There are few things that have
made life for diabetics easier than the cutaneous insulin
infusion pump. They can sit with the family, chomp away
at the holiday dinner, and enjoy their plum pudding without
wondering when the next injection is coming. What is coming,
though, is an innovative wireless glucometer that may
soon make diabetics' lives even easier.
Cutaneous insulin infusion pumps
have been around for a while. The small device is concealed
on the patient's person and provides a constant amount
of short-acting insulin, crudely matching normal pancreatic
function and eliminating the need for multiple daily
injections.
Most endocrinologists see the infusion
pump as a trend in the right direction in the quest
for a closed-loop system, where the patient only needs
to worry about whether his or her pump is connected
and infusing insulin.
This year's good news is that one
of the leading pump manufacturers in Canada has introduced
a wireless glucometer to be used in conjunction with
an insulin pump. Like a remote control, it eliminates
the need for the patient to fiddle with the pump controls
directly, and also packs other attractive improvements.
STEP
IN THE RIGHT DIRECTION
Dr Heather Lochnan, an endocrinologist at the University
of Ottawa, manages many diabetics with insulin pumps
and is excited by some of these new features.
"Insulin stacking, where too much
insulin is dispensed, is a big buzz-word in the business,"
she says. "We don't want to drive patients into hypoglycemia.
This wireless glucometer can keep track of the insulin
already dispensed, and suggest an appropriate dose."
Dr Farid Mahmud, a pediatric endocrinologist
at the University of Western Ontario, echoes her sentiments,
with hopeful notes for the future.
"It's possible that we might be
able to provide individualized programs for patients
that could be fed into the glucometer," he explains.
"For example, there could be 'sports day', 'study day',
or even 'sick day' programs which would alter the amount
of insulin infused."
Despite these improvements, however,
the basic mechanism of the insulin pump remains the
same. The glucometer enhances the traditional benefits
of the pump, but it does little to address the present
obstacles that prevent pumps from becoming fully independent.
These include the use of short-acting
insulin without a back up, the need to adjust the system
every three days, and the way blood sugar levels are
done. Even with a wireless glucometer, the blood still
needs to be collected the same way.
EDUCATION
IS KEY
With these obstacles still present, Dr Mahmud stresses
the importance of education. "Because this isn't yet
a closed loop system, it's still crucial to teach patients
how to think about their blood sugar levels. You need
to have an enthusiastic patient who is still willing
to think about the doses they are taking, and learn
about how the gadget works in the context of the disease."
"In the end, it's all about providing
diabetics with a choice," adds Dr Lochnan. "There are
many diabetics in Canada who are already on the pump,
despite the cost involved, but there are plenty who
still follow traditional injections. The wireless glucometer
may not change much about the actual mechanics, but
it offers patients another choice in the management
of diabetes."
The wireless glucometer may not
be the endocrinologists' Holy Grail, but it's pretty
likely that a talk with their family doctor will be
at the top of many diabetics' list of New Years resolutions.
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