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Blood Sugar–Testing Devices Go High-Tech

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Are you ready to make endless finger-sticks and insulin injections things of the past?

High-tech devices can help you manage diabetes with less pain and better blood sugar control.

Continuous Glucose Monitors (CGM)

Good for: People who need tight glucose control with intensive insulin therapy or don’t always know when glucose levels change.

If you rely on 10 or more finger pricks a day or are having a hard time regulating your blood sugar, the newest CGMs can really simplify your life. And you’ll have more accurate monitoring, with the equivalent of close to 300 checks per day with minimal finger sticks.

A tiny sensor, inserted under the skin of your belly or upper arm, reads the glucose level in tissue fluid every few minutes and sends it wirelessly to a monitor, smartphone or tablet computer. You can read the results directly on your monitor and use your smartphone or computer to keep track of your glucose levels.

A “stand-alone” CGM can be used with an insulin pump or without—the monitor tells you when your blood sugar is out of range, and then you can do your own insulin injections based on your diabetes management plan. Some models send out an alarm tone to alert you when your glucose level is too low or too high. These benefits make CGMs useful for people with type 1 diabetes and those with type 2 diabetes who need frequent insulin.

More advantages: You can wear the sensor and transmitter during most everyday activities, including showering and sleeping. A CGM also can relay readings to your doctor’s office. To consider… 

  • Abbott FreeStyle Libre. This sensor goes on your arm and can stay in place for 10 days. You scan a mobile reader over the sensor to see your glucose reading. A cloud-based software management system allows you to view reports, see trends and change settings. Unlike most CGMs, the FreeStyle Libre does not require finger-stick checks or calibrations. One drawback is that it does not send out alarms.
  • Dexcom G5 Mobile. This CGM sends glucose results to a receiver and your mobile device. Alarms and alerts warn of high or low glucose limits that you set in advance. This CGM does need to be calibrated with a finger stick every 12 hours. It can be worn for seven days and can be a stand-alone CGM or part of a closed-loop system with the Tandem Diabetes Care t:slim insulin pump (more on this later). You can share your data with your doctor or caregiver. The FDA has recently cleared the Dexcom G6, which is factory-calibrated—no need for finger sticks.
  • Medtronic Guardian Connect. This CGM is practically a mind reader, with a feature that alerts you an hour before you may hit either your high- or low-glucose limit. The sensor relays readings only to a smartphone app.

Also, you’ll need to do twice-daily finger sticks to calibrate it, and when used as a stand-alone and not in concert with a MiniMed system insulin pump (see below), you’ll need to check your glucose level with a finger stick before making a treatment decision.

Cost: There are up-front costs ranging from under $100 for the Abbott reader to $600 or more for the other CGMs listed, plus batteries and sensors. Insurance coverage varies and is changing all the time, so check with your carrier. Note: Medicare recently started covering some CGMs.

Combination CGM and Insulin Pumps: Hybrid Closed-Loop Systems

Good for: People who need many insulin injections every day and/or need to adjust insulin dosing based on their blood glucose level, meal type and physical activity.

A computerized insulin pump delivers insulin through a catheter inserted under your skin. The newest pumps and CGMs have been programmed to work together in what’s called a hybrid closed-loop system.

The CGM reads sensor glucose levels and sends readings to the pump. Then the pump adjusts the amount of insulin to deliver. You’ll still need to monitor your glucose level and perform finger pricks to confirm that the CGM is working correctly, plus make manual adjustments to account for meals and high blood glucose levels. Taking a training program at a clinic or diabetes center will help you become a pro at using it.

Hybrid closed-loop system options typically require a finger stick calibration several times a day, and the glucose-monitoring sensor can be worn for up to seven days at a time. Some are wearable while bathing and even swimming. To consider…

  • Tandem Diabetes Care t:slim. This insulin pump can function as a pump alone or can work with the Dexcom G5 Mobile. You can pick different tones that signal when blood glucose falls below or rises above levels you set.
  • Medtronic MiniMed 670G System. The latest model of the MiniMed has an AutoMode feature that automatically adjusts basal insulin delivery based on your glucose values and recent insulin delivery. It automatically stops insulin delivery if glucose gets too low.

Cost: The cost of an insulin pump itself is in the thousands, with a monthly cost for supplies. Many insurance companies do cover insulin pumps, but there may be co-pays and deductibles. Medicare may cover it with certain requirements.

Insulin Pens Get Smarter…

If you don’t need the level of insulin management a pump provides but still need insulin injections, the pen format is an advancement over a syringe and vials. You can load a cartridge in a reusable pen or use a single-use throwaway model.

Insulin pens are becoming smarter, too. For example, the reusable Companion InPen with Bluetooth technology and connectivity to Apple Health offers tracking and timing of insulin doses over time and even gives insulin temperature checks—the pen will send a message to your phone to remind you if you miss a dose and if your insulin gets too warm or too cold. An InPen itself lasts for one year, but you’ll need to replace its insulin cartridge weekly or monthly.

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Source: Elena Toschi, MD, insulin pump specialist and type 1 diabetes researcher at Joslin Diabetes Center and instructor in medicine at Harvard Medical School, both in Boston. Joslin.org Photo of Companion InPen: Courtesy of Companion Medical Date: September 1, 2018 Publication: Bottom Line Health
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