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Every child loves technology! How often have you heard children nagging their parents for a smart phone or an iPad. I always tell my children, I only got my first smart phone when I was way into my 30s! And we had to deal with the consequences of forgotten homework, we couldn’t send a message on the class whatsapp group to ask which pages of maths needed to be done. That argument goes down about as well as when my parents told me they used to walk to school and walk to hockey practice in the afternoon and played cricket in the streets in the afternoon. The bottom line is TIMES CHANGE and we can’t really expect our children to only get their first smart phone at the age of 35!
Technology has become and integral part of diabetes management. We have much more sophisticated glucometers that can sync with computers and upload data on a regular basis so that trends can be detected. Detecting such trends is crucial to diabetes management. Gone are the days of a little pocket diary with blood stains all over and randomly recorded readings. By detecting averages and trends in glucose monitoring, health care providers and patients are able to make much more informed decisions about diabetes management. Is it the medication that needs to be altered or was that 14mmol/l on Saturday afternoon as a result of pizzas for lunch? In which case, maybe we need to chat about “how to eat pizzas” rather than “take more medication”.
Insulin pumps have been available for some time now and have also become much more sophisticated. Some have the advantage of having a remote glucometer paired with a pump so that the actual pump can remain discreetly under the clothes and can be operated from a hand-held device. Pumps are able to have different profiles set so that provisions can be made for different activities during the week or over weekends or for holiday periods or times of hormonal changes. This allows the person wearing the pump to seamlessly change from day to day without too much trouble. Obviously these settings do need to be altered regularly especially as children go through growth spurts and changes in activities. Pumps also allow for small increments of insulin to be delivered at various times to compensate for the varied activities that children engage in. But they are only delivery devices! They do not do all the testing and thinking alone. They also require quite a bit of manipulation and comfortability with managing diabetes both from the patient and health care provider. They are not really the first option in answering the problem to an initial diagnosis of diabetes. You wouldn’t give an 18 year old, newly qualified driver a Ferrari to drive – start with a more economical, simple vehicle and then when you know how to drive, a Ferrari can become a luxurious comfort.
Over the last 24 months, we in South Africa have had exposure to five different types of continuous glucose monitoring systems. For many patients these are fast becoming the answer to many prayers. What these devices do is monitor glucose levels every 5minutes throughout the day and night. Each one is slightly different in its application and benefits and different types suit various patients. Some are simpler and less expensive than others and some others are more easily removable and interchangeable. Speak to your healthcare provider about which device would best suit your needs. The main benefit of these devices is they allow the wearer to make real-time decisions on lifestyle choices – imagine being able to see exactly how that pizza affects your glucose levels and the added cheese delays the glucose absorbtion or how a game of rugby drops glucose levels faster than an afternoon of golf. Even more exciting is that these levels can usually be shared with health care providers and care givers. It seems like an impossibility to most parents that they could sleep through the night and rely on an alarm to alert them when their child’s glucose levels become too low. And furthermore, these devices can even calculate the rate of change and alert you BEFORE the levels drop below normal. Parents, health care providers and patients can each set their own personal alarms so that during the day the child is alerted at school but at night, the parents are alerted without waking the child up. Children can go on a sports tour or school camp and parents can remotely still manage the glucose levels with a quick cell phone message to the child or teacher to say “Please give Johnny an extra 2u of insulin at dinner.” High school exams become much easier to negotiate, optimum performance at sports is possible and “normal glucose” readings become a distinct possibility!
Now we just need to get better at getting the glucose monitoring devices and insulin delivery devices to communicate more effectively with each other!
Many people are still asking about the artificial pancreas and whilst this may be a possibility on the horizon, many other exciting technological advances are happening. Any child who is involved in sports will know how difficult it is to time your pre-exercise snack and insulin correctly so that you do go hypo during the sport and then remain high all afternoon afterwards. What about connecting your Google calendar to your insulin pump so that the pump already knows you have soccer practice on Tuesday afternoon? What about a heart rate monitor or respiration rate monitor that detects when you are physically active and begins secreting insulin AND glucagon at the same time? And what if all these devices were combined on your smart phone or even smart watch? These are the exciting things that await in the not-too-distant future.
So what does this mean for patients and families with diabetes? Technology is always initially quite expensive but with time, the cost does come down. Think of how big and heavy our first cell phones were and within 10 years these have become so much more efficient and effective and much smaller! Speak to your diabetologist and make sure you are informed about what is available. Discuss the costs and the applications and choose the right “vehicle” for the road you drive on. There is no point in taking a luxury executive car to the beach nor in cruising on the highway in a 4×4 kitted out for the bush. Choose the treatment that is right for your needs. And isn’t that just what we want for our patients, our children and ourselves – the freedom to choose what we want and need best?
For almost 100 years we have had insulin to offer to our patients with Type 1. That has been our best option. The glass vials and syringes have been replaced with plastic disposable pens and for some even insulin infusion pumps but it is all still just insulin. So is there light at the end of this long tunnel?
Thankfully, there are some extremely passionate researchers and scientists and dedicated pharmaceutical companies who are working on trials to develop other options. This research does take years and millions of dollars of time and expertise. And for a good reason – we want to ensure the utmost safety and efficacy of these pharmaceuticals when they reach the open market.
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For the meantime we remain reliant on multiple daily injections and perhaps infusion pumps for the luckier few. But don’t lose hope as the tunnel is getting shorter and shorter all the time!
Often patients ask, “What should my levels be?”. The answer to this question is quite complex as it is certainly different for each individual. Daily management of diabetes for a type 1 can be quite challenging but here are some key points that I often find myself discussing with young people with diabetes.
Type 1 diabetes is a challenge and it does require sometimes require the services of various health care practitioners but this is far preferable than late night runs to the emergency room and days on end in hospital.
Type 1 diabetes is a different animal from Type 2 diabetes. Not only is Type 1 more common (but not exclusively found) in children, but it is also not usually associated with the typical genetic and lifestyle factors with which Type 2 is associated. Diabetes in childhood can be diagnosed at any time although we do often see it occurring seasonally perhaps a suggestion that it may well be precipitated by viral illnesses. Other precipitants that may trigger type 1 diabetes are trauma or life stressors but we are not entirely sure why or when type 1 diabetes will occur.
The initial days are often extremely stressful for families with the child often being left bewildered by all the attention, medication and often hospitalisation that ensues. Perhaps the best option at this stage is to find a health care provider you can trust and let them lead you through those initial days and weeks. The aim in the beginning is not to bombard people with information but rather just to keep the child out of danger. Adjusting diets and getting back into exercise and activity, having sleepovers, going on school camps and attending friends’ parties can all follow in due course.
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In most people with type 1 diabetes, they will enter a “honeymoon period” where little or no insulin is required. This often occurs without any warning but can be a nice time to reconsolidate some messages that may have got lost in the initial stress of the diagnosis. Parents can take a breath again and children may not have to bother with all the testing and injecting. Again, we are not entirely sure what causes this honeymoon but latest research suggests it may have something to do with re-activation of the B-cells in the pancreas that produce insulin. The obvious question is can we delay this period or at least predict it – a hot topic amongst researchers at the moment.
As the honeymoon phase wears off, a child with type 1 diabetes will go back to the regular routine of testing and injecting in order to keep glucose levels within a narrow band of readings that will ensure he/she remain danger-free.
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