Devil's advocate: diabetics do not want data logs, they want a better/longer healthy life. I do not have diabetes, but I would rather have an insulin pump that maintains glucose levels by itself than a meter that allows me to monitor them.
And yes, that pump will be imperfect, but it probably will do a better job than you can do yourself, let alone than you will do yourself.
I know that, traditionally, patients used glucose level measurements, stared at the numbers, guessed at what caused them and then tried to correct for similar future events, but AFAIK, that has never been very effective. It did give you some sense of being in control, but that was more an illusion than reality. e.g: your blood sugar is high. Is that because you drank a beer last night, because you went to bed late, because you did not sleep well, because you are stressed about something, because you had a fever two days before, because you took the bus to the train station?
However, except from the truly bloody obvious, that didn't help much maintaining blood sugar levels, unless you lived like a robot. Normal daily schedules simply vary too much to allow you to determine the true cause of atypical blood sugar level variations.
IMO, the time of stand-alone glucose meters has passed, and I do not see how having users process logs will help improve their lives. Reading individual measurements definitely will, but that is so that you can react at short notice, and adjust insulin intake.
I've been a diabetic for 14 years and that's exactly how I feel. The only way I can have perfect glucose levels is to live like a robot: wake up every day at the same time, eat exactly the same measured amount of food, check my glucose level every time my alarm beeps and do nothing out of the ordinary.
I'm trying to exercise more and the diabetes is the biggest barrier, I'm like a roller coaster right now.
I don't want to stare at a graph and do even more calculations, I want those calculations done by a machine, which can infuse insuline constantly and use more or less depending on my glucose trend.
There are new technologies out there, like this CGM [1] (continuous glucose monitor) which is very small and wireless (minilink minimed) which IIRC can work with an insulin pump (there is one that's very similar, wireless too, with a reservoir for three days of insulin)
> The problem? Price. Most insurances won't cover this, the initial purchase is not cheap and the maintenance cost a lot too.
I hear that a lot, but I think this may be a cached judgment and not be accounting for recent decreases in price and increases in CGM sensor quality. If you haven't asked your insurance recently, ask again.
I live in Spain and have no private insurance. Privates won't cover me because of the pre existing condition, if I had private insurance before being a diabetic they may have covered me, but things like CGMs and pumps always need a fight.
Public insurance won't cover CGMs right now and are hesitant to give out pumps. I checked yesterday again, a Dexcom G4 [1] is around 1.5K, and I would need around 200€ each month on sensors.
I'll probably end buying one out of pocket, but it's not something most people can afford!
What kind of price are we talking about here? Hundreds? Thousands? Tens of thousands? I realize that there are plenty of people who will be able to afford nothing beyond what their insurance covers, but of those that can, I imagine the price people would pay to live a "normal" lifestyle is relatively high.
Couple of points -
Yes, pumps give better control, yes it would be a lot better if it were a closed loop system between a continous monitor and a pump with a human confirmation point with suggested actions. We are a little way off that being supported by insurance/healthcare systems as cost effective, so really I am talking about the table as it is set up right now.
There are a number of biological factors that can make a difference, but for type 1 diabetics, the point should be that you know the ratio of carbohydrates eaten to insulin to take. This can vary, but good data helps you get the ratio right. It can also identify if you have high glucose points that match your circadian rhythm, or if you're becoming hypoglycaemic at a certain point regularly and just haven't mentally joined the dots.
Now, yes, you could do all of this through a log book on paper. I could sit down for a half hour each month and look for trends. But, I take readings on a device with digitised output between 4 and 8 times per day. I don't want to have to go analogue with that, I essentially want the blood glucose equivalent of google analytics. I can account for unusual variations (cycled for 10 miles/got blind drunk/etc.) much better if I have a dataset that demonstrates what the benchmark should be.
I forgot about differences between health care systems. In the one I know of (NL), AFAIK every type 1 diabetic who wants one and can handle using one gets a pump and insulin for free (my sample is N=3; replacement batteries, you have to pay, IIRC)
That makes sense, as companies are almost giving glucose meters away (in my N=3 sample, at least one owns more than one pump) to gain/keep market share for their 'razors', and as they improve quality of life so much for a relatively modest sum of money.
Also, suppose that you find the perfect formula for determining insulin intake. How are you going to apply it without an automated device?
> I do not have diabetes, but I would rather have an insulin pump that maintains glucose levels by itself than a meter that allows me to monitor them.
This does not align with the practical reality of diabetics or the biological reality of what pumps and sensors do. The situation is much better now with continuous sensors, which display a graph with a sample every 5 minutes with alarms for high, low, and changing too fast.
But you cannot take the human out of the decision process because the most important information needed to decide how much insulin to give is what (ie how much carbohydrate) you're eating, because the effect of insulin is delayed too much. Trying to make decisions from glucose measurements alone is completely inadequate. People are trying to do this anyways, by using dual pumps giving both insulin and glucagon (glucagon has the opposite effect as insulin). This hasn't left the research stages and I don't think it'll work very well.
And yes, that pump will be imperfect, but it probably will do a better job than you can do yourself, let alone than you will do yourself.
I know that, traditionally, patients used glucose level measurements, stared at the numbers, guessed at what caused them and then tried to correct for similar future events, but AFAIK, that has never been very effective. It did give you some sense of being in control, but that was more an illusion than reality. e.g: your blood sugar is high. Is that because you drank a beer last night, because you went to bed late, because you did not sleep well, because you are stressed about something, because you had a fever two days before, because you took the bus to the train station?
However, except from the truly bloody obvious, that didn't help much maintaining blood sugar levels, unless you lived like a robot. Normal daily schedules simply vary too much to allow you to determine the true cause of atypical blood sugar level variations.
IMO, the time of stand-alone glucose meters has passed, and I do not see how having users process logs will help improve their lives. Reading individual measurements definitely will, but that is so that you can react at short notice, and adjust insulin intake.