Dear Doctors: Our 14-year-old daughter was just diagnosed with type 1 diabetes. Her doctor wants her to start using her continuous glucose monitor and also consider using her insulin pump. I would like to know more about how these work.
Dear Reader: Your daughter's doctor has recommended two devices to help manage her type 1 diabetes. For those unfamiliar, type 1 diabetes is an autoimmune disease in which the body is unable to produce insulin. This occurs when the immune system mistakenly starts attacking specialized cells in the pancreas that produce insulin. Without this hormone, the glucose that our bodies process from food cannot move from the bloodstream to our cells. As a result, blood sugar levels rise, posing serious health risks. Left uncontrolled, diabetes can lead to a variety of dangerous complications, including diabetic ketoacidosis, nerve damage, blindness, heart disease, and stroke.
The main concern in all forms of diabetes is blood sugar control. If you have type 1 diabetes, you must use laboratory-made insulin every day. It's also important to track changes in blood sugar levels throughout the day. This not only tells you when you need insulin, but also reveals how your blood sugar levels are affected by food, activity, and insulin. That's where the device you asked about comes into play.
A continuous glucose monitor (CGM) is a wearable medical device that is about the size of two quads stacked on top of each other. A small filament is implanted into the skin of your upper arm or abdomen and tracks your blood sugar levels in real time. The collected data is sent via a transmitter to an app, smartwatch or dedicated receiver. Depending on the specific device, CGMs remain implanted for several weeks to several months. This device reduces the need for multiple finger pricks each day, an unpleasant part of maintaining blood sugar control. But blood-based blood sugar readings are the most accurate, so you still need to prick your finger from time to time.
Insulin pumps are also wearable medical devices. It is about the size of a pack of cards and administers insulin under the skin through either a tube, needle, or patch. The computers in these devices can be programmed to suit each person's specific and changing needs. Unlike insulin injections, pumps mimic normal insulin metabolism. They do this by providing a continuous supply of hormones throughout the day and night. Users can also increase their intake at mealtimes to manage the resulting blood sugar spikes. The insulin pump pairs with her CGM. This increased precision allows for more flexible dosing with fewer injections.
Each of these devices represents an advance in blood sugar management in type 1 diabetes. However, it is not suitable for everyone. Insulin pumps are expensive, can only deliver short-acting insulin, and can be more complicated than injections. CGMs can be expensive and must be used in conjunction with regular diagnostic finger sticks. Both are technologies that require competent and deliberate user participation. Your final decision should also include your daughter's ability to properly manage the device.
Eve Glazier, MD, MBA, is a physician and associate professor of internal medicine at UCLA Health. Elizabeth Coe, MD, is an internal medicine physician and assistant professor at UCLA Health. Send 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. Due to the volume of emails, I am unable to respond personally.
