New Devices: Today and on the Horizon
Never before has the landscape been richer for new devices to help families deal with diabetes. Technological and pharmaceutical companies have gotten a taste of the market, and that's good news for parents and families. While some products are still in the conceptual stage, others are being tested or even on the market. A cure is the goal, but better treatment will help along the way.
For the most part, continuous meters track interstitial glucose, giving a blood sugar reading about every five seconds, and a visible display of what the reading is and if the blood glucose is trending up or down. Those who have used them say it's changed the way they treat their diabetes.
Right now, a continuous meter means a second infusion site and a second device either worn on the body or carried with the person. Industry is hoping to make the meter part of pumps in the future. In all likelihood, in a few years these continuous meters will become the standard of care, once patients and providers learn how to use the data they provide. Clinical trials in children with Type 1 diabetes are under way throughout the United States. Ask your endocrinologist for details.
Until a few years ago, ketones could only be read in the urine, a practice that's vague and not timely (urine ketones are about two hours behind what is going on in the bloodstream). Today, the ketone meter means an instant reading of exactly what the ketone level is in your bloodstream. Medical teams love families that use these meters since in high blood sugar situations, this up-to-the-minute information can assist the teams to help the families keep kids out of the ER.
Right now the only ketone meter on the market is by Abbott, and the strips are expensive. If you can, get insurance to cover about thirty a month and always refill them each month even if you don't use them. In that way, you'll have enough on hand if a ketone emergency comes along. Again, most endocrinology teams have meters to give you, which means that you'll only need to buy the strips, perhaps with an insurance copay.
Continuous Glucose Monitors
A CGM is, quite simply, a sensor that is placed below the skin and attached to a transmitter that continually checks blood sugars and transmits them to a receptor, either part of an insulin pump or a separate device carried along or held. Because the sensor is checking constantly, the person with diabetes can see on a screen, not only a current reading of what their blood sugar is, but a graph showing how her blood sugars are trending over the day. At press time, CGMs were quite new but being used by adults and children with diabetes with great success.
Using a CGM, parents of diabetic children can know how their child trends through the day and therefore make smart adjustments to insulin. Having a place where the parents can see, on a screen, which foods make their child spike and how far, can help parents make diet decisions or up insulin doses for certain foods. A device that constantly checks (and is reliable) can also help parents give their child more freedom.
Right now, the CGM devices are not covered by insurance and most families using them are paying out of pocket about $200 a month. However, some individuals have fought with insurance companies and have been able to win coverage, and groups like the JDRF are working toward making coverage a law.
For most, the notion of another device can be worrisome, but some children find, particularly in the case of the Medtronic MiniMed System, that it's not as overbearing as one might think. In the case of the MiniMed , a sensor the size of a pump site goes in and is connected to a transmitter about the size of two-thirds of a playing card and about an eighth of an inch think. This transmitter is taped down to the body and is barely visible under clothing. Because the readings come through on the actual MiniMed pump, there is no additional device to wear or carry. Just push a button on your pump and you see your reading. MiniMed expects to debut a smaller transmitter some time in early 2007.
In the case of the DexCom , a similar site is put in, and a smaller transmitter is attached, about the size of two fingers. That transmits to a second piece, an oval-shaped device about the size of a pump, which can be carried in your pocket or purse but must stay within five feet of your body.
The Freestyle Navigator is similar to the DexCom in its working, and also requires an added piece to be carried. It is in clinical studies now.
Like pumps, choosing a CGM is a personal choice. If you are interested, let your child see all the models and consider how each would impact his life. In the end, let him help you make the decision. It's his body, after all.
Challenges of CMG
For now, those trying this new technology are finding it amazing and yet challenging. Having two sites in a child at all times is tricky: You'll need to work hard at rotating so as not to build up scar tissue. And learning to use the CGM as a tool and not a device that you become a slave to is important too. But, most who have tried it have found it to be life changing.
Some children, however, find that a CGM is too much. They don't want a second site and they don't want to have to know their blood sugars all the time. Another challenge is that, while most would like to think so, a CGM does not totally eliminate finger pricks, as they are needed for calibration. But, used well, a CGM can mean only two finger pricks a day on an average day (keeping in mind that, when in doubt, a back up finger prick is always advised). In the end, as always, your child's personal well being should come first.
What They Can Mean
If the theory that regulated blood sugars equate to an offset of complications is true, CGMs could mean even less chance of kidney failure and other such complications. They can also mean a better grasp on what diabetes does to the body on a daily basis. No one is certain of what happens between blood sugar readings, but now, those who choose to use a CGM will have that knowledge. However this knowledge also brings the challenge for parents and patients not to overreact to readings and to look at trends instead.
It is the hope of scientists that someday, the CGM and the pump will work as a team, reading blood sugars and then giving insulin as needed without the patient doing anything but wearing them. This is in the future, but being worked on.