Contributor: Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES
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Diabetes technology is growing at a rapid speed. There are so many new insulin delivery options, glucose monitoring options, and ways to stay connected to loved ones and your healthcare team. Here are some exciting updates with continuous glucose monitors, connected pens, insulin pumps, and mobile apps.
Continuous Glucose Monitors (CGMs)
A CGM can measure glucose every 1 to 5 minutes, or up to 1,440 readings per day! CGMs help provide more information than traditional finger sticks on how food, medications, physical activity, stress, and other factors impact blood sugar levels. For example, compare the effects of eating eggs versus eating cereal on two different days for breakfast. You will probably notice a big difference in your blood sugar 1-2 hours after the start of the meal. Devices are accurate enough to replace finger sticks, but there are some times when a finger stick is preferred - such as any time symptoms don’t match the CGM reading. Devices are worn for 7-14 days, and then a new sensor is inserted. They are usually worn on the back of the arm or stomach. The CGM also provides information about time in range. This is the percentage of time a person spends in the target range they have set with their healthcare team. The goal for most people is to spend at least 70% time in range.
Connected pens are also called smartpens. This type of insulin pen keeps track of insulin dosing through a mobile app. It helps to calculate mealtime insulin doses. It even monitors temperature to ensure your insulin is safe for use. It also keeps track of active insulin time, meaning if you want to give extra insulin to treat a high blood sugar, the pen knows if there is any insulin still working in your body from a recent injection. Active insulin would be subtracted from the recommended dose. This can help avoid insulin stacking, where a person gets too much insulin and has low blood glucose. Connected pens can be connected with glucose or CGM data, so all data be viewed together on one report to determine where any dosing adjustments are needed.
Insulin pumps provide an alternative method to deliver insulin versus insulin pens or vials. They are used for people that take multiple daily injections. They use just one type of insulin, which serves as both the background (basal) and mealtime (bolus) insulin. There are simple patch pumps that can provide 2 unit increment boluses. More sophisticated pumps can do all of the insulin calculations for meals, correct for high glucose, and keep track of active insulin. They can dose in tiny increments down to .01 units. We now also have hybrid closed loop pumps. These pumps communicate with your CGM to automatically adjust insulin doses. We are learning that many people require dynamic insulin dosing - meaning different amounts each day. These new pumps can determine the best doses by seeing how much blood sugar is rising or falling.
Most of the technologies mentioned above, including CGM, connected pens, and insulin pumps, have mobile apps that can allow the person with diabetes to view their information. For example, CGM mobile apps enable you to see your time in range and to view your data directly from a smartphone instead of using a separate receiver or reader. This data can also be easily shared with your healthcare team through the cloud. Some insulin pumps have mobile apps that allow you to see data and share it with your health care team. Connected pens have a similar feature where you can generate reports to share with your doctor. Additional mobile apps share data with friends and loved ones to alert them to high and low blood sugars. This can be an especially great tool for parents of children with diabetes.
The choice to use any of these technologies is a personal one. I strive for all of my clients to know about their options so they can make an informed decision about which ones will work best for them. If you have any questions or would like further information, I recommend asking your diabetes care and education specialist.
Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES is a Clinical Pharmacist and Certified Diabetes Care and Education Specialist. Dr. Isaacs earned a Bachelor’s Degree in Chemistry from the University of Illinois at Chicago and a Doctor of Pharmacy Degree from Southern Illinois University Edwardsville. Dr. Isaacs enjoys working on an interprofessional team and has established several clinical services within the Cleveland Clinic Diabetes Center. She is the 2020 ADCES Diabetes Care and Education Specialist of the Year.