One Guy, an Insulin Pump, and 8 PDAs
By Scott Hanselman, Sat Sep 08 00:00:00 GMT 2001

Most people give very little thought to advances in medicine beyond the never-ending search for the cure for the common cold. But wireless technology promises to free people with medical conditions most of us never have to deal with from the ropes holding their lives back.

I decided to take a vacation. Since I was diagnosed with insulin-dependent diabetes five years ago, I've let it keep me from taking the vacation I'd like. When diabetics cross time zones, things can get a little tricky. I might be in New York at 9pm, while my body insisted it was time for dinner. It can get quite confusing and potentially dangerous to cross a few zones in a single day.

Three devices

With work travel taking a lot out of me, the idea of dealing with diabetes on a personal vacation didn't sit well. After a few years of six shots a day and six finger sticks a day, I was tired of entering my blood sugar into Microsoft Excel every night. So I took a month off work and wrote GlucoPilot, which lets diabetics log their blood sugar levels, insulin and carbohydrates, and view ad-hoc charts, since historical trends are invaluable information for diabetics.

This summer I got hooked up to an insulin pump. The pump is strictly an insulin delivery device, and consequently doesn't make any dosage recommendations. Accompanying the pump in my treatment is a blood sugar meter. I prick my finger, place a drop of blood on the test strip, and 15 seconds later I know the level of glucose in my blood. Based on these readings, I decide how much insulin to take. These three devices, separate but working together, help keep my sugar level in check.

Now I've got three devices in my pocket -- each with screens, batteries, and buttons, but all alone in the world. Three devices, each with a distinct purpose, provide me with a little bit of information that I give my doctor. It's quite a mess, especially when it's time to change the batteries.

Heading East

After writing GlucoPilot, I felt prepared to take a cross-country vacation. A friend was moving to the East Coast of the US, so I tagged along. I grabbed a few more devices to round out the trip: a laptop, a few Windows CE devices, a wireless modem for the PalmPilot, and a cell phone. I figured if I couldn't manage my diabetes on a cross-country trip with $10,000 worth of hardware, I'd die trying.

I took a roundabout way from Portland to New York, on planes, trains, and automobiles. As I traveled between time zones, I reset my pump to the local time, and changed and checked my blood sugar often. I'd use the historical charts from my GlucoPilot to make guesses at how much insulin to program the pump to deliver. I also used GlucoPilot to export my sugar records to the format my doctor uses. As unusual situations came up, I emailed my new data to my doctor using my Palm and wireless modem, and awaited his advice and counsel. I was truly the wireless traveler. Well, I had a tube from the insulin pump into my side, but other than that, I was untethered.

A Wireless Diagnosis

I checked my blood sugar six to ten times a day, since I was eating different foods and changing time zones often. The whole exercise, including sending the e-mail, took about 10 minutes. I don't think all but the geekiest of us could have completed the multi-step process.

Of course, each of these devices has some interface to the outside world, but each comes with an interoperability catch. The pump has infrared, but it only communicates with proprietary software. The blood sugar meter has a serial port, but it only works with a custom cable and software. My cell phone has some kind of interface on its bottom, but no standard way to hook it up to any of these devices. The PalmPilot has a serial connector and infrared, but doesn't have support from the notoriously slow-moving healthcare industry.

Converging Vision

I imagine a world of true digital convergence -- assuming that I won't be cured of diabetes by some biological means in my lifetime -- an implanted pump and glucose sensor, an advanced artificial pancreas. A closed system for diabetics that automatically senses sugar levels and delivers insulin has been the diabetics' holy grail for years. But with the advent of wireless technology and the Internet, my already optimistic vision has brightened. If I had an implanted device with wireless capabilities, it could be in constant contact with my doctor. If the pump failed, it could simultaneously alert me, my doctor, and the local emergency room, downloading my health history in preparation for my visit. If it was running low on insulin, the pump could report its status to my insurance company, and I'd have new insulin delivered to my doorstep the next day.

Devices like the Handspring Visor further excite me. The Visor is a PalmPilot clone, but includes a proprietary "Springboard" slot, which allows the Palm lookalike to become a digital camera or an MP3 player. I imagine a Springboard that would turn my Visor into a blood-glucose meter.

But that's not enough. With Bluetooth coming, why couldn't my Visor monitor my newly implanted smart-pump? GlucoPilot could generate charts and graphics from information transmitted wirelessly from the pump. For that matter, the pump, implanted in my abdomen, could constantly transmit information to Bluetooth-enabled devices that surround me. The pump might use my cell phone to call in its data into a central server when I'm not using the phone. If I wander near my home computer, the pump or Visor might take the opportunity to upload its data. During a visit to the doctor, Bluetooth's 30-meter range could provide the doctor with my minute-by-minute medical history as I sat in the waiting room.

Technology You Shouldn't Have to Think About

The key is transparency. As powerful and ubiquitous as PDAs and laptops have become, they are still not transparent. I'm constantly reminded of my medical condition as I work with the pump, Palm, and blood-sugar meter six times a day. If I want to export, upload, or move data between these devices, it's a tediously manual process. Every two weeks I have to remember to refill my prescriptions for insulin and buy more blood-sugar test strips. Why can't the pump or meter handle these mundane tasks for me?

There are so many more possibilities, it boggles the brain. What's sad is that many technologies are in place today that could be utilized for such systems. But we just need the healthcare infrastructure to improve and companies to agree on standards so their products can interact. Diabetes maintenance is a billion-dollar industry, but there is no standard for data interchange among companies' products, no standard software, and not a peep about support for devices like the PalmPilot or wireless phones.

It will happen, with companies like WebMD/Healtheon streamlining the insurance processes, MedicaLogic connecting doctors' offices, and HealthScript providing an online pharmacy and repository for medical records.

When it all happens, I might just take this trip again.

Scott Hanselman is an engineer and freelance writer living in Portland, Oregon. He's written a number of successful applications, including the GlucoPilot Diabetes Manager for Palm OS. He's currently working on a book called 'Computer Zen: Answers for the Non-Geek.' He welcomes e-mail at .