Friday, March 30, 2012

Site Selector

Yesterday evening, Site Selector appeared on the iOS App Store. If you don't already know, it's a graphical log of where you're wearing you insulin pump and CGM. Since they lose effectiveness at different rates, sites can be reused with different frequencies, and their schedules are generally different, it can be difficult to keep on track of proper rotation. I didn't have trouble until getting the Dexcom, but I needed help and doing it on paper just didn't have the right accuracy.

So this is my first app. I've been doing web apps for pushing ten years, but this is my first iOS App. I used Phonegap, which lets you write native applications with HTML & Javascript. Used Sencha Touch 2 for the interface. There are other technical details on the project's Github page. (That's right. The webapp is open source).

Of significant importance with medical apps is your privacy. This log lives entirely on your device. It never touches the Internet. (If Apple decides to start replicating your data across devices, or backups, or..., or..., or...; that's different. I never push your data to the internet. I can't promise that Apple doesn't.) This also has the downside that all your data lives on the device. I hope it's safe. I've taken steps within the app to keep your data safe. But there's always the potential your phone takes a bath and the data disappears. It's possible an upgrade goes badly, and your data disappears. Perhaps a volcano halfway across the world erupts, and your data is swallowed in a river of lava. I don't think so, but the unexpected can happen. So best not to instantly forget where you've placed sites.

In the time this app has been under review by Apple, I've worked on bug fixes, and new features. The interface is a little easier to use. It's faster. Both insertion and removal dates are tracked. Times are now tracked. You can look up to 90 days into the past, to see sites from long, long ago.

One other feature I'm working on, and may be in the next release, or may not, is a CSV export. What that means is the data you enter can be transformed into a spreadsheet. Right now, I'm investigating what's possible, how to make that data available to you (Email? In iTunes? Copy/Paste? Haven't decided yet). I think that will be a useful feature, but want to get it right. And it'll make me feel a whole lot better about your data not living on the cloud: if your phone takes a bath one day, at least you'll have had the opportunity to back it up.

So that's Site Selector: It's available on almost all iOS devices. At least everything that runs iOS 4. Should even be attractive with the newest iPad, as it ships with insanely high resolution images.

Last: This is an opensource webapp based around Sencha Touch. Sencha Touch is supported on iOS, Android, Blackberry, and a couple of others. Phonegap has similar compatibility. I'm not especially interested in building or submitting for these other platforms, but if you are, go for it. Shoot me an email (site selector at alternate interior dot com) so we can coordinate but I'm all for this application being more accessible to people.

Tuesday, March 20, 2012

Public Knowledge

This is my first-ever contribution to the DMSA Blog Carnival.

Does your employer/school/friends know you have diabetes? Why or why not?

Most people I actually know are aware I'm diabetic. Details vary based on closeness, interest, etc, but for the most part, everyone is aware. While I certainly don't introduce myself as "My name's Brian, and I'm diabetic," there are inevitably occasions where my pocket is beeping, or I can't join in lunch, or have to check out of a meeting, or, or, or, and it's easiest to say "Diabetes" than to make up a filmsy excuse.

Even in the earliest days of my diagnosis, I would admit Diabetes. But while I was on shots, I was nervous about doing that in public. Even checking sugar, I would try to do in private. I have no problem using my pump in public, and I'm now comfortable checking sugar in front of others, but I tend to think if I ever had to go back on shots, I'd still be private about that. It's probably because you're more exposed with shots: it may not be clear what you're doing, but it's clear you're doing something serious.

But in just knowing, it's easier to put the knowledge out there. I've been fortunate in not having many run-ins with food police and even then, the convenience of not having to remember who knows what and who can know and that sort of drama far outweighs the annoyance of know-it-alls. There's also the benefit that, should anything ever happen, people would be better equipped to respond, if only to pass additional context on to first-responders.

So I put it out there because I'm lazy and it's self-serving.

Wednesday, March 7, 2012

The one with the swollen arm

Last night, I had a milkshake.

It was on the tail end of an infusion set. Took a truly absurd amount of insulin, ate, and enjoyed. Once I got home, I changed the set. Put the new one in my right arm.

Two hours later, I was at 165. Three hours later, I was at 120. I had owned that milkshake.

But then, suddenly, I got a ↗. Moments later, a ↑. By the time I rage bolused, I was up to 180 something and still raising. The pump wanted me to take about .7U, because I still had some on board. But I know better. So I took 7.0U. Blood sugar continued to rise as it was being absorbed but I topped out around 250. A second smaller bolus followed. Fought for a couple hours and got it down to 170, and went to bed.

Couple hours later, Dexcom buzzed. I was back up to about 230. Took the appropriate amount (not going to rage bolus if I won't stay up to babysit it) and went back to sleep. Looking at the graph, it got down to about 180 and then started right back up. Next time I woke up was closer to 300. Again, a normal correction, and back to sleep.

Tangent: Not sure what the point of trying to sleep with bad sugar is. It's the least restful thing I can imagine. 3 Hours of restful sleep is better than a full night of sleep on the glucocoaster.

When I finally woke up for real, I was around 200. And my arm felt swollen. And I realized, it wasn't the milkshake doing it to me, it was the infusion site. So I replaced it. Of course the old one bled. But the new one didn't stick! Half of it adhered to my belly while the other half flapped in the wind. I pressed and pressed, and there was no taming it. So I took it out. And it bled. Quite a bit.

The third infusion set in 12 hours went in without incident. My sugar is finally nicely and predictably declining. It just took using extra extra supplies that I'm going to need in another couple months. And enough time to convince myself it wasn't at all feasible that the milkshake was responsible for it all.

When I had the Medtronic pump, there was only one type of infusion site. It was 23" long, and I could put it in my belly, butt, back or thigh (and I wasn't brave enough to put it in my thigh). Now with the Ping, I have 46" tubing as well, and I'm using body parts like my arms that I just didn't ever use before. If I were to use the Ping exactly the same as the Medtronic, it'd work just as well. But it allows me to try sites I wouldn't have used before and they're just not at all a sure thing. The occasional failed site on a Saturday afternoon is one thing, but a failed site that costs me a night's sleep and 3 infusion sets is much more frustrating.