By Carla Cox, PhD, RD, CDE, FAADE, CPT
I LOVE pumps and sensors!
As a certified diabetes educator (or as I prefer to say, type 1 coach), I have started literally hundreds of patients on insulin pumps over the last few decades. I have a disclaimer: I do not wear a pump and do not have type 1 diabetes. BUT I have worked in the field from clinics to ski and summer camps, as a dog sled driver for little munchkins with our team of sled dogs, to backpacking and canoe trips – all with people who do have type 1 diabetes. Sometimes I grunt and groan when I get up to start an adventure, but then I meet up with the group and see someone taking shots! My emotions turn to glee when someone has a pump and a sensor…I realize it sometimes feels like being the bionic man or woman with all this technology but hey, what’s wrong with being such a diabetes stud or studdette?
So what is so cool about pump and sensor technology?
Well, if you’re like me and you like to participate in group sports or activities, the technology is amazing. Let’s say you are just starting off on an adventure (whatever that may be) with a group and you note on your sensor that your BG is 50 mg/dl.
Who wants to stop the whole team from proceeding? But then you realize you can take in some carbohydrates, lower your basal rate temporarily and watch your sensor to see if you are coming up and not only good to go, but where you will be in 5, 10, 15, 20 minutes…you get the idea.
What are the options available right now to help you manage your diabetes?
The Omnipod insulin pump is the only full functioning patch pump, meaning it is programmable with insulin to carb ratios, target BG, correction factors, etc. so your math is done for you. At this time, the Omnipod pump does not integrate with a sensor but you can certainly use the Dexcom sensor independently.
The Tandem insulin pump does have a tube that most folks find a minor inconvenience. Its great new claim to fame is that, as the software is updated (and technology is changing SO fast!), you can update your pump via the cloud. How cool is that! Your pump does not get outdated as the pump software is updated. This includes future changes, such as Dexcom sensor data on the screen, auto-suspend as needed with hypoglycemia and the eventual goal of a fully integrated sensor and pump where the pump responds to the data from the sensor and alters insulin delivery.
The Medtronic insulin pump company has led the charge not only with a sensor integrated pump where the sensor data is seen on the pump screen, but where the pump responds to low blood glucose values and impending lows, and adjusts basal rates as needed based on your basal history. Be warned, this is not a cure and still requires diligence on your part or the system will fail. Fasting blood glucose values have been shown to be excellent – generally close to the pump set target range of 120 mg/dl.
There are also two patch pumps that are NOT programmable and have a bolus only option (OneTouch Via) and basal/bolus option (V-Go). These are more likely options for those with type 2 diabetes.
You can always choose to continue with injections and utilize one of two sensors. Dexcom (glucose readings every 5 minutes on a receiver or your cell phone) or the new Freestyle Libre that allows you to scan your sensor patch and see your glucose on a receiver.
And where is all of this going?
Oh – it is SOOOO exciting! I am confident that in the next five years a fully automated system will be available with minimal input from the user. Tandem, Omnipod and Medtronic are all working on fully integrated pumps as responsibly fast as they can! In addition, other options are coming too, including a dual hormone system that has reservoirs for insulin and glucagon to keep you safe. And with the new insulin from Novo Nordisk that is reputed to start absorption in 2.5 minutes (wow!) one of the big barriers to insulin delivery may have just been resolved.
Although a cure is what we are all hoping for, technology is the next best thing.
Embrace it and stay tuned!