Monday Medical: Advances in diabetes technology
For Steamboat Pilot & Today
Living with diabetes can be a lot of work. From monitoring blood sugar levels to dosing insulin, it can feel like there’s always a decision to make or an action to take.
But recent advancements in technology can help.
Dr. Jessica Devin, an endocrinologist at UCHealth Endocrinology Clinic in Steamboat Springs who sees patients with diabetes, outlines the latest tools for managing the condition below.
Continuous glucose monitors
The amount of insulin someone with diabetes needs can vary based on a range of factors, from diet and exercise to hormones and illness. Take too much and your blood sugar will drop dangerously low; take too little and you’re dealing with the short-term and long-term effects of high blood sugar.
That’s where continuous glucose monitors can help. These monitors are worn on the body for 10 to 14 days and have a small sensor wire under the skin that measures the blood glucose level every few minutes. The information is then transmitted to a cellphone or device.
“These are the way of the future for people with type 1 diabetes,” Devin said. “Even the American Diabetes Association has created a new goal for blood sugar, which is time in range.”
There are a number of CGMs on the market, but the ones most popular with Devin’s patients are the Dexcom and the FreeStyle Libre. Neither requires calibration.
The FreeStyle Libre can be purchased at a pharmacy, and each sensor lasts for 14 days, while the Dexcom cannot be purchased at a pharmacy and each sensor lasts for 10 days. With the FreeStyle Libre, data must be downloaded before being shared, while the Dexcom can automatically share data and give notifications when the wearer’s blood sugar is outside of their range.
“Recently, I had a patient traveling on the other side of the world who was worried about blood sugar numbers,” Devin said. “Because the patient had shared their blood sugar numbers through our clinic account, I could easily see what was going on and make recommendations.”
CGM devices are typically covered by insurance for patients who need three or more insulin injections a day.
“These are life-saving devices for people who are caregivers, people who have hypoglycemia unawareness and don’t feel their lows, or people who are worried about middle-of-the-night lows,” Devin said.
While insulin pumps have been around for decades, they’ve made some recent advancements. Two companies — Medtronic and Tandem — now offer a closed-loop pump system, which can automatically adjust the doses of basal or background insulin, which helps keep blood sugar consistent when fasting.
“The CGM is connected electronically to your pump, and it automatically adjusts your basal rate of insulin based on your blood sugar,” Devin said. “That offers a huge safety feature in that once your blood sugar goes too low, the delivery of insulin stops. This is especially helpful for kids, athletes and people who don’t sense their low blood sugars.”
The Medtronic system uses its own CGM, while Tandem’s closed-loop pump works with the Dexcom CGM.
People still have to dose insulin for the carbohydrates they eat and must be prepared for issues that crop up.
“You have to maintain the pump. They can break down,” Devin said. “It’s not necessarily a better way of managing things, but a different way.”
Another popular pump is the Omnipod, which is a tubeless pump system that does not yet offer a closed-loop option — but should soon. And for people who prefer shots, the InPen is a Bluetooth-enabled insulin pen that tracks and recommends insulin doses.
“There can be a lot of mental anxiety when you’re dealing with a chronic illness like diabetes, and managing diabetes is a lot of work,” Devin said. “I think these tools can help alleviate a little of that.”
Susan Cunningham writes for UCHealth Yampa Valley Medical Center. She can be reached at firstname.lastname@example.org.
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