Dr Diarmuid Smith
Consultant Endocrinologist, Honorary Clinical Associate Professor, Honorary Secretary of the Irish Endocrine Society
People are now checking their glucose levels continuously, thanks to the latest diabetes technology. For children with Type 1 Diabetes and older patients, this has been a major breakthrough.
“Over the years, technological innovations have revolutionised the treatment and management of type 1 diabetes”. Dr Diarmuid Smith, Consultant Endocrinologist at Beaumont Hospital, Dublin, and Honorary Secretary of the Irish Endocrine Society. “Since I started to specialise in diabetes, around 1997, we have had numerous advances in the care of diabetes.
An advantage for the flash sensor, for example, is for the parent of a child with type 1 diabetes, children do not need to be woken up in the middle of the night to have a reading taken.
We now have better blood glucose testing devices, which will give you a blood glucose result within three seconds. Also improved insulin injection pens, new insulins. These are helping people with diabetes achieve better diabetes control, which are more flexible to use. We also have significant improvements in insulin pump therapy. More recently, we have developed continuous glucose monitoring systems that allow glucose levels to be checked constantly, day and night. These monitors show trends and patterns on whether blood glucose levels are falling or rising. They can alert the patient if their blood glucose levels are low.”
You don’t need to finger prick test all the time
There are two continuous glucose monitoring technologies. Continuous glucose monitoring (CGM) is a sensor typically inserted subcutaneously underneath the skin of the belly for 7-10 days at a time. The CGM continuously measures interstitial glucose (an equivalent of blood glucose) and can then immediately relay information about blood sugar levels to the person’s smart phone, or to their insulin pump. “You can even set an alarm to alert you if your blood sugar is low,” says Dr Smith. Some of the CGM systems allow users to share their data with up to 5 other people. So they can also see their glucose levels in real-time and get the same alerts/alarms.
“The benefit of CGM is that you don’t need to finger prick test all the time. Increasing data suggests that the more a person uses the CGM the more likely they are to have an improvement in their diabetes control.”
The more a person uses the CGM the more likely they are to have an improvement in their diabetes control.
The other type of monitoring innovation, known as flash glucose monitoring (FGM), is a sensor the size of a 20-cent piece, which sits in the upper arm, again for two weeks at a time. “People reveal their blood sugar level when swiping a reader over the sensor,” says Dr Smith. “They can see if their level is rising or falling — and how quickly or slowly the glucose level is rising or falling — or if it’s steady.”
Ireland child with type 1 diabetes
As a result people applying the sensor should find this simple and easily replaceable. “Therefore, an advantage for the flash sensor, for example, is for the parent of a child with type 1 diabetes, children shouldn’t wake up in the middle of the night to have a reading taken. The comfort this gives parents with children with type 1 diabetes is indescribable, says Dr Smith. “It’s an incredible advance.”
Early data from flash sensors is also showing an improvement in diabetes control, a reduction in hypoglycaemia and significant improvement in quality of life for people with diabetes. However, at present, flash sensing technology won’t alarm when the glucose level is low, unlike CGM.
Most of these technologies don’t completely remove the need for finger prick tests (self-checking blood glucose levels). This is because it’s either necessary to calibrate the monitor for most CGM systems or perform some confirmatory fingerstick checks. These occur in specific situations with the FGM technology.
However it is worth noting, one of the most recently launched CGM system will remove the need for fingerstick calibration. It is still currently a requirement to check your blood glucose (finger prick) before you drive if you are on insulin therapy.
Availability of new innovations
Unfortunately, glucose monitoring technology is in fact not free in Ireland in the majority of cases. “Diabetes medication and insulin therapy is paid for by the state,” says Dr Smith. “The flash sensor is available for free for anyone under 21 with type 1 diabetes; everyone else currently has to pay for the flash sensor.
Typically, CGM monitors also have to be paid for by the patient — although the government may provide this technology free in some instances for patients who have severe, recurrent hypoglycaemia”. Dr Smith encourages the government to ensure that these technologies are available free to all patients with diabetes on insulin.
Source: Dr Diarmuid Smith, Consultant Endocrinologist, Beaumont Hospital, Dublin. Honorary Clinical Associate Professor at Royal College Surgeons Ireland (RCSI. Honorary Secretary of the Irish Endocrine Society