John Walsh PA, CDE

John Walsh, PA is a Physician Assistant and Diabetes Clinical Specialist with Advanced Metabolic Care and Research. He has provided clinical care for patients with diabetes for more than 30 years, including thousands of people on insulin pumps. He is co-author of Pumping Insulin, now in its 5th edition, Using Insulin, STOP the Rollercoaster, and The Pocket Pancreas. President of the Diabetes Mall, he is also webmaster of diabetesnet.com, a highly trafficked source of diabetes information and technology visited by 6,000 people a day, and opensourcediabetes.org. John is a consultant and advisory board member for pharmaceutical and device corporations and a frequent speaker on diabetes, insulin pump therapy, bolus calculators, infusion set design, glucose management, and the future of smart pumps, meters and continuous monitors. His recent research, published in the Journal of Diabetes Science and Technology, explores the dosing and behaviors that lead to successful glucose outcomes by pump wearers. John has worn nearly every insulin pump and CGM available and is a sub-investigator on numerous research studies on diabetes drugs and devices.

Tandem's Project Odyssey May Change Upgrades from Hardware to Software

Tandem Upgrades

When a pump company brings out a new pump, wearers using the prior models often want to upgrade to the latest and greatest device for its advancements or improvements in software or hardware. And based on usual industry practice, they expect an upgrade policy that allows them to buy the new pump at a reduced price. Tandem Pump Company recently announced the good news that FDA approval for the new t:slim G4 insulin pump that comes with a built-in Dexcom G4 is expected later this year. This new pump has a new body, new software, and new parts that allow it to display Dexcom G4 data right on the pump screen. Tandem will be ready to ship 30 days after approval.

Device Connectivity – The Next Big Wave in Diabetes

The Apple Watch and its operating system iOS 8 holds great promise for people with diabetes when it and the iPhone finally connect wearers to Apple’s Health software. With Android options also rapidly developing, these advances hold great potential for easy passage of diabetes data between devices so it can benefit people with diabetes and their health care providers. The question we really want answered is when will the meter, pump and CGM talk to each other?

Ask John

Welcome to our Ask John column. Here, we'll be posting questions from visitors that John has answered. These questions cover a wide range of topics, including insulin pumps, infusion sets, continuous glucose monitors, and medications. If you would like to send John a question, visit our contact page to post them. Please note that any advice given should be discussed with your physician before you try them.

Tidepool - Acquiring, Storing, and Opening Data for Improved Diabetes Care

Who does your diabetes data belong to? You - obviously. You're the one who created it and needs it for diabetes management. Your glucose readings, your insulin doses, your carbs and meals consumed, your exercise events, your stress levels, your devices. How can you take charge of your data and benefit from it?

Duration of Insulin Action

The duration of insulin action time (DIA, or active insulin time) is how long a bolus of insulin lowers your glucose. The DIA time starts when a bolus is given and ends when the bolus is no longer lowering the glucose. Like any medication you take, it is important to know whether insulin is still working or is “used up” before you take more. Boluses are frequently given before the previous bolus or boluses are used up. This is called insulin stacking. In the APP study, 64% of 132,000 bolus doses from 396 insulin pumps were delivered within 4.5 hours of a previous bolus, so most boluses involve some degree of insulin stacking.1 After a bolus is given, an accurate DIA minimizes insulin stacking and lessens hypoglycemia by accurately tracking how much insulin activity remains from previous boluses. This is reported as Insulin On Board or active insulin on a pump screen.

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