Lantus may cause Cancer?

June 29, 2009

LantusThis morning I was surprised to read that some health care professionals are worried that Lantus may be linked with Cancer. In an article published by Bloomberg, a UBS analyst said that while they could not confirm any risk they “hear a number of long-established safety concerns, in particular that Lantus use may promote cancer.”

The concerns abou the link between Lantus and Cancer are not new. In 2006, Diabetes Health magazine reported in an article that Ernst Chantelau from the department of endocrinology, diabetes and rheumatology at Diabetesambulanz MNR-Klinik in Dusseldorf, Germany and Jenny Hirst for the Insulin Dependent Diabetes Trust published a paper where they speculates that cancer may be a long-term side effect of taking Lantus.

Aventis 17 page application to the European Medical Agency (EMA) in 2000, noted 7 areas of concern to diabetics and physicians considering the use of Lantus (insulin glargine or HOE901) in the management of diabetes mellitus.  In particular, the report  said that there were ocurrences of cancer on some animal trials. The EMEA, however,  decided the information was “irrelevant.” Lantus was then approved.

lantus_produktion_xlConcerns over Lantus have been revived by Ralph DeFronzo, a diabetes researcher at the University of Texas Health Science Center, on a June 11 conference call sponsored by Credit Suisse. DeFronzo said he expected an “earthquake” event that might prompt doctors to not “feel so comfortable with glargine” insulin, according to the call’s transcript. Glargine is a chemical name for Lantus. Pressed for details, DeFronzo said, “Can’t tell you anything. So keep your ears open. It won’t take too long.”

The European Asociation for the Study of Diabetes has published a webcast as well as four preliminary papers about the issue and some patient information from the EASD and from Hemkens et al. An official statement from Sanofi-Aventis can be found here.

Amy Tenderich also has some coverage over at Diabetes Mine

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Review: Freestyle Lite blood glucose meter

June 25, 2009

Freestyle LiteFREESTYLE Lite by Abbott Diabetes Care
This is the latest generation of the Freestyle meters. It offers some of the standard inclusions that you would expect in any modern meter today, 5 second tests, compatibility with alternate site, and more.

Size: 40 x 75 x 17 mm

Advantages: The Freestyle Lite features no calibration which I must admit is no big deal for me, although some people may find it convenient. It also has a bigger display, which I’ve heard is one of the shortcomings of the Papillon. This meter takes the smallest drop of blood I’ve ever seen in a meter, and I have actually never managed to under dose the strip, even when I’ve been convinced I would.

The meter also has backlight, which I was very indifferent about in all my other meters, but the fact that this one lights up the strip makes all the difference. Now I suddenly can test in the darkness of a cinema without having to worry about light. I must admit pricking your finger (or in my case your palm) in the dark takes a bit of getting use to, but is perfectly doable. Putting blood in the strip, however, would be impossible without the tiny but really effective light.

I’ve been downloading the data to my computer, using both the free software from Abbott and a piece of specialised software that I’ve been using for a while. It works great in both instances (how did I keep logs manually before this is now beyond me). It uses a special cable but the same as both the old Papillon (Freestyle Flash) and the Caresens.

Disadvantages: This meter is not perfect. For starters, it comes with the same butcher knife style pricker that I’ve seen in most Abbott meters (I’ve quickly solved this hiccup by substituting it with my trusty Softclix). The strip canister is smaller than other meters, which makes it a bit difficult to put your finger in to get a strip. I have to turn the container upside down, which can turn into a mess sometimes. The case is the same size to the Optium Xceed (and almost identical) which makes the point of being the smallest meter in the market a bit useless.

While the strips only use a very tiny drop of blood, it does not have a window to see your blood being “sucked” into the strip, which makes the wait for the confirmation sound a bit annoying. The strip also absorbs the blood from the side and not from the tip, which makes dosing awkward sometimes.

The main issue is that the results don’t seem to be comparable with any other meter I own. I’ve done a full side by side comparison (testing with two meters over 2 weeks) with both the Optium Xceed (Precision Xceed)  and the Accu-chek Performa (Aviva) and the number of the Freestyle seem to be higher by about 8% to 16% higher than the other two?

Verdict: This meter is a first class fully-featured meter. Like all others in the market it has its good and bad things and is up to you of wether it fits your requirements. Personally I have now replaced all my meters with this model.

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Meeting other people with Diabetes

June 22, 2009

Anglers Tavern nightLast Friday I spent a few hours at the Anglers Tavern with some of my friends with D.  We had dinner and shared some pretty good conversations about a bunch of D and non-D related matters. As I was driving back from the event I was thinking how lucky I am for being able to meet other people who know what I’m going through.

Here in Melbourne, Australia we have a group of people who participate in the Reality Check forums and meet up every three months or so. The group changes every time with some new people and also some familiar faces. These events draw together some experienced people and also some newbies.

Our experience im this area seem to be pretty rare. even other attempts to organize events like this in other parts of Australia seem to have much more troble in getting this meets to happen. The only other events of this class I know are Kerri Sparling in the US with the Fairfield Ladies, and the Tudiabetes meet-ups

If you are reading this and feeling “yes, I wish there were one of these around here”, then this is  your call to take action. Organizing or attending a catch up is a great to meet other people with Diabetes in an informal environment. Here are some tips on how to start:

  • Start by getting some interest. Post a message in one of the Diabetes communities.
  • Try to get a feeling of how many people are interested, so you can pick the right venue.
  • Make a decision, and set a date and a place for the catch-up. (keep in mind that consensus dosn;t always work here)
  • Pick something central to your area, easily accessible and/or with pblic transport (if this makes sense in your area)
  • Post your fnal details, so people can confirm and attend.

Making one of this events happen requires some effort, but for those who attend, they can be a window to a whole new world, a world were we are understood and were there is real people who share some of the same challenges we do. Thanks to all of you who take the time and put the effort to organize these events.

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First Look at Medtronic Patch Pump

June 18, 2009

Let me start by saying that the information in this post is, at the time of publishing, more than a week old. Although it is not fresh from the press, I still thought was important to share here.

During the American Diabetes Association conference in New Orleans, CNBC interviewed Bill Hawkins, Medtronic chairman & CEO. This was your typical analyst interview where Medtronic commented about their products, the new Paradigm VEO and their work towards a closed loop system.

What was really interesting, is that for the first time, Medtronic showed to the media the prototype of a patch pump.

Medtronic-patch-pump

Medtronic’s patch pump, which so far does not seem to have a name, is expected to compete head on with Insulet’s Omnipod. I personally would like to see how it compares, and more importantly for me, whether will be available here in Australia. The Omnipod is still only available in North America and is not expected to be available anywhere else for a while.

Maybe this will be our chance to finally move to a tubeless pump, but obviously there is a long road still to go.

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Review: Cleo 90 infusion set

June 15, 2009

Cleo_2-225x225Continuing with the evaluation of a number of infusion sets I have tested the Cleo 90. I’ve used a couple of these sets, manufactured by Smith Medical and distributed as part of the Cozmore brand.

This infusion set is very different to most of the other I’ve tried or seen. I’m not even sure it can be define as manual or automatic insertion. The best I can do is to say that it is a semi-automatic insertion, luer lock infusion set.

The Good

The connector in you is very small, and held by a circle of transparent plastic instead of fabric adhesive. This makes it very discreet, specially for people who want to expose a bit more flesh (just in time for the northern summer eh?).

The other big advantage of the Cleos is in the way it disconnects. It’s an 8 way connector, which means that regardless of the way in which is inserted, the line can be made to point to any direction. This is probably useful if you, like me, place the pump in different places depending in what you are wearing.

The Bad

There are a few things about this set that I’m not too convince about. The first one is the way it is inserted. While one of the insertions did not hurt at all, one of them was very uncomfortable. Because the needle is hidden in the inserter, there is no way to see when the pinch is about to happen.

The second thing that is a bit tricky is the way the set is adhered to the body. There is a transparent circle on the outside and then a small round connector in the middle. These two pieces are glued to each other on insertion and fill a bit odd.

The first time I used one of these sets, the adhesive was very worn. While it was still very solidly in place, it did look like it was about to fall.

Verdict

I personally didn’t like this set, although I know others that swear by them. I personally think that this sets are so different to anything else out there that it becomes a matter of love or hate.

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Review: Inset II infusion set

June 9, 2009

Inset-IIToday I’m concluding my 6 day test drive of the Inset II infusion set (also known as Inset in some markets). It’s been an interesting experience, specially considering that is the first non-Medtronic set that I try in my Minimed Paradigm 522.

These infusion set is manufactured by Unomedical, but is also marketed by Animas. It is available in three colors here in Australia (Blue, Pink and Grey) although a fourth color seems to be available in the USA.

The Good

For me, the biggest positive of this set was the integrated inserter. In the past, I’ve had some issues with infusion sets getting stuck to the reusable inserter. By using an integrated, single use inserter, I’m sure to get a perfectly placed, always working set.

The set is small and compact and easy to keep around, specially good if you want to carry in your bag. It was also good to see that once you have completed the insertion, you only need to put the cap back on and throw in the garbage bin. No need for a sharps container as the needle stays enclosed, great specially if you need to do an emergency change on the road.

The Bad

There are a number of things that I didn’t quite like about this set.  Having a single use inserter means that the quality and feel of the device is not as good as some of the reusable ones. In particular, the Inset does not use a spring to shoot the needle in but instead, it creates tension by twisting some of the plastic. This also means that the insertion is not as precise as it should, which ultimately increases the risk of a painful insertion.

I also didn’t like the connector on the set. Instead of the twist off motion on other sets, the Inset uses a straight pug, which I found hard to connect and disconnect.

The adhesive is a bit smaller than some of the other sets, and seemed to be more affected by water from the shower. That said, it lasted the full 3 days without any issue. This, however, may be more of a problem for those who wear their sets for longer.

Verdict

While so far I really like these set, I will probably not continue using them in the long run. For much that I like the concept of an integrated single use inserter I really value the precision on the insertion movement.

I have, however, decided to keep a couple of these sets in each of my emergency kits, as they would come handy in case I need to change my set while away from home.

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Review: Thinset Reservoirs

June 6, 2009

Thinset reservoirA few of you may remember that a few days ago I ordered a few supplies to do a comparison between different infusion sites available.  Most of the infusion sets I ordered had a luer lock connector, so I needed to order a special reservoir as well. The reservoir is called Thinset reservoir, and is made in the USA by Applied Diabetes Research.

The Good

The biggest thing about this reservoir is it’s that it allows Minimed Paradigm users like me to use luer lock infusion sets. This effectively means that for the first time since the introduction of the Paradigm series of pumps, we have the flexibility of choosing any set available in the market today.

In addition to this, there are also a few features worth noting. In particular, the plunger has a stop at the end of it, which makes impossible to separate the reservoir spilling insulin all over the place. It also has clear markings in the barrel, so it is easy to read.

The Bad

While I really appreciate the freedom of choice that the Thinset reservoir gives me, it’s also fair to say that this reservoir is not perfect, specially when compared with the standard Paradigm reservoir.

The first thing that becomes obvious as soon as you take the reservoir out of the package is that it does not have the guard/vial holder that I like so much on the Paradigm reservoir. Instead, you get a syringe style needle that you need to insert in your vial and then hold manually. Probably not a big deal for those used to handle syringes, but for me (I always used pens before the pump) it feels like juggling and balancing at the same time.

The other thing that feels odd about this reservoir is it’s fit in the pump. Don’t get me wrong, it fits with incredible precision on the compartment, but the main issue is the bits that end up sticking out. The reservoir has two little wings at each side of the connector to twist the reservoir in place. This in conjunction with the actual luer lock connector make the whole setup a bit more bulkier than the simple elegant Paradigm connector.

Verdict

Overall, this is a very good product because of the options it opens for all paradigm users, but for me, it’s use will be dependant on whether I choose to use a luer lock set going forward.

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