DIABETES TECHNOLOGY: TO INFINITY AND BEYOND
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 LIBRE CGM ▸ 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: Tubeless Pump Medtronic Omnipod Tandem
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
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