Today I am going to veer off a little and talk about Technology in the way of medical devices for T1D. I am only going to talk about medical advances that we as a T1D community use everyday to manage our T1D. I will talk about medical advancements for a T1D “cure” and I use that term very loosely because as of right now there is absolutely not a cure, another day. So first and foremost we have the glucose meter. Now every T1D uses a glucose meter because it measures the amount of glucose in our blood stream in the measurement of mg/ DL, or milligrams per deciliter. Also just a refresher to check our BG we have to poke our fingers to get a blood drop that is then administered to a small strip called a test strip. Our glucose meters are near and dear to our hearts as we need them everyday to survive. Fun little fact, did you know most test strips use a small amount of gold in them because of the conductivity of the gold and it’s malleability properties? Gold is the softest yet a very dense metal so it can be milled very very thin. Each strip has at least one tiny circuit in them and some up to 4, but sadly there isn’t enough gold to recover from the strips.. believe me people have been trying! Next let’s touch base on the insulin pump. I have mentioned pumps in the past, so a refresher, a pump is a device that holds insulin and administers a quarter of an hourly dose every 15 minutes. These hourly rates are called basal rates and they are used to control your BG through out the day not including when you eat. Throughout the day your insulin levels fluctuates adjusting to your hormone levels, most people have higher levels in the morning, your activity level, your stress level, environment and weather, sugars in your body, and many more things. Also your liver is releasing more or less sugars in reaction to all these factors and the insulin levels. So you see they work off of each other and create a very delicate balance… and you never even know. One thing that T1D taught me is to be in absolute awe of how amazing our bodies are and how they work. So if you don’t produce any insulin on your own, you have to look at BG patterns through out the day and come up with different basal rates, most pumps can program at least 10 different rates through out the day… this is a lot of programming and when you get a pump for the first time it can take up to a month to get all the correct numbers and factors programmed into your pump, and it is ALWAYS changing. I am always tweaking my pump; it is never ending because our bodies are always changing. Another insulin rate you program in is the bolus rate, which again, is the insulin you give yourself for meals. Throughout the day a T1D might have 3-4 different ratios of how many units of insulin they administer for a certain number of carbs, for instance, at noon it might be 1 unit for every 8 carbs. This is why folk it is VERY important we T1D count our carbs very carefully. Pumps also include how much insulin you have “on board”, say you had to give yourself a dose of insulin because your BG was high, it keeps that info for a set number of hours, you program that in too, and if you eat a meal it used that factor when suggesting a dose for your meal. Also you program a BG number you want to be your goal, say 85 or a range 80-100 and if it is above that range it suggests the dose on how many points above that range, which can change throughout the day and you have to program in. Is your head spinning yet? Also you can program both a MAX basal and bolus rate so if you accidentally push too many buttons on your pump it can’t go crazy and give you all your insulin. The most fantastic things about pumps is you can give yourself a either decreased or increases basal rate for a certain amount of time if you are planning on a certain activity… say you are going to be moving all day, you can have your pump give you 20% less insulin for a certain number of hours and also, YOU CAN SUSPEND YOUR PUMP. Why is this so important? Say you are having repeated episodes of low BG and you are alone. Suspending your pump will temporarily stop the delivery of insulin and sometimes this is what you have to do.
There are few different types of pumps. These pumps are a rectangle device that contain a reservoir, that holds the insulin, and the reservoir direct feeds into the tubing that goes to an infusion site on the body. The infusion site is inserted with an IV like system whereas you use a needle to insert the tubing and pull the needle out and a tiny tube, cannula, stays in the body. Pump sites can only be left in for 2-3 days because it in a insertion site where a fluid is being pushed into your body and if left too long your body starts to reject the infusion site and you can get an infection. There in another pump that is similar the only difference is that instead of a direct feed from the reservoir there is a piston style delivery system that only pushes so much insulin into the line at once. This is a great invention because one of the malfunctions of a pump is to push the WHOLE reservoir out at once and as you can imagine that would be a very horrible day. The last type of pump is a pod like Pump and is actually called the Pod. Pods are stuck to your body as a whole unit, they are waterproof, and as of recently there was only one other water proof pump which seems ridiculous because we as humans are waterproof and when a normal person goes swimming they don’t take out their pancreas out and stick it on the side of the pool. Pods are programmed and directed by a remote (other pumps have buttons or touch screens on them). Pods can be great but also are a bit cumbersome and can be knocked off, like a lot. There are issues with tubed pumps too such as site leakage and you can catch the tubing on a doorknob, or cabinet handle and it can also be ripped out. So pumps are great, but not perfect. I know T1Ds that use shots and ones that have pumps, I also have T1D friends that have used pumps for a number of years and then switched to pumps. Lastly I am going to talk about the Continuous Glucose Monitors, or CGM. A CGM is a device that continuously checks your BG every 5 minutes via transmitter, which then sends it to a receiver where you can see the info. The transmitter is inserted IV style again only the transmitter filament is inside the needle and then the needle is removed and the filament stays in the body. These needles are quite large since the filament is in the needle. The transmitters can stay in the body for a long period of time since it is not injecting anything into the body. The FDA has approved them to be left in for 7 days but most T1D get them to work for 10-14 days before they stop reading. CGMs are invaluable because of that constant BG reading. I actually mount mine right to my bicycle on the handle bars, in a waterproof cell phone case, when I go for ride because all I have to do to check my BG is push button. The CGM does require you to “calibrate” it at least 4 times a day with a finger prick BG reading to make sure it is on the right course. Also it has a 30% variance, which is perfectly fine in the middle range of BG but can be a huge pain on the low or high end. Say your CGM reads 100 but your BG is really 60 or your CGM read 250 but your BG is 300… you can see where this system isn’t perfect. Also you can have your CGM give alarms when your BG is high and low which is fantastic until you are kept all night because your CGM says your BG is low and it isn’t… at all… and you don’t sleep. So CGMs are fantastic and I wear mine almost constantly, but they aren’t perfect. Tomorrow we are going to talk MONEY! This folks gets very, very interesting.
Needlestosay 