Comparing the Accuracy of My Blood Glucose Meters


I was first introduced to the One Touch Verio IQ when I began using an Animas insulin pump in May 2016. The sales rep gave me a rave review of this blood glucose meter, telling me that it was one of the most accurate on the market. This meter had also been recommended for calibrating readings on a Dexcom system, which is often considered the golden child of continuous glucose monitoring in the diabetes community.

At the time, I was quite happy with my FreeStyle Insulinx and had no intention of switching. However, the Verio was quite a good looking meter and certainly more modern than any of the other devices I was using. So, I ended up placing it in my travel case and decided that I would use it as my spare.

As wonderful as the encasing, color screen, and rechargeable batteries were, my biggest deal breaker in using this meter was its accuracy. I have consistently found that the One Touch Verio reads at least 0.5 mmol/L (9 mg/dL), if not 1 mmol/L (18 mg/dL) higher than each of my other blood glucose meters.

There have been times where I’ve felt lows coming on, only to check my blood sugar using the Verio and still see a reading within range. From my personal experience, this is not a meter that I can trust.

To be fair, all blood glucose meters will only be accurate to the nearest 1 mmol/L (18 mg/dL) of a laboratory result. Which explains why two simultaneous blood glucose checks will likely produce two different results.

Most blood glucose meters must have a mean absolute relative difference (MARD) within 15 to 20 percent of laboratory results. This standard deems these devices a reliable indicator of blood glucose levels and safe to dose insulin from.

Which blood glucose meter can I trust? I conducted an experiment of sorts at home comparing all of the blood glucose monitoring devices that I currently use. Pictured from left to right, these include FreeStyle Libre, OneTouch Verio IQ, Accu-Chek Guide, and FreeStyle Insulinx. (Note: The FreeStyle Libre is a flash glucose monitoring system that measures interstitial fluid, and produces a reading each time the reader is waved over the sensor worn on the upper arm.)

Given that any moisture or dirt on my hands can impact glucose readings, I washed and dried my hands thoroughly before lancing my finger and repeated this experiment three times.

  Lowest Reading Highest Reading Variance
Experiment 1 FreeStyle Insulinx (7.0 mmol/L) OneTouch Verio IQ (8.2 mmol/L) 1.2 mmol/L
Experiment 2 FreeStyle Insulinx (7.1 mmol/L) OneTouch Verio IQ (8.4 mmol/L) 1.3 mmol/L
Experiment 3 FreeStyle Insulinx (6.2 mmol/L) OneTouch Verio IQ (7.8 mmol/L) 1.6 mmol/L

The FreeStyle Insulinx produced the lowest blood glucose reading in each of my three checks, while the OneTouch Verio IQ produced the highest. Variances between the lowest and highest reading were fairly consistent, ranging from 1.2-1.6 mmol/L.

  Lowest Reading Highest Reading Variance
FreeStyle Libre 7.3 mmol/L 7.4 mmol/L 0.1 mmol/L
OneTouch Verio IQ 7.8 mmol/L 8.4 mmol/L 0.6 mmol/L
Accu-Chek Guide 7.2 mmol/L 7.6 mmol/L 0.4 mmol/L
FreeStyle Insulinx 6.2 mmol/L 7.1 mmol/L 0.9 mmol/L

When comparing the performance of each meter across my three checks, the Accu-Chek Guide reported the lowest variance among the standard blood glucose meters with 0.4 mmol/L. The FreeStyle Insulinx reported the greatest variance, with a 0.9 mmol/L difference between the lowest and highest reading.

I also decided to repeat my experiment a second time with an elevated post-meal blood sugar, as I had my suspicions that the variances might be greater.

Lowest Reading Highest Reading Variance
Experiment 1 FreeStyle Insulinx (10.3 mmol/L) OneTouch Verio IQ (11.5 mmol/L) 1.2 mmol/L
Experiment 2 FreeStyle Insulinx (10.6 mmol/L) OneTouch Verio IQ (12.7 mmol/L) 2.1 mmol/L
Experiment 3 FreeStyle Insulinx (8.7 mmol/L) OneTouch Verio IQ (12.1 mmol/L) 3.4 mmol/L

Once again the FreeStyle Insulinx produced the lowest blood glucose readings across my three checks, while the One Touch Verio produced the highest. Interestingly variances between the lowest and the highest readings ranged significantly higher than my first experiment, from 1.2 mmol/L to 3.4 mmol/L.

Lowest Reading Highest Reading Variance
FreeStyle Libre 11.1 mmol/L 11.3 mmol/L 0.2 mmol/L
Accu-Chek Guide 10.8 mmol/L 11.1 mmol/L 0.3 mmol/L
OneTouch Verio IQ 11.5 mmol/L 12.7 mmol/L 1.2 mmol/L
FreeStyle Insulinx 8.7 mmol/L 10.6 mmol/L 1.9 mmol/L

The Accu-Chek Guide again reported the lowest variance in each of my three tests, while the FreeStyle Insulinx reported the greatest variance. Interestingly, the OneTouch Verio and FreeStyle Insulinx showed significantly larger variances in this second experiment.

I thought it would also be interesting to compare the accuracy of each brand of test strip with laboratory results. This information can also be found on the information packets inside test strip boxes.

Glucose concentrations of less than 5.5 mmol/L (100 mg/dL):

  Within 0.3 mmol/L (5 mg/dL) Within 0.6 mmol/L (10 mg/dL) Within 0.8 mmol/L (15 mg/dL)
Accu-Chek Guide 94.1% 100% 100%
FreeStyle Lite 70.1% 95.5% 99.5%

Glucose concentrations of less than 4.4 mmol/L (75 mg/dL):

  Within 0.3 mmol/L (5 mg/dL) Within 0.6 mmol/L (10 mg/dL) Within 0.8 mmol/L (15 mg/dL)
OneTouch Verio 88.2% 100% 100%

Glucose concentrations greater than or equal to 5.5 mmol/L (100 mg/dL):

Within 5% Within 10% Within 15%
Accu-Chek Guide 71.5% 97.6% 99.8%
FreeStyle Lite 66.9% 91.1% 98.8%

Glucose concentrations greater than or equal to 4.4 mmol/L (75 mg/dL):

  Within 5% Within 10% Within 15% Within 20%
OneTouch Verio 71.1% 94.8% 90.0% 100%

All glucose meters were accurate within 15 or 20 percent of a laboratory result, likely meeting medical device regulations.

All meters showed greater accuracy among the lower glucose level classifications than higher ones. The Accu-Chek Guide also scored significantly better than the other brands at being within 5 and 10 percent laboratory result.

Interestingly, laboratory testing for the OneTouch Verio strips was classified differently from the FreeStyle Lite and FreeStyle Insulinx. The higher glucose level classification started at 4.4 mmol/L (75 mg/dL), compared to 5.5 mmol/L (100 mg/dL) for the other brands. In the higher glucose level classification, the Verio only reached near perfect accuracy at 20% of a laboratory result, compared to 15% for the other brands.

Feeling overwhelmed with all of this data? I think it is best not to get too caught up in the differences. Most meters are only accurate to the nearest 1 mmol/L (18 mg/dL), and two finger pricks will not guarantee you two identical results.

Stick with one meter that you feel comfortable with and that you feel you can trust. Ensure that your hands are clean and dry before lancing your finger and that you obtain a sufficient sample of blood. Finally, you will obtain more insight into your blood glucose data the more frequently you check your blood sugar. As the old saying goes, test early and test often!

The Latest and Greatest in Insulin Pumps and Sensor Technology


diabetes pumps and sensors

love pumps and sensors!

As a certified diabetes educator (or as I prefer to say, type 1 coach), I have started literally hundreds of patients on insulin pumps over the last few decades. I have a disclaimer: I do not wear a pump and do not have type 1 diabetes. But I have worked in the field from clinics to ski and summer camps, as a dog sled driver for little munchkins with our team of sled dogs, to backpacking and canoe trips – all with people who do have type 1 diabetes. Sometimes I grunt and groan when I get up to start an adventure, but then I meet up with the group and see someone taking shots! My emotions turn to glee when someone has a pump and a sensor…I realize it sometimes feels like being the bionic man or woman with all this technology but hey, what’s wrong with being such a diabetes stud or studdette?

So what is so cool about pump and sensor technology?

Well, if you’re like me and you like to participate in group sports or activities, the technology is amazing. Let’s say you are just starting off on an adventure (whatever that may be) with a group and you note on your sensor that your blood glucose (BG) is 50 mg/dL.

Argh.

Who wants to stop the whole team from proceeding? But then you realize you can take in some carbohydrates, lower your basal rate temporarily, and watch your sensor to see if you are coming up and are not only good to go, but where you will be in 5, 10, 15, 20 minutes…you get the idea.

What are the options available right now to help you manage your diabetes?

The Omnipod insulin pump is the only full functioning patch pump, meaning it is programmable with insulin-to-carb ratios, target BG, correction factors, etc. so your math is done for you. At this time, the Omnipod pump does not integrate with a sensor but you can certainly use the Dexcom sensor independently.

There are also two patch pumps that are not programmable and have a bolus only option (OneTouch Via) and basal/bolus option (V-Go). These are more likely options for those with type 2 diabetes.

The Tandem insulin pump does have a tube that most folks find a minor inconvenience. Its great new claim to fame is that, as the software is updated (and technology is changing so fast!), you can update your pump via the cloud. How cool is that! Your pump does not get outdated since the pump software is updated. This includes future changes, such as Dexcom sensor data on the screen, auto-suspend as needed with hypoglycemia, and the eventual goal of a fully integrated sensor and pump where the pump responds to the data from the sensor and alters insulin delivery.

tandem and dexcom cgm

The Medtronic insulin pump company has led the charge not only with a sensor integrated pump where the sensor data is seen on the pump screen, but where the pump responds to low blood glucose values and impending lows, and adjusts basal rates as needed based on your basal history. Be warned, this is not a cure and still requires diligence on your part or the system will fail. Fasting blood glucose values have been shown to be excellent – generally close to the pump set target range of 120 mg/dL.

MiniMed 670G

You can always choose to continue with injections and utilize one of two sensors. Dexcom (glucose readings every 5 minutes on a receiver or your cell phone) or the new Freestyle Libre that allows you to scan your sensor patch and see your glucose on a receiver.

And where is all of this going?

Oh – it is so exciting! I am confident that in the next five years a fully automated system will be available with minimal input from the user. Tandem, Omnipod and Medtronic are all working on fully integrated pumps as responsibly fast as they can. In addition, other options are coming too, including a dual hormone system that has reservoirs for insulin and glucagon to keep you safe. And with the new insulin from Novo Nordisk that is reputed to start absorption in 2.5 minutes (wow!) one of the big barriers to insulin delivery may have just been resolved.

Although a cure is what we are all hoping for, technology is the next best thing.

Embrace it and stay tuned!

Pump Vacation’s End


lantus

When my Lantus pen finally neared empty after my evening dose on Wednesday, I knew that I was just about ready to reconnect to my insulin pump.

It’s been almost a month since I started this pump break and it’s been just what I’ve needed to clear my head and feel a little more “free” from my diabetes.

But I’m also beginning to feel a little over the effort required to physically inject my insulin, moreso at this time of the year.

When I was in the comfort of my own home with all the time in the world to spare, injecting wasn’t really a big deal. But when I was on the go and short of time, I was really starting to miss the convenience that wearing an insulin pump allowed me.

I really had to make a big point of injecting before I could go and have my morning tea or lunch. This meant finding a place where I wouldn’t be disturbed, pulling out my iPhone, opening up the RapidCalc app, calculating my insulin dose and then concentrating on actually injecting it.

Concentrating?

Yep, concentrating.

If I didn’t put all of my focus towards the task of actual injecting, I ended up with those annoying little drops that manifested on the end of my insulin pen. I was left wondering how much insulin actually went in, shooting out half a unit to compare while deliberating over whether or not I should top up.

In case you’re wondering, there is a technique to avoid this. Gently lift the skin beneath your injection site (don’t pinch), inject your insulin, hold the pen in for 15 seconds after the injection, release the skin and then pull the needle out. I’m not sure I’ve quite mastered it yet, but I have successfully revealed a few clean needles by using this technique.

Then there was the effort required to swap out blunt needles. Because they sure did hurt when I forgot to change them.

Injecting is a lot of effort to put in during my break when I really want to be savoring my coffee and Walkers Shortbread. Or when I’m in the car, trying to give a quick correction in between traffic light changes. Also in the middle of the night, when I actually have to switch on my lamp and physically get up out of bed to make sure I properly administer my correction dose.

I fully get that these are all first world problems and I’m super grateful that I have the luxury and choice to choose the style of management that suits my needs.

On Wednesday evening before bed, I inserted a fresh pump site on my left side and loaded a fresh insulin cartridge. When I woke up on Thursday morning, I skipped my morning dose of Lantus and clipped my pump line into the clean infusion site on my hip. I rode out the day as the rest of my Lantus tapered off. By 3:30 p.m. I thought I could safely switch my basal rate back on and I was pumping insulin once again.

Automated Insulin Delivery (Artificial Pancreas, Closed Loop)


artifiical pancreas

 

The development of automated insulin delivery has many names – artificial pancreas, hybrid closed loop, Bionic Pancreas, predictive low glucose suspend – but all share the same goal: using continuous glucose monitors (CGMs) and smart algorithms that decide how much insulin to deliver via pump. The goal of these products is to reduce/eliminate hypoglycemia, improve time-in-range, and reduce hyperglycemia – especially overnight.

See below for an overview of the automated insulin delivery field, focused on companies working to get products approved. Do-it-yourself automated insulin delivery systems like OpenAPS and Loop are not included here, though they are currently available and used by a growing number of motivated, curious users.

We’ve also included helpful links to articles on specific product and research updates, as well as some key questions.

Who is Closing the Loop and How Fast Are They Moving?

Below we include a list of organizations working to bring automated insulin delivery products to market – this includes their most recently announced public plans for pivotal studies, FDA submissions, and commercial launch. The organizations are ordered from shortest to longest time to a pivotal study, though these are subject to change. This list excludes those without a commercial path to market (e.g., academic groups). The first table focuses on the US, with European-only systems listed in the second table.

Updated: November 4, 2017

US Products

Company / Organization Product Latest Timing in the US
Medtronic MiniMed 670G/Guardian Sensor 3 – hybrid closed loop that automates basal insulin delivery (still requires meal boluses) FDA-approved and currently launching this fall to ~35,000 Priority Access Program participants in the US. Pump shipments to non-Priority Access customers will start in October, with sensors and transmitters to ship by the end of 2017 or early 2018. Medtronic is experiencing a global CGM sensor shortage that won’t resolve until spring 2018.
Tandem t:slim X2 pump with built-in predictive low glucose suspend (PLGS) algorithm; Dexcom G5 CGM

t:slim X2 pump with built-in Hypoglycemia-Hyperglycemia Minimizer algorithm; Dexcom G6 CGM (including automatic correction boluses)

Launch expected in summer 2018. Pivotal trial now underway, with FDA submission expected in early 2018.

Launch expected in the first half of 2019. Pivotal trial to begin in the first half of 2018.

Insulet OmniPod Horizon: pod with built-in Bluetooth and embedded hybrid closed loop algorithm, Dash touchscreen handheld, and Dexcom G6 CGM

User will remain in closed loop even when Dash handheld is out of range

Launch by end of 2019 or early 2020, with a pivotal study in 2018
Bigfoot Biomedical Smartphone app, insulin pump (acquired from Asante), and a next-gen version of Abbott’s FreeStyle Libre CGM sensor (continuous communication)

The smartphone is expected to serve as the window to the system and complete user interface

Launch possible in 2020, with a pivotal trial expected in 2018
Beta Bionics Bionic Pancreas iLet device: dual chambered pump with built-in algorithm; hybrid or fully closed loop; insulin-only or insulin+glucagon; custom infusion set, Dexcom CGM

Likely to launch as insulin-only product, with glucagon to be optionally added later

Currently using Zealand’s pumpable glucagon analog

Insulin-only: possible US launch in the first half of 2020, with a pivotal trial to start in the beginning of 2019.

Insulin+glucagon (bihormonal) pivotal trial expected to start in the beginning of 2019. Timing of FDA submission and launch depend on a stable glucagon, among other things.

European Products

Company / Organization Product Latest Timing in Europe
Medtronic MiniMed 640G/Enlite Enhanced – predictive low glucose management

MiniMed 670G/Guardian Sensor 3 – hybrid closed loop that automates basal insulin delivery (still requires meal boluses)

Currently available in Europe

No timing recently shared. Approval was previously expected in summer 2017

Diabeloop Diabeloop algorithm running on a wireless handheld, Cellnovo patch pump, Dexcom CGM Pivotal trial expected to complete in February/March 2018. Possible European launch in 2018
Roche, Sensonics, TypeZero Will use Senseonics’ 180-day CGM sensor, Roche pump and TypeZero algorithm Pivotal trial expected to begin in Europe in early 2018
Cellnovo, TypeZero Cellnovo patch pump with integrated TypeZero algorithm; presumably a Dexcom CGM Aims for a 2018 European launch. No pivotal trial details shared

Helpful Links

Medtronic: MiniMed 670G

Tandem

Insulet

Bigfoot

Beta Bionics

Test Drives:

test drive – UVA’s Overnight Closed-Loop Makes for Great Dreams. Kelly participates in UVA’s overnight closed loop trial and reports back on an incredible opportunity for the field to move fast, reduce anxiety, and beat timelines.

test drive – Kelly and Adam take UVA’s DiAs artificial pancreas system home 24/7 for a three-month study. Their key takeaways, surprises, and next steps.

Key Questions for the Artificial Pancreas

Are patient expectations too high? If we expect too much out of first-generation artificial pancreas systems – e.g., “I don’t have to do anything to get a 6.5% A1c with no hypoglycemia” – we might be disappointed. Like any new product, early versions of the artificial pancreas are going to have their glitches and shortcomings. Undoubtedly, things will improve markedly over time as algorithms advance, devices get more accurate and smaller, insulin gets faster, infusion sets improve, and we all get more experience with automated insulin delivery. But it takes patience and persistence to weather the early generations to get to the truly breakthrough products. We would not have today’s small insulin pumps without the first backpack-sized insulin pump; we would not have today’s CGM without the Dexcom STS, Medtronic Gold, and GlucoWatch; we would not be walking around with smartphones were it not for the first brick-sized cellphones. Our research trial experience with automated insulin delivery recalibrated our expectations a bit – these systems are going to be an absolutely terrific advance for many patients, but they will not replace everything out of the gate. Let’s all remember that devices need to walk first, then run, and it’s okay if the first systems are more conservative from a safety perspective.

What fraction of patients will be willing to wear some type of automated insulin delivery system? Right now, many estimate that ~30% of US type 1’s wear a pump, and about 15% to 20% wear CGM. There are a lot of reasons why that may be the case, including cost, hassle, no perceived benefit, no desire to switch from current therapy, wearing a device on the body, alarm fatigue, etc. Will automated insulin delivery address enough of these challenges to expand the market?

Will healthcare providers embrace automated insulin delivery? Today, healthcare providers lose money when they prescribe pumps and CGM – they are very time consuming to train, prescribe, and obtain reimbursement for. We need to make sure that automated insulin delivery systems make providers’ lives easier, not more complicated.

Will there be a thriving commercial environment and reimbursement? It’s extremely expensive to develop and test closed-loop systems, and companies will only develop them if there is a commercial environment that supports a reasonable business. Reimbursement is a major part of that, and it’s hard to know if insurance companies will pay for closed-loop systems for a wide population of patients. We are optimistic that reimbursement will be there, especially if systems can simultaneously lower A1c, reduce hypoglycemia, and improve time-in-range.

What’s the right balance between automation and human manual input? The holy grail is a fully-automated, reactive closed loop that requires no meal or exercise input. But insulin needs to get faster to make that a reality. For now, daytime systems need to deal with balancing human input with automation, and there’s an associated patient learning curve. How much should automated insulin delivery systems ask patients to do? How do we ensure patients do not forget how to manage their diabetes (“de-skilling”) as systems grow in their automation abilities?

Insulin-only or insulin+glucagon? Ultimately, we believe that the question is partially one of patient preferences. There will be some patients who may want the extra glycemic control offered by the dual-hormone approach and will be willing to accept a bit more risk or a more aggressive algorithm. An insulin+glucagon system could be helpful for those with hypoglycemia unawareness, and if such a system makes it to the market, some patients will certainly want to give it a try. We believe a range of options is a good thing for people with diabetes, since all systems and products have pros and cons. Ultimately, cost considerations may present the largest factor in adoption. An insulin+glucagon system certainly brings multiple cost elements to consider – a second hormone, a dual-chambered pump, custom infusion sets, potentially higher training, etc. It’s hard to know at this point how the relative costs/benefits will exactly compare to insulin-only systems.

Keeping Your Insulin Cool with Medactiv Travel Cases


One hurdle many people face is how to keep their insulin cool while out doing what they do, whether it be hiking up a mountain, relaxing on the beach, or any other time you may not be keeping your insulin on your kitchen counter. For those on multiple daily injections (MDI), keeping your insulin pens with you is essential, but how do you keep them from getting too warm — especially in the summer?

IMG_5472Medactiv has a solution. Their travel bags have a special cooling pack on the inside that, when soaked in water, swells and keeps your insulin cool (not too cold like ice packs would).

The packs work by holding on to the cool water and through the process of evaporation, cool the inside of the pouch. After soaking the special blue pack in cold water for 2 minutes, simply wipe excess water off (I did squeeze mine a bit to get a lot of the water out as well, but it still maintained it’s swollen appearance and cooling abilities), and place it in your travel bag along with your insulin pens.

I received my sample bags (the Classic and the Single) just before my annual trip to the beach. I really wanted to put the packs to the test. So, as we were packing, I soaked my cool pack inserts and packed them away in my suitcase. IMG_5474For most of the trip, I used the small, single-pen pack to keep my fast-acting insulin with me on the beach. I did not keep my pack in the sunlight, but rather packed in amongst other beach essentials in my beach bag (towels, wipes, etc) which stays under a shaded tent. I just knew in the 90-degree heat that it wouldn’t last, but surprisingly, it worked very well for the 2 hours we would spend on the beach. For 2 days, I was able to keep my insulin pen cool in the pack.

The larger pack can hold 3 insulin pens, but is also large enough to accommodate an insulin pump as well if you are one to take it off while on the beach or for whatever other event you may be at.

There’s only one drawback to these cases, which seemed to be sort of a pain by the end of the trip. While the larger one may more easily accommodate possibly a travel bag (snack-bag) with insulin pen needles, the small, single case did not have a spot for them. So one either just be free-floating in the case or you would have to keep the case in with another case that would have your other essentials (pen needles, alcohol wipes, etc).

The cases do their job of keeping your medication at room temperature at least, but they aren’t diabetes supply cases, so keep that in mind if you choose to order one.

Yes, You Can Hack a Pacemaker (and Other Medical Devices Too).


On Sunday’s episode of the Emmy award-winning show Homeland, the Vice President of the United States is assassinated by a group of terrorists that have hacked into the pacemaker controlling his heart. In an elaborate plot, they obtain the device’s unique identification number. They then are able to remotely take control and administer large electrical shocks, bringing on a fatal heart attack.

Viewers were shocked — many questioned if something like this was possible in real life. In short: Yes (except, the part about the attacker being halfway across the world is questionable). For years, researchers have been exposing enormous vulnerabilities in Internet-connected implanted medical devices.

There are millions of people who rely on these brilliant technologies to stay alive. But as we put more electronic devices into our bodies, there are serious security challenges that must be addressed. We are familiar with the threat that cyber-crime poses to the computers around us — however, we have not yet prepared for the threat it may pose to the computers inside of us.

Implanted devices have been around for decades, but only in the last decade have these devices become virtually accessible. While they allow for doctors to collect valuable data, many of these devices were distributed without any type of encryption or defensive mechanisms in place. Unlike a regular electronic device that can be loaded with new firmware, medical devices are embedded inside the body and require surgery for “full” updates. One of the greatest constraints to adding additional security features is the very limited amount of battery power available.

Thankfully, there have been no recorded cases of a death or injury resulting from a cyber attack on the body. All demonstrations so far have been conducted for research purposes only. But if somebody decides to use these methods for nefarious purposes, it may go undetected.

Marc Goodman, a global security expert and the track chair for Policy, Law and Ethics at Singularity University, explains just how difficult it is to detect these types of attacks. “Even if a case were to go to the coroner’s office for review,” he asks, “how many public medical examiners would be capable of conducting a complex computer forensics investigation?” Even more troubling was, “The evidence of medical device tampering might not even be located on the body, where the coroner is accustomed to finding it, but rather might be thousands of kilometers away, across an ocean on a foreign computer server.”

Since knowledge of these vulnerabilities became public in 2008, there have been rapid advancements in the types of hacking successfully attempted.

The equipment needed to hack a transmitter used to cost tens of thousands of dollars; last year a researcher hacked his insulin pump using an Arduino module that cost less than $20. Barnaby Jack, a security researcher at McAfee, in April demonstrated a system that could scan for and compromise insulin pumps that communicate wirelessly. With a push of a button on his laptop, he could have any pump within 300 feet dump its entire contents, without even needing to know the devices’ identification numbers. At a different conference, Jack showed how he reverse engineered a pacemaker and could deliver an 830-volt shock to a person’s device from 50 feet away — which he likened to an “anonymous assassination.”

There have also been some fascinating advancements in the emerging field of security for medical devices. Researchers have created a “noise” shield that can block out certain attacks — but have strangely run into problems with telecommunication companies looking to protect their frequencies. There have been the discussions of using ultrasound waves to determine the distance between a transmitted and medical device to prevent far-away attacks. Another team has developed biometric heartbeat sensors to allow devices within a body to communicate with each other, keeping out intruding devices and signals.

But these developments pale in comparison to the enormous difficulty of protecting against “medical cybercrime,” and the rest of the industry is falling badly behind.

In hospitals around the country there has been a dangerous rise of malware infections in computerized equipment. Many of these systems are running very old versions of Windows that are susceptible to viruses from years ago, and some manufacturers will not allow their equipment to be modified, even with security updates, partially due to regulatory restrictions. A solution to this problem requires a rethinking of the legal protections, the loosening of equipment guidelines, as well as increased disclosure to patients.

Government regulators have studied this issue and recommended that the FDA take these concerns into account when approving devices. This may be a helpful first step, but the government will not be able to keep up with the fast developments of cyber-crime. As the digital and physical world continue to come together, we are going to need an aggressive system of testing and updating these systems. The devices of yesterday were not created to protect against the threats of tomorrow.

Source:Forbes