From the artificial pancreas to new ways of testing blood sugar and more, we take a look at the future for those with diabetes.
Diabetes is a rollercoaster ride of blood sugar ups and downs, and tight control can be hard work. But there’s good news: while some researchers are working on a cure, others are making life easier for those with diabetes right now, through technology.
Carine Visagie brings you a roundup of the top new technologies out there.
Continuous glucose monitoring (CGM) devices are soon going to take blood sugar control to another level.
With the help of tiny electrodes stuck beneath the skin, CGM devices allow for real-time glucose readings throughout the day. The results are sent wirelessly to a monitor you can clip onto your belt and access on the go, and some devices can even send results to your doctor. Normal finger prick testing is still required (for a double check and to calibrate the CGM sensor), but you can rest assured that a CGM device will alert you if your sugar spikes or drops below your limits.
Examples include the Flash Glucose Monitoring System (Abbott) and the Guardian REAL-Time Continuous Glucose Monitoring System (Medtronic).
Ask the expert: Dr Joel Dave, endocrinologist
“24-hour glucose monitoring is going to be very helpful in patients that have difficulty controlling their blood glucose levels, as it will provide a 24-hour 360-degree view of their diabetes control.”
Ask the expert: Dr Wayne May, endocrinologist
“I’m looking forward to the Abbotts Flash Monitor, as it will stay on for 14 days and doesn’t require calibrating with a second machine.”
Insulin pumps keep getting smarter: some of the latest ones sync with CGM devices, while others are incredibly accurate at giving just the right insulin dose at the right time.
One example is the touch-screen Tandem t:slim insulin pump, which shows the date, time, how much insulin is ‘on board’ (seeing this before you bolus can help you avoid stacking your insulin*), duration of insulin action, and the amount of insulin in the reservoir. It looks like a smartphone and data is easily transferrable via a USB port. Plus, it can deliver insulin in very small doses.
*Insulin stacking is injecting a second dose too soon after a first, without taking into account the insulin already in your system. This can result in low blood sugar.
Another insulin pump to watch is the MiniMed530G by Medtronic – the first pump to shut off when blood sugar goes below a predetermined level.
Ask the expert: Dr Joel Dave, endocrinologist
“Although an insulin pump isn’t the ideal way of administering insulin for everyone, many diabetics find a pump improves their diabetes control and quality of life. Since the addition of CGM, the use of this technology has improved even more, especially in children and patients with very erratic blood sugar.”
Bionic (artificial) pancreas systems are the next big thing in diabetes management. These systems, the first of which is still being tested, combine the latest CGM tech with the most advanced insulin pump tech and add a sophisticated computer programme to simulate the function of the pancreas.
The system constantly checks blood sugar levels by means of a CGM, and responds automatically by administering either insulin (to lower blood sugar) or glucagon (to raise blood sugar levels quickly) via two separate pumps. The system hooks up to a programme on your smartphone that makes decisions every few minutes, telling the pumps via Bluetooth how much hormone to deliver.
The bionic pancreas should be available in the next 5 years.
Ask the expert: Dr Joel Dave, endocrinologist
“The artificial pancreas has been the ‘holy grail’ for diabetes care for many years. The system has been vastly improved and early studies are showing great promise. Although not for routine clinical use at the moment, in the near future it will be a life-changing addition to the diabetes care of many patients.”
What about now? Smartphone apps for diabetes
If the future of diabetes tech seems too far away, keep an eye out for apps that can help you deal with diabetes right now, on your smartphone. We like:
Glucose Buddy: to track blood sugar readings, insulin doses, carb intake, exercise, blood pressure and weight, and
Diabetic Connect: helping you tap into trusted advice, friends, support and tips.
But be warned: many international apps use mg/dL, the US blood glucose standard, instead of mmol/l, the South African standard.
In issue 12 of Sweet Life magazine we interviewed insulin pump expert (and user) Imke Kruger about her experiences with the insulin pump – and got her to answer your questions. Take a look at the article, here.
Here are some more of your insulin pump questions, answered by Imke, the Product and Sales Manager for Insulin Delivery Systems at Roche Diabetes Care.
How much is an insulin pump with and without medical aid?
The cost implications depend on a few aspects, one being the type of medical aid plan, and whether the particular medical aid covers the costs fully or partially. It would be best to discuss this with your healthcare professional or your medical aid. In order to buy a pump, you need to be a patient at one of the accredited pump centres in South Africa. Your doctor will decide if you are a pump candidate according to the Association of Clinical Endocrinologists of South Africa (ACE-SA) guidelines. If you are, you will need a script to claim the pump through your medical aid, or buy it cash from one of the supplying pharmacies.
How do I apply for a pump that I can afford?
You need to visit your doctor. If they agree that pump therapy is the best option for you, depending on your medical aid, the doctor will send an application to the medical aid. We at Accu-Chek® can also assist you with this process. You can contact me via email or alternately you can call the Accu-Chek® Customer Care line on 080- Diabetes/ 080-34-22-38-37
What are the advantages and disadvantages of using an insulin pump?
In short, insulin pump therapy improves metabolic control while giving you greater freedom and enhanced quality of life.
• Your metabolism stays more stable, with better HbA1c values and fewer episodes of hypoglycemia
• You may enjoy greater efficiency and more energy, even in times of stress or an irregular work schedule.
• You can be more flexible in your eating, if you understand the concept of carbohydrate counting.
• You can participate in sports whenever you feel like it — without having to plan in advance
I would say the disadvantages are that you have too much freedom in making food choices. There is a risk of diabetic ketoacidosis (DKA) from pump malfunction or absorption problems.
Deciding on insulin pump therapy is not a simple decision and should be carefully considered with the help of your healthcare professional team. However, feedback from many pump users, physicians and other healthcare professionals show that they are very satisfied with the results of Insulin pump therapy.
How would the insulin pump be used for sports? Are there special casings made or will I have to play without it? For example, a cricket game with a long duration and the risk of the pump being hit by the ball.
You can engage in any kind of physical activity while wearing an insulin pump. However, for sports involving intensive body contact and water sports we recommend temporarily disconnecting the insulin pump, but not for longer than 1 hour. We have special cases and pouches that protect the pump that would enable you to play cricket with the pump. However, we do advise patients to insure the system, for 100% assurance.
What is the risk of infection?
If you follow the right hygiene steps, the risks are low. You should always disinfect your insulin pump site before inserting the infusion set. It is also critical to replace the infusion set every three days as per the package insert of the product. In rare cases, patients can be allergic to the adhesive plaster, and need to use a tegaderm plaster underneath the infusion set to prevent allergic reactions.
How do I know if I’m ready to pump?
Visit our website to find out all the details you need: from how pump therapy is different to multiple daily injections, to how pump therapy benefits your help, how to wear and handle the pump, what a typical day looks like, what features to expect and how they make your life easier. There’s also a questionnaire. some FAQ, and all the contact details you need. What are you waiting for? Find out if you’re ready to pump.
This month, we welcome a new member to our Panel of Experts – Dr. Claudine Lee, a GP from Hilton in KZN. Find out more about her (as well as the rest of the experts) here.
Here are a few tips from Dr. Lee on how to manage diabetes well – and what advantages insulin pump therapy offers. Let us know if you have any questions for her!
Top tips for Type 1 diabetes good blood sugar control :
- Regular exercise – one sure way to keep things controlled (it must be a way of life).
- Correct food choices in terms of carbs, especially portion size and dosing correctly to “mop up” the carbs without any lows.
- Knowing if you are more sensitive to insulin in the morning or evening and adjusting your dose in connection with that.
- Knowing your numbers and testing, if you don’t know where your sugar is at you can’t respond to it.
- Being on the correct insulin to match your lifestyle/meals/exercise.
Advantages of insulin pump therapy:
- Getting rid of hypoglycemia (lows) especially bad lows.
- One prick every 3 days.
- Basal rate of insulin matched specifically to you, less insulin used (thus better weight control).
- Bolusing for meals is extremely simple and aided to control sugars exactly.
- Better control = better wellbeing generally.
- For the young: you can decide impromptu to stay over at a friend/function as all you have for the next 3 days for your diabetes is on your person.
I have extreme problems with high sugar levels. I was recently in Unitas Hospital where Dr Moolman recommended that I must get an insulin pump as soon as possible.
The problem is that I cannot afford one. I’m trying now to apply for one the Department of Health but are having problems there as well.
I’m 42 with Diabetes Millitus and its affecting my whole life.
Can you please give me some advice as to how to apply for a pump which I will be able to afford.
Thanx for your time,