Diabetes Bites bites october 2012.pdf By more seamlessly integrating into people’s lives,...

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  • DDiiaabbeetteess BBiitteess October, 2012 Integrated Diabetes Services presents a quick synopsis of the latest diabetes

    discoveries and happenings. Send your comments or questions to:

    [email protected]*

    *this e-mail goes to office administration. To reach Gary Scheiner directly, e-mail

    [email protected] To reach Karen Franey, e-mail

    [email protected] For Jennifer Smith, e-mail [email protected]

    Special thanks to MJ Scheiner for our “bites” logo!

    ©Copyright 2012, Integrated Diabetes Services LLC

    333 E. Lancaster Ave., Suite 204

    Wynnewood, PA 19096

    (610) 642-6055

    (877) 735-3648

    Fax: (610) 642-8046



    In This Issue

    Dexcom G4 Now Available! …2

    News Youz Can Use …4

    App Rap …6

    New Product Feature …9

    Events of Interest …10

    The Diabetes Store …11

    How to trial a CGM …12

    Trivia Question …12

  • Halle-Freakin’-Lujah!

    G4 Is Finally Here

    After who-knows-how-many months and years of waiting,

    Dexcom has announced the FDA approval of the G4 Platinum

    Continuous Glucose Monitoring System. Compared to its predecessor, the Dexcom 7+, every aspect of the G4

    is “new and improved”. The sensors are smaller and sport a more streamlined insertion process. The

    transmitter is much more robust – emitting a signal that travels 20 feet or more. And the receiver is slimmer

    and features a bright, full-color LED screen. Several new customization options are built into the receiver,

    pertaining particularly to the high/low alert features. The receiver is also more water resistant – something I

    can appreciate having accidentally dunked and fried my share of 7+ receivers. New web-based downloading

    software is also in the works.

    In pre-release studies, G4 performed extremely well. Compared to laboratory glucose values, G4’s MARD

    (Mean Relative Absolute Difference) was only 13% – a value that is far and away the best in the industry.

    Fingerstick blood glucose meters, incidentally, are only required to be below 15% MARD. The sensors

    performed particularly well in a hypoglycemic and near-hypoglycemic range, with more than 80% of values

    within 20% of the lab measurements. Sensor longevity – something that Dexcom is famous for – continues to

    be a strength. Sensor accuracy was found to be as good on day 7 as on day 4, and 94% of sensors were able to

    perform beyond the standard seven day life cycle.

    On the downside (we can’t have everything!), the G4 transmitter is only warranted for 6 months, compared to

    12 months for the 7+ transmitter. This is due to the greater power consumption needed for the wider

    transmission range. Also, G4 should to be calibrated only when glucose levels are in a relatively steady state.

    G4 is priced at $1200 plus the cost of the disposable sensors. For those who currently have a Dexcom 7+

    system that is still in warranty (purchased in the past year), the cost is $399. For those who purchased since

    September 1, 2012, an upgrade to G4 will be provided for free.

    Dexcom is currently taking orders for G4, with shipment expected to begin before the end of October. Given

    the high demand for G4, there may be a bit of a wait to reach the sales department, and shipment may take a

    few weeks extra. But hey… if anything is worth the wait, this certainly is! Lord knows we’ve waited long


    For more information, visit www.Dexcom.com/G4Platinum. To place an order, call Dexcom toll-free: 877-339-


    To see a video demonstration of the new Dexcom G4 Platinum CGM, visit here:



  • (Advertisement)

    Introducing the latest in glucose sensing technology

    Dexcom proudly presents the Dexcom G4 PLATINUM

    Now in color and better than ever.

    Dexcom® is excited to announce the continued innovation of the Dexcom Continuous Glucose Monitoring (CGM) system

    by introducing Dexcom G4™ PLATINUM. With modern design and exceptional accuracy, the Dexcom G4 PLATINUM

    provides enhanced user conveniences and sensor performance that customers have long associated with Dexcom.

    Continuing our vision of patient-centric solutions, the Dexcom G4 PLATINUM brings the first, large color CGM screen to

    life, along with other user-friendly features and remains the only system with a sensor approved for up to 7 days of wear.

    By more seamlessly integrating into people’s lives, Dexcom anticipates continued improvements in patient compliance

    and retention that is already the highest among CGM companies.

    Demonstrated clinical benefits of CGM include:

    • Improve HbA1c levels without increasing hypoglycemia 3

    • Ability to reduce glycemic excursions 4,6

    • Improve time spent in ”target levels” or euglycemia 5

    • Reduce frequency and time spent in hypoglycemia 5

    http://www.youtube.com/watch?v=FAvQSkK8Z8UDexcom, Inc. | 6340 Sequence Drive | San Diego, CA 92121

    Product Support 1-888-738-3646 | www.Dexcom.com

  • News Youz* Can Use (*Philly for “you all”)

    More Good News on Degludec

    Degludec is a new super-long-acting insulin that produces a very flat basal profile in the bloodstream when

    taken on a daily basis.

    In a recent study, Type 1 diabetes patients who took a combined formulation of degludec and aspart

    (Novolog/NovoRapid) at dinner, with just aspart at other meals, had better nighttime BG control than patients

    on basal-bolus therapy with detemir (Levemir) as the basal insulin. Patients in the degludec group needed

    fewer injections and had 37% fewer episodes of nighttime hypoglycemia compared to the insulin detemir

    group. There were no differences in Health-Related Quality of Life or lab measurements, or in adverse events.

    Dr. Irl B. Hirsch, who led the study stated , "While it is important this was shown… I don't believe a co-

    formulation will become the standard of care in this population where we generally prefer more flexibility

    with the prandial (mealtime) insulin." Dr. Hirsch added, "We can't comment how this co-formulation would

    perform with tighter levels of glucose control and A1C levels less than 7%. Nevertheless, for some type 1

    patients who may do better with a co-formulation of degludec with insulin aspart, the same benefit of

    reduced nighttime low BG can be expected."

    Novo Nordisk is hoping to market the degludec/aspart combination as Ryzodeg and has submitted the product

    for regulatory review in North America, Europe, Japan, South Africa, India, Australia, Brazil, and Russia. In

    June, the U.S. Food and Drug Administration extended its review period for Ryzodeg.

    Walking after Eating Lowers Glucose in Healthy People and Diabetes Patients

    Walking or other light exercise after meals may reduce glucose levels by more than half in both healthy people

    and type 1 diabetes patients. Dr. Yogish Kudva led a study at the Mayo Clinic in Rochester, Minnesota. He

    found that even minimal activity sustained for 30 minutes (such as walking at a

    leisurely 1.5 MPH pace) lowers post-meal glucose concentrations.

    The results are from a larger study on patterns of postprandial glucose tolerance.

    Dr. Kudva and his team studied 12 people with type 1 diabetes and 12 healthy

    controls. For three days and four nights, the researchers monitored the

    participants' diet and calorie intake, physical activity and glucose levels in a

    controlled environment. Implanted continuous glucose sensors measured glucose

    levels, and triaxial accelerometers (motion sensors) reported body positions and


    The participants walked after two of their daily meals and sat after a randomly designated third meal. The

    researchers reported data for the glucose measurements taken 4.5 hours after eating. At that interval, healthy

    people had 13% higher glucose levels after inactivity compared to when they walked.

  • The diabetes patients had 45% higher glucose after inactivity compared to when they walked (p

  • App Rap:

    Lilly Glucagon Mobile

    Lilly Diabetes recently launched the FREE Lilly Glucagon

    Mobile App to educate those who support people living with

    type 1 diabetes. This interactive app is available on the iTunes

    store for iPhone and iPad devices and provides caregivers,

    diabetes educators, and school nurses with visual and audio

    emergency instructions, as well as tools to track locations of

    glucagon kits and alerts for expiration dates.

    People with type 1 diabetes who experience severe

    hypoglycemia (low blood sugar) during insulin treatment may

    require glucagon, a hormone produced in the pancreas to raise

    blood sugar levels. Diabetes patients should ensure that their relatives and close friends know that if they

    become unconscious, immediate m