Diabetes Technology

If you are living with diabetes, your health care provider might recommend self-monitoring blood glucose as part of your daily routine. In order to measure blood glucose, you will use a glucose meter. A glucose meter will use a small drop of blood often called a “fingerstick” to determine your blood glucose. These readings help provide valuable information that you and your health care team can use to make decisions about your eating patterns, food portions, medication(s), and insulin to improve or control your diabetes. Getting familiar with your blood glucose patterns will help you and your health care provider understand better how your body reacts to your food, exercise, and medications.

Most people with diabetes will be monitoring blood glucose levels several times a day. There are many different types of glucose meters available. How often people with diabetes need to check their blood glucose and the recommended target level varies from person to person. Be sure to talk with your health care provider about what is best for you.

When choosing a glucose meter, here are some things to consider:

• Meter size
• Amount of blood needed for the sample
• How long it takes to display the reading
• Ease in reading the display
• Ability to save the results in the meter’s memory and download to a computer
• Cost of the meter and blood glucose strips
• Whether sites other than the finger can be used to get a blood sample
• Talking meters are also available for people who have impaired vision or blindness.

Insulin pumps are small, computerized devices that mirror the way the pancreas works. Insulin pumps will deliver a small dose of insulin in a steady measured dose (basal rate) and“on demand” (bolus dose) around mealtimes.

You and your health care provider will program the pump worn on your body to provide you with a continuous dose of insulin.

Pumps may be a good choice for you, if:

• You don’t mind wearing the pump on your body all the time
• You have type 1 diabetes or insulin-requiring type 2 diabetes 
• Pumps also work best for people who are willing to learn to manage their own insulin doses and monitor blood sugar. It also may be beneficial for some people with unstable glucose levels that vary from using injectable insulin.

Common advantages of insulin pumps include:

• Flexibility to adjust insulin as needed
• Insulin delivery is consistent
• Precise insulin delivery- ability to accurately deliver 1/10th of a unit of insulin
• You prefer one needle stick every 2-3 days over multiple daily insulin injections

The decision to select an insulin pump with or without a tube varies with each individual and may be influenced by:

• Occupation
• Level of Physical Activity
• Insurance Coverage & Price
• Risk of infection at the catheter site
• Comfort with technology

Continuous glucose monitoring, also called CGM, is a way for people with diabetes to monitor glucose levels. CGM measures glucose levels in the fluid between body cells every few minutes throughout the day and night.

CGMs use a tiny sensor to test the fluid between the body cells. This sensor checks the level of glucose every few minutes. The information is then sent wirelessly to a reader that shows the glucose levels. Some CGMs can even send this information right to your phone so that you can share it with a family member or Health Care Specialists. There are several CGM systems available. Each system is a little different in how glucose levels are checked and how glucose levels are shown.

Most CGM systems consist of three main parts:

• A small, disposable sensor is inserted under the skin to measure glucose in the body fluid. The sensor is replaced every 3–7 days, depending on the model.
• The transmitter is a small device that attaches to the sensor and is placed on the skin. It uses radio waves to send information about glucose levels to a wireless monitor, also called a receiver.
• The monitor, a device the size of a cell phone, shows information about glucose levels on a screen. Users wear the monitor on a belt or keep it in a pocket. The monitor includes the alarm that warns of out-of-target glucose levels. In some models, information can be displayed directly on an insulin pump.

CGM systems provide several kinds of reports about glucose levels. For example, one report graphs average glucose levels for several hours or a whole day and night. CGM systems also allow users to note when they eat meals or take medicines, which can help you understand their glucose trends.

Changes in glucose levels can happen very quickly or unexpectedly. If you have type 1 diabetes or type 2 diabetes and need to take insulin, a CGM system may be right for you. Depending on the CGM, children as young as 2 years old can even use CGMs. Studies have shown that CGMs can help people living with diabetes keep blood glucose levels on target without an increased risk of severe hypoglycemia. Staying on target can mean fewer health problems, day-to-day and in the long run.
Some people may decide that CGM is not for them. They find it hard to get used to having a sensor under the skin and dealing with alarms. Some may be overwhelmed by the amount of information CGM provides or may not be comfortable with technology.

There are also different ways that a CGM can be used and how often it is used can vary for each person.

• CGMs can be used if you are taking insulin injections or using an insulin pump
• CGMs can be used continuously or for brief periods of time
• Talk with your healthcare team about what is best for you.

In recent years, CGMs have become just as accurate as blood glucose meters and come with many benefits including:

• Allowing for insulin dosing and decisions to be made directly from the CGM.
• CGMs show the changes glucose levels around the clock, this can help in the decisions you make about insulin, food, and exercise.
• They show how fast glucose levels are changing, to make help decisions about adjustments needed to help keep glucose levels in a safe range.
• Provide useful reports on your glucose trends to help make decisions about care.
• Send alarms or alerts when glucose levels are too high or too low and can also give a prediction if the glucose level might be high of low in the near future.
• Offer easy sharing with healthcare teams and/or family members.

Blood glucose meters and CGMs both show your current glucose level. But CGMs can also record the past levels reports the present and predict the future glucose levels.

Trend arrows are a big advantage of using a CGM. Trend arrows are typically small arrows that help you know where your glucose level is heading. For example, if you see trend arrows pointing down, you can expect your glucose level is going to drop. This can help you plan ahead and catch high or low glucose levels before they become dangerous.

Trend arrows can also be used to adjust the amount of insulin you take with meals. The exact amount of insulin that you add or subtract depends on the person taking the insulin and on the type of CGM system you are using because not all trend arrows are the same. It is important to talk to your healthcare team to help you understand what the trend arrows mean before using trend arrows to adjust your insulin. Each commonly used continuous glucose monitor has special features like- who can use them, how the sensor is inserted, how data is collected, shown and shared.

Talk with your healthcare provider about what is best for you.

Most blood glucose management systems are considered open loop which means a system along with “human help” is used to set insulin doses. Newer technology is exploring the closed-loop system which are wearable devices that work with less help from humans. The nickname for these closed-loop systems is “artificial pancreas.” The main functionality of the artificial pancreas would mimic a human pancreas delivering the exact dose of insulin as needed automatically. This device does not replace the actual organ, only taking over some of the organ’s responsibilities.

Open-loop: Continuous blood glucose readings through an insulin pump or a continuous glucose monitoring (CGM) system. The user monitors these readings and adjusts insulin dosages in response to blood glucose levels.

Hybrid closed-loop: A system that continually adjusts insulin delivery except for mealtime. The bolus dose is still administered by the user.

Closed-loop system: A continuous cycle insulin of insulin delivery is administered using an algorithm to determine changes in glucose levels then gives the dose automatically without “human help.”

Apps are platforms that make life with diabetes and dealing with diabetes information easier. These apps have three main goals:

• Coaching platform to help support daily management (e.g. WellDoc, BlueStar, Livongo, and Lark)
• Data integration platform to sync with other glucose management devices (e.g.Glooko, Cornerstones4Care, One Drop, mySugr)
• Decision support platforms can help users make the best decision with glucose management (e.g. SugarIQ, bolus calculators)

A reusable injector pen plus an intuitive smartphone interface that supports dose control, automatic delivery and measurement. An insulin care logbook supports temperature, dose calculation, dose reminders, and reporting without doing anything different.

The goal of the medical community is to improve blood glucose management. Insulin pumps and CGM’s make insulin delivery automatic by allowing users to see the daily effects. Insulin analog has big advantages for dealing with changes in glucose levels. Insulin pumps provide flexibly with how to deliver insulin. Now experts are looking to close the loop and move diabetes management to the background and not a part of a daily struggle.

Diet, exercise, sickness, stress, sleep, and many other factors can make the insulin demand fluctuate. Because of these unpredictable variables, designing an algorithm that will work in all conditions and all people is next to impossible. Newer technologies for treating diabetes can help you maintain a healthier life, possibly even returning your glucose levels to normal levels. Talk with your healthcare provider to learn what is best for you.