Scott Hanselman

The Promising State of Diabetes Technology in 2016

June 16, '16 Comments [20] Posted in Diabetes | Open Source
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Glucopilot helped PalmPilots users in the 90sI've been a Type 1 Diabetic now for nearly 25 years. The first thing that every techie does once they've been diagnosed with Diabetes is they try to solve the problem with software or hardware. Whatever tool they have, they use that too to "solve their Diabetes." Sometimes it's Excel, sometimes it's writing a whole new system. We can't help ourselves. We see the charts and graphs, we start to understand that this is a solvable problem.

However, innovation in Diabetes technology has two sides. There's the "what can we do within the medical establishment" side, and there's the "what components do I, the actual diabetic, have to work with" side. We are given insulin pumps, glucose meters, and drugs but we aren't involved in the development, which makes sense to a point.

Fifteen years ago (yes, really, 15) I went on a trip with a PalmPilot, OmniSky wireless modem, Blood sugar meter, and insulin pump and quasi-continuously sent my blood glucose numbers back to a server and my doctor. Many many years later I demonstrated on stage at a Microsoft conference (video) how a remote management system like NightScout along with other innovations in IoT are taking these concepts so much further. It's through the work of hundreds of innovators and tinkerers that I think we're on the cusp.

Aside: If you are wholly unfamiliar with how Type 1 Diabetes works, please take a moment and read Diabetes Explanation: The Airplane Analogy. This post pretty clearly explains how blood sugar rises and falls and why fixing this isn't a simple problem.

Four years ago - four years ago this week in fact - I wrote a post called The Sad State of Diabetes Technology in 2012, largely in frustration. It became one of my most popular posts. For some it was a turning point and was called "seminal." For most Diabetics, though, the post said what everyone already thought and already knew. Diabetes sucks deeply, the technology we are given to manage it sucks deeply, and we are pretty much tired of waiting. We've been told a "cure" (or at least, a mostly fool-proof way to manage it) is just 5 years out. I've been told this, personally, every year for the last 25.

Here we are four years after I wrote my angry post and I'm actually feeling like we are on the edge of something big.

I believe that now we are inside a 5 year window of time where we WILL make Type 1 Diabetes MUCH MUCH easier to deal with.

Using this generation diagram from the JDRF, it's totally clear that the open source diabetes community is making Stage 4 happen today.

6 stages of "Artificial Pancreases"

Let's stop and level set for a moment. Here's a generalization of your day if you're not diabetic.

The "Normal Sugared" have it easy.

Here's what a Type 1 diabetic (like me) does:

Diabetics have to constantly manage their sugar, manually

What we need is for the "loop to be closed."

Is a Closed-Loop System for Diabetes Management like a Self-driving Car?

You know how the press just loves to call the Tesla a "Self-driving car?" It's not. I've driven one for over 15 thousand miles. It has two main features and they are both effectively cruise-control. There's the cruise control that slows down when there's a car in front of you, and then there's the "Tesla Auto-Pilot" feature. Amazing, sure, but realistically it's effectively "side to side cruise control." It will keep you in the lanes, usually, to a limit. You can't go to sleep, you shouldn't be texting. You are in charge. This isn't to minimize the amazing work that Tesla has done, but using a closed-loop insulin stages above as a parallel, a Tesla is barely stage 3 or 4.

However, this is still a fantastic innovation and for a diabetic like myself, I *would* like to take my hand off the diabetic wheel as it were, at least for the easy stuff like staying in the lanes on the freeway while going straight. Automatic basal insulin dosing (background insulin dosing) would free my mind up a LOT.

It's possible and it's happening.

What's required for a closed loop?

In order to close the loop, what are the components we need? For this simple exercise please assume that "safely and securely" applies to all of these statements.

  • The ability to tell an insulin pump to deliver insulin
  • The ability to read data from the insulin pump.
  • The ability to read current blood sugar from a continuous glucose meter
  • Some CPU or "brain" where an algorithm or controller lives to coordinate all this.
  • Storage, cloud or otherwise, to keep all this historical data

There are a number of issues to think about, though, if the open source community wants to solve this before the commercial companies do.

  • Most pump manufacturers don't like the idea of remotely controlling them after a series of insulin pump proof of concept "attacks."
    • This means that some systems require the use of an older pump to allow remote control. We, the community, need to encourage pump manufacturers to create pumps that allow secure remote control.
  • Most CGM manufacturers don't publish their specifications or like 3rd party apps or systems talking to their stuff.
    • We, the community, need to encourage manufacturers to create glucose meters that allow secure access to our sugar data. 'Cause it's our data.
  • Universal concern that someone will accidentally hurt or kill themselves or someone else.
  • Where should the "closed loop brain/algorithm" live? The cloud? Your phone? Another CPU in your pocket?

What happened in the Diabetes Technology Ecosystem in the last 4 years to make this possible?

The interesting part about this problem is that there are many ways to solve this. In fact, there are multiple closed loop OSS systems available now. Lots of things have made this possible.

Here's a rough timeline of the Open Diabetes Ecosystem.

  • Insulaudit -  Ben West starts an open source driver to audit medical devices
  • Decoding CareLink -  Driving an insulin pump with Python, Oct 2012
  • Decoding Dexcom - Pulling data off a Dexcom CGM 3 years ago!
  • CGM-Simple-Reader - Using Windows 8 DLLs from Dexcom Studio to get CGM data. Next step was uploading it somewhere!
  • Pebble - Being able to remotely view Nightscout Data on your wrist on a pebble.
  • Nightscout - Remote viewing of glucose data by pulling from a CGM and uploading to a web app. The addition of a REST API (Web API) was the killer that kick started other apps.
  • Parakeet Google App Engine - Gets data from The Parakeet Unit and talks to xDrip over the cell network. "OnStar for diabetes"
  • Nightscout Share Bridge - Takes Dexcom G5 data and copies it over to Nightscout.
  • xDrip - Talk to a CGM without a Receiver. Pulling the signal off the air itself. Can we improve their algorithm ourselves?
  • PingRF - Talking to the Animas Ping Pump via RF
  • OpenAPS - Open Artificial Pancreas System. A platform for building a closed-loop with open tools. There are almost 100 people running their own closed loops, today.
  • Watch Dana Lewis talk about OpenAPS at OSCON this year!
  • RileyLink - A bridge that can talk a Medtronic Pump. Make a the pump's RF programmatically available via Bluetooth
  • Loop - iPhone-based closed loop that uses RileyLink
  • xDripG5 - iOS Framework for talking to Dexcom CGMs over Bluetooth
  • OmniAPS - Talking to an OmniPod Pump

I realize this isn't comprehensive, but the point here is to understand there are dozens of ways to solve this problem. And there are dozens (hundreds?) of excited and capable people ready to make it happen.

Here's the systems that I have. This is my Dexcom G5 on my iPhone showing my blood sugar in near-realtime. Here I can see my sugar, but I have to make my own decisions about dosing.

Dexcom G5 on an iPhone

Here is a Raspberry Pi running OpenAPS. This is the brain. The algorithm runs here. It's talking to my Dexcom, to Nightscout in the cloud, and to my Medtronic Pump via RF via a USB device called a CareLink.

OpenAPS on a Raspberry Pi

Here is OpenAPS again, this time running on an Intel Edison sitting on a SparkFun Block with a battery and a TI C1111 RF transmitter. The Edison is the brain and has Bluetooth. The TI transmitter can replace the CareLink.

IMG_0058

As an alternative to OpenAPS, here is a RileyLink custom board that can also talk to the pump, but doesn't have a brain. There is no algorithm here. Instead, this is a bridge with RF in one hand and Bluetooth in the other. It makes a pump controllable and readable. The brain lives elsewhere.

RileyLink

Here's the RileyLink in a 3D printed case. I can keep it all in my pocket and it will run all day.

RileyLink in a 3D printed case

Here is a build of Loop from Nathan Racklyeft that uses Bluetooth to talk to both my CGM (Glucose Meter) and the Pump via the Riley Link. In this example, the phone is the brain. This is good and bad. You can't really trust your phone to keep stuff running if it also runs Candy Crush AND has a crappy battery. However, if both my Pump AND CGM spoke Bluetooth, we can imagine a world where the brain of my "artificial pancreas" is just an app on my phone. No additional hardware.

Loop puts the brain on your phone

The most important point here is that a LOT of stress could have been avoided if the manufacturers had just created open APIs in the first place.

There's also amazing work happening  in the non-profit space. Howard shared this common on my original "Sad State" Diabetes Post:

Great article, Scott. You've accurately captured the frustration I've felt since my 12 year old daughter was diagnosed with T1D nine months ago. She also wears a pump and CGM and bravely performs the ritual you demonstrate in your video every three days. The technology is so retro it's embarrassing.

Since then, Howard created Tidepool and recently spoke at the White House! On the commercial side, there are lots of players rushing to market. Medtronic may '>'>'>have a hybrid closed loop called the 670g by spring next year although trials move slowly so I'm thinking later or possibly 2018. Lane Desborough from Bigfoot Biomedical has also closed the loop and they are bringing it to market...soon we hope!

For more information, go watch Mark Wilson's talk at D-Data Exchange 2016. It is an excellent 30 minute overview of the ecosystem and a call to action to everyone involved.

Check out this visualization of 6 years of Hacking Diabetes. These are all the projects and commits as folks dump into Open Diabetes Hacking Community.

What's the take away? It's an exciting time. It's happening. It can't be stopped.

More Diabetes Reading


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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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MSBuild Structured Log: record and visualize your builds

June 4, '16 Comments [7] Posted in MSBuild | Open Source
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MSBuild has been open source for a while (over a year now!) and is used to build .NET and .NET Core projects. In fact, MSBuild is used to build the .NET Core Runtime itself.

MSBuild Structured Log

Recently Kirill Osenkov published a new tool called MSBuild Structured Log that makes it easy to visualize your builds and the build process. Install and run MSBuild Structured Log from here.

It is an MSBuild logger that can be passed to MSBuild during a build and it records information about everything that happens in the build. But instead of just dumping everything into a huge text file it preserves the structure and relationships between elements, and lets you save and open the structured log in .xml format. This has significant advantages to help you understand and navigate large build logs.

It's easy to install and auto-updates itself. You can open a log file directory or it will build your project and show you the results in a friendly and searchable tree format:

MSBuild Log visualized as a tree view

Here's a more complex multi-project example. You can see what ran, what didn't, dependencies, and the logs themselves.

A complex MSBuild example visualized

Tools

There is a great list of MSBuild-related resources and tips and tricks including these tools:


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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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Is technology killing curiosity?

June 1, '16 Comments [70] Posted in Musings
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Photo via WoCinTechChat used under Creative Commons

I was talking with Kishau Rogers this week at a Hackathon we were helping with at The White House for ThinkOfUs. (See how I dropped The White House in there like it was nothing? It was everything. More on that later.)

You'll remember Kishau from her excellent podcast where she proposed that we should NOT teach kids how to code...but rather we need to teach kids (and people) how to think about systems. Folks just don't know how stuff works. Maybe we're old(er) but we found ourselves asking, is tech killing curiosity? This post has more questions than answers, so I hope you sound off in the comments!

I have this glorious pocket super computer with me now. It connects to all the world's collected knowledge, has an advanced battery, radio transmitter, and so much more. But most people have no idea how it works? Yes, technically you don't have to know how it works, but aren't you curious?

We can make lists about how "there's two kinds of people in the world" and split them up into techie and non-techie, or computer literate or non-computer literate...but I'm thinking it's simpler. There's the curious and the not-curious.

I took apart my toaster, my remote control, and a clock-radio telephone before I was 10. Didn't you? What's the difference between the people that take toasters apart and the folks that just want toast? At what point do kids or young adults stop asking "how does it work?"

As each new layer of abstraction becomes indistinguishable from magic we may be quietly killing curiosity. Or shifting its focus. Is the stack so deep now that we can't know everything?

There's a great interview question I love to give. "When you type foo.com into a browser, what happens? Then what happens? Then what happens?" I ask this question not because I care how deep you can go; I ask because I care how deep you care to go. Where does your interest stop? How do you THINK it works? Where does technology end and where does the magic (for you) begin? HTTP? TCP? DNS? Voltage on a wire? Registers in chips? Quantum effects?

I do an Exploring Engineering class at local colleges each year. I love to open up a text file, type the alphabet, then open that text file in a hex editor and go "hey, the letter 'a' is 61 in ASCII, why?" Then I add a carriage return/line feed (13/10) and ask a room of confused 18 year olds "what's a carriage and why does it need to return?" I take a record player in and talk about the similarities between how it works versus how a hard drive or blu ray works. I see where the conversation takes the class. Inevitably the most engaged kids (regardless of their actual knowlegde) will end up being great engineering candidates. But where did their curiosity come from?

Perhaps curiosity is an innate thing, perhaps it's taught and encouraged, but more likely it's a little of both. I hope that you're stretching yourself and others to ask more questions and explore the how and why of the world around you.

What do you think? Is 21st century technology making it too easy? Are iPhones so magical sitting atop the last millennium of technology that it's not worth teaching - or even wondering - how it all fits together?


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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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White House Visit - Foster Care and Technology Hackathon

May 24, '16 Comments [20] Posted in
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Going to the White HouseHey friends! I am so proud to be a technology advisor for the the White House Foster Care and Technology Hackathon this week!

While I'm participating in this event and advising as a private citizen, there is a Microsoft team. Here is a brief statement about the Microsoft team's involvement in this cause:

The Microsoft team is honored and excited to participate in this year’s White House Foster Care and Technology Hackathon on May 26th-May 27th. It is a wonderful opportunity for top technical talent across different industries to work together in collaboration with the White House, the Dept of Health and Human Services, Annie E. Casey Foundation, and Think of Us, with the goal of improving the US foster care system and outcomes for children and families who experience care.

The hackathon participants are tackling the biggest problems in the foster care system including topics such as empowering foster youth and alum with decision-making abilities, getting more innovative technology into child welfare agencies, and preventing homelessness and unplanned pregnancy for youth.

Another huge area of concern in the foster care system is that of substance exposed infants and children. Each year, nearly 440,000 infants are affected by prenatal alcohol or illicit drug exposure. Oftentimes, the mothers of these children who are battling substance abuse struggle with seeking care and treatment for themselves and the children. Many of these mothers are young and do not have the support system that they need to get advice and help to both overcome their additions, and take care for their children. Even if they have the inclination to get help, where do they start? And how can they do this without being stigmatized?
The Microsoft hacking team is looking to create a streamlined process by which mothers can access the resources they need, and easily ask for help.

Mothers with addiction problems often struggle to keep their addiction and pregnancy secret, and are therefore hesitant to seek the help they and their children so desperately need. The solution must take this sensitivity into account. Locating relevant information about available resources is another problem. It must aggregate resources into a single place that is simple and easy to use but also non-judgmental.

The team seeks to create a marketplace for social services that will be useful to the mothers in need. Rather than solely aggregate data, the marketplace will include a recommendation system based on the anonymous inputs of the users’ needs, backed by a rating system that is commonly seen online. Influenced by the ratings systems of websites like Yelp, the team seeks to create an atmosphere that younger generations are used to by allowing them to anonymously rate the services they used, and benefit from the feedback of others.

The team is made up of Program Manager, Yossi Banai, along with technologists Paul DeCarlo, Mostafa Elzoghbi, Stacey Mulcahy, Heather Shapiro and tech advisor Scott Hanselman. Several members of the team have been personally touched or affected by the problem of pregnant and parenting mothers dealing with substance abuse and are passionate about improving the current situation for struggling mothers and their children. They will continue their efforts after the hackathon by maintaining the resources and programs created.

I'll take as many photos and instagrams as I'm allowed. Many thanks to Sixto Cancel from Think of Us, Kishau Rogers, and Vida Williams for including me on this project. I'll be speaking on Thursday along with a room full of amazing folks across the Child Welfare System and the Administration.

I'm excited to meet all the teams including the folks from StackOverflow, Slack, Clef, Uber, Twillio, Prek12Plaza, and more!


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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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.NET Core 1.0 RC2 - Upgrading from previous versions

May 19, '16 Comments [24] Posted in ASP.NET
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.NET Core at http://dot.net.NET Core RC2 is out, it's open source, and it's on multiple platforms. I'm particularly proud of the cool vanity domain we got for it. http://dot.net. ;) It makes me smile.

Here's the important blog posts to check out:

Head over to http://dot.net and check it out. A great aspect of .NET Core is that everything it does is side-by-side. You can work with it without affecting your existing systems. Be sure also explore the complete .NET Downloads Page for all the manual downloads as well as SHA hashes.

The best way to develop with .NET Core on Windows is to download the Visual Studio official MSI Installer and the latest NuGet Manager extension for Visual Studio. If you don't have Visual Studio already, you can download Visual Studio Community 2015 for free.

We'll have documentation and insights on how to moving from ASP.NET 4.x over to ASP.NET Core 1.0 soon, but for now I've collected these resources for folks who are upgrading from previous versions of .NET Core and ASP.NET Core (the framework formerly new as ASP.NET 5).

Enjoy!


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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.