Scott Hanselman

The Sad State of Diabetes Technology in 2012

June 17, '12 Comments [118] Posted in Diabetes
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animation1I've been diabetic for almost two decades. It's tiring, let me tell you. Here's a video of my routine when I change my insulin pump and continuous meter. I'm not looking for pity, sadness or suggestions for herbs and spices that might help me out. I'd just like a day off. Just a single day out of the last 7000 or the next, I'd like to have a single piece of pie and not chase my blood sugar for hours.

Every time I visit the doctor (I do every 3 months) and every time I talk to someone in industry (I do a few times a year) I'm told that there will be a breakthrough "in the next 5 years." I've been hearing that line - "it's coming soon" - for twenty.

I used to wait a minute for a finger stick test result. Now I wait 5 seconds but we still have blood sugar strips with +-20% accuracy. That means I can check my sugar via finger stick twice and get a number I'd take action on along with one I wouldn't. Blood sugar strip accuracy is appalling and a dirty little secret in the diabetes community.

I started with insulin that would reach its peak strength after about 4 hours. Today it takes about an hour. Awesome, but that's not fast enough when a meal can take me to the stratosphere in minutes.

We are hurting here and we can't all wait another five years. Diabetes is the leading cause of blindness, leading cause of kidney failure and leading cause of amputation.

I wrote the first Glucose Management system for the PalmPilot in 1998 called GlucoPilot and provided on the go in-depth analysis for the first time. The first thing that struck me was that the PalmPilot and the Blood Sugar Meter were the same size. Why did I need two devices with batteries, screens, buttons and a CPU? Why so many devices?

NewColorSmall_smallIn 2001 I went on a trip across the country with my wife, an insulin pump and 8 PDAs (personal digital assistants, the "iPhones" of the time) and tried to manage my diabetes using all the latest wireless technology. Here's what I had to say 11 years ago:

With Bluetooth coming, why couldn't my [PalmPilot] monitor my newly implanted smart-pump? GlucoPilot could generate charts and graphics from information transmitted wirelessly from the pump. For that matter, the pump, implanted in my abdomen, could constantly transmit information to Bluetooth-enabled devices that surround me. The pump might use my cell phone to call in its data into a central server when I'm not using the phone. If I wander near my home computer, the pump or Visor might take the opportunity to upload its data. During a visit to the doctor, Bluetooth's 30-meter range could provide the doctor with my minute-by-minute medical history as I sat in the waiting room.

Back in 1998 when I was writing and marketing GlucoPilot I was using a custom cable that connected directly from my PalmPilot to the glucose meter and downloaded my historical glucose data. Fast forward to 2012 and what new technologicals innovation do we have?

Yes, that's a custom cable to plug-in to my PDA. Yes, I'm a frustrated diabetic. This a 15 year old solution with no backing standards, no standard interchange format, no central cloud to store the data in. It's vendor lock-in on both sides.

Kudos to the Glooko guys for fighting the good fight and shame on the blood sugar meter manufacturers for making their job hard.


Fifteen years ago we talked about data standards and interoperability. I was even on a standards board for a while to try and pressure the industry to standardize on data interchange formats. I have personally written multiple blood sugar meter data importers from the very simple (CSV) to the very complex (binary packed and purposely obscured to prevent 3rd party data dumps) and I can tell you that the blood sugar meter manufacturers are not interested in making it easy to move our data around. This is a billion dollar industry.

Today I read an article about the iBGStar (a forgettable name) glucose meter that plugs directly into an iPhone 30 pin port. The article came up on Hacker News and one of the designers said this in a comment:

I'm one of the designers of the iBGStar and we considered Bluetooth. We actually have another FDA cleared product that uses Bluetooth, but cost, battery life, and a bunch of technical issues led us to favor the 30 pin.

iBGStar-IPhoneThis is hugely disappointing especially since Bluetooth 4.0 is said to offer battery life as long as 10 years on some products. Given all the new iPhones have Bluetooth 4.0 just waiting for devices to connect to, you'd think this is a perfect opportunity for a Bluetooth 4.0 glucose meter.

I appreciate the attempts and the word that is being done in the space, I truly do, but as an end user when I see products like this that are trying to push the envelope but fail with fundamental usability issues, I'm saddened. Most diabetics check their blood sugar 10 times a day or more. I can't keep this glucose meter attached to my phone. It'll fall off, get bent, mess up the 30 pin connector. It's simply not reasonable for a day to day use coming in and out of pockets.

A more reasonable mode of usage would mirror the FitBit. It's tiny, clips to my belt and automatically notices when I pass by my computer then uploads its data wirelessly. That's how wireless is supposed to work. And the battery lasts at least a week.

Twenty years and no significant moves. We are still wiring our devices together, translating from one format to another, all the while being hamstrung by the FDA and their processes. When we do start to get something working well, it's attacked and we're told that our insulin pumps can be hacked from a mile away and we can be killed in our sleep. This will no doubt slow progress and make the FDA even more paranoid when approving new technology.

I've just this week switched from a Medtronic Continuous Glucose Meter to a DexCom, which is another company. This new CGM gives me more accurate data with less lag time. However, I still have the same insulin pump. This means my meter and pump aren't integrated so I carry another device on my person. This is because while the Animas Vibe, a pump that integrates both the DexCom meter and an insulin pump as well as other features like being waterproof, is available EVERYWHERE but the US. It's in the FDA process. Maybe ready in 6 months? 18? Who knows. When it shows up, the technology will be years old while the iPhone is on generation 6. We've got 3D TVs to watch crappy movies on by my insulin pump's firmware hasn't changed in nearly a decade.

The article about the iBGStar is poorly researched and galling.  I appreciate what Hacker News commenter lloyd said with emphasis mine, calling out this inane line from the article.

"Could this be the beginning of mobile diabetes monitoring?"

As so many people above have stated, no, you moron. We've been monitoring blood sugar on the go for the past 30 years.

I've got Type 1 diabetes...and my current meter is smaller than the one shown here. I can plug it into my Mac via USB to download and visualize the data (& can control my insulin pump via bluetooth using the meter).

The only benefit with this particular iPhone-compatible meter would be enhanced, immediate visualization of results. Which might be easier to get, and might not, given the inconvenience of having to remove an iPhone case and plug in the meter. (Not to mention other issues - what if my iPhone's batteries are dead? Will it still work?)

Unfortunately, this product reminds me of 5 years ago, when someone would announce a new toaster, and the tech crowd wouldn't be impressed...unless it was a Bluetooth toaster. We're so focused on it being the hot new thing (it's compatible with iOS! Oooh!!) that we ignore the fact that there's nothing revolutionary being presented here.

The way I see it, this doesn't really change anything in terms of treatment. If it's a more accurate meter, great - sell based on that. Not on the bogus "we're taking blood glucose monitoring mobile" claims.

You may feel like technology is amazing and it's moving so very fast and it surely is. But as a diabetic who relies on technology to stay alive as along as I possibly can, it feels like nothing has changed in 20 years. Maybe something will happen in just 5 more.

Sponsor: I want to thank the folks at DevExpress for sponsoring this week's feed. Check out their DXperience tools, they are amazing. You can create web-based iPad apps with ASP.NET and Web Forms. I was personally genuinely impressed. Introducing DXperience 12.1 by DevExpress - The technology landscape is changing and new platforms are emerging. New tools by DevExpress deliver next-generation user experiences on the desktop, on the Web or across a broad array of Touch-enabled mobile devices.

About Scott

Scott Hanselman is a former professor, former Chief Architect in finance, now speaker, consultant, father, diabetic, and Microsoft employee. He is a failed stand-up comic, a cornrower, and a book author.

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Hackers can kill Diabetics with Insulin Pumps from a half mile away - Um, no. Facts vs. Journalistic Fear mongering

August 5, '11 Comments [54] Posted in Diabetes
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UPDATE: Jay Radcliffe, the researcher discussed in this post, has emailed me, a little upset. In the interest of transparency I've included our email thread at the end of this post so that Jay's perspective on any inaccuracies may be seen. I encourage you to draw your own conclusions.

There's a story making the rounds on Twitter right now. Engadget "reports" researcher sees security issue with wireless insulin pumps, hackers could cause lethal doses.

Wait till you see what researcher and diabetic Jay Radcliffe cooked up for the Black Hat Technical Security Conference. Radcliffe figures an attacker could hack an insulin pump connected to a wireless glucose monitor and deliver lethal doses of the sugar-regulating hormone.

First, a little on my background. I've been Type 1 diabetic for 17 years. I've worn an insulin pump 24 hours a day, 7 days a week for over 11 years and a continuous glucose meter non-stop for over 5 years. I also wrote one of the first portable glucoses management systems for the original PalmPilot over 10 years ago and successfully sold it to a health management company. ( link) I also interfaced it (albeit with wires) to a number of portable glucose meters, also a first.

Engadget's is a mostly reasonable headline and accurate explanation as they say he "figures an attacker could..." However, Computerworld really goes all out with the scare tactics with Black Hat: Lethal Hack and wireless attack on insulin pumps to kill people.

Like something straight out of science fiction, an attacker with a powerful antenna could be up to a half mile away from a victim yet launch a wireless hack to remotely control an insulin pump and potentially kill the victim.

The only thing that saves this initial paragraph is "potentially." The link that is getting the most Tweets is VentureBeat's "Excuse me while I turn off your insulin pump," a blog post that is rife with inaccuracies (not to mention a lot of misspellings). Here's just a few.

  • "Insulin pumps use wireless sensors that detect blood sugar levels and then communicate the data to a screen on the insulin pump."
    • Way too broad. Pumps don't. Some CGMs (continuous glucose meters) communicate with special integrated pumps. The most popular integrated system is a Medtronic Paradigm. Most other CGM system have a separate "screen" device that's separate from the pump.
  • "The sensor has to run on a 1.5-volt watch battery for two years."
    • Nope. The Medtronic receiving sensor needs to be charged ever 3 to 6 days. The pump battery is usually a AAA that lasts a few weeks.
      UPDATE: The Dexcom receiver is recharged every 3 days but the body transmitter is warrented for a year with a small watch battery.

One useful paragraph in the VentureBeat post points out again that Jerome wasn't able to decode the message. Here, emphasis mine.

Then Radcliffe went through the process of deciphering what the wireless transmissions meant. These transmissions are not encrypted, since the devices have to be really cheap. The tranmissions [sic] are only 76 bits and they travel at more than 8,000 bits per second. To review the signal, Radcliffe captured the signal with a $10 radio frequency circuit board and then used an oscilloscope to analzye [sic] the bits.

He captured two 9-millisecond transmissions that were five minutes apart. But they came out looking like gibberish. He caputred [sic] more transmissions. About 80 percent of the transmissions had some of the same bits. He reached out to Texas Instruments for help but didn’t have much luck. He told the TI people what he was doing and they decided not to help him.

That was as far as he got on deciphering the wireless signal from the sensor, since there was no documentation that really helped him there. He couldn’t understand what the signal said, but he didn’t need to do that. So he tried to jam the signals to see if he could stop the transmitter. With a quarter of a mile, he figured out he could indeed mess up the transmitter via a denial of service attack, or flooding it with false data.

Now, to the security issue. One has to read these articles and blog posts very carefully. It's easy Link Bait to say "A hacker can kill diabetics wirelessly without them knowing it!" (I assume we'd figure it out at some point, though.) While Jerome Radcliffe, the gentleman who did the proof of concept, is no doubt very clever, the folks who are blogging this fear mongering should do their homework and read the details. Jerome is presenting some of his findings at the BlackHat conference. Here's his abstract with emphasis mine. Note also that SCADA means "supervisory control and data acquisition." He's saying that we "cyborgdiabetics" (my term) are human control and data acquisition systems as data-in/control-out controls our health, well-being and ultimately our lives.

As a diabetic, I have two devices attached to me at all times; an insulin pump and a continuous glucose monitor. This combination of devices turns me into a Human SCADA system; in fact, much of the hardware used in these devices are also used in Industrial SCADA equipment. I was inspired to attempt to hack these medical devices after a presentation on hardware hacking at DEF CON in 2009. Both of the systems have proprietary wireless communication methods.

Could their communication methods be reverse engineered? Could a device be created to perform injection attacks? Manipulation of a diabetic's insulin, directly or indirectly, could result in significant health risks and even death. My weapons in the battle: Arduino, Ham Radios, Bus Pirate, Oscilloscope, Soldering Iron, and a hacker's intuition.

After investing months of spare time and an immense amount of caffeine, I have not accomplished my mission. The journey, however, has been an immeasurable learning experience - from propriety protocols to hardware interfacing-and I will focus on the ups and downs of this project, including the technical issues, the lessons learned, and information discovered, in this presentation "Breaking the Human SCADA System."

Just to be clear, Jerome has not yet successfully wirelessly hacked an insulin pump.

UPDATE: See below email thread. Jerome says he can change settings and pause the pump. This may be via the USB wireless interface one uses to backup settings and send their blood sugar to their doctor. That's an educated guess on my part.

He's made initial steps to sniff wireless traffic from the pump. I realize, as I hope you do, that his abstract isn't complete. Hopefully a more complete presentation is forthcoming. I suspect he's exploiting the remote control feature of a pump. This is a key fob that looks like a car alarm beeper that some pump users use to discretely give themselves insulin doses. However, I feel the need to point out as a pump wearer myself that:

  • Not every Insulin Pump has a remote control feature.
  • Not every remote-controllable insulin pump has that feature turned on. Mine does not, for example.

In this AP article reposted at NPR called Insulin Pumps, Monitors Vulnerable To Hacking they give us more of the puzzle which confirms that Jerome was - in at least one hack attempt - using the optional remote control feature of the pump. A feature that few turn on. Their tech is a little off as well with talk of a 'USB device,' probably an Arduino with an RF shield.

Radcliffe wears an insulin pump that can be used with a special remote control to administer insulin. He found that the pump can be reprogrammed to respond to a stranger's remote. All he needed was a USB device that can be easily obtained from eBay or medical supply companies. Radcliffe also applied his skill for eavesdropping on computer traffic. By looking at the data being transmitted from the computer with the USB device to the insulin pump, he could instruct the USB device to tell the pump what to do.

Finally, another piece of the puzzle is found at SCMagazine's scary "Black Hat: Insulin pumps can be hacked" article where they open with:

"A Type 1 diabetic said Thursday that hackers can remotely change his insulin pump to levels that could kill him."

ZOMG! Someone can remotely control my insulin pump? They continue...

"Radcliffe, now 33, explained that all he requires to perpetrate the hack is the target pump's serial number."

Oh, you mean the serial number that I use to pair with the transmitter to use the highly touted remote control function? This is like saying "I can open your garage door with a 3rd party garage door opener. Just give me the numbers off the side of your unit..."

What Jerome has done, however, is posed a valid question and opened a door that all techie diabetics knew was open. It is however, an obvious question for any connected device. Anyone who has ever seen OnStar start a car remotely knows that there's a possibility that a bad guy could do the same thing.

For example, literally last month I personally exchanged emails with a friendly hacker who successfully hacked the web services for the Filtrete Touchscreen WiFi-enabled Thermostat. Harmless? Perhaps, but his hack could successfully remotely control a furnace or AC in the house of anyone with this device. Any control device that's connected to the "web" or even "the air," in the case of insulin pumps, is potentially open for attack.

I appreciate the message that Jerome is trying to get out there. Wireless medical devices need to be designed with security in mind. I don't appreciate blogs and "news" organizations inaccurately scaring folks into thinking this is a credible threat.

We don't know what brand pump was experimented on, and fortunately the gentleman isn't giving away the technical details. If you are a diabetic on a pump who is concerned about this kind of thing, my suggestion is to turn off your pump's remote control feature (which is likely off anyway) and turn off your sensor radio when you are not wearing your CGM. Most of all, don't panic. Call the manufacturer and express your concern. In my experience, pump manufacturers do not mess around with this stuff. I'm not overly concerned.

All this said, I'd love to have him on my podcast. If you're reading this and you're Jerome Radcliffe, give me a holler and let's talk tech.

Of course, all this talk would be moot if we cured diabetes. In encourage you to give a Tax Deductable Donation to the American Diabetes association:

Also, feel free to show people my "I am Diabetic. Here's how it works" educational video on YouTube with details on how I setup a pump and continuous glucose monitoring system every 3 days. takes you right to the YouTube video.

UPDATE: In the interest in full disclosure, here is my email thread with Jay. As I've said, I'm happy to update the article, as am I doing here, with all perspectives. This was as much a blog post about the media and that meta-point as it was about the tech. Given that I had to piece this post together from several other posts and articles just to get an idea of what the big picture is, kind of makes my point about the problems of hyperbole in the media. Again, my concern is more about sensationalism than it is about the tech. I have no doubt a pump CAN be hacked. Any connected device can be hacked.

Here's our thread from earliest to latest:

From: Jerome Radcliffe

I *can* hack an insulin pump. I can suspend it, change all the settings remotely. I did that on stage. I'm quite disappointed that you did not verify any of the information in your article. People do die from hypoglycemia. Is it an extreme example? Yes. It needs to be. These devices need to be researched for security flaws. To talk about why someone might hack a pump misses the point.

From: Scott Hanselman

I'm sorry, I only found the articles I linked to, plus the abstract that said you hadn't. I tried to verify everything to the best of my ability to Google. Would you send me some newer links and I'llr update my post? My post was meant as an analysis of the news coverage more than the attack. Send me new info?


From: Jerome Radcliffe

I understand your position. but as a blogger/journalist there is a certain level of responsibility to publishing facts. You come off as hypocritical blaming the media for being inaccurate on diabetics being killed by pumps, and write a piece riddled with inaccuracies on my research.
1. There is a CGM that runs on a 1.5v battery for two years. You state that my research is wrong. It is not.
2. Check CBS in las Vegas's web site. They have a video of the demo. Several media outlets reported that demo.
My name is fairly unique and my email address is easy to acquire. I would have rather you contact me for clarification rather then publish a critique of my research that is far from accurate.

From: Scott Hanselman

A random blogger and a trained journalist are certainly different things, I'm sure we can agree on. I do certainly want to improve the post and add the facts and am more than happy to do so.
I'm not sure where I said "your research is wrong" in my post, but I will re-check it. Again, most of my post is quotes from actual journalists who presumably interviewed you and I quoted them. I also quoted your black hat abstract.
I searched twitter for Jay and Jerome Radcliffe but didn't find you and wasn't able to find your blog, I suppose because of the flood of new links and stories.
This CGM runs for 2 years without recharging? Perhaps I'm confused about semantics. I've had a number of CGMs, some 1.5V and all the ones with embedded batteries needed recharging. I'll check around. Again, however, my assertion wasn't against you at all, rather the journalists whose stories were inaccurate.
I feel like we are getting off on the wrong foot here. I thought I wrote a post about how other journalists and bloggers were sensationalistic and inaccurate in their coverage. My post isn't meant as, nor should it read as, a personal attack on your hard work. As I said earlier, I'm more than happy to make updates and edits and fall on my sword with any inaccuracies. I'm even happy to post our email exchange.
Be well!

From: Jerome Radcliffe

Anytime you publish, blog or newspaper, you should be responsible for the content. There is no difference between a trained journalist and a blogger. You can't duck your own criticism of responsible reporting because you feel like your [sic] just a random blogger. The fact you are so critical of my work, you have been getting a lot of press. Your article was in the Slashdot headline, which is one of the most popular sites on the Internet. The fact is your article was highly critical of my work, and highly inaccurate. Even after I specifically told you about the inaccuracies in your writing you have not corrected them.
It's really hard for me not to be offended in this case. For the last three days I have had to answer people's questions, many have cited your article based from the Slashdot coverage.

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About Scott

Scott Hanselman is a former professor, former Chief Architect in finance, now speaker, consultant, father, diabetic, and Microsoft employee. He is a failed stand-up comic, a cornrower, and a book author.

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Details on the 2010 Diabetes Walk and a Thank You

September 7, '10 Comments [10] Posted in Diabetes
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Over the last few months I've blogged and tweeted about diabetes (in between my regular stuff) and you guys, Dear Readers, have be so kind as to donate over US$32,000 to Team Hanselman via the American Diabetes Association. We haven't hit our arbitrary $50k goal, but I'm totally amazed we made it this far, using only and entirely social media.

If you're interested in learning more about Diabetes and Type 1 Diabetes (what I have) then check out some of the stuff made this summer.

As a point of interest, in 2007 I tweeted every single time I had to manage some aspect of my diabetes in a day. You might be surprised how often we diabetics have to think about diabetes. I hope YOU think about it as you enjoy that cookie! ;)

Also, check out "Diabetes: The Airplane Analogy" for a clear explanation on how blood sugar, insulin, and all this equipment works together.

This next Sunday the 12th, as a culmination of all this, we'll be walking as Team Hanselman in the ADA's StepOut to Fight Diabetes. If you are in or around Portland, you are welcome to join our team and meet us at the Team Hanselman tent.

We'll be walking with many thousands at the Rose Quarter in Portland. We'll be doing the three mile walk.

General Schedule:

  • 8am: Registration opens w/ light breakfast
  • 8:40: Opening ceremony begins – Red Strider Ambassadors, ADA Researcher Dr. Michael Harris, Warm-ups, NAYA Youth Dancers and NARA Drum Group
  • 9:00: One, three and six mile walk begins through Irvington District
  • 10:15ish: Lunch, entertainment, bouncy houses, basketball hoop, music from the River City Ramblers, Health Fair Tent, face painting and more.
  • 11:15: Kids Race Walk w/ Coach Carmen
  • 12:30: Portland Step Out: Walk to Fight Diabetes Finishes

Thanks to EVERYONE for all their help and support! Remember if you donated to please make sure your company matches your donation. Also, there's still time to make a tax-deductable donation and get it matched. Also feel free to give to your local country's diabetes organization as well!

Feel free to spread the word on social networking sites with this short link:

You're a wonderful bunch of Dear Readers and I truly thank you for your support.

About Scott

Scott Hanselman is a former professor, former Chief Architect in finance, now speaker, consultant, father, diabetic, and Microsoft employee. He is a failed stand-up comic, a cornrower, and a book author.

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Hanselminutes Podcast 214 - Type 1 Diabetes and Running Marathons with Gary Schmidt

May 7, '10 Comments [3] Posted in Diabetes | Podcast
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stl-half-marathon-2009-race-pic-1 My two-hundred-and-fourteenth podcast is up. Gary Schmidt from runs marathons and triathlons. He also wears an insulin pump 24 hours a day, just like Scott. These two Type 1 diabetics chat about what's involved in being both diabetic and active.

I would also encourage you to watch my "I am Diabetic" video on YouTube, and consider donating to the ADA if this blog as ever helped you.

(Ya, I know, I'm late to post this.)

Subscribe: Subscribe to Hanselminutes Subscribe to my Podcast in iTunes

Download: MP3 Full Show

Links from the Show

Do also remember the complete archives are always up and they have PDF Transcripts, a little known feature that show up a few weeks after each show.

I want to add a big thanks to Telerik. Without their support, there wouldn't be a Hanselminutes. I hope they, and you, know that. Someone's gotta pay the bandwidth. Thanks also to Carl Franklin for all his support over these last 4 years!

Telerik is our sponsor for this show.

Building quality software is never easy. It requires skills and imagination. We cannot promise to improve your skills, but when it comes to User Interface and developer tools, we can provide the building blocks to take your application a step closer to your imagination. Explore the leading UI suites for ASP.NET AJAX,MVC,Silverlight,Windows Formsand WPF. Enjoy developer tools like .NET reporting, ORM,Automated Testing Tools, TFS, and Content Management Solution. And now you can increase your productivity with JustCode, Telerik’s new productivity tool for code analysis and refactoring. Visit

As I've said before this show comes to you with the audio expertise and stewardship of Carl Franklin. The name comes fromTravis Illig, but the goal of the show is simple. Avoid wasting the listener's time. (and make the commute less boring)

Enjoy. Who knows what'll happen in the next show?

About Scott

Scott Hanselman is a former professor, former Chief Architect in finance, now speaker, consultant, father, diabetic, and Microsoft employee. He is a failed stand-up comic, a cornrower, and a book author.

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A Diabetic Product Review for Non-Diabetics - The Medtronic MiniMed Paradigm "Revel" Insulin Pump and CGM

April 22, '10 Comments [22] Posted in Diabetes
Sponsored By is a review for Diabetics. If you're not a diabetic, consider this and it might help you enjoy this review. This is a product that will never affect your life. You've probably not thought about how an insulin pump works or its features. Here's a nice analogy I use to explain how diabetes works. It's called Diabetes: The Airplane Analogy.

I've just received an upgrade to my insulin pump and I'm thrilled. Products like this are as important to us (diabetics) as your phone, your fancy remote control, your new DVD Player. I touch this device as often as my phone. It's attached to me 24 hours a day, it's an "external organ" to me. I've worn an insulin pump every day, all day (except showers) for the last decade.

If you find this interesting, please consider helping fight diabetes: or tweeting the link  

I've had Medtronic pumps since 2000. I upgraded to a Paradigm with a CGM "Continuous Glucose Meter" in 2006. Last week I upgraded to a new Paradigm "Revel" Insulin Pump with a number of new features. Insulin Pumps have come a long way since they were backpacks.

If you're not familiar, here's some diabetic equipment basics.

Diabetes Basics

blood_glucose_385x261I'm a Type 1 Diabetic. That means my body produces no insulin of its own and I need to get insulin from outside sources. When I eat food, the sugar in my blood goes up and isn't delivered to my cells and my body starves while marinating it its own sugar. When I take insulin, my cells unlock, sugar (fuel) is delivered to the cells, and my blood sugar values go down. Eat, go up, take insulin, go down.

What's a Blood Sugar Meter do?

It does just that, it measures the level of sugar in my blood. I prick my finger, usually 10 times a day or so, and I put the drop of blood on a small gauze strip that goes into a machine and gives me a number. If it goes high too long, I'll die slowly. If it goes low too long, I'll die quickly. So, we need to keep that number as close to number as possible.

What's an Insulin Pump do?

Blood Sugar Meter I took manual shots for 5 years. Some diabetics take just a few shots, 3 or 4, using a mix of short-acting (take a few hours) and long-acting (spreads over 12 or 24 hours) insulin. Others use a MDI (Multiple Daily Injections) technique, as I did, taking as many as 6-10 small shots of insulin a day. This is not uncommon and is often referred to as the 'poor man's pump.'

As a diabetic, once you've started taking that many shots, you get tired of taking shots. Enter the insulin pump. Once every 3 to 6 days, you poke a longish needle into your fat, then pull it out leaving a soft plastic canula embedded in you and held with tape. The insulin is sitting inside the pump and is pushed by a motor in the pump, slowly, through a long tubing and into you.

Now you can make tiny manual adjustments all day without shots. It's like the difference between making large, coarse movements of the steering wheel while driving and making those tiny back and forth adjustments you make just to say in your own lane on the road. Insulin pumps allow you 10-20x more precision over shots.

Everything inside an Insulin Pump is manual. It does nothing automatically other than a small background amount of insulin. My insulin pump gives me more control and means I get poked less often. But, it's not automatic. It doesn't cure or solve Diabetes.

So, to review. I did shots for 5 years, then a fairly standard insulin pump for 5 years. Then I got a CGM.

What's a CGM (Continuous Glucose Meter) do?

Paradigm Insulin Pump with CGM Pricking your finger and check your blood sugar tells you your sugar level now, but not 5 minutes ago, nor does it show the trend. Hey, my sugar is 80! Was it 200 a half hour ago? Or was it 50 a half hour ago. A single sugar value is about as useful as a single speed value or a single altitude value.

A CGM, or Continues Glucose Meter, is a transmitter that sits inside you body, usually inserted with a needle and a sensor then uses tiny micro-currents against your body's interstitial fluids to estimate (extrapolate) your blood sugar. It doesn't test blood and they are not typically very accurate. In fact, they have a little disclaimer that effectively says "don't make decisions using these values."

CGMs do not replace finger sticks. They are not as accurate, but they provide valuable slope data that diabetics need. Accurate single value readings via finger sticks, combined with not-as-accurate slope information, combined with the ability to easily give myself small or large amounts of insulin without shots (I change the pump every 3 to 6 days, that does involve a needle) means I've got the information I need to maintain good control.

Fingersticks Alone - Chart CGM Chart

The Paradigm series of pumps are an Insulin Pump, but also a CGM receiver. They talk wirelessly to the CGM transmitter (see the picture above that is not my stomach) as well as wirelessly to a finger stick blood sugar meter. It's all one integrated thing.

Now, what's new in this new pump?

Medtronic MiniMed Paradigm "Revel" Insulin Pump

To review, insulin pumps are not automatic. They don't deliver without me saying so. While the pump talks wirelessly to meters and CGMs and stores values in memory, it doesn't act on them. There is no "closed loop" system. The delays involved are too great. However, the new "Revel" pump does add a number of cool new features that are making my life easier already. I think it's a great upgrade and if you have a MiniMed pump you should try to upgrade with their "Pathway Program." It's worth it.

New Features

Better charts. Previously the charts were either 3 hours or 24 hours. Far to zoomed in, or so far out as to be useless. Now you can zoom 3, 6, 12, 24. Here's some screenshots:

Paradigm Pump Paradigm Pump

Paradigm Pump Paradigm Pump

It was amazing how this apparently small upgrade changes the experience with the pump. The 6 hour view is a dream.

Predictive Alerts

This is the killer feature that has already helped me at least twice a day in the last week. The new Revel has a "rate of change" detection algorithm that is totally user-settable. If the pump decides that you will hit a high blood sugar if your current rate of change goes unchecked, it'll let you know via an alarm. This is the one feature I always needed and it works just as you'd wish it did.

Paradigm Pump  Paradigm Pump 

Paradigm Pump  Paradigm Pump

This feature did initially cause me to stack insulin a bit and caused a few lows as I was acting extra aggressively to squash highs, but I am finding I'm getting used to it. I wish it hadn't taken 5 years to get it. That's the tragedy of medical devices. You're thrilled with your multi-touch color screen portable device and I'm happy if I get one firmware update every 5 years. The difference is, my phone crashed twice today. This pump has never crashed in 10 years. We sacrifice innovation for stability.

Subtle but Important Improvements

One of the most important numbers for a pumper is the amount of insulin that's "pending" or "active." Most insulin takes about 3-4 hours to get out of my system, so if I take 5 units now, and 5 more units in an hour, that's stacking doses. If I remembered or was told that I had ~5 units active, I might not have taken that second dose and could avoid a nasty low. The Revel automatically calculates the active insulin and shows you it in three new places. First, on the status screen, second in the manual bolus (dose) screen, and again on the Bolus Wizard. It was buried in the UI before, now it's front and center.

The motor is more precise now, letting you do basal rates as low as 0.025 units per hour, crucial for young people.


This upgrade, the Revel, makes a great pump better. It was totally worth the $399 Pathway upgrade. If you're on a Minimed pump, get the upgrade. If you're not on a pump, consider getting one, it'll change your life.

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About Scott

Scott Hanselman is a former professor, former Chief Architect in finance, now speaker, consultant, father, diabetic, and Microsoft employee. He is a failed stand-up comic, a cornrower, and a book author.

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Disclaimer: The opinions expressed herein are my own personal opinions and do not represent my employer's view in any way.