hours away from home for 9 months out of the year. It can be difficult to determine which state you should be seeing a doctor in, and how to get to and from appointments.

An automatic, seamless syncing and integration of data to all diabetes devices would also be extremely beneficial for college students. Much like a CGM, this would help students to see trends and provide them (and their doctors!) with more context on what the numbers really mean. 

How can CDN help a college student and how can students connect with CDN? 

We know from experience that there’s a power in having friends around you that “get it.” CDN can help students to connect with a community of people on their campus who understand what they’re going through. We also connect them with information and resources that they need to handle situations specific to life in college – dating, internship opportunities, alcohol, studying abroad, sports, professors – we’ve got them covered.

To find out more about starting/connecting with a CDN chapter at your school, contact Program Director Jo Treitman at jtreitman@collegediabetesnetwork.org

By tracking your measurements and automatically inputting your data right into your smart phone, the Dario Personal Smart Meter fits right into the lifestyle habits of students today.

Preventing Tragedy: How a Doc Was Driven to Transform Diabetes Self-Care

Dr. Paul RosmanDr. Paul Rosman is an accomplished endocrinologist who has dedicated his career to simplifying the way diabetes is treated so that everyone with the condition can live healthier and happier lives. As a member of our Scientific Advisory Board, he wants to help those living with diabetes get actionable information out of their meter so that they can live their dreams with as little interference from diabetes as possible. We recently spoke with him about his passion for diabetes and his interest in Dario.

You spent 27 years as a practicing endocrinologist in Warren, Ohio. Why was this a “dream come true” for you?

Dr. Rosman: In my practice, I met many people with diabetes who struggled. Some fought and succeeded – that was always wonderful. There were many patients who could not conquer the burdensome legacy of their diabetes complications and some died. I was left with the memories of the strength and courage I witnessed and it left me believing in people.

However, too often the tragedies were preventable.  I kept finding myself thinking, “If they only know how to manage their diabetes earlier.” I saw this as an unmet need. My research, and that of others confirmed for me that this was truly something that needed to be fixed. So, I figured out how to show people what they could do to manage their diabetes better than before, using information they already had and knew about.

I became interested in when treatment worked and why that was different than when it didn’t. Working with shift workers in steel mills on assembly lines or in hospitals taught me about sleep and time of day. I began understanding how recurring events, like interrupted sleep, impacted hormone levels and discovered that they were tightly connected. This led me to consider how individuals’ life events – not just food, but sleep patterns, physical activities, and stress levels – can impact blood sugars in a predictable way.

This challenge kept me alert, excited and growing in a busy and demanding solo practice. My dream had been to practice medicine with challenging medical problems where I could learn every day, grow my expertise and make a difference in prolonging and improving the quality of people’s lives. There it was.

What excites you about Dario?

Dr. Rosman: Dario can talk! Dario can talk to people with diabetes, and it can provoke an urgent phone call if the need arises.

The exciting challenge is to personalize our diabetes management tools. Dario can say different things to people engaging in different sugar changing activities as they go throughout the day. Dario can show people when their body works for them in managing their diabetes better.

Dario can warn them of impending problems and what actions to take to avoid them before they occur and when the danger is likely to be over. Dario can tell them when their medication starts to work, when to consider (with their doctor) when to alter their medication dose, and when their different medications are likely to stop working. It can also warn them that the medicine they just ingested may last for 5 days if that is the case, can make their sugar too low, considering the levels that were just recorded.

Dario can tell them when they need to check their sugar just because they begin an activity that is likely to cause a dangerously low or unwanted high sugar level. If integrated with a daily calendar it can tell if someone is going to be doing sports they never do or the things they usually do at the same time every day. Dario is a brilliant application of reliable technology to bring obtainable clinical information into actionable knowledge for predictable outcomes – and all with perhaps with only a handful of sugar checks at the appropriate time!

What are the key challenges that doctors have supporting their patients with diabetes?

Dr. Rosman:

 1. Docs don’t know what it means for each individual patient to “win” with diabetes. You have to ask the patient to find that out. Target HbA1c’s are nice, but sustaining that success is the real goal if people are going to enjoy the legacy of health that is promised but not always delivered.

2. The script that docs work with is cluttered with data that means nothing usually because it is about what has already happened and does not usually allow patients to get predictable outcomes in the future.

3. Docs want to give medicine to people, but sometimes less is better. Docs don’t seem to know when that is. They don’t look to see what people are really able to do for themselves, and what they cannot do. They also don’t look at what glucose control systems still work in people even though they have diabetes.

4. You cannot address the needs of someone adequately when your major metric, blood sugars, can double in 10 minutes and fall by ½ in 20 minutes and you don’t expect to see that person or talk with them for the next 3 months. That makes no sense.

How do we make things better?

Dr. Rosman: 

1.   Look for positive things individual patients are doing, encourage them to build upon their successes, rather than focusing on the negatives that can make an office visit a depressing, functionally useless confrontational experience.

2.   Stop overloading doctors, nurses and patients with cluttered data no one can use.

3.   Talk with or have a trained nurse talk with people with diabetes more frequently – even twice per week – if they need it. Docs should be guides for people to get their bearings about their diabetes, and as caretakers, supporters and providers they need different tools and a different approach than is being used now. Diabetes is an intimate disorder, and doctors need to treat it with that in mind. It is not part of their training unfortunately.

4.   Learn to look for and find the recurrent daily events that impact sugar trends consistently. That’s the way to get an early success and multiply it.

If you could help every person with diabetes understand one thing, what would it be?

Dr. Rosman: You can manage your diabetes well and live your life with a legacy of health, productivity and joyfulness! Let’s show people with diabetes and those who care for them how to do that.

Dr. Rosman is a recent addition to the Dario Scientific Advisory Board. Thirty years ago, as Dr. Rosman was beginning his career helping people with metabolic disorders, he saw how badly diabetes management approaches were failing patients. This has inspired him to spend most of his career researching and validating a new approach that could work for both doctors and patients. He has helped build an online diabetes university and tested out the management theories with thousands of people living with diabetes. The results were transformative and confirmed his hypothesis, inspiring a journey to build tools to help everyone with diabetes to realize their dreams for healthy and meaningful lives.

Educator of the Year Dreams of a Smart Meter Future


When Gary Scheiner talks about the future of diabetes technology, we listen. He understands diabetes both as someone who has lived with type 1 for almost 30 years and as an internationally renowned Certified Diabetes Educator. His is author of six books, including the famed Think Like a Pancreas and recipient of the 2014 Diabetes Educator of the Year by the American Association of Diabetes Educators. He actively coaches people around the world at IntegratedDiabetes.com. He also recently joined our Scientific Advisory Board to help ensure we achieve our mission of helping people with diabetes thrive.

How important has diabetes technology been to improving outcomes?

Gary: To be honest, it should make more of a difference than it has.  Patients continue to struggle to achieve and maintain reasonable A1c and stable glucose levels despite the advent of sophisticated pumps, meters, and downloading software & apps.  There is often a disconnect between using technology and benefitting from technology.  It takes a motivated and well-trained patient (and support system) to generate better outcomes.  One possible exception:  Continuous Glucose Monitors (CGM) seem to make a difference for almost everyone in terms of cutting down on the frequency & severity of hypoglycemia.

However, people with diabetes certainly have better quality of life through new technologies.  The latest devices and software can make living with diabetes considerably more pleasant — less time consuming, less painful, more flexible, more engaging.  This should be viewed an “improved outcome,” but it rarely is considered by the healthcare industry or 3rd party payers.

Gary: You’ve worn practically every diabetes technology device out there…In what areas are we still falling short?

One of the major areas where we fall short has to do with the speed with which insulin works.  Our so-called “rapid-acting insulins” aren’t even close to matching the speed with which pancreatically-produced insulin works.  They’re really just “rapider than regular”.  This is the major cause of after-meal blood sugar spikes and hypoglycemia with exercise, and it is hindering progress in developing an artificial pancreas.  Otherwise, my personal wish list includes a true all-in-one blood glucose meter (no loose parts to carry around), a CGM that integrates with a cell phone, and a full-feature patch pump that allows dosing right on the device (without requiring a remote control).  I’d also like a way to make carb counting easier & more accurate.  Perhaps a wand to wave over the food item, like Dr. McCoy used on Star Trek to diagnose and treat virtually every health malady.

Gary: How can smart meters help support diabetes educators and their patients?

The key to truly benefitting from BG meter data is to present the information in a clear and organized way.  Overall summary data is nice, but we really need to look at and evaluate data by time of day.  There needs to be a quick/simple way to categorize readings as pre-meal, post-meal or “other”, and then be able to chart the data according to mealtime.  The meter needs to be universally downloadable and viewable remotely as well as in-person.  We work with clients all over the globe, so we have to be able to see their data in an online format, or they have to be able to easily transmit the data or specific reports to us via e-mail.

Gary: What features should we be working on next?

Dario is the closest I’ve seen to a truly integrated system.  I’d love to be able to test on the meter without having to first plug it into a phone, in case I don’t have my phone with me at the moment.  A small display on the meter would be great.  I’d also like the test strips to be more easily accessible.  If it allows me to complete the entire BG checking process in under 10 seconds, I’ll be impressed.

Thank you, Gary!

Read more about the Dario Glucometer on the Dario website.

Diabetes Doesnt Mean You Have to Stop Living


Mike Lawson is a self-proclaimed social media junkie and a doctor-proclaimed type 1 diabetic. Since his type 1 diagnosis, Mike has used the Internet and social media to connect with other people living with diabetes and to receive help with staying healthy. His YouTube series, “My Life As A Pin Cushion” is a positive, comedic way for him to share some of the lessons he has learned living with diabetes and to spread the positive message that a diabetes diagnosis doesn’t mean that you have to stop living. Mike is also documenting the training for his first marathon at MikesMarathon.com.

What inspired you to start training for a marathon?

Mike: I’ve wanted to run a marathon for years.  I have friends that run and it’s always seemed like an accessible super-human strength that I could acquire if I just put my mind to it.  Running 26.2 miles is currently way outside of my abilities, and at the place I’m sitting right now feels almost impossible and scary.  This past March I cheered on friends that were running in a marathon and I was overwhelmed with a feeling of jealousy.  Why was I just sitting on the curb with my Starbucks instead of running?  That night I signed up to run the Oakland marathon on March 22, 2015.

Do you have fears or frustrations around managing diabetes during your training and your future race?

Mike: Running is so foreign to me right now and I’m just slowly picking up my pace.  Today, my blood glucose levels are not interfering with my short runs  too much.  I’m worried, however, what long runs will look like.  I’ve been trying to take a read-before-doing approach to training, and so far most I’m just reading books from marathoners…not marathoners with diabetes.  I’m worried about how to carry glucose.  I’m worried about stopping to test.  I’m worried that diabetes might get between me and the finish line.

How do you use diabetes technology to help manage your diabetes while training? 

Mike: I currently test my blood before and after a run.  I’m also using a Dexcom Continuous Glucose Monitor (CGM) that will alert me if my blood glucose level gets too high or low.

Understanding how Dario works (connecting you more directly to your doctor, tracking all your meals, doses, BGs, etc.), how do you imagine a smart meter could help you train? What features—whether data analysis, integrations, community tools, or something else—would help set you up to succeed?

Mike: I would love to find a way to connect the dots a little better.  I want to find the patterns.  Right now I need to go to one place to see when I ran and how far I ran.  Then to another place to see my BGs before and after.  And then another place to see how much insulin I had on board and when my last meals were.  It would be nice to know that, for example, my blood glucose level starts dropping around a particular mile in a run. Or that I tend to avoid hypos if I eat a banana before a workout.

I’m tracking my training at MikesMarathon.com with videos and written blog posts.  I’m certainly not an expert marathoner—I’m just documenting the journey.

Thank you, Mike! Good luck with your training!

Did you know that the Dario glucose meter and app helps you manage your diabetes together with your physical activity and even integrates with your Runkeeper! You can read more here or download the app here.

How Patient-Centric Smart Meters Can Deliver Better Diabetes Health

William Polonsky small

William Polonsky

Upon his joining the Dario Scientific Advisory Board we had a chance to ask William Polonsky some questions about how he sees the future for people with diabetes and what we should be doing to improve health outcomes for people with chronic illnesses 

Meters have seen tremendous advances over the past twenty years, yet improvements in health outcomes have not kept pace. Why?

There has been a steady impressive improvement in making blood glucose testing less of a hassle and more convenient – there’s no doubt about that whatsoever. The reason we haven’t seen impressive improvement in long-term glycemic improvement is that there hasn’t been a tandem improvement in how we make good use of those numbers. Making a device convenient is a great first step, but if it doesn’t make it interesting and helpful enough for patients and doctors to make good use of the data than we shouldn’t expect to see improvement in results.

If you could build any feature into a Smart Meter like Dario, what might it be?

I would build in structured home experiments, involving tests before and after a specific event (repeated over a period of days), so that people can use their meter and get a summary of the results in a way that it could answer important, interesting and engaging questions for them. I wonder if my insulin bolus calculation works? How well do I do at lunch or dinner? How good am I at actually guessing my blood sugar?

The guessing one is an interesting example. The most important issue is whether or not you are good at guessing, or noticing, when you are low.  As a first step, at what low number do you and your doctor agree that you should stop what you’re doing and take action? The most dangerous answer to this question is when a patient says “it depends”. I remember talking to a guy with a very high level job and he said, “It depends.” So I asked, “On what? What if it’s 40?” And he responded, “It depends on what I had been doing, whether I took insulin, how recently I exercised, when I had last eaten, how I’m feeling and more.” And I’m thinking, “You’re at 40, there’s not enough sugar going to your brain, and you’re going to engage in a complicated calculation while your blood glucose continues to drop?  Not a good idea!.” So I work with him and say, “Let’s find your number.”

So we work to understand, first, how many times were you low, then determine how many of those times did you accurately guess that you were low.  Basically, it doesn’t matter how close you are to guessing correctly the actual number. The real issue is can we help you get better at knowing when it is time to take action action to catch and treat a low.

Have you see any evidence that connecting patients using technology can provide positive social support?

There’s no question that we have seen, and will continue to see, a remarkable ability for technological innovations to have an enormous positive impact on helping to connect people, in particular helping people with diabetes to feel less isolated and to learn from each other. And we know there are tremendous health benefits when people feel less alone with diabetes, that people understand what they’re going through, that they’re are people out there who are rooting for them.

On the other side, there are definitely some challenges that come with connecting people online. 

We know that one of the challenges of connecting people – and we see this on the internet quite a bit – is that there is often a lot of advice given that is crazy and in fact sometimes harmful. I don’t know if we have actually counted the positive versus negative advice – which side would actually win – but we still want to encourage connecting. But are we encouraging people to spread ideas that are flat out wrong?

I’ve always wanted to get someone like my good friend Dr. Rich Jackson of the Joslin Diabetes Center to have a weekly online column where we identify one “fact” about diabetes, such as an alternative treatment of some sort, being spread from person to person via social media and take a close look at it. Do acai berries or cinnamon, for example, really help? What can science tell us?  What is known and what is not known?  Is it possibly true but has not yet been investigated? People are free to ignore evidence, but it would be a really cool addition to add a little unbiased, “scientific light” to these online conversations.

From Coping to Flourishing: How a Better Mindset Can Transform Health

Riva Greenberg

Riva Greenberg is an author and patient advocate living with type 1 diabetes for over 40 years. I recently spoke to her about her research into flourishing with diabetes. As our Dario™ tagline is Thriving with Diabetes, Together, this resonates closely with our mission. We want to transform the humble glucose meter into something more. 

What’s the difference between coping with diabetes and flourishing with diabetes?

Coping and flourishing are two different orientations for living with diabetes. Coping depicts struggle, you are fighting to come up to what society calls “normal.” A coping orientation is problem-focused, paying most attention to what’s not working.

Flourishing, conversely, is solution-focused. It’s looking at what is working and building on that. Flourishing says wherever you are – hope and possibilities are before you. I’ve talked to hundreds of people with diabetes who are flourishing, who have full, robust, healthy, happy, meaningful lives – often because of diabetes. Their diabetes motivated them to take better care of themselves and reshape their priorities.

In the language of chronic illness we are so used to hearing the word coping, that we don’t stop to think about its connotation. But, notice, your body has a different physiological response to both words. Say “coping” and you feel tense. Say “flourishing” and you feel relaxed and energetic.

For those who are deeply immersed in a coping mindset, how do you break through to a flourishing one?

It begins by shifting your focus from what’s not working in your management to what is. Pause to notice and acknowledge what you’re doing well. Take it in and feel good about yourself. Also hold a vision of how you’d like your life to be. Holding a picture in your mind is very powerful. Your unconscious will begin to move you toward your picture through the choices and decisions you make and actions you take.

And this doesn’t just apply to patients. This can help health care providers be more effective when they start from a flourishing approach?

Most doctors work with people with diabetes from a coping orientation. It’s what they’ve been taught. They look at where we’re falling short and attempt to fix the problem. For instance, if you bring your logbook to your doctor and half your numbers are out of range that’s what he or she will notice. But they could equally notice that half your numbers are in range. That’s what they’d notice working from a flourishing approach. They’d congratulate you and then ask, “How did you do that?” with awe and appreciation. Then they’d help you figure out how you could do more of that.

I think the first shock for health provider, when I teach them how to work from a Flourishing Approach, is how little they truly listen. Listening more and talking less is a key principle of the Flourishing Approach as are empathy, strength-building and collaboration. I like to say, “Rapport before Report.” See me before you dive into my numbers. While I know “patient-centered” is the buzzword in healthcare, the Flourishing Approach recognizes that there are two experts – the health care professional on the medical aspect of diabetes and the patient on his or her diabetes and life. Together, much more is possible.

I also describe a visit with a health professional who’s using the Flourishing Approach as a “Happiness Intervention.” Wouldn’t you feel happy working with a health professional who is looking at what you’re doing well and congratulates you? Another benefit for health professionals? Patients want to please you, which means they do better, and they want to come back.

Could you give an example of the inner thoughts of a flourishing mindset compared to a coping mindset in a “life with diabetes” type of situation?

In a coping mindset I may spend a lot of time worried I’ll get complications. I think I don’t do anything right when it comes to my management. I beat myself up for getting high blood sugar numbers and it feels like diabetes runs my life. I often feel angry and resentful.

From a flourishing mindset, I see a high blood sugar and wonder what happened without the self-recrimination. I’m also able to see something positive diabetes gives me.

Personally, I know diabetes has made me healthier. It has given me great motivation to eat healthy, walk an hour a day and keep my weight down. It’s given me appreciation for all that I do have in my life. It’s given me great friends through this work and the joy of this work.

Are these conscious decisions or an issue of innate temperament?

I think they are both. Some people naturally have the capability to see the positive. They also feel, “I can do anything!” Others don’t come by that naturally, but they can be taught, coached and supported to shift their thinking. The adage is, “Practice makes perfect,” but a more apt expression might be, “Practice makes permanence.” What we practice becomes a new habit.

Where can someone turn to get help with transforming their mindset?

Like myself, a health coach who helps individuals shift to this perspective and work toward their personal goals, people can look for a coach, or a counselor if they’re having difficulty.

If health professionals are interested to learn how to work from a flourishing approach, they can contact me. I give workshops across and outside of the country. I was just in Bangalore, India, teaching the health professionals at an amazing diabetes clinic the Flourishing Approach.

There are also books in the positive psychology field on flourishing and positivity, and my own book, The ABCs Of Loving Yourself With Diabetes, is an empowering series of essays to strengthen one’s resilience and put flourishing into practice.

I’d like to share two last thoughts. One, it’s simplistic, but by focusing on our successes we grow stronger and more successful. And two, attitude is contagious. Don’t surround yourself with people who are negative. They will bring you down. Find people who, as Pollyanna as it sounds, look for the good in life. That may just rub off on you.

Riva is committed through her research, writing, workshops and lectures to help others live an exceptional life, not despite having diabetes but because of it, using diabetes as a catalyst to create a healthier, happier, more meaningful life. Riva is the author of three books on diabetes: an instruction book for managing diabetes, Diabetes Do’s & How-To’s, 50 Diabetes Myths That Can Ruin Your Life and the 50 Diabetes Truths That Can Save It and the primer for developing emotional strength and resilience, The ABCs Of Loving Yourself With Diabetes. She writes about her own experience on her blog Diabetes Stories.

Strip Safely: Patient Advocate Bennet Dunlap Pushes for Greater Meter Accuracy

Bennet Dunlap

Bennet Dunlap

Strip Safely: Patient Advocate Bennet Dunlap Pushes for Greater Meter Accuracy

Bennet Dunlap is a parent of two children with type 1 diabetes and one of the creators of the Strip Safely – an initiative to ensure that regulations require the highest feasible level of test strip accuracy.

We recently interviewed Bennet about his effort to make the latest proposed FDA guidelines on meter accuracy in the United States responsive to patient needs.

Early this year, the FDA proposed new guidance on meter accuracy How does this impact people with diabetes?

Bennet Dunlap: Yes, there were two guidelines in fact. One proposal for individual and personal use. The other draft was for meters to be used by health care professionals in the hospital or clinic.

But let’s take a step back, because there are two big issues with meters. First there are some that fail to preform to the accuracy standards for which they were approved. Diabetes Daily has an excellent piece that outlines the problem. Second to that the accuracy standards required in the USA can and should be tighter.

First: There are meter systems in the US that are approved by FDA that are not keeping up to the level of accuracy they were approved to deliver. That issue is what we started StripSafely about. I want to be very clear, StripSafely is not about any brand or strip or meter. It is about all delivering the accuracy so people with diabetes don’t have to think twice about it.

There is a “click bait quiz” about accuracy, see what you know here in this Strip Safely Quiz. Go have a look, we’re not gonna tell ya what star you are but we are not gonna farm your interest either–well, unless you join the StripSafely mailing list–but at least we are fair about making that a clear sign up.

I also want to be clear. I am not a doctor. I am not a PhD, engineer or a scientist. But, folks – I am making this up. I am happy to share the issue with copious footnotes here.

Secondly, the accuracy standard for meters was last set in 2003. In general it called for meters to be +/- 20% – 95% of the time. Technology can and should advance. Hence the need for new guidance proposals.

What was proposed? What are the key issues at stake here?

A lot is proposed. The proposals are 30 to 40 pages each.

Key issues in the guidance are accuracy, labeling, lot release criteria, and a partridge in a pear tree. Within each, there is a fair amount nuance. For example, the drafts call for different accuracy level for personal and professional use. Labeling the box so patients can choose accurate strips, but often our insurer makes that choice for us.

A very key issue is that, even with these new standards, the old stuff based on old standards will still be approved and able to be sold. It will be cheaper since no R&D investment in upgrading will be needed. Forgive my cynicism but what do you think you insurer wants to pay, less or more?

How can people living with diabetes impact the outcome?

When the FDA proposes new guidance there is a comment period, 90 days. Anyone interested, and people with diabetes should be interested, can comment to the dockets. At Strip Safely we have draft comments and links to the FDA dockets. It is not much harder than commenting on a Facebook status except there isn’t a “like” button.

The more people with diabetes who comment the bigger influence we have in comparison with the interest of strip marketers who may be able to profit from less accurate less regulated strips.

So if nothing else, those who dose insulin to live and breathe may want to suggest to FDA that the new rules be specifically labeled to dose insulin. That may help create a situation where prior devices that lack that label can’t be seen as meeting the dosed insulin requirement. Is that a stretch? Yes it is maybe more than what the FDA is asking for.

The FDA doesn’t have a lot of official opportunities for PWDs to share our views on meter accuracy. The last rule change was in 2003. So if the FDA is listening, let answer the questions they ask and one they didn’t ask. Commenting is very easy, take two minutes and is part of the StripSafely site. Here are several “Cut and Paste” ready sample comments here.

We need to drive people to the dockets.

If FDA sees a huge turn out from people with diabetes, and I think they are seeing that now, the diabetes online community’s influence will shoot up. That is good; we need to balance economic interests.

If you could look at the future of smart meter technology, what features or services would you like to see beyond just great accuracy?

You don’t need a crystal ball to see the future of diabetes. You probably have what you need and that is a smart device and the Cloud. The future is making information more effectively serve the needs of people with diabetes. That currently means their smart phone and maybe their smart watch, and who knows, maybe even the Google Glucose-Sensing Contact Lenses. 

It isn’t just blood glucose measured by a finger stick. It is all that crazy information that come up in a day with diabetes, you know, all the silly little inadequate measure of what we call life; finger stick, CGM info, insulin on board, working out, stress, Mondays, etc. It all meshes together and in diabetes care it is all separated and walled off into little clumps that not talk with each other. We need a common Diabetes User interface, a D.U.I…wait that may not be the best name for it. I wrote a piece about this future in a post on my blog here.

Bennet’s other projects Drinking with Diabetes project, a resource for families sending type 1 students to college. Living with type 2 diabetes himself, Bennet is also an integral member of the Spare a Rose/Save a Life campaign supporting the IDF’s Life for a Child Program. Read more from Bennet at his blog, Your Diabetes May Vary.


Dario welcomes Ginger Vieira as our own community leader


We are proud to welcome Ginger to Dario™ as our own community leader.

Ginger Vieira is an author and community leader who has lived with type 1 diabetes and celiac since 1999, and fibromyalgia since 2014. As Editorial Director at Diabetes Daily, a cognitive coach, certified personal trainer, and Ashtanga Yoga Instructor, she helps nurture success in people living with chronic illness. Her personal strategy towards thriving with any chronic illness is to maintain an ambitious attitude and always being willing to learn and adapt. Her books include “Dealing with Diabetes Burnout,” “Your Diabetes Science Experiment” and “Emotional Eating with Diabetes.” She also produces short videos on life with diabetes at her YouTube channel. Ginger has a Bachelors of Science in Professional Writing from Champlain College.

What People Wish For in a Lancet


Blog 18.3

Here at Dario, we are committed to making the experience of procuring a drop of blood as convenient and painless as possible until the day when bloodless monitoring is viable. So we recently interviewed over 200 members of the Dario community to learn about their views on lancets.

(Thank you to all who shared their views!)

As you might guess, those who responded were frequent checkers. 85% checked at least two times per day and most checked four or more times. Two thirds of the respondents had type 1 diabetes, while the rest had type 2.

The most interesting trend was that although every lancet is labeled for a single use – you are supposed to put in a new lancet every time – only 25% of respondents actually changed their lancet every time. The rest are reusing them, typically until they become painful to use.

We were most interested in how our community wants the lancing process to be improved. The most frequent requests were smaller lancets and integration with the meter itself. This validates that our approach with Dario is on the right track. We are proud of our innovative, all-in-one system: our lancets are only 30 G and part of a pocket-sized device that has everything you need to secure a drop of blood and check it’s sugar content right on your smartphone.

What are you looking for in a next generation lancing device?

Our research and development team is listening closely!

Send us your details here to receive Dario news and information.

Events: We Support Walk for Diabetes Youth 2014 #NewZealand – 9 March 2014

Screen Shot 2013-11-24 at 10.06.42 PMHere at LabStyle Innovations, we like to help bring awareness for anything and all good things that help support the diabetes youth movement around the world.

On March 9, 2014, towns across New Zealand will gather to walk for Diabetes Youth.

DYNZ has recently announced its  first National Walk to raise awareness about Youth with Diabetes.

They have set out to create an event that will not only bring national public awareness to youth with Diabetes, but to also act as a signature fundraising event for DYNZ and local organisations around the country.

The misconceptions about Diabetes is boundless and especially when it comes to youth. Their goal is to bring to the forefront the differences between the types of Diabetes, how it affects the children of New Zealand and the challenges families face in the day to lives of young diabetics.

If you want to get involved, reach out to walk@diabetesyouth.org.nz. You can also stay up to date by visiting the organisation’s National Walk Facebook page.

How the Diabetes Online Community Spared a Rose to Save a Child This Valentine’s Day

Valentine’s Day is a special day, no doubt. It’s a celebration of love where usually the most common gift is a bouquet of roses. For children with diabetes in underdeveloped countries, this Valentine’s Day was even more special, all thanks to people who chose to spare one rose from their bouquet and donate the value of that rose to the “Spare a Rose, Save a Child” campaign organized by Diabetes Online Community (DOC) in support of the Life for a Child Program.

The campaign was launched last year and was met with great enthusiasm from the Diabetes Online Community, which raised over $3,000 in only week.

This year, the DOC has set the bar higher, aiming to raise $10,000 for the cause in two weeks leading up to Valentine’s Day. Harnessing the power of social media, the community urged people to tweet using hashtags like #sparearose, post on Facebook and blog in order to raise awareness about the campaign and encourage people to spare a rose for kids with diabetes. As it turns out, all the tweeting, Facebook posting and blogging has paid off: together, people who chose to buy an extra rose raised nearly $20,000, which was double the original target.

Since the launching of the Spare a Rose campaign last year, it has already raised over $22,500 for children with Diabetes in developing countries.

The money raised goes towards providing insulin, test strips and other medical supplies that are critical and necessary to the survival of these children. Recently, the “Life for a Child” program that organized this campaign has signed up 8 more centers in countries like Cambodia, India and St. Lucia. These centers will be joining the existing 35 centers and together they provide life-saving care to 11,200 children. In most of these countries, the Life For a Child program is the only source of insulin. Without it, most of these children have a guaranteed death sentence.

Next time you’re buying flowers for someone special, consider sparing one to save a child’s life. Not only will you make that special someone’s day, but you will be making a huge difference in the life of a child with diabetes.

New Year – New Resolutions (Here’s to Making Them Stick!)

There can be bumps and hills along the journey towards self-improvement. But when a year ends and a new one is upon us, it feels easier to refocus on our untapped potential. But too often we think of all the possible things we can do, or rather the things we should do in order to avoid these bumps and hills.

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Most of the time, New Year’s resolutions are just promises we make to ourselves, but deep down know we just can’t (read: won’t) keep.

Some of us try, and some of us succeed, but sadly there are more of us who make these promises with the knowledge and understanding that it won’t last. Still, we’re all determined that maybe this year will be “my year”—the year you decide to put shifts in gear, save money, get into shape, eat healthier and maybe, finally kick that terrible habit (whatever it may be) to the curb.

Because diabetes requires its own kind of hustle and bustle, it can be even more difficult to maintain a New Year’s resolution. It can leave you thinking, “What’s the point? Resolutions are just doomed to fail.” But pick your chin up because here are three simple and straight to the point resolutions that might end up sticking, and who knows…maybe you can use Dario to help you out along the way!

1. SIMPLICITY: It’s always best to start simple. Think of something you’d like to change. For example, we’re all guilty of forgetting to check our blood sugar now and then. You should always know what your glucose levels are and test yourself on a regular basis. Sometimes, it’s the things that you must do on a daily basis that we forget about, or put on the back burner. MAKE IT A PRIORITY! Believe it or not, this kind of information is quite important in managing your diabetes. At MyDario, we believe in simplifying diabetes management. Using “Reminders” in our free diabetes app, you can receive a push notification when you should be measuring your levels. You can then easily enter your blood glucose level into the glucose meter, the amount of carbs you’ve consumed, your exact insulin dose, and more.

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2. GET REAL: If you’ve never been the “wake up in the morning and go for a run” type of person, then you might have a hard time starting now. But that doesn’t necessarily mean you can’t give it a shot and maybe try something a little less intense. Making a change requires taking a risk and taking steps (baby steps if needed) outside of your comfort zone. Some exercise is always better than no exercise. Always remember that it’s ok to exercise the way that’s suitable for your lifestyle. In the “Logbook” feature of Dario, you’re able  to “tag” your meal, your current mood or any kind of physical activity you’d like to log. Let’s say you just ate dinner. Did you go for a walk? Log it! (USEFUL FACT: Did you know just 20 minutes of activity can lower your blood sugars 15% or more?)

3. BREAK DOWN THE BARRICADE: Those bumps and hills I spoke about earlier brings me to number three; take a minute to write down what your roadblocks have been in the past and how they’ve stopped you from doing what you’ve wanted to do. Once you are capable of identifying these barricades, it will be so much easier to figure out a way to surpass them–hopefully even before it occurs. As time moves on, it’s easy to forget what you want to accomplish in the new year. When you make note of how your diabetes is “trending” in the app, you have the option to take a look at your “Overview” which allows you to view every bit of information you may need in order to see what works for you and what doesn’t. Plain and simple; make a list, check it twice, and if you forget, you’ll have your list to go back to. From there, it’s only onward and upward.

Life these days is never simple. But challenging yourself is always good. Keep a food journal, log your exercise for the day, and remember–Dario’s here–happy and ready to help. You can also search the database for the foods you desire and if you just cooked a fantastic meal, why not log it?! Don’t forget–one step at a time. After all, Rome wasn’t built in a day.