Day 4 started off with another 8 a.m. session titled: Diabetes Self-Management Education and Support - Embracing Data and Digital Dialogue Advances.

In HUMAN SPEAK: More talk about dtech as teaching tools.

Takeaways

One of the speakers pointed out that psychological insulin barriers — as in fear of injections and fears that insulin might be too complicated are big issues with t2 — hence the reason for creating apps.

But let’s not forget about cost. In my opinion, COST is a HUGE fear factor — and no matter the type.

There was lots of talk re: smart phone apps.

Here’s the thing: If you’re going to spend time and money designing a diabetes app, GREAT.

I like and have actually had great results from using several diabetes apps.

But gosh damn, D language not only matters — it’s the key indicator of having a successful app or an abysmal one. #LanguageMatters.

Language in an app that shames or labels the user as a failure, fails the person with diabetes the app was created to help.

Apps that teach with visual cues, continually encourage and build the user’s confidence, and are positive in tone — that’s what people with diabetes want… and that’s what we REQUIRE.

Speaking of apps, let’s make sure that the design and required usage of said apps don’t drain the user’s data plan. Because going over your data plan because of a diabetes app that is supposed to help — actually is an added diabetes cost with monthly penalties in the form of $$.

Sidebar: My favorite speaker was Ulla M. Connor - a Linguist who presented on language and diabetes to the room full of diabetes healthcare professionals — and continued to bring the point home.

Yep, I was fangirling pretty hard — and when I had the opportunity to take the mic (literally), I did. And thanked her on behalf of every single person living with diabetes.

I also told every diabetes healthcare professional in the room that their words stick with us — so choose them wisely. And then people started clapping, loudly.

The rest of the day was spent looking at advances in diabetes tech.

The 2nd session in the morning was about Medtronic’s MiniMed 670G System, sharing real world data about increasing Time In Range using automated insulin delivery.

Takeaways

670G was approved for pediatric use for children between the ages of 6-13 — that’s big.

There are strong feelings that “time in range” may be more likely than HA1C to correlate with patient reported outcomes, as in quality of life, because the outcome is more representative of the whole patient experience.

Which in real world speak translates to less low BG readings per month —  even though our A1C is considered textbook tight.

Tight A1C’s usually mean higher incidents of low blood sugars — and it’s exhausting.

Medtronic also acknowledged that data has the potential to be overwhelming — and I appreciated them saying that.

The final presentation of day 4 was all about the Omnipod DASH.

Full disclosure - I’ve been podding since 7/31/2017 — you’re darn right I wanted to know what to expect from the DASH.

Takeaways

The Omnipod DASH’s  PDM isn’t an actual PDM at all. It’s a Samsung smartphone with touch screen, whose sole function is to act as a PDM - as in, you’re not going to use it for Snap-Chat.

Sidebar: Really hoping that it comes with a brightly colored PDM gel skin because a black phone, wearing a black rubber gel skin, that’s going to be placed in the blackholes that are the majority of handbags and knapsacks out there — no good will come of it.

The extra screen real-estate on the DASH is utilized because (and I’m paraphrasing): “Who has time to read the User Guide anyway?”

Also: It’s much easier to read than the current PDM.

The DASH has a built in Calorie King Food Library that supports the bolus calculator, a “Find My PDM,” function (it’s like Omnipod was in my head — because that’s my biggest fear), and the ability to add more detailed and personalized Glooko data management reports, via cloud integration.

Also: WOW, a heck of a lot of people (12) can track the graphs of the person using the DASH, if they want them to, through the Omnipod VIEW app. Glad it exists… I think. And I’m also glad that function must be turned on using a separate app — and is hopefully not always on full blast. I see the benefit but it makes me feel a little anxious as the person wearing it, that the entire village could be tuned in and watching at the same time.

ADA was a whirlwind and I learned so much.

Thanks again to the folks at Ascensia for giving me this incredible opportunity!

First up on Day 3 was “Building A Case for Getting Reimbursement for Behavioral Health In Diabetes.”

You know I was into it.

Fact and my opinion: Diabetes is 24x7, 365 days a year with no time off for good behavior.

Diabetes is never-ending and incredibly hard work that often goes unappreciated.

Diabetes Burnout (see day 2), runs rampant and has the ability to make people living with diabetes feel both overwhelmed and hopeless. We need help with both the emotional side of diabetes and the physical because our current and future health depends on it. Therefore, it’s a no-brainer: Behavioral health should be covered and healthcare professionals and patients shouldn’t have to struggle to be reimbursed or covered.

Takeaways

Just sitting in a session where Diabetes Healthcare Pros were presenting on this topic and who realized that treating the emotional and behavioral health of PWDs (people with diabetes), was equally as important as treating the physical aspects of living/managing diabetes, was BIG.

As patients, sometimes we forget that it’s difficult (IMPOSSIBLE), for our HCP to get us beneficial services without a proper billing code — and even sometimes when there is.

Also: Insurance companies need to stop treating diabetes as a “character flaw,” no matter the type.

Billable Codes (or lack thereof), impact both diabetes and mental health.

One speaker pointed out that even things that are considered cost effective in the long run for PWDs (as in they have long-term benefits to both our overall health and quality of life) are often  unaffordable in real time.

THAT is the reality of living with diabetes. And in my IMO, it is indicative of our broken healthcare system.

Speaking of… Another presenter stated that federally funded state insurance programs are more apt (as in willing) to approve the billing codes for preventive screenings for diabetes & mental/emotional health than private insurance companies.

DON’T. EVEN. GET. ME. STARTED.

My advice to Health Insurance Companies: If you want better diabetes outcomes for the clients on your health plans — and yes, we are your clients —you need to help people living with diabetes and the healthcare professionals who treat them.

You need to pay for preventative measures in mental health for PWDs, create the appropriate billing codes, without either party having to continually jump through hoops re: treatment coverage.

By doing so, you will allow people with diabetes to live better quality lives, make our healthcare teams’ jobs/lives easier in the process, and reduce the amount you need to payout in the long run. EVERYBODY WINS.

Sidebar:This info is neither new nor rocket science. This topic has been discussed in the Diabetes Online Community for as long as I’ve been a DOC Citizen - which is over 10 years — and well before that by some learned diabetes healthcare professionals.  

Day 3 continued with a session dedicated to "closing the loop with blood glucose meters, and how they are supporting current and future CGM therapies.”

Takeaways

Not all glucose monitors are created equal when it comes to accuracy.

The Diabetes Technology Society tested 18 blood glucose meters in a triple blind study and 6 received their Seal of Approval.

Here’s the link to that study and the names of the meters who received a seal of approval.

Also: GOOD TO KNOW.

Accurate meters aide in the accuracy of CGMs — they complement each another.

Sidebar and my personal observation: Not all insurance companies cover accurate meters, or the preferred meters recommended to partner with your diabetes pump or CGM.

And if they do, they don’t always (as in rarely), cover enough test strips.

And I don’t want to hear about not needing meter strips if you’re using CGM.

No diabetes tech is 100% foolproof and in my opinion, we always need something to compare the numbers on our screens too — we always need backup.

Why? Because the only thing that is 100% accurate, 100% of the time, is a perfectly functioning pancreas — and that’s no longer a viable option in my wheel-house.

Also, what if you inadvertently rip out your sensor or run out of sensors before your insurance pays for the next refill?

You bet you’re going to need your meter and strips.

Also: sometimes you just want to be disconnected for a bit.

IMO and I can’t stress this enough: Diabetes technology is fantastic - I am incredibly grateful for it, and love and benefit from it.

BUT, I believe that both industry and loved ones need to remember that as with any tech, visual data can be incredibly overwhelming. Users must be taught and encouraged that every part of their diabetes ecosystem allows for breaks — both for the person wearing and the person(s) watching.

And that it’s paramount that people with diabetes know and recognize what low and high blood sugar symptoms feel like — not only to better understand your own diabetes, but also because you never know when you will need to cope without your dtech.

The Vibe

So before I get into what rocked my world on day 2, I wanted to describe the ADA vibe.

It’s inspiring, all encompassing, incredibly overwhelming, mentally challenging, physically never ending (because the days start before dawn and continue well into the evening), and ADA has the ability to overload your senses and rock your world.

IT'S AMAZING.

It’s amazing to be surrounded by people who are fighting and working hard for people living with diabetes.

It’s magical to walk down the hall and suddenly strike up a conversation with a diabetes healthcare professional from London, Africa, Philly, or a town in the Mid-West that you’ve never heard of.

It’s awe-inspiring to be sitting in a scientific session that brings up emotions in all dimensions — and then look around the room and realize that you’re not the only one on the verge of tears, cheers, rage, or hope.

And it’s exhilarating to be surrounded by D Advocates, diabetes healthcare professionals, and industry people of all ages and continents.

As you walk through the hallways, you are literally surrounded by people speaking in different languages peppered with the same recognizable words. Including, but not limited to: “diabetes,” meters,” “CGM,” “insulin,” “pump,” “cure,” “diabetic,” “PWD,” and “patient.”

It’s mind-blowing.

In My Head

Day 2 started out with an 8 a.m. symposium about the integration of smart devices and CGM systems to provide better support — where it matters most.

In my head I thought: It matters “most” to everyone living with diabetes. Not just a particular subset — not just a certain age, group, or type. And it isn’t just limited to CGM systems. It is the same for other dtech like BGM and pumps.

One of the speakers mentioned that diabetes devices were seen as “part of a daily uniform.”

And in my head I was like: Children get tired of wearing the same uniform everyday — so do adults. Being able to change, unplug, disconnect, or go full blast with D devices is key!

The same speaker also mentioned that the desire to have less visible devices and systems allowed the child with diabetes to choose who they shared their diagnosis with.

In my head I was like: OK, I get that. Teenagers, in particular, often want to be invisible or want to create their own labels - and sometimes D is the last freaking thing they want on their “label.” At the same time diabetes is nothing to be ashamed of — the days of hiding in the diabetes closet are over, dude. Diabetes, no matter the type, isn’t a character flaw. Also: #LanguageMatters.

And FYI: Hiding that you have diabetes isn’t smart or safe.

A few presenters talked about reducing the burden of D by simplifying therapies, and being aware of d tech overload - I could relate.

My next, and favorite session was called: Making A Difference in Five Minutes - Interventions in Diabetes for Anyone with Diabetes.

It was near and dear to my heart for many reasons.

The session was all about diabetes healthcare professionals getting into the heads and hearts of people with diabetes — treating us with empathy, compassion, and understanding in order to get the best outcomes and quality of life for people living with diabetes. 

The session was inspired by the late, great, and very much missed, Dr. Richard Rubin from Johns Hopkins.

For those of you who don’t know who he was, that makes me sad.

I knew him — not well — he probably wouldn’t have remembered my name — but I have a feeling he would have remembered my story — and he inspired me every time I heard him speak.

Kind and caring, he improved the lives of people with diabetes and influenced diabetes healthcare professionals to do the same. He coined the phrase “Diabetes Burnout,” and its more scientific alter ego “Diabetes Overwhelmus,” and he understood both. His older sister and his son both had t1D.

And I know the kind, compassionate, and wicked smart speakers in this session would have made him proud.

They brought home crucial points to help D healthcare professionals make positive changes in both their diabetes dialects and dialogues with patients — changes that take less than 5 minutes — but make a world of difference.

Simple, common sense and familiar to many in the DOC (diabetes online community) who believe that #languagematters, and believe that compassion and empathy are key tools to our overall health.

Simple things for healthcare providers to do, like: Checking tone and choosing words wisely when talking with (never at) their patient who should also be recognized as their partner.

Speaking of partnering — assign homework, “identify barriers to success,” and work together.

Always point out the positive, focus on at least the one thing the PWD does well and build on it.

All the speakers pointed out that guilting, shaming, or using scare tactics on the person/people with diabetes, not only doesn’t work the majority of the time… it usually has the opposite effect.

On a personal note: Diabetes guilt is an anchor around the necks of people with diabetes that we don’t even know we’re wearing, until we let it go. TRUST ME.

Lastly, when a D healthcare professional isn’t sure what to do — they should talk less, listen more, acknowledge disappointments and fears, while offering hope, encouragement and compassion.

YEP, day 2 inspired and validated my feelings as a person living with diabetes.

Also: It made my eyes leak~ 

First: BIG thanks to Ascensia for reaching out and asking me blog about my experience at the American Diabetes Association’s, 78th Scientific Sessions in Orlando, Florida, aka #ADA2018.

Second: My name is Kelly Kunik, I'm from the United States, I’ve lived with t1 diabetes for a ridiculously long time — as in decades.

When I was first dx’d, the original Star Wars was on movie screens and diabetes glucose meters and diabetes technology were pure science fiction.

Instead of checking blood sugars, we checked urine (it was disgusting), there were only a few insulins out on the market and they were anything but smart.

We are now well on our way to leaving the “Diabetes Dark Ages” behind us, and although there is still work to do, diabetes tech and data are game changers.

Speaking of diabetes technology and data, my first day at ADA was spent in DiabetesMine’s day long DData Exchange event —  discussing and learning about diabetes data and innovations, in all dimensions. It was amazing and overwhelming all rolled into one.

I spent the day in a room where a substantial number of people live with/love someone with diabetes (always a plus), or who have a passion for all things diabetes tech and data related.

And a good number of PWDs (people with diabetes) in the room were “Looping,” which was both surprising and at the same time anything but, considering all the people in the room were passionate diabetes innovators and diabetes early adopters.

When I first started blogging in 2007, I never imagined that blood sugars could be shared in real-time and with multiple people, that diabetes algorithms could be a thing, or that predictive blood sugars could be a possibility. And I never thought that the FDA would actually want or push for greater interchangeability with diabetes tech and data, more efficient regulatory pathways, and faster approval of diabetes innovations.

Diabetes tech has changed tremendously since the mid 90’s and at an even more rapid fire pace since 2011. Today, as in right this minute, diabetes tech has developed into a unique, crazy, interconnected diabetes ecosystem that benefits the end user — as in you, me, and every single person living the diabetes life.

A Diabetes Ecosystem created from diabetes tech and diabetes data

The day started with a heck of a lot of talk about diabetes tech and ddata in this diabetes ecosystem, and the how the FDA are helping to push through the tech, to make the diabetes ecosystem more vibrant.

And once the crazy diabetes tech filled ecosystem images left my head, it made a lot of sense.

Think about it: When the FDA approves dtech fast (which they are), our diabetes ecosystem becomes diverse and multilayered with tech partnerships — all of which benefit us (the people living with diabetes) and of course the companies that work together to cultivate said diabetes ecosystems. That’s a given, whether you pump, prefer MDI, use a CGM, rely heavily on meters, or use a combo of all of the above.

No matter your preferred diabetes tech combos, cross integration between pumps, CGMs, meters and diabetes data management companies that are working together seamlessly, allows us to share our ddata with our Endo’s (and our loved ones…Or not) and on our smart phones, watches, laptops and home computers. And if we feel we are getting ddata overload, we can always turn off any part of the ecosystem we want. That is an important point to keep in mind as this can all feel more than overwhelming.

That’s one crazy, awesome diabetes ecosystem.

We have to help EVERYONE living with diabetes 

Doctor Anne Peters gave a passionate talk and shared heartbreaking stories of people with diabetes in underserved communities who were and continue to be, failed by the healthcare systems at the national, state and tech levels —  and whose lives were and continue to be cut short because of it.

I was sitting at a table where every single person was living with diabetes — and we were in tears.

Dr. Peters challenged a room packed full of diabetes tech companies, healthcare professionals, industry, and people living with diabetes, to act as champions for all PWDs in underserved communities to improve access to dtech, and overcome the educational, financial, and language barriers that hold them back — their very lives depend on that access and our help. Check out Dr Peters’ Simple Language Guidelines for Insulin Pumps & Pens for underserved communities.

Every single one of us must remember that underserved people with diabetes can and will benefit from diabetes technology… as long as they have access - and that’s on us.

Dr. Peters received a standing ovation at the end of her talk — and she deserved it.

Diabetes tech and data makes it easier to embrace my inner chef without freaking out about carbs

Near the end of the day the winner of the Ascensia Diabetes Challenge was announced and it made my inner chef all sorts of happy.

First place went to Whisk’s AI-Powered Culinary Coach.

Said AI-Powered Culinary Coach will have the ability to provide users with food recommendations based on a person’s individual preferences. It will allow users to input recipes (either yours or recipes you have found online) and receive the nutritional data for those recipes, and they eventually hope to expand to restaurant and supermarket meals.

Whisk’s Culinary Coach crunches the nutritional data in recipes so we don't have to.

I AM STOKED!

In the future they want to build the ability to link these food choices to a person’s glucose data, which will create a more personalized d-algorithm that understands how your favorite recipes react to your body and your diabetes.

In my opinion, this isn’t just for people with type 2 diabetes, which is what the challenge was designed for, this is for anyone who likes to cook and or eat.

I like to cook because I like to eat and I like to create. I DO NOT LIKE TO CLEAN. Whisk’s AI-Culinary Coach cannot help in that department. BUMMER.

FTR, I didn’t write about Whisk winning the Ascensia Diabetes Challenge because Ascensia hired me to report from ADA. I wrote about it because when I heard what it was all about and what it has the potential to do for ME.

Also, I was impressed with the runners up Qstream and xbird - check them out!

Final Thoughts: My head was spinning by the end of the day — and in a great way. 

I learned so much and I’m still processing it all.

Since Friday, images of my own “Diabetes Ecosystem” variations keep going through my head and in different dtech and ddata incarnations - depending on my mood, state of mind, and lack of sleep. But all of those images make me smile~