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November 22, 2016 0

Part 3: The Medications

A few months ago, I went for a blood test and found out my A1C was over 10%. This, combined with an unexplained weight loss of about 30 pounds, lead doctors to the obvious conclusion that I had joined the ranks of about 30 million Americans who had diabetes. At this point, the two major questions were which type of diabetes, and how can I treat it? Because it came on suddenly and quite severely, my doctors suspected type 1. I, knowing my diet and physical activity regime over the last 30 years, suspected type 2.

As diabetes is very complex, it’s more than just taking medication every day to treat this disease. There is a great deal a patient has to know about diet, exercise, devices, drug interactions, dosing, and testing. As there was so much to take in, I decided to detail my experience as a newly diagnosed diabetic and the challenges I have faced, having spent so much of my time on the marketing side, to now be on the patient side. In this article, I detail my experience with diabetes medications and why I chose the ones I did. My final article in this series will deal with the overall consumer experience.

Upon getting my diagnosis, my doctor prescribed me two things, insulin shots 3 times a day, with meals, and Glimepiride (Amaryl). I was surprised not to receive Metformin, as I heard this was usually a first line treatment, but was told that Glimepiride was secondary to Metformin in history and lack of side effects. For my other prescription, I was given Humalog quick acting insulin, along with a very quick primer on how to use it and instructions on self-dosing.

For reference, my numbers at this meeting were awful. My A1C was around 12%, which equates to a blood sugar around 300 mg/dL. My cholesterol was also awful, with a total of 327 mg/dL. My LDL was 228 mg/dL and my triglycerides were 206 mg/dL. Other endocrine numbers were also terrible but those were the most alarming to me, especially since all of these readings were normal at a physical almost a year earlier.

My instructions were to take the Glimepiride twice a day and take the Humalog twice a day, with 1 unit of insulin for every 40 points of blood sugar over 140 I was getting. Early on, most of my readings were in the 240 range, which equated to 3 units of insulin 3 times per day. The Glimepiride was easy, just a small pill, twice a day, no side-effects. My endocrinologist told me I’d see results pretty quickly if it worked, but I saw almost nothing from the pill alone. A few days later, once I mustered up the nerve to do the injections, I added the insulin to my regimen.

This immediately started to bear fruit, not only reducing my average blood sugar to the low 200s over the next few weeks but controlling my spikes. After a high carb meal, I could hit over 300; but now my spike would usually stay down in the 250 or less range. While this was an improvement, it was still way too high for me.

As far as taking the insulin, the hardest part was doing the injection. My instructions weren’t great and sticking a needle in your own stomach goes against every instinct you have, so it was a hard mental barrier to overcome. The Humalog pen, however, made it much easier than this otherwise would have been. Choosing an insulin dose was incredibly simple, physically injecting and administering the medication was quite simple, and with the insulin not needing refrigeration, it was a matter of keeping it out of heat and direct light, as well as making sure I had the proper equipment.

The needles given to me were Becton Dickinson ultra-thin micro-needles. Supposedly, they are some of the smallest needles on the market and, as my nurse told me, were lubricated to make injection/removal simple and painless. For the most part, this was true. If I could muster up the nerve, the injections were pretty easy, removal was always quick, and there was only occasional some redness or marks at the injection site.

I never really noticed many side effects from either medication or the physical injections, except for an occasional sting when the medicine was being administered. There occasionally may be some small bleeding if I came in at the wrong angle or a sting like getting pricked at the wrong spot if I hit a nerve, but the mental part was much harder than the physical part. I attribute that a lot to the quality of the penlike injection device and the quality of the needles as I don’t know how I could make it through this if I needed individual needles, syringes, and vials as previous diabetics would.

Adding an additional treatment option

While this was starting to move my numbers, I still wasn’t happy with the progress I was making so I requested my doctor add Metformin to my treatment plan. I was told that it could cause stomach discomfort but discounted that as I rarely experience digestive side effects from medication that is prone to cause those, but I erred significantly here. Firstly, I was prescribed 4 XR 500mg pills, 2 each twice a day. The pills are massive horse pills, so they physically aren’t the easiest to take. But the side effects made the experience much worse. At two a day, I experienced mild and occasional discomfort, but three (taken two in the morning and one at night) made things much worse. Frequent diarrhea, stomach pains, and overall discomfort became fairly common. Once I increased to four, it became almost unbearable as it went from an inconvenience to a real impediment in living my daily life.

If I was seeing major results, it would have made the effects more palatable, but I only saw maybe a 20-30 point drop in my already high blood sugar range during this time, to the 180s to low 200s on average. Because the side effect risk with Metformin, other than the stomach issues, was very low, as was the cost, I elected to remain on the medication but wanted to find an additional treatment option to hopefully reduce or replace my reliance on these medications.

I examined many type 1 medications, which are few and far between, as I was told it was likely type 1 early in my journey. Upon finding out a few weeks later that it was type 2, that opened up my world of medication options. I was looking at several, including Actos, Januvia, and Invokana, as I was adamant that I did not want to take any more injections. However, the potential side effects I read on many of these medications was enough to frighten me off, as was the cost on several of them. After further research and seeing that by body did react to insulin, I decided to go with a long-term insulin. I felt it would be the most effective, have the least side effects, and possibly replace one of my other injections so it wouldn’t really be adding to my troubles.

After examining my options, I tried to decide between Toujeo and Tresiba, the two newest on the market. Toujeo had a long-history as a somewhat newer version of Lantus. However, you needed a fairly strict dosing schedule on this insulin. Secondly, the discount program was less than stellar (more on this in my next article). Lastly, the patient reviews I read on for it were really poor, with lots of adverse reactions. While I know that people who have bad experiences are much more likely to post than those with good, I found there to be enough ratings to be of significance and they rated poorly compared to similar products.

I found this not to be the case for Tresiba. The fact that it would work for almost two days gave me some comfort as I was still figuring out my dosing and medication needs so that flexibility was something I valued. I could get it at a very reasonable cost while I tried it out so the financial investment wasn’t terrible. Lastly, the user experiences and clinical trial results for it were very favorable. Therefore, I had no problem anxiously asking my doctor to try Tresiba.

Upon starting Tresiba, about a month after my initial diagnosis, the hardest thing I found about it was the actual purchase (more on this next article). Taking the medication was very similar to the Humalog, with a similar device. However, I found, for whatever reason, it was even easier to take. The injections were simpler and less painful, the needle went in more easily (despite it being the same needle), and the medication caused less of a reaction. The pens also kept a long time, for about 45 days rather than the 30 days as with other pens. For someone like myself, who was put on a very low dose (8 units, even lower than the recommended 10 unit start dose), this allowed me to use the entire pen before expiration, saving me both inconvenience and money.

I was told the Tresiba could take nearly a week to work but within 3 days, my numbers fell substantially. I was getting my first readings in the normal range at that point, well enough that I could both dial back on the Metformin and no longer needed the quick-acting Humalog. Instead of getting in the upper 180s as I was prior to this prescription, I was getting most of my pre-meal readings around 120, with my spikes only going up to around 170 or so. For medical purposes, within a week of Tresiba, I was getting readings akin to what a healthy person would get.

All that was left was to fine tune my medicinal treatment and diet plan. Shortly after starting Tresiba, I spent ten days in Germany on a long-planned vacation. With a diet heavy on beer and pretzels, I was quite nervous what would happen to me, yet I only spiked to over 200 if I was REALLY bad with my diet. I would also come down to normal readings by the next morning and almost never experienced low blood sugar.

Long-term planning

Once I returned home, I was able to normalize my schedule and found even better results. I switched to taking my Metformin to one pill in the morning and two in the evening, from two pills twice a day. Suddenly the unbearable stomach issues I had from taking four pills were nullified almost that day. Furthermore, my waking blood sugar was down from its prior readings of 120-140 to around 90-110. I was so pleased with these results that I quit the Glimepiride entirely without any adverse results about a month later.

Keeping myself only on the 8 units of Tresiba for about two months and 1500 mg of Metformin XR for about a month, I went in for a followup blood test. I figured my A1C would be way down, based on my blood sugar monitor readings and that my diet was better so my cholesterol would be down. However, I was shocked when my results came in. My A1C, which was measured in late July at around 12%, was down all the way to 6.6%, which was pretty much within normal range. I expected improvement, but not that much.

Even more shocking was what happened to my cholesterol. When I took my initial test, my doctor wanted to put me on a statin immediately but I wanted to see what treating the diabetes would do. He approved this line of treatment but said not to expect a significant improvement. Therefore, he was shocked to see most of my numbers were cut nearly in half. Total cholesterol down to 167 mg/dL. Triglycerides down to 113 mg/dL. LDL down to 88 mg/dL. All of these numbers were improvements beyond my best hopes, despite mediocre commitment to diet and exercise. Furthermore, the significant 30 pound weight loss I obtained from diabetes has been maintained.

For now, I am maintaining my treatment of 8 units of Tresiba every morning and 1500 mgs XR of Metformin. I am thrilled with the results and finding that, thanks to the medications I am on, just three months after a terrible diagnosis, I am able to live my life much as before while keeping my numbers in a normal range. Other than annoying side effects from the Metformin, I have very little issues from my treatments. I don’t workout nearly enough and I am not strict about my diet, although I try to avoid high carb sides and desserts, as well as eat smaller portions than before, yet I have still achieved and maintained successful numbers with very few troublesome spikes. I have kept my weight lower; my vitals and cardiovascular numbers have improved considerably. While injecting myself every day is an annoyance, it’s not a major problem. I am still hoping for a longer-lasting insulin so I can cut my dosing, but I am comfortable that maintaining this treatment plan and nothing else can lead me to a long, healthy life – something I never thought I’d be able to write a few months back.

Scott Ehrlich

September 28, 2016 1

Part 2: The Blood Glucose Monitor

Editor’s Note: This is the second installment in Scott Ehrlich’s multi-part series, What’s a Diabetic to Do? Join us as he shares a first-hand account of his experiences as he moves along his treatment journey after having been diagnosed late this summer. Click here to read his first article on this subject.

A few months ago, I went for a blood test and found out my A1C was over 10%. This, combined with an unexplained weight loss of about 30 pounds, lead doctors to the obvious conclusion that I had joined the ranks of about 30 million Americans who had diabetes. At this point, the two major questions were which type of diabetes, and how can I treat it? Because it came on suddenly and quite severely, my doctors suspected type 1. I, knowing my diet and physical activity regime over the last 30 years, suspected type 2. I decided to detail my experience as a newly diagnosed diabetic and the challenges I have faced, having spent so much of my time on the marketing side, to now be on the patient side.

In this article, I detail my experiences with the blood glucose monitors. My future articles will deal with the medications available and the overall consumer experience of being a newly diagnosed diabetic.

After going to my GP with my initial blood results, I went to an endocrinologist for a follow-up. I was sent home with an Accu-Chek Aviva Plus meter. However, my insurance prefers OneTouch meters, so I acquired one of those, a OneTouch Verio. I also received an offer for a free Abbott FreeStyle meter, which I took advantage of as well. Lastly, I took a trip to Europe and was able to acquire an Abbott FreeStyle Libre wearable monitor, which isn’t yet available in the United States. My impressions of all of these monitors are detailed below.

avivaplus-packagingAccu-Chek Aviva Plus

The Accu-Chek Aviva Plus monitor was my first experience using a blood glucose monitor. It looked similar to a stopwatch and had some pretty good functions on it that allow you to mark when you did your test, get averages, and transfer to a computer. It takes 0.6 µL of blood for a successful test that go into a strip from the front. You know you have enough blood when the strip sucks it up. All in all, upon first glance, it didn’t seem that difficult.

My actual experience with the monitor itself was far less pleasant. It took me quite awhile to figure out how to use it properly. The biggest issue I had was that it would often flash that too much time had passed from when I inserted the strip to putting blood on it, and that I had to try again. This meant I had to prick myself again AND waste another testing strip (which weren’t cheap), even when I knew I had done the test promptly. It was only after a few weeks that I learned that this message really meant that there wasn’t enough blood on the strip.

While 0.6 µL didn’t seem like that much blood, compared to some older and cheaper monitors that took 1 µL, it was often more than I got from a single finger prick, meaning I had to do lots of squeezing or additional pricking to get enough blood for a sample. And once you put blood on a strip, if there wasn’t enough, you couldn’t add more blood, so that strip was lost. I wasted probably 1 out of every 2 strips at first and even after a few weeks, I was still wasting 1 out of every 4 or so. That’s a lot of money on wasted strips.

Another thing I disliked was how it transmitted your data. It came with a wireless way to connect and transfer data to your cell phone, for storage and further analysis, which I thought was great. It was only when I tried it that I learned the wireless wasn’t compatible with my Droid phone so all of that functionality was out the window and I could only import some raw numbers via USB.

Between the strips’ issue and cost, the large amount of blood needed for testing relative to other current meters, the lack of alternate site testing, and the mediocre interface, this was my least favorite meter I used. I still have it for emergencies, in case something happens to one of my others, and it’s certainly functional, but I didn’t find anything on it that was comparatively excellent and it definitely had many shortcomings.

VerioIQOneTouch Verio IQ

The next meter I tried was a OneTouch. My insurance said they preferred OneTouch so I was allowed to get one of a variety of meters for no cost. I opted for a OneTouch Verio IQ. This meter was advertised as only needing 0.4 µL of blood and had some alternate site testing. It also had an analysis program that you could do through computer. And, since my insurance worked closely with the makers of OneTouch, I thought the strips would be very affordable.

On some accounts, this meter was all that it advertised. Taking it out of the box, it was by far the slickest looking meter, looking like a modern iPod, with a full color interface. It had the best graphics and definitely looked like a modern monitor should look. It also took less blood to work, which was nice. The blood, however, was inserted into the side of the strips (which were much smaller than the Accu-Chek strips); I found that to be easier after a few tries. It was a promising meter but it did have a few shortcomings.

Firstly, it wouldn’t turn on when I took it out of the box. I realized it has a rechargeable battery, unlike the rest, and needs to be charged before use. That’s not a big issue, but can be a problem if you need to test right away or frequently and don’t remember to charge it regularly. Another issue is that the alternate site testing was somewhat limited. Think your palm or sides of fingers but not other places on the body, if that matters to you. Finally, it only came with ten strips and, despite being the preferred (and, in fact, only covered meter) by my insurance, they still wanted nearly a dollar a strip, considerably more than I was paying for the Accu-Chek. Because of this, I opted not to continue use past the ten included strips. For the limited time I used it, it seemed like a quality monitor and if someone really needed a lot of analytics on their blood tests and tested frequently, it could be very useful, even if it still left some things to be desired.

InsuLinxFreeStyle InsuLinx

The final monitor I tried was the Abbott FreeStyle InsuLinx. I received this through a coupon I found on the Abbott FreeStyle website. While the coupon has proven incredibly difficult to use (more on this in a future article), I found the trouble to be worth it with this monitor. I was excited about it because it only required 0.3 µL of blood and allowed testing in many sites. When I first used it, I was hoping it would make my testing, which I had done quite frequently at that time, much easier. It’s nice to see I was proven correct.

Firstly, it required only half the blood as the Accu-Chek monitor and about 75% as much as the already low amount needed by the OneTouch. Secondly, you can test nearly anywhere you like. So if you are getting sore or have an aversion to testing on your fingers, you can use forearms, upper arms, wherever. And finally, my favorite part, if you don’t get enough blood on the strip when you test, you have 60 seconds to add more. This gives you plenty of time for one or two additional pricks if need be, meaning you almost never have to waste a strip. The strips themselves are also tiny and allow you to put blood in from either side, giving a lot of flexibility that way as well. From a simple testing standpoint, this is by far the best monitor of the three in every way.

This is important because the in-monitor features, at least the ones I’ve found, are minimal. You can only do a small bit of labeling, analytics are pretty much none existent, and I have not found out how to do any sorts of averages on the monitor itself. The interface is also nothing special, with the ability to choose a background image the most advanced thing I have found.

Still, analytics aren’t that important to me as I just need to stay in a fairly wide range of sugars and don’t have to treat often with insulin or other meds throughout the day. So for me, simple functionality with little blood and little wasted strips is paramount. And to that end, this monitor is by far the best of the ones I have used.

DexcomContinuous Glucose Monitors

Despite that, I still felt there had to be something more. Pricking your finger, testing a few times a day, getting a few snapshots of blood sugar readings. All of these things seemed very archaic with today’s technology. So, in researching for something better, I found two continuous blood glucose monitors. These were wearable devices that would give you your blood sugar on a fairly constant basis without finger pricking or strips. The first, which is currently available in the United States, is made by Dexcom. This is a device you can wear on your arm for seven days and get consistent blood sugar readouts. Unfortunately, the cost of $700 or so for the initial device and its lack of coverage by insurance made testing it a bit out of my reach.

Another device I had seen was the Abbott FreeStyle Libre. This device, at a cost of $80 for a wearable patch and another $80 for the scanning device, along with a wear time of 14 days, was much more in my wheelhouse. When I found out that you can use an app on your cell phone instead of purchasing the reader, bringing down the cost of trying it even further, I was even more intrigued. There was one hitch, however; this device has yet to be submitted to the FDA for approval and is therefore not available in the US. In fact, you can’t even access the website or apps from a US computer.

This was quite discouraging. As luck would have it (or as lucky as someone can be when having diabetes), I was headed to Germany for an extensive vacation around this time, where it was for sale, so I made some arrangements to procure a single pod for trial. I was curious to see how my newly diagnosed body would hold up to the diet of beer and pretzels I planned on feeding it, as well as how my blood sugar reacted outside of my normal testing hours or while I was sleeping.

LibreAfter getting my device and downloading the app, I watched YouTube videos on how to set it up. Seeing the size of the needle I would need to put into my skin to “install” it, however, made me quite queasy (although seeing six-year-olds putting it in themselves without even flinching both put me at ease and made me realize how big of a baby I was). Still, after a copious dose of liquid and pretzel courage, I had my wife put it into the fatty part of my left arm. To do this, you put the pod (about the size of a quarter) in an applicator-type object, push down almost like a stapler, and take it off. Shockingly, not only did it not hurt, I didn’t even feel it go in. And yet there it was, on my arm. I initialized it with the app and took the first reading on my phone. I then checked it against my blood glucose monitor. They were nearly identical.

I was enthralled with this device, how it could be there, attached to my arm and I could just wave a phone over it to get my blood sugar, cursing that this wasn’t available in the US. I checked my blood sugar over and over, amazed at this new technology. Oddly, though, my sugar readings dropped, first to slightly low, then very low, then to the point where I would be in a hypoglycemic coma, then to the point I would be dead. I confirmed on my blood sugar monitor that I was not, in fact, dead at that point, nor were my readings even low, and thus I began to see a flaw in my new toy. Further research told me it could take 1-3 days to calibrate the device. With only 14 days of use and it being basically useless for the first few, I became less enthralled. Furthermore, my wife noticed a fairly massive (albeit painless) bruise forming from the insertion site, taking up most of my upper arm. Perhaps technology wasn’t as great as I thought it would be.

After toying with removing the device, I waited out the few days and it did, in fact, calibrate. The results would deviate from my blood sugar monitor, sometimes by five points, sometimes as much as 20. I read that because this was measuring your sugar through fluid in your skin rather than blood, the readings wouldn’t be as current as finger testing and weren’t to be used if your sugar was rapidly changing, such as after eating or if you needed it for insulin doses. This was a fairly severe limitation of the product. I am not sure if this calibration time or inaccuracy was a result of the device itself or the third party app I used to read it, but it is definitely an issue.

Still, this device was amazing. I could swipe my phone over my arm for a few seconds and get an instant reading. I could test as much as I want, wherever I wanted, in seconds. I could have, at a glance, all my results for days, including during when I was sleeping. I could see my highs and lows, when I was rising and falling, what really caused my sugar to spike and drop. It was very instructive and I could see this sort of device is the future.

After 12 days (and another few beers), I took it off. It peeled off fairly simply and painlessly, and the bruise itself started to go away. I don’t feel the need to get another device because of the trouble involved in procuring one and the lack of support once I had it, as well as the fact that it is also a bit cost prohibitive now since it is a cash payment. I do, however, think that when Abbott submits this to the FDA in 2017 or 2018, assuming it’s approved, I would definitely consider using it again, maybe even as a replacement for my other device. Right now, at $80 every 14 days, I am not sure the value is there. But cut that to $10-$20 with insurance and improve the issues with calibration, this could cause testing compliance to skyrocket. Improve the life to 30 days and this device would really take off. As much as I find my other Abbott FreeStyle InsuLinx to be useful, it’s obvious that a wearable CGM, integrated with apps and analytics on common cell phones, is the future of testing.

Scott Ehrlich

August 25, 2016 1

Part 1: Testing And the Lancing Device

Editor’s Note: Last month, DTC Perspectives’ President & Chief Operating Officer, Scott Ehrlich, was diagnosed with diabetes. Join us in the multi-part series as he shares a first-hand account of his experiences as he moves along his treatment journey.

About a month ago, I went for a blood test and found out my A1C was over 10%. This, combined with an unexplained weight loss of about 30 pounds, led doctors to the obvious conclusion that I had joined the ranks of about 30 million Americans who had diabetes. At this point, the two major questions were which type of diabetes, and how can I treat it? Because it came on suddenly and quite severely, my doctors suspected type 1. I, knowing my diet and physical activity regime over the last 30 years, suspected type 2.

As diabetes is very complex, it’s more than just taking medication every day to treat this disease; there is a great deal a patient has to know about diet, exercise, devices, drug interactions, dosing, and testing. As there was so much to take in, I decided to detail my experience as a newly diagnosed diabetic and the challenges I have faced, having spent so much of my time on the marketing side, to now be on the patient side. In this article, I detail with the lancing devices I have had to learn to use. My future articles will deal with the various monitors and medications available, and the overall consumer experience of being a newly diagnosed diabetic.

After going to my GP with my initial blood results, I went to an endocrinologist for a follow-up. After taking a quick and painful finger prick with the lancing device at the office, they quickly confirmed that I had diabetes, with a fasting blood sugar of 273mg/dL at that time. (A normal result for fasting blood glucose ranges from 70-110 mg/dL.) I was also told that the blood work, to determine which type of diabetes I had would take a week. However, because of how high my blood glucose was and that the doctor suspected type 1, he decided an aggressive course of treatment should be tried, well beyond diet and exercise. Being that I was deathly afraid of needles, this was awful news for me. I was told I needed to test my blood sugar at least four times a day and inject insulin into my stomach three times a day on a sliding scale depending on where my glucose was. After a very brief demo, the nurse sent me home with an Accu-Chek meter, a FastClix pen, and 100 units/mL of Humalog fast-acting insulin.

Testing with the Well-Knowns

The first thing to deal with was the testing. I had read, prior to this visit, that FastClix was one of the preferred pens of diabetics as far as reduced pain and ease of use was concerned. The FastClix device was small and came with a cartridge for lancing devices that held six lancets. When pushing the button, you never actually saw the needle, which was good for a needle-phobe like myself. After mustering up the courage to prick myself, I put it on the second lowest depth and proceeded to prick the side of my finger. The button to give the injection is like the button on the back of a pen, except you have to push pretty hard. I kept pushing and pushing, holding my breath, waiting for that stinging pain. Finally, after pushing down a good bit, it finally kicked into action, the lancet pricked me, a little blood bubble was drawn, and I had done my first test.

I was pleasantly surprised to see that this really didn’t hurt. However, I was not happy that it wasn’t comfortable and, the knowledge that I’d have to do this three to four times a day at least, every day, for possible the rest of my life, would leave my fingertips pretty torn up. This was confirmed by the fact that, by the end of the second or third day, and even though I would switch up fingers, they were pretty sore. There’s not a lot of places you can inject on the fingertips and, being useless with my left hand, there is really only one hand I could use for the pen. FastClix also isn’t meant for alternate site testing so I could see my index and middle fingers on my left hand were due for a rough ride. Still, for the price and ease of use, as well as the lack of any real pain (like briefly pricking your fingertip on a thorn at worst), it could have been a lot worse than the FastClix.

Trying an Alternative Device

Still, I was concerned about the frequency of the testing and the accumulated discomfort. Knowing I had to do this a lot, I tried to see if there were any devices that could be better and provide less discomfort or more choices as to where to do the testing. I came across an interesting device called Genteel, developed by an engineer. There weren’t a ton of reviews I could find on it and the price of $129 for a lancing device seemed a bit steep, compared to the $20 or far less most others would cost. Furthermore, most of the positive reviews I could find either came from the site itself or from people given a free sample for testing. The website featured a video of a sleeping child getting tested on their shoulder by a parent and not being woken, which also seemed hard to believe. Still, hating needles more than I hated parting with my money, I decided to order one and give it a try, as it’s only available via online order.

When I received it a few days later, it was much bigger than the other device and came with a bunch of highly visible lancets. There are also some attachments you put on top to control the depth of the stick. It is certainly less intuitive than the FastClix, with a lot more moving parts, to start. I put on the one for the smallest stick, which is largely recommended for finger sticks, since body skin may be thicker. I set it up, put it on my shoulder as in the video, and pushed the button. At that point, the plunger pops up and you are supposed to hold the button for a few seconds before taking it off. Aside from the loud pop it makes when you push the button, I didn’t feel anything. No stick, no pressure like with the FastClix. I took it off and figured I’d need to put on the cap for a deeper stick on the arm when I looked down and saw a perfect blood droplet sitting there. I couldn’t believe it.

I tried the same thing on my finger. It wasn’t easy to find a spot on my fingertip that would fit the device at first due to its size, and also it needs a vacuum seal to work properly. However, once I lined it up right and did it, it was much the same result. Painless, and, unlike the FastClix, largely sensationless. You’d also usually draw more blood with each prick, even on the lowest depth, which could be very helpful in machines that require a good amount of blood for each test (more on these in the next article).

One of my only complaints about it is that, for the price, it’s not the most durable device. I dropped it on the floor when trying to set the plunger and the back part fell off. While it is removable for cleaning, it was a pain to get back on and even when I did finally get it back on, the device didn’t work properly, either flying off when I tried to test or pricking way too deep leading to real pain. I was able to get it working again, however, in a few hours and I am certainly no engineer when it comes to fixing devices. I was also sent another device immediately after I said something to their customer service rep, who was available to be reached through an online chat, on a Sunday night no less. Their service is superb. My only other issue with this device is that it is a bit bulky compared to others, so carrying it in a pocket or a small carrying case, such as the one provided, along with my other diabetes supplies, isn’t easy. However, it’s a great device and I haven’t used my FastClix since I received it.

Factors Impacting Compliance

Testing is one of the most important things for a new diabetic to learn and compliance with testing is paramount, regardless of the type or severity of the disease. With the FastClix, I didn’t fear testing, but I certainly would not do it more than I had to; I sometimes had to talk myself into it. With Genteel, I had no trouble convincing myself to test. In fact, I was testing so frequently I ran out of my first month’s supply of testing strips in about a week. For someone like me that hates needles, doesn’t do well with pain, and likes to be able to vary their testing sites, Genteel has been a tremendous help in frequent testing, the first step in keeping my blood sugar numbers stable.

However, I am also a consumer that has both means and did a lot of research. Neither my endocrinologist or his assistant had ever heard of it. Most insurances won’t cover it. It doesn’t come with any glucose meter. There is no DTC behind it. It’s not sold at pharmacies. So most consumers will be using something like the FastClix or the OneTouch Delica (which came included with my OneTouch Meter). These are good devices and I’m sure much better than what preceded them. They are cost effective (both of them were free for me) and get the job done. They both come with glucose meters, are widely available, and are backed by well-known and respected companies.

If testing was infrequent, cost was a major driver, or the patient was a bit tougher around needles than I was, I think both would be perfectly sufficient. However, if you were like I was, and building up the courage to do each and every single finger prick was a struggle, the Genteel was well worth it. And if my two-year-old son, for example, was the one who had diabetes instead of me, the Genteel is a no brainer. It has been a game changer for me in maintaining testing compliance, and pharma companies would do well to integrate it or a similar lancing device into their treatment packages. Because no matter the diabetes type, no matter the severity, no matter the treatment plan, regular and frequent testing is a necessity. That becomes much harder when the patient has any amount of fear of or dislike for their lancing device.


Scott Ehrlich