Advancements in technology and diabetes management 19 March 2014 Diabetes can present many demands on you – making healthy food choices, getting enough exercise and checking and recording your blood glucose levels. Some of you are also counting carbohydrates and taking tablets and/or insulin injections, all while trying to keep your glucose levels within target and managing an already busy life. Today, advances in technology means that there are many new devices that can help you manage diabetes more easily including: Insulin pens Insulin pens with built-in memory Insulin pumps Continuous glucose monitoring (CGM) Glucose meters with insulin calculators Insulin pens An insulin pen is a pen for injecting insulin. It is easier to use than a syringe because you don’t need to draw up the insulin from a vial. The pen holds a cartridge of insulin. Each time you inject, a new needle is attached to the pen and you then simply use the pen dial for your insulin dose. Insulin pens can be disposable or reusable. A disposable pen is already pre-filled with insulin and when the cartridge is empty the entire pen is thrown away. A reusable pen needs you to insert the insulin cartridge. When the cartridge is empty it can be replaced and the pen can be used again. Reusable pens can be used for several years as long as they are checked regularly by your diabetes educator to make sure they are working well. Insulin pens are convenient when travelling. They take up less space and have less parts than the syringe, needle and vial method. Insulin pens are available in different colours which can be helpful when you have more than one type of insulin as you can easily recognise one from the other. Insulin pens with memory It’s not always easy to remember if you’ve taken your insulin. To help with this there are now insulin pens available with a built-in memory including: The NovoPen Echo Â® remembers your last dose of insulin and how long ago since you last injected. It can deliver half unit doses of insulin so it is mainly used by children and adults with type 1 diabetes. Only Novo Nordisk insulin can be used in this pen. The HumaPen Memoir remembers your last 16 doses of insulin injected as well as the dates and times that they were given. Only Eli Lilly insulin can be used in this pen. Insulin pumps An insulin pump is a small electronic device that delivers small amounts of quick-acting insulin through a cannula (small plastic tube) that is inserted under the skin every two to three days by the person wearing the pump. The pump is worn 24 hours a day although it can be removed for short periods of time, such as when you shower or go swimming. An insulin pump works a bit like a pancreas releasing a small amount of quick acting insulin continuously to keep blood glucose levels steady between meals and overnight. Extra insulin is given when food is eaten to keep blood glucose readings in target. When used well the main benefits of insulin pumps are: They can reduce your risk of hypos You can more easily adjust rates for exercise and sick days You can fine tune your blood glucose levels to help lower HbA1c Wearing a pump is not for everyone, and if you want further information you can read the I’m considering an insulin pump resource here and discuss this with your endocrinologist and/ or diabetes nurse educator. Continuous glucose monitoring Continuous glucose monitoring (CGM) is a way of measuring your glucose levels continuously throughout the day and night. This helps you to detect hidden high or low glucose levels that you may miss with your blood glucose meter. CGM has three parts: a glucose sensor, a transmitter and a small external monitor. Some external monitors look like an insulin pump and have a screen showing the glucose levels. Others do not have a screen and are downloaded by a diabetes health professional after the person has worn it. This allows the diabetes team to see a pattern and then suggest changes. A small cannula (plastic tube) is inserted just under the skin and this reads the glucose levels in the fluid that surrounds the cells in the body (interstitial). There are some insulin pumps that have the CGM built into them. At this stage they cannot communicate with the pump and you still need to make decisions based on your blood glucose levels, but watch this space!Because CGM reads interstitial glucose and not blood glucose, it doesn’t replace finger pricking. You still need to check your blood glucose levels with a BG meter in order to check the CGM and confirm accurate results. In particular, CGM may not be accurate when glucose levels are changing rapidly and so can’t be used to adjust insulin doses. CGM is used to establish patterns and trends whereas BG meter results can be used to adjust treatment. Blood glucose meters Most blood glucose meters these days are accurate and easy to use. There are features that may help you decide which meter is right for you. Most meters now available do not need to be calibrated. Some meters allow you to identify which blood glucose readings are before or after meals, and you can make notes about readings that are checked during sick days, exercise or with extra foods. Many of the meters are also able to download your blood glucose levels into charts/graphs that can help you to understand patterns. Only one meter, the Freestyle Optium, checks for blood ketones. Ketone testing is important for people with type 1 diabetes, especially when unwell. Some of the newer blood glucose meters have also become a little smarter, such as the Accu-Chek Aviva Expert and Freestyle InsuLinx, which have in-built insulin calculators. These calculators can help you to adjust your quick-acting insulin based on how much you eat, your blood glucose level at the time and any insulin that you may have on board from a previous dose. To use these meters well you need to be able to count carbohydrates and have a good understanding of how your insulin works. If you are interested in using one of these meters, you will need to see your diabetes nurse educator and be trained in how to use it. The OneTouch Â® Verio Â® IQ Meter helps you to look for hidden patterns of high and low blood glucose. This may help you and your diabetes team to make adjustments to your insulin and or medications. The iBGStarÂ® is a very small meter that can be attached to either your iPhone or iPod touch. Once attached the iBGStarÂ® will automatically download your glucose readings onto your iPhone. There is also the iBGStar Â® Diabetes Manager App which you can download here. With this app you can track not only your blood glucose levels but also your carbohydrates, insulin doses and any notes that you might like to make such as exercise or illness. This information can then be printed or emailed to your health professional.