Exciting Innovations in the World of Diabetes Technology

Research and scientific discovery is constantly evolving in relation to diabetes, including exciting technological innovations. Through recent years the use of insulin pumps and continuous glucose monitors has become more and more common, with a range of different models now readily available. Future advancements are coming, with hope relying heavily on news of the artificial pancreas, which may really change the landscape of diabetes care beyond recognition. Gone are the days of large bulky blood testing machines and insulin drawn from little glass bottles by one use needles.

An insulin pump is a device that is worn on a type-1-diabetic patient’s body. Suppliers of insulin pumps in the UK are Medtronic, Dexcom, Abbot and Animas. A pump provides a constant trickle of insulin through a cannula which is inserted under the skin and can receive blood glucose results from a linked meter via a Bluetooth sensor. In reaction it then automatically calculates the amount of insulin units needed to correct a high reading if requires, or to cover the amount of carbohydrate in a snack or meal. Pump settings can be adjusted to personal rates of insulin sensitivity and target ranges as well as be used to track progress and patterns in blood sugar control.

An insulin pump can also be linked to a Continuous Glucose Monitor (CGM). This is a small sensor which is placed on the skin and used to track blood glucose at regular intervals. A CGM can work alongside an insulin pump to predict and provide the means for a type 1 diabetic to administer the appropriate insulin doses required. The most innovative product on the market at the moment would appear to be the FreeStyle Libre if hype and demand is anything to go by. Comparing the Libre to a CGM, the charity INPUT explains “Both measure the glucose in interstitial fluid but Libre could be better described as CGR – continuous glucose recording – with the ability to read that record each time the sensor is ‘flashed’. It does not transmit, and cannot notify the user of adverse events as they happen.” At present however, a Freestyle LIbre cannot be funded on the NHS and the initial outlay as well as pay out for sensors can become costly.

Neither a pump nor CGM take away the need for someone with type 1 diabetes to be proactive and in charge of their own medical needs. Both devices can make living with diabetes more manageable but they are certainly no easy cure and can also be very difficult to get to grips with. Some type 1 diabetics have described the process as close to the experience of diagnosis all over again, and having to learn from the beginning.

Currently, NHS funding and availability for these types of technologies is unfortunately regionally dependent. This failure was addressed in the All-Parliamentary-Group’s recent report Levelling Up: Tackling Regional Variations in Diabetes Care which explored ways in which such post-code lotteries can be dissolved. Additionally, recently published NICE guidelines for children and young people as well as their recommendations for adult indicate the crucial need for type 1 diabetics to have access to such technology to adequately treat their condition.

INPUT are a UK based organisation with a 'mission to support people in accessing diabetes technology.' On the work they do, Chief Advisor Melissa Holloway, explains:

“Many people who contact us are interested in a pump or continuous glucose monitoring, or Libre, and want to talk about what might suit their needs best. Some people have been told they aren't suitable for a pump and they want to go back to their team with some further points for discussion. Others have been recommended a pump and want to hear from people with first-hand experience.”

For someone suffering from ED-DMT1 or Diabulimia a pump or CGM may be beneficial, but the process needs to be carefully considered and comes with a high degree of risk. A comprehensive breakdown of the possible advantages and disadvantages that should be acknowledged in evaluating such a situation can be found in our members' section as part of January’s premium content. We also provide examples from two individuals that had differing good and bad experiences of using a pump while also managing an eating disorder.

On the important considerations required to determine pump and CGM suitability for someone with ED-DMT1, Melissa from INPUT said: "There are cases where a pump has helped someone with diabulimia, but there are also cases where someone has disconnected their pump and purposely missed insulin to lose weight.

"If someone isn't checking their glucose level to begin with, could they get into a medical crisis from not calibrating a CGM?" A CGM can't help someone keep better control if they turn off the high alarms; would someone who is prone to under-dosing actually find it more stressful to have constant data? Can Libre lead to better outcomes even when someone isn't regularly bolusing for meals? This is an area where there are lots of individual variables and unanswered research questions.”