What’s Coming and What’s Delayed in Continuous Glucose Monitoring?

This content originally appeared on diaTribe. Republished with permission.

By Albert Cai

Updates and delays from Abbott, Dexcom, Medtronic, and Senseonics

With several clinical trials on hold due to the COVID-19 pandemic, we’re bringing you a roundup of the latest updates on future continuous glucose monitors (CGM). Understandably, the FDA also announced a few months ago that it would focus its efforts on devices related to COVID-19. With the disclaimer that it’s impossible to know exactly when the pandemic will subside, when trials might resume, and how FDA reviews might be affected, here is the latest news we’ve heard from companies.

Click to jump to a product, which are organized alphabetically.

Abbott FreeStyle Libre 2

CGM

Image source: Abbott FreeStyle

What’s new? FreeStyle Libre 2 keeps the same “scanning” feature as the original FreeStyle Libre, but adds Bluetooth connectivity. This is important because it enables optional high and low glucose alerts. Users who enable these alerts will be able to get a notification on their reader or phone whenever their glucose reading goes above or below their specified ranges. Looking ahead, the Bluetooth feature will also allow FreeStyle Libre 2 to be part of automated insulin delivery systems (AID), like Insulet’s Omnipod Horizon.

Like the original FreeStyle Libre, FreeStyle Libre 2 has 14-day wear, is factory-calibrated (no fingerstick calibrations required), and can be scanned with either a phone or a reader device (the reader for FreeStyle Libre 2 is blue, instead of black). Importantly, FreeStyle Libre 2 will be offered at the same price as the original FreeStyle Libre.

When’s it coming? The FreeStyle Libre 2 has already launched in a few European countries (we know of Germany and Norway) and will launch in others soon. In the US, FreeStyle Libre 2 has been under FDA review for over a year. In March, Abbott said that it was working through “some finishing items” and was “very confident” the device would be cleared soon.

Dexcom G7

Dexcom

Image source: Dexcom

What’s new? Dexcom’s G7 will be fully disposable (the transmitter and sensor are combined and thrown away together) and have longer wear (we believe somewhere around 14-16 days). Remember that the Dexcom G6 sensor lasts for 10 days but has a transmitter that is re-used for 90 days. The G7 will be considerably slimmer than G6 and will have a lower cost of manufacturing in bulk, though consumer pricing is not yet determined – we imagine it will be similar. The G7 will keep the same accuracy, no fingerstick calibrations, and Bluetooth connectivity as the G6.

Dexcom has been developing G7 in partnership with Verily, the division of Alphabet formerly known as Google Life Sciences. There has been mention from Verily that an accelerometer may also be built-in to the G7 device, but we aren’t sure if that feature made it into the final version of G7. Having a built-in accelerometer could allow the G7 to also track physical activity, like a Fitbit or other fitness tracker.

When’s it coming? Dexcom planned on launching G7 in “early 2021,” but with most clinics placing new trials on hold, Dexcom is expecting a “minimum delay of approximately six months.” It’s difficult to know when clinics will be able to conduct trials (and when people will feel comfortable enrolling in trials), but assuming a six-month delay, G7 could be on the US market sometime in the second half of 2021.

Medtronic “Project Zeus” CGM

Abbott FreeStyle

Image source: Medtronic

What’s new? Medtronic’s next CGM, referred to as “Project Zeus,” will reduce the number of required fingerstick calibrations and have improved accuracy (compared to its current offering, Guardian Sensor 3). The new CGM will require day-one calibration (unclear on the number of fingersticks that will be required on day one), compared to Guardian Sensor 3, which requires at least two fingerstick calibrations every day. Medtronic expects Project Zeus to launch with a “non-adjunctive” indication, meaning users will be able to bolus insulin based on CGM reading alone, and not have to perform a confirmatory fingerstick. the new CGM will keep the same seven-day wear, size and shape, and reusable transmitter component as the Guardian Sensor 3 (pictured above).

When’s it coming? The trial for Project Zeus began in June 2019 and is expected to wrap up within the next month. Medtronic expects to submit the CGM to the FDA by the “end of the summer.”

Senseonics Eversense XL (180-day)

Eversense XL

Image source: Eversense XL

What’s new? The “XL” extended life-version of Senseonics’ Eversense in the U.S. will have the same size and features as the original Eversense, but the Eversense XL is implanted for 180 days, rather than the 90-day Eversense. As a reminder, the Eversense sensor is implanted in the users’ upper arm in a clinic and remains there for the sensor duration; a silver-dollar sized on-body transmitter is worn on the outside of the arm to deliver readings to a smartphone. Senseonics is targeting reducing calibrations from 2 per day to 1 per day with same non-adjunctive indication.

When’s it coming? Eversense XL is already available in Senseonics’ European markets. The trial for Eversense XL in the US wrapped up in late March, and Senseonics has previously aimed for FDA clearance in “late” 2020. We aren’t sure whether that timeline has been pushed back due to COVID-19, but the fact that the trial has already completed is encouraging.

Source: diabetesdaily.com

A D-Mom’s Changed Perspective Using Basal IQ

Technology continues to make managing our diabetes easier. Continuous glucose monitors, apps for carb counting and insulin pumps have all alleviated some of the stress of managing our condition. Tandem Diabetes created Basal IQ technology, which allows us to spend less time worrying about going low and let our devices do the work. For a person living with diabetes, this means less stress and more sleep.

Basal IQ technology helps reduce the frequency and duration of lows by predicting glucose levels and suspending insulin if the blood sugar level is thought to go below 80 mg/dL or the Dexcom reading goes below 70 mg/dL. Insulin delivery will start automatically once the blood glucose starts to rise again.

Basal IQ is different than the newly released Control IQ, in that Control IQ can adjust insulin delivery, including the delivery of automatic correction boluses as needed, therefore helping patients avoid episodes of hyperglycemia. Using either one of these systems also means fewer fingerpricks, as you will no longer have to get manually take your blood glucose reading.

Basal IQ technology has given many people living with diabetes, and those who love them, a little more rest and some peace of mind. A pivotal study showed the use of Basal-IQ Technology on the t:slim X2 Insulin Pump demonstrated a 31% relative reduction in time spent below 70 mg/dL when compared with a CGM-enabled pump without Basal-IQ Technology. Important to note, the less amount of time spent at lower glucose levels did not mean more time spent at higher glucose levels. Maintaining your target range has become a lot easier thanks to Basal IQ technology.

Photo credit: Allison Hoffman

One woman, Allison Hoffman, who helps manage her 10-year-old daughter, Becca’s diabetes, raved about the changes to her overall well-being since switching over to Basal IQ technology after relying on Omnipod for the past few years.

Here is her story:

For 7 years my mornings were absolute hell. While I would see others sleeping in, meditating, going to the gym, etc, I was a slave to Becca’s whackadoodle blood sugar swings, which would often start around 5:00 AM. My body learned to wake up at this time, and that I doubt I’ll ever be able to change.

My mornings would include me running up and down the stairs entering the bedroom, praying I wouldn’t wake her and deny her the right to sleep in, suspending insulin (audible beep I couldn’t silence), sticking glucose tabs in her mouth, often with the pay-off of a horrible blood sugar spike. I would start 95% of my days this way.

And the frustration! No adjustments to her settings were right. If I reduced her insulin she’d go high; .35 too low, .4 too high. I would wake up at 3:00 am to set a temp basal to get the amount she needed that Omnipod didn’t have as a preset-still wouldn’t work. Nothing I did was right.

Since starting on t:slim pump with basal IQ, I finally have my mornings back. It allows more fine-tuned insulin delivery and suspends when it predicts her to go low. As long as her sensor is good, and her insulin settings aren’t way off (I will always need to determine her insulin needs, it isn’t automatic), I can have a pretty peaceful morning now.

I can watch the news, or another show, or read, and my coffee doesn’t go cold. I can sit with my dog on my lap and not have to jump up every ten minutes to go deal with diabetes. I can breathe. And Becca can sleep peacefully.

I’ve made four seesaw activities for my students this morning and she’s still sleeping.

7 years of hell. I finally have my mornings back.

If you are living with type 1 diabetes and are considering a pump, you may want to look into t:slim X2 pump along with the Dexcom G6 so you can make use of the new Basal IQ or Control IQ technology. Their slogan is “live more and worry less” and I am so glad this seems to be the case for so many.

Have you tried out this technology? How has your experience been?

Source: diabetesdaily.com

How to Make an Emergency Preparedness Plan

The reality of living in a time of a global pandemic, such as COVID-19, is slowly starting to sink in for millions of Americans. Without any preventive antibodies, vaccine, or cure, it is extremely scary when the closest thing we can do to protect ourselves is to wash our hands, avoid sick people, and remain socially distant at all times. With society all but shut down, here’s our guide to creating an emergency preparedness plan if you get sick and/or need to quarantine in place for a long period of time.

What and How Much to Stock Up on to Shelter-In-Place

With shelter-in-place mandates in all but a handful of states, it’s important to know what you’ll need for (ideally) several weeks without leaving home. People with diabetes are more susceptible to having severe complications from COVID-19, so even though grocery shopping and going to the pharmacy is permitted under a shelter-in-place order, it’s not necessarily recommended. Even though the food supply-chain will not break down, it’s best to not be running to the grocery store any more often than you absolutely need to, so try and stock up on at least two weeks’ worth of shelf-stable food, water, and toiletries. In a pinch, apps like Instacart and Amazon Fresh offer online grocery orders, so if you’re running low on some staples but don’t want to leave home, these are a great option to have.

Shelf-stable foods:

  • Dried beans
  • Rice
  • Lentils
  • Flour
  • Pasta
  • Canned and frozen vegetables
  • Canned soups
  • Peanut butter
  • Canned and frozen fruits
  • Canned meats and seafoods

In a March interview with NPR, Dr. Peter Jacobson, a University of Michigan professor of health law and policy, advises a stockpile of at least 90 days for medical supplies:

“People should not be caught short of having enough heart medications, diabetic medications, or any potentially life-saving medication that they need on a routine, daily or weekly or monthly basis,” he said.

Sometimes this can be as easy as signing up for your pharmacy’s mail-order option or talking to your pharmacist and asking if they can fill your routine medications for 90 days instead of 30.

Contacts to Have on Hand

Now is an excellent time to gather all of your important phone numbers for doctors and family members should you need to get in contact with them quickly (or if you fall ill and your spouse needs to contact someone quickly). Important numbers to gather and have in a communal space (like pinned up on the refrigerator):

  • Endocrinologist
  • Primary Care Physician (PCP)
  • Your Employer
  • Immediate Family Members
  • Trustworthy Neighbor
  • Local hospital (where your insurance is accepted!)
  • Your Pharmacy/Pharmacist
  • Water Company
  • Power Company
  • Internet Provider
  • Children’s School or Daycare

Have a Plan B If You Need to Evacuate

Have a plan in place if you’ll need to evacuate your home or city. Reach out to your support network of family members or close friends should you need to self-isolate due to COVID-19 exposure, or if you feel your city is becoming unsafe and you need to get away. Make sure you prepare a packing list, have a to-go bag ready, and prepare your home if you need to leave quickly. Conditions can change quickly, so it’s important you know where you can go, how to get there, and what to bring if and when you need to leave.

Important things to pack in a to-go bag:

  • All medications, insulin, and diabetes supplies
  • Cold and flu medicines
  • Low supplies
  • Toiletries and extra towels
  • Clothing/pajamas/exercise clothes and extra socks and shoes
  • First aid kit
  • Copies of important documents, such as prescriptions and ID
  • Chargers for CGM, cell-phone, etc.
  • Vitamins and self-care essentials
  • Books and important mementos

What Do I Do in the Case of…?

It’s a scary time to be quarantined in your home, away from many friends and family. It’s even scarier when you have diabetes. Here are some common conundrums and resources to help you:

  • I Suspect I Have COVID-19: Read up on COVID-19 , and if you suspect you’ve been exposed to the virus, self-isolate immediately and call your physician to describe your symptoms. They will guide you as to what your next steps should be.
  • I Have a Bad Low and I’m Home Alone: If you’re home alone and are battling a bad low, call 911 immediately. If you can access your glucagon, get that while you’re on the phone with an emergency dispatcher. It’s best to know how to inject glucagon before you ever need to know. Learn how to do so here.
  • I’m Sad and Scared During This Time: If you are having trouble managing the emotional toll during this time, check out our top ways to protect your mental health. You can also take advantage of telehealth, and schedule some time with a counselor to talk about your feelings during this hard time.
  • I’m in DKA: If your blood sugar has been persistently high, you have ketones, and you think you may be developing diabetic ketoacidosis (DKA), it’s time to either go to your local emergency department, or call 911 (if you are unable to drive). Be sure to act quickly, as time is of the essence when it comes to extremely high blood glucose levels. Medical professionals will be able to re-hydrate you, better regulate your glucose levels, and monitor you, keeping you safer than you will be at home.

Whether you come down with coronavirus, you are quarantined, or you are self-isolating, you may be unable to venture out to pick up your prescriptions. You may be able to get your medication delivered directly to you. Here’s how:

  • Reach out to big chain drug stores. Both CVS and Walgreens are currently offering free home delivery of prescription drugs.
  • Call your regular pharmacy. Many smaller pharmacies will usually deliver medications for free.
  • Try a mail-order pharmacy. They often offer great discounts (sometimes as much as 90-day supplies for the co-payment of 60 days) as well as free shipping. Find out if your insurance company will cover a mail-order option.
  •  If you need a new prescription, but either can’t get to your doctor’s office, nor can you take advantage of telehealth, consider using HeyDoctor, GoodRx’s telehealth service. HeyDoctor visits cost a flat fee of $20, regardless of your insurance (and even without insurance). They’re currently offering free COVID-19 screening consults.
  • Check out new programs directly from insulin manufacturers. Eli Lilly , Novo Nordisk, and Insulet have recently set up new affordability programs.
  • I Lost My Job: This global pandemic has quickly turned into an economic crisis, with millions of Americans losing their jobs and having their work hours cut, in short order. In the US, losing a job can often mean also losing your health insurance, which is terrifying for someone living with diabetes. Check out our guide to finding affordable health care if you find yourself recently unemployed due to the COVID-19 crisis.

We’re living in extraordinary times, but having an emergency preparedness plan in place can help you manage circumstances in these extreme conditions. What are some ways in which you’ve planned for the worst (but hoped for the best?). What has helped you the most? Share this post and comment below; we love hearing your stories.

Source: diabetesdaily.com

Spouse of Type 1 Warrior and Cancer Survivor Stays Positive Amidst COVID-19

The COVID-19 pandemic is affecting all of us, but for those with multiple underlying health conditions, is of even greater concern. David, whose wife not only lives with type 1 diabetes, but is also a cancer survivor, took time to speak to us about how their family is handling these challenging times.

David, thank you so much for taking the time to talk to me. The COVID-19 pandemic has left us all in fear, especially for those who are elderly or have pre-existing conditions, and for those who love them. Knowing that your wife, Pamela, fits this demographic by not only being a type 1 warrior but also a cancer survivor, adds an extra layer to this difficult time.

I am sure you are very worried about Pam. I know you are an extremely supportive husband. So much so that I was lucky enough to meet you at a diabetes event in Philadelphia a few years back!

I thought it would be nice for our readers, especially those who are “type 3” and love someone who is living with diabetes (and other conditions) to hear a perspective of such a dedicated husband!

At what age was Pamela diagnosed and how old is she now?

Pam was diagnosed at the age of 11 and she is 42 years old now.

When you made those vows to Pam, what were some things you vowed to do for her knowing that she lived with this chronic condition?

My mom was type 1 since before I was born. I knew going into it what the risks were. My mom had open heart surgery and amputations when I was young. I vowed to take care of my wife like I did mom.

When was Pam diagnosed with oral cancer? I can’t imagine how difficult that was to get through for Pam and her family. How did you find ways to keep Pam and yourself positive?

In 2006, when we were 28 and married for five years, and again in 2007. I did not allow myself to think of a negative outcome. I try to think positively about things.

Before this pandemic started, how were things going? How has Pam’s health been? Her diabetes management? Thankfully, I know she is cancer-free. 

Things were going well. We have the Dexcom and Omnipod to help with control.

Once you heard COVID-19 was picking up speed in your area, what was the first thing you did to prepare?

Shopped for more than just a few days. Typically, we make store runs a few times per week so we tried to lessen our public exposure. It’s really just starting in our rural area.

Photo credit: David

Did Pam run into any problems getting anything she needed in terms of medication, supplies, etc.?

Not really because we try to keep ahead of diabetes supplies. There have been times in our younger years where she did not have insurance, so we like to be prepared.

How is your family handling what is going on in the world? What extra precautions are you taking given that Pam is living with type 1 diabetes and has also battled cancer?

She is also asthmatic so we have been staying home as much as possible. Limiting contact with other people as much as possible.

I am sure you have worried many times over the years about Pam’s health. That takes a toll on our loved ones and makes us worry! How have you made sure to take care of your own emotional, mental and physical well-being?

I try to think positively and not dwell on the negative things. My wife does that enough for both of us.

If there is one piece of advice you would offer to spouses, parents or anyone else with loved ones with preexisting conditions or other health issues who are going through the same thing?

Be there with them so that they aren’t going through it alone.

If there is one positive to come out of this crisis, what would it be? I think we could all use a silver lining!

That people will not take their loved ones and the time spent together for granted, maybe have more compassion for fellow humans.

Thank you so much for taking the time to talk to me. I hope you and your family continue to remain safe and healthy!

Source: diabetesdaily.com

A 10 Year Old’s Advice on How to Beat Boredom During COVID-19

Written by Danielle Caggia

With my children home indefinitely, I thought an appropriate project for my very bored 10-year-old daughter was to come up with a list for kids, by a kid, on how to not stayed bored during this challenging time. I hope you and your children enjoy Danielle’s tips on how to stay entertained. Stay safe, everyone!

The Coronavirus has forced all of our schools, stores, gyms, and restaurants to close down. While we will keep busy with distance learning, we kids need some ideas on how to pass the time, too. If you are a kid like me and looking for things to do, here are my top 10 ways to avoid boredom while being stuck at home.

Provided by Jillian Rippolone

1. Get Crafty

I love to draw and create things. There are so many ideas online and you can even get creative with the things in your home like cotton balls and paper plates! (Allison’s tip: if your child with diabetes wears a continuous glucose monitor or an Omnipod, you can be creative and decorate them! Check out my favorite from my friend, Jillian Rippolone, T1dChick.)

2. Watch Movies

Let a family member pick a new movie each night. It will allow you and your family to be together and appreciate each other’s favorite movies, too. So far, my brother and I have agreed on all of our choices! (Allison’s tip: there are so many movies that portray diabetes inaccurately. Get a laugh with your family watching movies from this list. And be thankful for technology and the progress we’ve made as a community!)

3. Start a Journal

With everything going on in the world, this is a great time to put down your thoughts and feelings. Hopefully, when this is all over, you can look back and reflect. (Allison’s tip: This is not a bad time to let children with diabetes take some ownership over their diabetes management if they show interest. Jotting down what they’ve eaten, the carb count, and the insulin dose taken may be a great exercise to empower them in the future! This may also be a great exercise for us adults living with diabetes and can also help our mental state.)

Provided by Allison Caggia

4. Connect with Others

I miss my friends! Thanks to phones and social media, I can stay connected and we can make each other smile! (Allison adds: We really all need each other to lean on during this time. No matter where you stand on screen time, make sure to take advantage and stay connected to your loved ones like grandparents and your friends who are alone.) (Allison’s tip: This is a great time for children with diabetes to get a penpal! Beyond Type 1 has an amazing Snail Mail Program that will help your children to form friendships and not feel so alone.)

Provided by Allison Caggia

5. Bake

My mom loves making healthy foods. I am going to help her come up with some tasty desserts that will last us a while. Check out some ideas here! (Allison’s tip: This is a great time to experiment with some low-carb options of your favorite desserts, visit Caroline’s Keto Kitchen for some delicious ideas.)

Provided by Allison Caggia

6. Get Some Fresh Air

With the warmer weather coming, we should all take advantage of the not so cold temperatures. Getting outside can also help stop the spread of germs. And it can also help us clear our minds. (Allison’s tip: Someone posted in my neighborhood Facebook group about having the children participate in a “rainbow hunt.” We all asked our children to draw a rainbow and place it somewhere noticeable outdoors, on your door or a window, etc. Then take a nice walk with your family and see how many you can find!)

Provided by Allison Caggia

7. Have a Picnic in the Car

My mom and I love being out and about! Two of our favorite things to do are going out to lunch and shopping. We decided to have a lunch date in the car and it was nice to get out of the house for a while. (Allison’s tip: Always be prepared. I wound up going very low because the food we ordered for curbside was taking longer than expected. Luckily, I had a Gatorade in my glove compartment. I was glad I was prepared and that my low didn’t ruin our mommy-daughter time!)

Provided by Allison Caggia. This was taken way before social distancing was even a thing.

8. Do Something Good for the Community

There is so much sadness in the world right now. Figure out a way your family can safely help. My mom and I always ask our elderly neighbors if they need anything when we go to the grocery store. And our project for this upcoming weekend is to look through this list and pick a way to give back! (Allison’s tip: Check-in on your local diabuddies to make sure everyone has insulin and supplies. I taught my daughter and her friends a valuable lesson this winter, when we delivered insulin to a diabuddy in need.)

Provided by Allison Caggia

9. Pamper Yourself

I love face masks! And lotions! Use this time to take bubble baths, try new hairstyles and maybe even offer a family member a free manicure! (Allison’s tip: Our skin is often put through the wringer with harsh adhesives and constant pricks and injections. Rotate your sites and let your skin breathe!)

Provided by Allison Caggia

10. Get Active

It’s important to not just sit around and be lazy. We must take the time to exercise our brains and our bodies! If you have a mom who is a CrossFit fanatic like mine, you may find yourself doing “wods” (workout of the day). She sometimes schedules workouts, and my friends join in from their homes, it’s a lot of fun! This is my friend, and our moms are doing an awesome workout called Deck of Death! Find a way to be active; you won’t be sorry! (Allison’s tip: Check out our latest article COVID-19: Apps to Stay Active at Home).

This is a really strange time for all of us. I am trying my best to stay upbeat and happy. Because I know I do have a lot to be thankful for. I can’t wait to see my friends and do all the things I love again! I hope you all stay safe, healthy and entertained!

Source: diabetesdaily.com

Automated Insulin Delivery: Six Universal Observations and Understandings

This content originally appeared on diaTribe. Republished with permission.

By Laurel Messer

Six universal facts about automated insulin delivery systems, and the things you should keep in mind about this revolutionary technology

Automated insulin delivery (AID) systems are moving towards the forefront of diabetes management. AID systems combine continuous glucose monitors (CGM) with smart algorithms to automatically adjust insulin delivery.

The Tandem Control-IQ system was recently cleared by the FDA, and the Insulet Horizon and Medtronic Advanced Hybrid Closed Loop systems are beginning pivotal trials. These are encouraging developments. As more systems move through the pipeline and eventually into the commercial market, important patterns are emerging in user expectations and user experience. As a diabetes nurse, certified diabetes educator and research investigator, I, along with my team at the Barbara Davis Center, have worked with nearly every AID system in the pipeline, and other systems that will never make it to market. Here are six insights we have gleaned, which seem to be universal (thus far) to all AID systems:

1. You can always beat an AID system with compulsive diabetes management

Many people with diabetes compulsively attend to diabetes care in order to achieve ultra-tight glucose ranges – and are the first to ask about automated systems. What ends up happening is that these “super-users” are invariably frustrated that the system is not yielding the same results that they were able to achieve with their own calculations and management. An important point is that many automated systems are excellent at reducing mental burden for taking care of diabetes, excellent at reducing hypoglycemia, and adequate at improving glucose levels. Humans can beat automated systems if they attend to diabetes care near-constantly. The individuals who will likely be satisfied with AID are those who are comfortable with an A1C in the 7s or above, but they want to reduce the mental load of adjusting settings and micromanaging high glucose levels. The most important question to ask is, “Why do I want to start using an automated system?” If it is to achieve near-perfect glucose levels, the system will likely disappoint. If it is to reduce the burden of “thinking like a pancreas” all the time, it may be a good option. AID will excel at the marathon of diabetes care but may disappoint in the hour-to-hour sprint.

2. Systems work best when you let them work

Using both research and commercial systems, we have seen all the ways to “trick” AID systems—entering phantom carbohydrates, changing set points, performing manual corrections, overriding recommended doses. More often than not, these behaviors lead to glucose instability – reactionary highs and lows from the system destabilizing. All systems will perform best if they are used according to user instructions. This is difficult for the individual who would prefer to micro-adjust settings or desire control over all insulin delivery. Most systems work best when users learn to trust them.

3. Give the system a chance – 2-4 weeks before deciding long term potential

It may benefit us to think about AID like a new significant relationship – it can take some time to “settle.” I mean this both on an interaction level (learning how to respond to alerts, when to intervene, when to let it ride) and on an algorithm level (allowing the system to adjust internal algorithm parameters based on usage). In addition, programmable user settings may need some adjustment in the first few weeks of use, so working with diabetes educators can be helpful for initial set-up and early follow-up.

4. Bolusing is still king

If I could go back in time, I would caution device manufacturers against any whisper of not needing to bolus with AID systems. Bolusing is the singular most important action a person with diabetes can do to optimize insulin delivery on current and near-future automated systems. This will be true until insulin action time gets exponentially faster or artificial intelligence gets better at predicting human behavior, neither of which is on the immediate horizon. In order for people with diabetes to see the best performance on any system (automated or manual), they need to bolus before carbohydrates are consumed. Specific to AID, the timing of the bolus (prior to carb intake) is especially important, as the system will automatically increase insulin delivery after an initial rise of glucose levels, so a late bolus (e.g., after the meal) could lead to insulin stacking and hypoglycemia.

5. Rethinking low treatments

Low glucose levels (hypoglycemia) still happen when using automated systems. What is different with AID is that the system has been trying to prevent the low by reducing/suspending insulin, possibly hours before the low occurs. This means that an individual may need to consume significantly fewer carbs to bring glucose levels back into range – perhaps 5-10 grams of carb at first, reassessing 15-20 minutes later. This can be difficult when wanting to eat everything in sight; however, it can reduce the chance of rebounding into the 200s after over-treating.

6. Infusion sets are still infusion sets

While AID algorithms are revolutionary, the infusion set is not. It is the same plastic or steel cannula that occludes, kinks, or inflames. This hardware limits automated systems and can very quickly lead to hyperglycemia or diabetic ketoacidosis (DKA). It is important for people using AID to recognize signs of infusion set failure – persistent hyperglycemia, boluses that do not bring glucose levels down, ketones, vomiting, etc. Knowing how to treat ketones (via syringe injection of insulin and set change) can prevent a hospital admission or worse.

I love that the diabetes community learns from its members and experiences. Check out our Barbara Davis Center PANTHER (Practical Advanced THERapies for diabetes) website for our team’s latest insights on automated insulin delivery, and tools for people with diabetes, clinicians, and engineers.

Are you considering AID? Feel free to share this article with your healthcare team. For more information about AID systems that are currently available or in the pipeline, click here.

About Laurel

Laurel H. Messer is a nurse scientist and certified diabetes educator at the Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO. She has spent the last 15 years studying how to best utilize new diabetes technologies, and remembers fondly teaching families to wrap up their corded CGM system in a plastic shower bag for bathing. Ok, not that fondly, but look how far we have come! Dr. Messer works with the Barbara Davis Center PANTHER team (Practical Advanced Therapies for diabetes), conducting clinical research trials on promising technologies to make life better for children, adolescents, and adults living with type 1 diabetes. Get in touch at Laurel.Messer@cuanschutz.edu

Source: diabetesdaily.com

Diabetes, Just Tell Me!

This content originally appeared on Test Guess and Go. Republished with permission.Lately, I have been having days, well actually weeks when I am starting to question how I deal with my diabetes. I have used an insulin pump for 15 years and don’t really want to change back to injections. For me a pump is […]
Source: diabetesdaily.com

Diabetes Tech Updates: Spring 2019

This content originally appeared on Type 1 Writes. Republished with permission.A couple of Saturdays ago, I was lucky enough to attend the Type 1 Tech Summit in Perth, where I had the opportunity to catch up with some of the reps from the diabetes device companies to find out what’s new. Mylife Diabetescare Last May, […]
Source: diabetesdaily.com

10 Dos and Don’ts of the Sensor & Site Life

If you’re new to continuous glucose monitor (CGM) or pump technology, you may have a few questions up your sleeve: can I go in the hottub with it on? What happens in extreme humidity? What about sex? Welcome to the world of diabetes technology! We’ve asked all the hard questions, so you don’t have to. […]
Source: diabetesdaily.com

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