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House Call: New technologies simplify diabetes treatment

Diabetes is a metabolic disease that affects your blood sugar regulation. Diabetics have higher than normal blood sugars and over time high blood sugars damage just about everything in your body, especially the eyes, kidneys, nerves and heart. Control of high blood sugars reduces the damage to the body’s organ systems. As of yet, there is no cure for it, but technology continues to make great strides in the treatment of this serious condition.

Early treatment advancements involved the development of quick- and long-acting human insulins that help individuals with diabetes keep from having drastic highs and lows in their blood sugar levels throughout the day. When I started as doctor, the insulin that we gave diabetics came from pigs. Patients sometimes developed allergies, which made treatment difficult. It was a huge step when insulin identical to our own natural human insulin, made in a laboratory by genetically engineered bacteria, became available in 1982. Oral and injectable medications that help achieve the same goal have been developed and improved over time as well.

There are a number of newer technologies making the treatment of diabetes simpler and more accurate. They are mostly used in treatment of Type 1 or insulin-dependent diabetes.

Continuous glucose monitor: With this technology, you have a small sensor that you wear all the time. It tests the glucose level in the fluid between your skin cells every few minutes and sends the information to a monitor wirelessly. Today, it is even possible to send the information to your smartphone. Many CGMs allow you to set alarms to let you know when your glucose level goes above or below thresholds that you set. This allows you to better manage your diabetes and experience fewer low blood sugar emergencies. Although a CGM does not eliminate finger sticks entirely (you still have to do it twice a day), it does mean fewer per day for the majority of patients.

Insulin pump: An insulin pump is also a device that you wear all the time. It delivers small steady doses of insulin throughout the day, which can also make it easier to keep your blood sugar levels more even. If you need more insulin at mealtimes, you can give it to yourself through the pump, so you have fewer needle sticks per day.

Smartphone apps: As I mentioned earlier, some continuous glucose monitors can send your blood sugar information to your smartphone. Many apps that can receive this information also allow you to enter information about what you eat as well as when and how long you exercise. Tracking as many factors that affect your blood sugar level as possible can help you see trends that allow you to avoid high and low levels.

Automated insulin delivery systems: The latest technologies that are just now becoming available are automated insulin delivery systems, sometimes called artificial pancreas systems. These devices continuously monitor your blood glucose level and automatically adjust your insulin dose as appropriate. As this technology becomes better and more widely available, it will be a boon for many people with diabetes. However, it should not be a substitute for eating a healthy diet, exercising, and taking good care of yourself.

On the horizon in diabetes care, researchers are looking for ways to restore the body’s ability to produce insulin: implanting insulin-producing islet cells that are not attacked by the immune system; personalizing treatment through genetic mapping; stopping the immune system from attacking the insulin-producing cells in the pancreas in the first place and more. The more we learn about diabetes, the more complicated it’s becomes, but with the persistence of dedicated doctors and scientists around the world, treatment is improving all the time.

Dr. Bob Riggs is a family medicine physician practicing at Kaiser Permanente’s Riverfront Medical Center. His column appears biweekly in The Spokesman-Review.


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