diabetes technology: to infinity and beyond€¦ · to infinity and beyond diabetes technology:...
TRANSCRIPT
TO INFINITY AND BEYOND
DIABETES TECHNOLOGY:
HEMOGLOBIN A1C
▸Hemoglobin A1C
TIME IN RANGE
TYPES OF INSULIN
▸Rapid acting, short acting or bolus insulin
▸Humalog, Admelog (insulin lispro)
▸Novolog, ultra rapid acting Fiasp (insulin aspart): onset within 2.5 minutes
▸Apidra (insulin glulisine)
▸Long Acting Insulin or basal insulin
▸Lantus, Basaglar and Toujeo (insulin glargine); Toujeo is 18 years and older
▸Levemir (insulin detemir)
▸Tresiba (insuln degludec); starting dose is 75% of Lantus/Levemir
▸Other
▸NPH, regular insulin (not widely used in type 1 diabetes anymore)
INSULIN DELIVERY
▸Vial and syringe
▸Pens
▸Full unit pens
▸Half unit pens
▸ Insulin pumps (short acting insulin only)
▸Medtronic
▸Omnipod
▸Tandem T-Slim
CONTINUOUS GLUCOSE MONITORS (CGM)
▸Medtronic
▸ (used with or without artificial pancreas)
▸Dexcom
▸ (used with or without artificial pancreas)
▸Freestyle Libre
▸ (18 years and older)
▸Eversense implantable CGM
▸ (18 years and older)
GLUCOMETER
▸ There are a number of meters that
are able to upload data to an app on
a phone.
▸ Dependent upon personal
preferences and insurance
coverage
INPEN BY COMPANION MEDICAL
▸ Reusable insulin pen that uses
Bluetooth technology and a smart
phone app to calculate and record
insulin doses
▸ Use in patients 12 years and older
▸ Can deliver in 1/2 unit increments
up to 30 units total
▸ Compatible with Humalog and
Novolog insulin
IN PEN: AT A GLANCE
▸ This screen shows the patient’s
current status at at glance.
▸ You can see when the last dose
of insulin was given, active
insulin and previous doses given.
INPEN: DOSE CALCULATOR▸ The patient enters in blood sugar
reading and carbohydrates and the
app will calculate the dose.
▸ Also takes into account insulin on
board/active insulin.
▸ This minimizes the risk of
hypoglycemia from “stacking of
insulin”
▸ This is also how insulin pumps
calculate insulin doses
INPEN: DOSE REMINDERS▸ Can be set to remind patients to
take insulin, check blood sugars,
take their long acting insulin dose,
check blood sugars after eating and
change the insulin cartridge.
INPEN: REPORTING
▸ This report can be shared from the
app with medical providers to
optimize glycemic control.
INPEN: TEMPERATURE ALERT▸ Temperature extremes can affect
insulin potency.
CONTINUOUS GLUCOSE MONITORING
▸Dexcom
▸Medtronic
▸Freestyle Libre
▸Eversense
DEXCOM CGM
▸ Dexcom G6: reads interstitial blood
sugars every 5 minutes and sends that
data to a receiver (iphone, some Android
device or a Dexcom receiver)
▸ 10 day wear
▸ No calibration
▸ No interference with Acetominophen
▸ Allows up to 10 people to follow along
(only if using a phone as the receiver)
MEDTRONIC CGM
▸ Medtronic Guardian 3 sensor reads
interstitial blood sugars every 5
minutes and sends that data to the
Medtronic 630 or 670G pump
▸ 7 day wear
▸ Requires calibrations
▸ Difficulty for other people to see
the blood sugars in real time
FREESTYLE LIBRECGM
▸ Libre: consists of a handheld reader
and a sensor worn on the back of the
arm. Measures readings every
minute.
▸ 14 day wear
▸ Requires the user to actively scan
to get a reading
▸ Not able to be alerted to low or
high blood sugars unless the
sensor is scanned
▸ FDA approved for 18+ years
▸ Libre link up app allows
family/friends to view your blood
sugars after you scan
INSULIN PUMP
▸Advantages
▸Less risk of low blood sugars from stacking insulin
▸Can give fractions of units
▸Lifestyle improvements (no injecting in public, can eat more frequently, etc)
▸Disadvantages
▸No long acting insulin which raises the risk of DKA with pump malfunction
▸Cost
TUBING PUMPS AND TUBELESS PUMPS
Tube Pump:
Medtronic
Tandem
Tubeless Pump
Omnipod
ALL PUMPS HAVE THEIR PROS AND CONS
ARTIFICIAL PANCREAS TECHNOLOGY
▸ *Patient must wear both and insulin pump and a continuous glucose
monitor
▸ *Automatically administers and withholds insulin based on predicted
blood sugars received from a CGM
HYBRID CLOSED-LOOP SYSTEM
MEDTRONIC 670G HYBRID CLOSED LOOP INSULIN PUMP WITH SMARTGUARD TECHNOLOGY
▸ Auto Mode
▸ Adjusts basal insulin every 5 minutes based on CGM readings
▸ Suspend before low
▸ Stops insulin up to 30 minutes before reaching preset low limit
▸ Automatically restarts insulin when blood sugar recovers
▸ Requires fingerstick calibrations of CGM to stay in Auto Mode
HYBRID CLOSED-LOOP SYSTEM
TANDEM T:SLIM X2 WITH CONTROL-IQ TECHNOLOGY
▸ Automatic insulin
adjustments based on
Dexcom G6 readings
▸ Requires no fingersticks
▸ Treatment values are set
▸ Can set sleep and
exercise activity settings
▸ Will leave Control-IQ if
Dexcom and Tandem
pump lose connectivity
NON-FDA APPROVED TECHNOLOGIES
▸RileyLink
▸NightRider BluCon