Diabetes Technology Part 3 – When Used Together

This is the third of a three part series, you can read part 1 here and part 2 here

My last two blogs have covered CGMs (continuous glucose monitor) and insulin pumps. This is what’s possible when the two technologies are combined!

Medtronic 670g with auto mode (closed loop)

A couple of years ago Medtronic was the first company to get FDA approval for their closed loop insulin pump. Instead of the CGM just alerting the wearer that BGs (blood glucose or blood sugar) are going out of range, the pump has the ability to use the CGM data to adjust basal insulin rates to bring BGs back into range with no input needed from the wearer. Going too high? No problem the pump will automatically start giving more insulin. Going too low? No problem, the system will decrease or suspend insulin until BG comes back up.

Medtronic may have been the first but this year Tandem t-slim launched their first closed loop system and Omnipod hopes to by the end of 2020. These closed loop systems do half the work for the diabetic, making the small adjustments when needed and only need user input when the small adjustments aren’t working. Yes counting carbs and inputting the number is still an important component of these closed loop systems but they are getting closer to doing everything else. T1 diabetics using these closed loop system see increased time in range and lower standard deviation.

Over the next few years, the closed loop systems are only going to get smarter and better. Control of pumps and reading CGM data is moving from proprietary devices to smart phones. Within the next couple of years, insulin pumps will no longer have screens or buttons, they will be controlled completely from a smartphone. Therefore pumps can be smaller and hidden better under clothing since it’s no longer necessary to have easy access to the pump.

Every new tool makes the fight a little easier

One of the most challenging aspects of being a T1 diabetic is that there is never a break. You can’t take a vacation from it, you can’t take a sick day, it’s a 24/7/365 job. But once control of a pump moves to a smartphone, it will become a little easier for a support person to give us a break. As long as that person is well trained in T1 management, they can be handed the phone and take over. Yes they will still have to be in the same room but to let a T1 sleep through the night while they attend to any alerts and only wake the T1 up if they need juice, that is priceless to the diabetic. The technology will soon be there so that we can hand off our “pancreas” to someone else for a little while.

There are many new innovations in development for T1 diabetes that are expected to come out in the next few years. Right now most CGM sensors can be worn from 7-10 days. There is a 3 month sensor but it can only be inserted in a doctor’s office by a trained medical professional and unfortunately most insurance still doesn’t cover it. They will have an updated 6 month sensor coming soon and the hope is that will bring the cost down so more insurance companies will agree to cover it. Overall CGMs are getting smaller with a longer life and smarter too. There are also multiple new cannulas in development (the connection on the skin for the insulin to go in) that will work better, have less painful insertion and are designed to last longer that the current 3 days.

One new cannula in development

In the long term, new pumps are being tested that have both insulin and glucagon (a natural hormone produced by the liver to raise BGs). The problems have been getting a stable liquid glucagon (which we finally have) and overcoming the fact that injected glucagon side effects are common (headache, nausea). But the idea is that one day, a pump can be made so that the user only has to refill it every few days and it will be a completely closed loop system with no input needed from the wearer, not even carb counting! It would be the closest thing to an artificial pancreas possible.

Insulin + Glucagon pump in trials

Even with all this technology, being a T1 diabetic still is challenging. But as technology advances it offers better control, better management, improved quality of life and lower risk of diabetic complications. It is believed that it will also truly offer the T1 diabetic a full lifespan with less effort. So while still not as great as a cure for T1, the technology future is bright.

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