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Dear Doctors: Our 14-year-old daughter has just been diagnosed with Type 1 diabetes. Her doctor wants her to start using a continuous glucose monitor, and also to consider using an insulin pump. We would like to know more about how these work.
Dear Reader: Your daughter’s doctor is recommending two devices that can help manage Type 1 diabetes. For those who are unfamiliar, Type 1 diabetes is an autoimmune disease in which the body cannot produce insulin. It arises when the immune system mistakenly begins to attack the specialized cells in the pancreas that produce insulin. Without this hormone, the glucose that our bodies process from food cannot move from the bloodstream into the cells. The result is elevated blood sugar, which poses serious health risks. If left uncontrolled, diabetes can lead to a range of dangerous complications, including diabetic ketoacidosis, nerve damage, blindness, heart disease and stroke.
The primary concern of any form of diabetes is blood glucose control. For those with Type 1 diabetes, that involves daily use of lab-made insulin. It’s also crucial to keep track of the changes that occur to blood sugar levels throughout the day. This not only signals when insulin is needed, but also sheds light on how blood sugar levels are affected by food, activity and insulin. That’s where the devices you asked about come in.
A continuous glucose monitor, or CGM, is a wearable medical device about the size of two stacked quarters. Tiny filaments embed in the skin of the upper arm or abdomen and track blood sugar levels in real time. The collected data is sent via transmitter to an app, a smart watch or a dedicated receiver. Depending on the specific device, a CGM remains embedded for a few weeks to a few months. Using the device reduces the need for multiple daily finger sticks, an unpleasant part of maintaining blood glucose control. But because blood-based glucose readings are the most accurate, occasional finger sticks are still needed.
An insulin pump is also a wearable medical device. It’s about the size of a pack of cards and, either via a tube, needle or patch, delivers subcutaneous insulin. The computers in these devices can be programmed to each person’s specific and changing needs. Unlike insulin shots, pumps mimic normal insulin metabolism. They do this by providing a continual flow of the hormone throughout the day and night. The user is also able to give themselves an increased dose at mealtimes to manage the resulting surge in blood glucose. Insulin pumps pair with CGMs. This increase in precision allows for more flexible dosing with fewer injections.
Each of these devices represents an advance in blood glucose management in Type 1 diabetes. However, they may not be for everyone. Insulin pumps are expensive, only deliver short-acting insulin and can be more complicated than an injection. CGMs can also be costly, and they must be used along with regular diagnostic finger sticks. Both are technologies that require competent and vigilant user participation. A final decision will have to include your daughter’s ability to successfully manage the devices.
Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.
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