Elena Toschi, MD
Elena Toschi, MD, insulin pump specialist and type 1 diabetes researcher at Joslin Diabetes Center and instructor in medicine at Harvard Medical School, both in Boston. Joslin.org
Bottom Line: It’s not your father’s diabetes management anymore. Blood sugar monitoring has gone high-tech.
Are you ready to make endless finger-sticks and insulin injections things of the past?
High-tech devices can help you manage diabetes with less pain and better blood sugar control.
Good for: People who need tight glucose control with intensive insulin therapy or don’t always know when glucose levels change.
If you rely on 10 or more finger pricks a day or are having a hard time regulating your blood sugar, the newest CGMs can really simplify your life. And you’ll have more accurate monitoring, with the equivalent of close to 300 checks per day with minimal finger sticks.
A tiny sensor, inserted under the skin of your belly or upper arm, reads the glucose level in tissue fluid every few minutes and sends it wirelessly to a monitor, smartphone or tablet computer. You can read the results directly on your monitor and use your smartphone or computer to keep track of your glucose levels.
A “stand-alone” CGM can be used with an insulin pump or without—the monitor tells you when your blood sugar is out of range, and then you can do your own insulin injections based on your diabetes management plan. Some models send out an alarm tone to alert you when your glucose level is too low or too high. These benefits make CGMs useful for people with type 1 diabetes and those with type 2 diabetes who need frequent insulin.
More advantages: You can wear the sensor and transmitter during most everyday activities, including showering and sleeping. A CGM also can relay readings to your doctor’s office. To consider…
Also, you’ll need to do twice-daily finger sticks to calibrate it, and when used as a stand-alone and not in concert with a MiniMed system insulin pump (see below), you’ll need to check your glucose level with a finger stick before making a treatment decision.
Cost: There are up-front costs ranging from under $100 for the Abbott reader to $600 or more for the other CGMs listed, plus batteries and sensors. Insurance coverage varies and is changing all the time, so check with your carrier. Note: Medicare recently started covering some CGMs.
Good for: People who need many insulin injections every day and/or need to adjust insulin dosing based on their blood glucose level, meal type and physical activity.
A computerized insulin pump delivers insulin through a catheter inserted under your skin. The newest pumps and CGMs have been programmed to work together in what’s called a hybrid closed-loop system.
The CGM reads sensor glucose levels and sends readings to the pump. Then the pump adjusts the amount of insulin to deliver. You’ll still need to monitor your glucose level and perform finger pricks to confirm that the CGM is working correctly, plus make manual adjustments to account for meals and high blood glucose levels. Taking a training program at a clinic or diabetes center will help you become a pro at using it.
Hybrid closed-loop system options typically require a finger stick calibration several times a day, and the glucose-monitoring sensor can be worn for up to seven days at a time. Some are wearable while bathing and even swimming. To consider…
Cost: The cost of an insulin pump itself is in the thousands, with a monthly cost for supplies. Many insurance companies do cover insulin pumps, but there may be co-pays and deductibles. Medicare may cover it with certain requirements.
Insulin pens are becoming smarter, too. For example, the reusable Companion InPen with Bluetooth technology and connectivity to Apple Health offers tracking and timing of insulin doses over time and even gives insulin temperature checks—the pen will send a message to your phone to remind you if you miss a dose and if your insulin gets too warm or too cold. An InPen itself lasts for one year, but you’ll need to replace its insulin cartridge weekly or monthly.