We’ve developed a strong interest recently in Diabetes related technology since Cass was diagnosed in August. The most frequent question we’re asked about it is shrouded in a general confusion around blood glucose monitors, continuous blood glucose monitoring (CGM), insulin pens, insulin pumps and how all of these different bits fit together. Diabetes UK has some excellent information sheets about diabetes treatment here, but here’s the elevator pitch.
There are two parts to treatment – Step 1: knowing what your glucose levels are/are doing and Step 2: artificially raising (by consuming simple sugars) or lowering (with insulin) glucose levels.
Blood glucose monitors
Blood glucose monitors help with the first. They always require a finger prick test as it measures glucose levels in the bloodstream, for which it obviously needs a blood sample.
Blood glucose monitors have been around for a long time and now come in a multitude of shapes and sizes. Some are very simple machines that just measure the glucose in a drop of blood obtained with a finger prick. Some will have limited connectivity and connect to mobile phones or send the data to an insulin pump remotely.
Some will do some basic calculations – like calculating how much insulin should be injected based on the level of insulin-on-board, carb count at a meal and current glucose levels. They are generally inexpensive (although the disposable supplies add up), available on prescription and can be bought at pharmacies and on-line shops like Amazon. Anyone can buy one, lots of people use them.
Continuous glucose monitoring
CGMs are a relatively new technology and also help with the first – i.e. blood sugar monitoring. It does not require a blood sample. CGMs have 3 components –
(i) a disposable sensor that is inserted under the skin that lasts 5 – 14 days, depending on the brand. These cost around £45-50 each.
(ii) a transmitter which may be integral to the sensor (Libre) or for some attaches to each sensor (Medtronic). These cost around £500.
(iii) a receiver or ‘reader’ used to display the data collected. Sometimes its a small free-standing device, for most it can also be your mobile phone and for other systems, like Medtronic, it’s your insulin pump. Sometimes an additional small device – usually at extra cost – is required to make your phone work as a receiver.
It is not medically recommended to use CGM data for treatment decisions, so a blood glucose monitor remains essential, but this is the only data that paints the bigger picture, letting you know what your levels have been in the preceding hours and whether they are going up or going down as well as the rate of change. It’s extremely useful data that in conjunction with a blood glucose test, makes it much easier to make the most appropriate treatment decisions.
CGMs are being connected to insulin pumps in semi-closed looped systems. For example, integrated CGM-pumps have the capacity to suspend insulin, when glucose levels detected, are nearing hypoglycemia, which is particularly useful during the night. It’s the latest and greatest emerging technology and where the future of Type 1 Diabetes management resides.
Insulin pens and pumps
Step 2 in diabetes management is keeping blood glucose levels within a narrow range – or trying to. Type 1 Diabetes is a condition of hyperglycemia and without insulin, blood glucose levels continue to climb until, if untreated, the end result is fatal. Insulin is injected to lower high glucose levels to within a normal range. The first medical administration of insulin to a boy with Type 1 Diabetes happened in 1922. Insulin was injected with a syringe which evolved into insulin pen syringes that is still in use today.
The first insulin pump was designed in 1963 and the size of a backpack. Insulin pumps were approved for medical use by NICE in the UK in 2003. Insulin pump availability and distribution is increasing rapidly and pump technology is advancing incredibly quickly. It allows a level of fine tuning that insulin pens cannot match and is particularly advantageous in young children that require much smaller and more variable amounts of insulin for optimum management.
Type 1 Diabetes does not cause hypoglycemia – low blood sugar – insulin therapy does. It’s still very tricky to try and match the body’s metabolism and with current technology, it’s impossible to do it perfectly. If too much insulin is circulating in the body, blood sugar drops too low and has to be raised. Simple sugars are used to raise blood glucose levels quickly.
The future is bright for Type 1 Diabetes management. Technological advances provide better options and fewer lifestyle restrictions. A hundred years ago, there was no effective treatment and anyone that developed Type 1 Diabetes was placed on a starvation diet and died within a few months. Medicine has come a long way since then and technology has and will continue to play a vital, key role in effective management strategies.