I proudly present Samantha Katz as Exhibit A: the graduate student from Northwestern University who (along with project partner Erik Schickli) won last year’s DiabetesMine Design Challenge Grand Prize, and was subsequently hired by Medtronic Diabetes to help design their next-generation insulin pumps. (See yesterday’s big Medtronic announcement.) Samantha is living proof that “crowdsourcing” exercises like this contest can shake Pharma’s big tree.

This year, Samantha is one of our expert judges for the 2010 contest. Here’s what she has to share about it all:


DBMine) What got you interested in designing for diabetes?

SK) I am naturally drawn to fixing things; for example, products that do not work as intended or services that are misaligned with the recipient’s needs.  This led me to pursue a degree in design concurrent with my MBA.  However, the turning point for narrowing in on diabetes came when my teammate in the 2009 Design Challenge told me about the challenges his mother faced daily as a Type 1.  I knew nothing about diabetes until that point, but I immediately thought that there has to be a better way.  It has been a rewarding experience ever since.


Can you tell us about the experience of winning the Grand Prize last year?

I was completely surprised to have won among so many impressive submissions, and it was wonderful to receive validation from diabetes and design experts that my idea had legs.

On a personal note, winning the competition gave me confidence that my desire to make a career in developing products to improve the lives of those with diabetes was justified.  For the first week or two I felt like a mini-celebrity, since several design and medtech blogs had picked up the story, as well as one of my school’s publications.  I also had the chance to spend a few hours with medical device design experts at IDEO, where I received valuable feedback on the design and shared ideas for improving upon it even further.


How much time did you spend creating the LifeCase/LifeApp prototype, and what were your expectations going into the contest?

We heard about the contest late in the game, so we only had a month to develop the concept, perform user research, and create the prototype.  It was a very tight timeline, but we felt strongly about our idea and thought the contest would be an opportunity to both hone our design skills and have some fun.


You’ve been hired by Medtronic Diabetes now, to work on development of new pump systems. What are your top priorities in evolving insulin pumps for the better?

As we are developing future product platforms, ensuring a safe experience is always our top priority.  Additionally, we are focusing on improved technology that leads to both improved clinical outcomes and a more convenient patient experience.

Clinical research has shown that combining the components of insulin delivery, continuous glucose monitoring, and therapy adjustment allows patients to tighten glucose control and achieve an optimal clinical outcome; so we will continue to focus on these elements.  Our goal is to develop products that fit more seamlessly into a patient’s life, by giving users a product that is simpler to use, adaptable to their specific needs, and more comfortable.


Do you have any tips for contest entrants this year?

Research, research, research!  I’m always amazed by how different people experience ideas and products differently.  A design that makes perfect sense to you may be challenging for someone else to use, and a product that meets your needs may not have the same benefit for another.  The initial concept for LifeCase/LifeApp was certainly our own, but refining the design and features through several rounds of research where we spoke to and observed people with diabetes gave us insights that we could not have come up with on our own.

And of course — have fun!  This is a great opportunity to not only design, but also potentially improve lives in the process.


Thank you, Samantha. We’re glad to have you, both on the panel AND in the industry.

Happy St. Patrick’s Day, again.  See this morning’s post with some wee silliness on that.

A quick newsflash on this lovely green day: this morning Medtronic has announced that it has received FDA approval for its new Paradigm Revel combination insulin pump/continuous glucose monitor, which they’re calling “the industry’s most advanced integrated system for diabetes management” (see product info here).

That may be an overstatement, considering the Revel does not include the automatic-suspend feature that can stop insulin delivery when your BG level dips, which is included in the Medtronic Veo system, currently only available in Europe (see also, notes bottom of this post on the Veo).

Here’s what IS new and different about the Paradigm Revel, according to a spokeswoman I talked with this morning:

* the system includes “predictive alerts” that can give early warning of impending lows and highs

* the controlling algorithm is also “stronger at detecting hypos” for added protection

* you can set up to 8 different thresholds for your low alerts, depending on time of day and your activity level

* it offers “alert-based navigation,” meaning that any time an alert goes off, the screen automatically takes the user to the task area for making the necessary adjustments

* higher precision dosing: the Revel can deliver insulin in smaller increments, down to .025 units per hour for basal or bolus (whereas the previous system only goes down to .05 u/hr)

* for insulin-using type 2 patients, who are often more insulin resistant, they can achieve tighter BG control using the new 1:1 carbohydrate ratio

* you can also set up missed-meal bolus reminders

I’m sure anyone in the market for a combined insulin pump / CGM system (who isn’t?) will appreciate the advances. For existing Medtronic users, upgrading to the Revel will cost $399 to $499 depending on the system you are upgrading from.  Keep your eye on their website for more details (watch the demo video there, as well).

I often wonder what it would be like to have diabetes in a different western industrialized country — one that has a sensible, functioning health care system, for example. Or just someplace smaller, and greener.

This being St. Patrick’s Day, I thought I’d look up Ireland. Here are a some interesting wee tidbits that Google coughed up:

♣ The website of the big national advocacy organization, The Diabetes Federation of Ireland, has much the same content that most of ours do. To wit: they don’t recommend “diabetic foods” either.

♣ The Federation’s website is a production of Novo Nordisk, however — which is not well disclosed.  I only noticed because I happened upon the tiny copyright info at the very bottom of the home page. Bedad! (that’s Irish for surprise)

♣ The Federation has a Facebook page, but it has only 100+ fans to date. Wisha! (more Irish for surprise)

♣ A recent study of primary care physicians concludes: “Delivery of diabetes care in Ireland remains largely unstructured.”

♣ Things appear to be especially bad in Northern Ireland.

♣ Patients over there are just as confused/frustrated about carb-counting as we are.

♣ A search on “Diabetes and alcohol Ireland” brings up a very measured approach. (I’m going PC and omitting expression of surprise here).

♣ It’s the same all over: a new report shows that Ireland is “facing a dramatic rise” in both type 2 and type 1 diabetes (expected to rise 33% by 2015). Here I am actually not surprised.

♣ Hoping for a pot of gold for diabetics? I think not. What do you expect from the country that brought you Corned Beef and Cabbage?

♣ But they do good research — for example, Trinity College Dublin just came out with some helpful findings about Type 2 diabetes in young adults.

♣ And for Type 1’s, they’ve got the Paradigm Veo (and we don’t!) That’s Medtronic’s new combo insulin pump/CGM system can automatically suspend insulin delivery when your BG level dips, protecting you from severe hypoglycemia. (Anybody know the Irish for ‘When are we getting that?!‘)


♣ Here at home, you can visit a real Irish Lassie who has diabetes on her D-blog.  Dia duit, Sheila!

→ Wait, Sheila, you live in Guatemala? You might not know what you’re missing, Lassie. (Or do you?)

When I met fellow D-writer Catherine Price for coffee recently, I immediately gushed about everything we had in common: two brunette journalist-types living in the SF Bay Area, both diagnosed a few years ago with LADA (or so I thought). Catherine gave me a sideways look, and then began grilling me about the formal definition of LADA. I had to admit, it’s pretty fuzzy. Today, I gratefully present you with the results of her investigation into this mysterious acronym:


A Guest Post by Catherine Price, of ASweetLife

Having had Type 1 diabetes for nearly ten years now, I can handle most diabetic terms and acronyms thrown my way.  Hemoglobin A1c? Got it. Carb ratios? Insulin sensitivity? No problem. But one term has continued to confuse me: LADA.

Short for Latent Autoimmune Diabetes in Adults, it’s also known as Slow-Onset Type 1 Diabetes, Type 1.5 Diabetes or, occasionally, Late-Onset Autoimmune Diabetes of Adulthood. Four names for the same thing? That’s never a good sign.

Until recently, the most common definition I’d heard for LADA was that it was a Type 1-like form of diabetes diagnosed in adulthood. But I didn’t understand the details. Does being diagnosed with Type 1 diabetes as an adult automatically mean you have LADA? Is there a difference between LADA and the classical definition of Type 1?

To answer these questions, I spoke with Marie Nierras, the program officer of the genetics programs at Juvenile Diabetes Research Foundation. She cut right to the chase. “There is a lot of confusion about LADA,” she told me, “but Type 1 diabetes and LADA are not the same thing.”

Here, to get us started, is how JDRF’s Adults With Type 1 toolkit defines LADA:

“Type 1 diabetes diagnosed in adults over 30 may be Latent Autoimmune Diabetes in Adults (LADA), sometimes known as Type 1.5 Diabetes. LADA is often misdiagnosed as type 2 diabetes because of age; however people with LADA do not have insulin resistance like those with type 2. LADA is characterized by age, a lack of family history of type 2 diabetes, a gradual increase in insulin requirements, positive antibodies, and decreasing ability to make insulin as indicated by a low C-peptide.”

And here’s some further detail from the National Institutes of Health:

“Most people with LADA still produce their own insulin when first diagnosed, like those with type 2 diabetes. In the early stages of the disease, people with LADA do not require insulin injections. Instead, they control their blood glucose levels with meal planning, physical activity, and oral diabetes medications. However, several years after diagnosis, people with LADA must take insulin to control blood glucose levels. As LADA progresses, the beta cells of the pancreas may no longer make insulin because the body’s immune system has attacked and destroyed them, as in type 1 diabetes.”

Many people assume that the first line of the JDRF definition – i.e. an older age at diagnosis – is LADA’s most important characteristic. But it turns out that’s not true. According to Nierras, the key difference between Type 1 diabetes and LADA is not the age of the person when they’re diagnosed, but the gradual way the disease progresses. Whereas people with classical Type 1 diabetes tend to be completely insulin-dependent within twelve months after diagnosis (usually less), people with LADA can often survive without artificial insulin for years.

As Nierras explains, “It’s as though they have Type 1 diabetes, but something slows down the disease so they can stay off of insulin much longer than the classically definable Type 1.”

With that said, age does play a part: for reasons not entirely understood, the older you are when you’re diagnosed with autoimmune diabetes (i.e. Type 1), the longer it usually takes for your immune system to kill off all your insulin-producing cells. A five-year-old with autoimmune diabetes typically becomes insulin-dependent more quickly than a 45-year old – a phenomenon researchers are struggling to understand. But it’s possible, says Nierras, for that same 45-year-old to present with a classic, fast-developing case of Type 1, or for a younger person to present with signs of LADA. According to Nierras, our tendency to emphasize age comes from arbitrary lines drawn by clinical trials — since most trials for Type 1 diabetes only accept people under 30 years old, new cases of Type 1 in people over 30 often are tossed into a generic LADA “junk drawer,” even though age itself is not the defining characteristic of the disease.

All of this might sound like semantics if you already know you have insulin-dependent diabetes. But for people whose diabetes is not quite so clear-cut, LADA is associated with a big, under-acknowledged problem: thanks to the ambiguity of its symptoms, it’s often misdiagnosed as Type 2 diabetes.

Imagine you’re a doctor and a patient comes in, 40 years old, not obese but also not lean, with high blood sugar but no signs of diabetic ketoacidosis (a warning sign for Type 1). What’s more, the patient responds well to meal planning and diabetes pills (both of which, according to Diabetes Monitor, are sometimes effective in early stages of LADA). If you aren’t aware of this weird hybrid – I like to think of LADA as the Prius of diabetes – wouldn’t you think she had Type 2?

Unfortunately, this example is not purely hypothetical; according to the National Institutes of Health, up to 10 percent of people who have been diagnosed with Type 2 diabetes may actually have LADA. This can lead to months, if not years, of incorrect treatment – which puts people at risk of going into diabetic ketoacidosis and developing long-term complications (not to mention spending a long period of time feeling inexplicably rotten).

So what’s the bottom line? If you’ve been diagnosed with Type 2 diabetes and your ability to control your blood sugar with oral medications and lifestyle changes has decreased over time, you might want to be tested for LADA – especially if you are normal weight and don’t have any relatives with Type 2 diabetes. (Tests for LADA are the same as for Type 1 – a blood test to see if any autoantibodies are present, and a measure of C-peptide levels to determine how much insulin you are producing.) The bad news of LADA is that if you have it, you will eventually need to take artificial insulin. But there’s positive news as well: once you’ve been diagnosed correctly and start the right treatment, you can get back on the road to good health.

Graph: from an Australian diabetes org

Postscript: Researchers are very interested in the connection between Type 1 diabetes and LADA, but there are only a few clinical trials in progress. Hopefully that will soon change – and in the meantime, you can find one exception here.

Additional information about LADA:
-    http://diabetes.niddk.nih.gov/dm/pubs/overview/index.htm
-    http://www.diabetesmonitor.com/lada.htm

Wow, thank you Catherine. Now I’m confused as ever, though. Guess I really am a classic Type 1 diagnosed super-late — or somewhere in that LADA “junk drawer” you mentioned (?)

Alcohol and diabetes. Never a more timely topic than this week. Please enjoy today’s guest post responsibly

A Guest Post by Hope Warshaw, nutrition expert and CDE

St Paddy’s Day 2010 is just days away. Thinking of gulps of green beer or Guinness Stout, or sips of Irish whiskey or Bailey’s? Alcohol, in its many forms, is at-the-ready for pouring to mark holidays, family events, religious holidays and myriad annual festivities. St Patrick’s Day is just one day among many.

Do you wonder: Can I drink alcohol? If so, how can I sip it safely and responsibly? Let’s cut to the chase and talk straight.

Diabetes and alcohol? Yes, they can mix? If (oh yea, aren’t there always ifs), you don’t have/have had a problem abusing alcohol or medical reasons or problems (related to or beyond diabetes) to avoid alcohol. All clear? Then you’re welcome to belly up to the bar for a moderate amount of alcohol. How is moderation defined by the experts? One drink a day for women and two for men (One drink is defined as: 12 oz beer, 5 oz wine, 1.5 oz distilled spirits).

Let’s dive deeper…moderate amounts of alcohol, when sipped along with some food, has little impact on your blood glucose. However, hyperglycemia (high blood glucose) can result due to the added calories from mixers which may be added to drinks – regular soft drinks, tonic water, fruit juice, syrups, etc. – and calories from foods you eat, along with the sips of alcohol.

On the flip side, alcohol can cause hypoglycemia (low). Whether alcohol does so has nearly everything to do with whether you take blood-glucose lowering medication(s) and which ones you take. Here’s the quick physiology lesson: alcohol can increase the glucose-lowering effect of insulin as well as several oral medications (ones that stimulate the pancreas to put out more insulin). Hypoglycemia can happen because alcohol slows down the liver’s ability to breakdown glycogen (stored glucose) and supply glucose (from stored energy) to keep blood glucose on an even keel.

Hypoglycemia can occur soon after you drink alcohol if you’ve not had much food to eat to raise your blood glucose and/or the blood-glucose lowering medication you’ve taken is at peak action (e.g.: an hour or so into the action curve of rapid acting insulin) and you’ve downed more than a few drinks.

An often missed detail is that alcohol can cause hypoglycemia a number of hours post drinking. This is due to the impact noted above on the liver and because of the greater chance to begin with (without alcohol on board) of hypoglycemia during the night due to hormonal changes.

Think back: have you had a low or two from over celebrating at previous St. Patrick’s Day or other times of alcohol overindulgence? Has it been immediate or several hours after you’ve finally fallen into a sweet slumber? Your answer is likely several hours later.

If you have type 2 and don’t take blood glucose lowering medications that typically cause hypoglycemia, you’re unlikely to experience it. Your concerns with sipping green beer or other liquid concoctions should be the excess calories and risk of hyperglycemia.

So, Sip with Smarts:

•    Don’t drink if your BG is low or headed low. Eat something to raise it before you start to drink.

•    Carry BG testing supplies. Check your BG more often. The results will help you prevent lows and get ahead of impending lows. In addition, BG checks can help you gather data about the effect of alcohol on your body for future reference.

•    Be prepared to treat a low by having hypoglycemia treatments handy. Don’t count on these aids being in close proximity when you need them. Easy to tote foods are hard candy, Lifesavers, boxes of raisins or juice. Sources of pure glucose may work even quicker, such as tablets, liquid, or gel.

•    Check your BG before you drive after you’ve had alcohol. Make sure your BG is in a safe range and you are competent to drive. If your BG is headed south (low), eat carbs to raise it.

•    Don’t hit the pillow for the night without checking your BG. Eat if you are low and/or think you haven’t eaten enough in the last few hours.

•    Wear medical ID. A bracelet or necklace is best. Realize the symptoms of intoxication and hypoglycemia can be similar.

•    Educate people you are with about your usual signs and symptoms of lows. Let them know how to help you should a low that you can’t handle alone arise.

With these tips in tow and, of course a bit of Irish luck, sip one or few this St Patrick’s Day and at many more of life’s celebrations, but please do it safely.

- Hope Warshaw, MMSc, RD, CDE


Hope is author of numerous ADA-published books on diabetes and nutrition, including Diabetes Meal Planning Made Easy.