Diabetes Technology
Technology has changed the landscape of life, but what can it do for a diabetic
Each diabetic follows different diets, exercises at different levels and requires various quantities of insulin, but we all need an accurate, dependable piece of technology that can show us what our blood sugars are doing.
There is no miracle tech; as like anything, it is only as good as the person controlling it. What we need to establish is whether it fits in with our lives, we are confident in using it and it aids in our ability to control BGL’s.
Below is a list of current tech that helps Diabetics manage their numbers.
Blood Glucose Monitor
Continuous Glucose Monitor (CGM)
Insulin Pump
Flash Monitor
Smart Tech (Watches and add-ons)
Blood Glucose Monitor
The First and Most Important Tool
Blood Glucose Monitors are the cornerstone of diabetes management. They are handy little gadgets that can tell us what our BGL is within a few seconds and provide data to allow us to manage them. But with the arrival of flash and continuous glucose monitors, do we even need them any more? Well yes sir, you do.
There are literally dozens and dozens of BGM's. Go to your local chemist or speak to your diabetes educator/endocrinologist to get a free one initially. The main companies that manufacture them are Abbott, who make the Freestyle Neo and Lite and Accu-Check, who make the Performa and Neo.
BGM’s are invaluable. They are often highly subsidised or free and if you don’t have one then I suggest you get one immediately. Even if you don’t use it often and it just sits there next to your bed, make sure its there. Why? because they are part of your life as a diabetic. Here’s how they work;
BGM’s are pocket-sized devices that measure your BGL’s via a drop of your blood. You do this by pricking your finger with a lancet and then applying the blood to a test strip that is connected to the BGM.
Here’s the thing; if you google ‘best blood glucose monitor’, you will be overwhelmed by dozens of options. This is counterintuitive. It will actually slow down the process of you choosing one. This is not what we want; we want you to be checking your BGL’s straight away. Therefore, go to your local chemist or Diabetes Educator and see if you can get one for free. It doesn’t matter which one it is, only that it checks your BGL. Now use it for a while. See how you go. Are you happy with its features? is there anything that annoys you about it?
The point is, it really doesn’t matter what you’re using initially, only that you ARE using. When I was diagnosed I was given an Accu-Check Mobile. I have tried others since but keep going back. Why? because I don’t need separate test strips; its relatively accurate; the lancet device is attached so I don’t even need a little pouch to carry it around in. Plus, it is frequently free in chemists, so once it's been beaten around I drop by and pick another one up. This is personal and subjective to me and what I want from a BGM, so go out there and try some out.
As stated above, I will refrain from putting a list up at the moment. I understand some will want to discuss this so please do and get in touch. I will place a product list up shortly.
Continuous Glucose Monitor
The Game Changer
CGM’s measure your Blood glucose levels continuously, day and night, in order to create patterns and trends in your BGL’s. This allows you to gain invaluable insights into how and what affects your glucose levels, particularly at times that can be most difficult. i.e. when you’re asleep or during high-intensity exercise.
They are small devices, generally no bigger than a 20 cent coin and have a very thin and sophisticated needle (roughly 1/2 inch long) that detects glucose in the fluid under the skin. This measurement is then transmitted from the device to a transmitter - attached to the sensor (needle) and then onto a monitor wirelessly.
It's important to note here that this measurement is of ‘interstitial’ fluid NOT blood. This fluid is made up of glucose, but also salt, fatty acids, and minerals. When monitoring your BGL the measurement will not be the same as a finger prick at the same time. It will be roughly 10 to 15 minutes behind. Therefore, if your BGL’s are falling or rising rapidly, it is worth checking them on a finger prick as well.
Pros:
CGM’s monitor blood glucose levels every few minutes over a 24 hour period for up to 14 days consecutively.
They are generally small and unobtrusive.
You won’t need to prick your finger as often.
You can view the trends of you sugar levels from your phone or monitor, often resulting in better management and control.
CGM’s offer a feature that alerts you if your BGL runs too high or low. This means you can react quickly to remedy it.
You can attach a CGM to an insulin pump, which will allow an even greater level of control and convenience to manage your daily glucose levels.
Cons:
As CGM’s are to as accurate as finger prick tests and are also slightly delayed in their measurement, they increase your chances of more erratic glucose levels.
If your BGL changes rapidly, it is still wiser and safer to perform a finger prick test to ensure proper control.
Without private health insurance, CGM’s are very expensive. New models are around $9000.
Many people do not like a needle (cannular) in their body over a prolonged period of time. This can also increase your chance of an infection.
Overall, CGM's are a huge benefit to a diabetic's management of their blood sugars. If you can get your hands on one then embrace it and pretty soon, you won't know how you lived without one.
Insulin Pump
Life - that bit easier
“An insulin pump is a small battery-operated electronic device that holds a reservoir of insulin. It is about the size of a mobile phone and is worn 24 hours a day. The pump is programmed to deliver insulin into the body through thin plastic tubing known as the infusion set or giving set. The pump is worn outside the body, in a pouch or on your belt. The infusion set has a fine needle or flexible cannula that is inserted just below the skin where it stays in place for two to three days.” - Diabetes Australia.
It is important to note that an insulin pump only uses Rapid Acting Insulin. You do not need to inject long-acting insulin, because the pump is programmed to deliver insulin in response to food. When you’re not eating it provides a small and consistent amount of insulin. Many diabetics would also use a CGM to monitor their BGL alongside the pump as not to go to high or low.
Pros:
Insulin pumps have shown to reduce the frequency of hypoglycemia.
They can improve your glucose control.
They take the guesswork out of calculating insulin/carbohydrate ratio. Resulting in decreased hypos and hypers.
Good for children with less control/understanding of glycemic levels.
You can obtain a pump for free if you have private health insurance. You do not need extras cover, only hospital cover.
Cons:
Increased risk of infection. Particularly at the site of the cannula (needle)
Device must be attached to a belt or clothing. Along with the tubing, this can be a nuisance when taking part in any physical activity and also at night as they are worn 24 hours per day.
If there is an electronic malfunction, the consequences could lead to ketoacidosis (DKA).
The cost of a pump is between $4000 and $8000 without private health insurance.
Insulin pumps have a lot of moving parts and there is a large learning curve when starting to use one.
Flash Monitor
Get Your blood Sugar Reading In A Flash
As it stands, there is only one flash monitor on the market. The Freestyle Libre. But what is it and how can it help.
This flash monitor comprises of a small sensor (about the size of a 20 cent piece) with a needle attached at its center. The user places this sensor to the back of their upper arm where it monitors their BGL’s continuously.
You have to scan the sensor with a handheld monitor (about the size of a small phone) when you need to see your BGL. The sensor lasts for 14 days and will need to be replaced.
Pros:
You don’t need to prick your finger as you can scan at any time.
Quick and convenient.
Safer than finger prick when driving or doing other activities.
See trends in glucose levels.
See nighttime glucose trends.
Others can scan your arm when you’re asleep.
Cons:
No alarm function if your BGL goes to high or low.
When BGL goes low or high rapidly, it is still safer to test with a finger prick.
The sensor can be moved whilst asleep and this can affect its accuracy.
The sensor measures interstitial fluid so there is a lag of roughly 15 minutes behind a finger prick test.
The cost is not covered by the Australian government (It is in the UK and other countries)
Out of pocket cost is $200 per month after purchase of the monitor, which is $99.
If you are newly diagnosed, then please take one step at a time and start with just a Blood Glucose Monitor and your medication. Of course, it won’t be as easy as a pump and CGM but you NEED to learn quickly on how to manage your BGL’s, what affects them and how your body copes with various quantities of Insulin.
Important note: If you have a T1D child, it may be better to move straight onto a pump, so speak to your medical team to find out more. You can then move forward and try new technology to help you. This is a natural and logical path.
Diabetes tech is growing fast and I don’t want to sound cynical here, but you’re dealing with full profit companies, not altruistic charities. Tread carefully and assess each piece of kit and how it suits your own individual needs, not how many bells and whistles it has.
I have a freestyle Libre. The reason being is that I began a very low carb diet and high exercise routine during my honeymoon phase and to this day I have not needed any further help in controlling my BGL’s. I am not perfect and often get it wrong, but I want to make sure I am an expert on managing my disease before I begin to loosen the reigns and let some gadgets with complex algorithms that I’ll never understand tell me what to do or even do it for me.
Smart Tech
The Robin To Your Batman
The most important thing to understand when looking at any tech is that it only accompanies your own vigilance and discipline in managing your BGL’s; It can never replace this. However, once you are confident in your own ability to understand the subtleties of balancing your BGL’s, new tech can enhance this ability and make you a true pro.
So, what's out there that you can ‘add-on’ to your current diabetes management tools. Most BGM’s, CGM’s, Pumps and Flash Monitors are accompanied by APP’s that will provide data management of your glucose levels. This is very useful for your overall understanding but it also shows you trends and further reports on average BGL’s over a given period, daily patterns, time in target, low glucose events, average glucose and estimated HbA1c. The more informed you are, the better you will be at understanding how and what affects your BGL’s.
Freestyle Libre (Flash Monitor)
This handy tech has an accompanying APP, but you can also turn your smartphone into a monitor as well. Your phone must have NFC (near field communication) technology, but you can then scan your sensor with your phone instead of carrying a monitor as well.
This makes it useful at checking your levels when your out and about very quickly, particularly during exercise. However, it is another added expense. With the cost of the Libre being $200 per month (In Australia), the MiaoMiao is another $200 one-off payment. Plus, it is not waterproof. I have checked the warranty (12 months) and it states you are not covered if it breaks due to negligence. Therefore, it would be interesting to see whether you can access replacements easily or not. It is relatively easy to obtain replacement sensors by Abbott for the Libre though. Simply call and explain the situation and they regularly send new ones out at no additional cost. Trying this once a month might not bear much fruit though.
Another accompanying gadget that has been built for the Libre is the ‘MaioMaio‘ (this is NOT manufactured by or associated with Abbott who makes the Libre). This interestingly named tech fits onto the sensor (on your arm) and basically turns it into a CGM (Continuous Glucose Monitor). It reads your sensor every 5 minutes and sends the data to your smartphone or smartwatch.
There is a similar product that is in the USA but can be bought via eBay (in Australia). This is the ‘Blucon Nightrider’.
Again, this tech attaches to the Libre sensor (but is not associated with Abbott) and will effectively turn it into a CGM, sending data directly to your smartphone or smartwatch every 5 minutes.
The Nightrider has 2 varieties; One which is waterproof and sticks on top of the Libre sensor ($85 every 2 weeks), but this will need to be changed every 2 weeks along with the Libre sensor; and another which is not waterproof ($135) and has to be attached with an armband or tape but has replaceable batteries, essentially meaning you don’t have to replace it as often (they do not state how often on their website).
Let’s be very honest here; if it will help you manage your BGL’s better, resulting in a greater quality of life and less stress then who’s to argue with that. However, we must balance the pros and cons.
Again, the costs;
MiaoMiao = $199 one-off payment (12-month warranty)
Nightrider (waterproof version) = $85 per fortnight
Nightrider (not waterproof version) = $135 one-off payment with replaceable batteries
Pros of MiaoMiao and Nightrider:
If you own a smartphone or smartwatch, both technologies will assist in gaining instant insight into your BGL’s.
As they turn the Freestyle Libre into a CGM, you get the benefit of alarms telling you if your BGL goes to high or low.
If the cost is not an issue, it may well be worth a try to enhance your visibility over your BGL during exercise and sleep.
Cons of Miaomiao and Nightrider:
Cost: Many people struggle to afford a Freestyle Libre, let alone the MiaoMiao or Nightrider.
Convenience: If you want a shower, it must be removed. If you want a swim, it’s coming off. (note: there is a waterproof version of the Nightrider)
Obtrusive: Many diabetics find the Freestyle Libre conspicuous and both these gadgets enhance this by increasing the size of the sensor by roughly double.