Eliminating Injections: Alternative Insulin Delivery Methods

For many Type 1 diabetics, especially the elderly, multiple daily injections of insulin becomes wearisome and can be problematic. Some elderly patients may be unable to administer the injections by themselves, develop needle phobia, have scar tissue build up on injection sites, or feel as though the injections interfere with daily activities. Thankfully, alternatives to multiple daily injections are in the process of being developed. Although most of these technologies and/or ideas are in their beginning stages, some seem to be extremely promising. Let us take a look at some of the possibilities the future holds:

                                                      Insulin Pills
This method has puzzled researchers for 40years since, so far, it has been impossible to develop a pill that can get past acidity and digestive enzymes in the stomach while keeping the insulin intact. Another problem is opening the intestinal membrane to insulin transport. Although no solution to these problems has been developed, researchers have not given up hope.

Nasal Delivery
Nasal delivery would consist of the patient using a nasal spray to deliver insulin through their nose. The problems arising with this idea is that it requires much larger doses of insulin (about 100 units would be administered for 10 units to reach the patient's blood stream) which would increase costs. However, scientists are working to develop a chemical that would enhance the insulin transport to make it more effective. These chemicals can be problematic, however, because they cause irritation of the naval cavities. Finally, if the patient has a cold or runny nose it can change the efficiency of the delivery of insulin. It is apparent that much work needs to be done to improve the efficiency and reliability of the nasal delivery, but it does seem promising.

                                       Inhaled Insulin
Perhaps one of the most promising new alternatives to injections is inhaling insulin. Because the lungs serve as a large surface area for the transport of insulin, this idea has had increasing popularity. At the moment, the main concern about inhaled insulin is the possibility of negative consequences from the transport of a growth protein through the lungs. Tests are currently being conducted to analyze these possible consequences and most have reported that the consequences are not grave. Inhaled insulin is the product that most companies have actively pursued products for with three main companies—Elli Lily, Nova Nordisk, and Pfizer—creating inhalers for insulin. Although the products were approved and put on the market for some time, their failure to be as effective and safe as insulin injections made the companies eventually withdraw their products from the market. Some negative consequences to the products were: side effects such as coughing and shortness of breath, exclusion of smokers and those with lung diseases for those allowed to use the inhalers, and inability to delivery precise insulin doses (the lowest dose was 3 units, making it very hard for precise control).

Yes, it may seem as though all three of these methods—insulin pills, nasal delivery, and inhaled insulin—failed to attract patients and prove their effectiveness; however, it is important to remember that these are all in their early stages of development and that rapid growing technology is allowing scientists to explore these ideas in much better ways. This examination of possible alternatives to injected insulin is not meant to be seen as bleak, instead we should view these with hope to realize that the future holds limitless possibilities and will provide us with ideas that scientists back in the 1920s (when insulin was first developed) had never even dreamed of.


References:
http://www.diabetesnet.com/diabetes_treatments/insulin_inhaled.php#axzz16vlBeJoY
http://www.drugdevelopment-technology.com/projects/exubera/
http://diabetes.webmd.com/inhaled-insulin

Contour USB Glucometer: Blood Glucose Meters Still Improving!

Contour USB

Although it may seem that scientists and innovators are focusing on new technologies, they have not forgotten to improve old technologies as well. One such example is the evolution of the blood glucose meter. In 2009, Bayer USA released their Contour USB Blood Glucose Meter—a much improved version of the traditional blood glucose meter.
I find that the Contour USB is especially beneficial for the elderly for numerous reasons:
-the brighter lighting (higher resolution screen) and colors make blood glucose readings easier to see
-standard test strips only need 0.6 microliters of blood as opposed to traditional meters that need 1.0 microliters.
-blood glucose readings that are above or below a set target range are presented in a salmon color
-alarms can be set to remind the patient to recheck their blood glucose in a set amount of time
-after blood sugar sample is taken, the meter prompts the patient to indicate if this is before or after a meal
-a "notes" section allows the patient to choose for a list of notes (ex. taken after exercise)

Illuminating Light

-a light can be illuminated underneath the area where the test strip is inserted to make checking blood sugar in the dark much easier
-a USB is incorporated into the meter so it can be plugged into a computer to download results
-results can be viewed through a computer program and can be viewed as charts, graphs, etc

Bayer says that the meter caters to teens and those in their 20's; however, I feel as though this meter is perfect for the elderly. The lighting, alarms, and color coding are beneficial to patients who have difficulty seeing or are experiencing slight memory loss.

USB connection plugs into any computer

I highly recommend the Bayer USA Contour USB blood glucose meter to anyone. Bayer's website is also very helpful and provides patients with a virtual view of the blood glucose meter. Click here to explore the Contour.
For even more information, the user guide is very helpful as well.
With new technology on the rise, I hope people realize that having a good blood glucose meter is crucial for any diabetic.


References:
http://www.bayercontourusb.us/home
http://bernardfarrell.com/blog/blogger.html
http://www.bayercontourusb.us/pdfs/CntrUSB_UG_US
http://www.healthcentral.com/diabetes/c/17/94967/contour-usb-meter

Intensive Care as the Best Technology?

With new technologies emerging every day, Type 1 diabetics, especially the elderly, may be overwhelmed with these new discoveries and may have difficulties finding what technology is best for them. It is important for us to remember that sometimes the best technology is simply intensive care, meaning that the patient is an active and determined participant in their care. There are two methods of taking care of diabetes, the standard approach and the intensive approach. With tools such as nutritional information, diet/nutrition books, insulin, exercise, etc, patients are able to live much longer than they did before. 

         A study conducted for the Diabetes Control and Complications Trail (DCCT) in 1993 lasted 10 years and followed 1,441 people with Type 1 diabetes. The group was split in two, with one group having standard control and one group having intensive or "tight" control over their diabetes. The results showed that those with "tight" control of their diabetes- having an A1C (average blood sugars over a 3 month period of time) of between 6-7%, consisting of blood glucose levels of 70-130mg/dl before meals and less than 180mg/dl two hours after eating- had less complications in certain areas of health and these complications were minimized even 10 years after the study. 

Areas in which complications were minimized consist of:

-eye disease

-kidney disease

-nerve disease

        People using intensive care had 3/4 less eye diseases, 1/2 less kidney diseases, and 2/3 less nerve diseases. Moreover, those who already had these diseases and who transitioned to intensive care were much less likely to see their existing complications get worse. This is VERY important for elderly diabetics who have perhaps been using older technology and more standard methods their whole lives and as a result, have already begun to see certain complications from diabetes. This is why many argue that for the elderly, transitioning to intensive care- as opposed to continuing standard care or moving to new, difficult to manage, and confusing technologies- is extremely beneficial. 

Here is a synthesis of what consists of intensive care and how one can use it in their daily lives:

-multiple daily injections before meals as well as an long lasting injection that gives insulin throughout the day.

-multiple blood glucose testing: at least once before every injection and preferably 2-3 hours after every meal.

-documentation of diet and exercise (to see patterns)

-have scheduled eating times to make insulin injections regular times apart.

-create a team of doctors consisting of: primary care physician, endocrinologist, dietician, diabetes educator etc.

In conclusion, in some cases, especially the elderly, I would recommend the use of intensive care. Often this is what will help the patient expand their life and reduce complications that diabetes causes. It can be considered the best technology

References:

http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/tight-diabetes-control.html

http://www.agingcare.com/Featured-Stories/95735/Managing-Your-Elderly-Relative-s-Diabetes.htm

Choosing the Right Constant Glucose Monitoring Device for You

Lately it may seem as though traditional glucometers are going out of style. The trend seems to be moving towards constant glucose monitoring devices which are placed on the patient's body in order to monitor blood glucose levels at a rate of about every 5 minutes (constantly). These devices usually consist of a sensor placed on the patient's body and a "cell phone-like" device that displays the patient's blood sugar. At the moment there seems to be three main companies who are creating these devices: Dexcom, Medtronic, and Abbott. Here I will analyze the differences between the three and the benefits or disadvantages of constant glucose monitoring (CGM) devices in general.
Each glucose monitoring device includes directional arrows which demonstrate if the patient's blood sugar is trending upwards or downwards, alarms that can be set to signify high and low blood sugars, graphs that show a patient's blood sugar over a specific amount of days, and a software program that allows patient's to view their trends on a computer. All devices are water proof and claim virtually painless insertion.
Dexcom's device is called the SEVEN Plus. This device is beneficial because it includes a sensor that has been approved to be worn for 7 days whereas the other two companies have only been approved to be worn for 3-5 days. The SEVEN Plus also claims to be the smallest and lightest sensor transmitter, therefore creating less discomfort as it is less apparent on the patient's body. The final advantage and difference of Dexcom's device is its ability to allow the patient to enter daily activities or "notes" for times that will correspond with the blood sugar readings in order for the patient and care taker to understand how specific activities may influence blood sugars.

Medtronic's device, the Guardian REAL-time, is different because of its third layer of protection known as "predictive alerts". These alarms can be set to alert the patient 10-30minutes BEFORE a low or high blood sugar is reached. For example, if the patient has set an alarm to go off to tell them of their low blood sugar when their blood sugar reaches 60, the device can detect that blood sugar will decrease to 60 in about 30 minutes and an alarm will be set off. The device also has "skins" or covers that can customize one's monitor.
Abbott's device is known as the FreeStyle Navigator. This device is unique because as opposed to the other two devices which provide a blood sugar reading for every 5 minutes, it is the only device to provide a reading every single minute. Also, it only needs to be calibrated by a finger stick about 4 times over a 5 day period, whereas the other devices ask for 2 calibrations a day. Finally, the FreeStyle Navigator has the largest sensor-monitor range, allowing 10 feet of distance between the patient and the monitor.
A survey conducted by Abbott regarding their FreeStyle Navigator shows that on average, patients viewed these constant glucose monitoring devices as very promising. These devices can be especially beneficial for the elderly. By diminishing the need for finger sticks, the elderly can prevent their fingers from loosing feeling due to constant finger pricking. In addition, the loud alarms can help elderly we have lost some cognitive activity and are less able to recognize high and low blood sugars on their own. The devices have so many safety features that attempt to prevent or eliminate high and low blood sugars that can be detrimental to the elderly's health and safety.
Although there are many benefits, however, it is also important to remember that GCM's might not be for everyone.  As a teenager, I tried Dexcom's SEVEN-Plus and did not feel as though it was right for me. The accuracy of my blood sugars was not very good since there seemed to be a malfunction with the way the sensor was inserted and water ended up making the blood sugars displayed on my monitor as incorrect. Moreover, it was hard for me to get used to having a device on my body which was slightly apparent through clothing and was noticeable anytime I was in a bathing suit. However, in the future I do plan to try out other models and try the SEVEN-Plus again (when it is not malfunctioning) in order to give CGM's a second chance. I highly recommend that all diabetics (ESPECIALLY the elderly) try these devices and see which one is right for them.

References:
http://www.dexcom.com/products/seven_difference
http://www.minimed.com/products/guardian/features.html
http://www.FreeStyleNavigator.com/ab_nav/url/content/en_US/10:10/general_content/General_Content_0000013.htm

How Much DOES the World Care About Diabetes?

For all diabetics or those who care for or have a loved one with diabetes, good news has arrived! Technology to improve the quality of life for Type 1 diabetics throughout the world are increasing at a more rapid pace then ever seen before. As we hear more and more about new technologies and research projects, I decided to investigate just how much does the world care about diabetes? Essentially, how much money and time does our world use to focus on making life better for diabetics?

According to the MedMarket Diligence report conducted in July 2010, $36 billion dollars in the global market annually is used on diabetes management products. The products and technologies covered can be found at the MedMarket report.  Because of intense competition between different companies, more products are being developed and are designed to be as efficient and cost-effective as possible. The report also projects how the market will change over the next 10 years (until 2018) and states that global research and technologies are projected to increase exponentially in the decades to come.
Europe is expected to have a growth of 11% in the market for diabetes management products while Asia is expected to have an astounding 24% growth. Despite Asia's predicted growth, Europe and the United States still dominate the market for these products, representing 68% of the global market.

Some of the new technologies and products that are said to be investigated are: new continuous glucose monitoring systems, islet cell transplants, vaccines, antibody treatments, oral/inhaled insulin delivery, and most importantly the closed loop blood glucose monitoring system (also called the artificial pancreas). The report was very optimistic about the speed in which these products will be adequately researched and tested in order to be placed on the market in the "very near future".
For all diabetics, this is great news to hear that the world does indeed care about our wellbeing. This emphasize on creating diabetes management products can be attributed to the fact that there is a growing number of type 1 diabetics worldwide. According to the American Diabetes Association, 1.6 million cases of diabetes are newly diagnosed each year in people over the age of 20. With more diabetics, it is important for products to be developed that will help their every day lifestyle. The rapid pace at which research is being conducted is relieving for some elderly diabetics who may have believed that they would be using the same technology for the rest of their lives. The fact that a report that looks at diabetes products growing rapidly in just 10 years span gives hope to diabetics from ages 50-80 years old who could be some of the first to use this new technology in old age. I urge diabetics and caregivers to look into the future with optimism as new technology emerges daily.

The complete MedMarket report can be ordered online at http://mediligence.com/store/page34.html

References:
http://www.prlog.org/10862901-new-technologies-in-type-1-and-type-2-diabetes-management.html
http://www.diabetes.org/diabetes-basics/diabetes-statistics/
http://www.mediligence.com/rpt/rpt-d510.htm

Calibra Finesse Pen Patch- Pros and Cons

Finesse

On January 25, 2010, the FDA approved Calibra Medical's new insulin pen patch called Finesse. This pen patch is a new and improved version of an insulin pump that delivers insulin to the patient through their skin. The patch is 2 inches long, 1 inch wide, and 1/4 inch thick, designed to be slim and unapparent under most clothing. This pen patch holds 200 units of insulin at a time. The insulin is moved from the patch to the patient's body through a 27 gauge needle and by pressing the buttons on the side that click for every unit of insulin delivered into the patient's body. Both buttons must be pressed for insulin to be dispensed in order to avoid accidental delivery of insulin. This pen patch can be worn for 2-3 days at a time and is designed with withstand daily activities such as exercise, swimming, and showering.

The development of the Finesse is a huge step forward for smaller pumps and it seems will soon replace insulin pens or needles that require numerous injections per day. This new technology presents numerous advantages and disadvantages for the elderly.

Comparison of needle sizes

It is apparent that this pen patch will minimize daily injections since it only needs to be changed every few days. Most diabetics use insulin pens to inject themselves about 3-4 times a day, meaning that this pen patch would eliminate about 10 injections per 4 days. However, the patch only contains bolus insulin, meaning that patients are still obligated to inject themselves with a long lasting insulin once a day. Moreover, most insulin pen needles are 33 gauge needles, however as a 27 gauge needle, the pen patch may hurt more when being injected into the patient's skin. On the other hand, even if it is a bigger needle, the avoidance of multiple daily injections can reduce bruising and the creation of scar tissue that often occurs to the elderly when they are forced to inject themselves. 

Calibra Medical has taken precautionary steps to help the elderly use this new technology. Each Finesse comes with a packet of stickers to remind patients on what day of the week to change the pen patch for a different one. This is especially helpful for the elderly who sometimes have memory problems and could forget to change their pen patch. 

A downside to this new technology could be cost. Although Calibra Medical is fairly certain that most major insurance companies will cover their equipment, this is not certain yet. Since most of the elderly are on Medicare which sometimes seems to cover the bare minimum, it is possible that their insurance would not cover this, placing an immense financial burden on the patient. 

A final point to consider is style and comfort. Although slim, the Finesse can be seen through certain clothing and can cause insecurity issues as it is exposed when one wears bathing suits etc. However, I believe this is an example of how it could benefit the elderly more than the youth as the elderly usually do not care as much about their looks. Another point to consider is the comfort. Having tried numerous constant glucose monitoring systems that are placed constantly on my body much like the Finesse, I become anxious at the idea of having something on my skin at all times and was extremely cautious about bumping into things or moving around too much. Although this technology is extremely stable, for me, it was a matter of unreasonable fear. Therefore, if one feels comfortable wearing a piece of equipment like this, I believe that the Finesse is definitely worth trying. However, it is true that this piece of technology may not be for everyone.

For another blog which analyzes the benefits of the Finesse pen patch go to: http://bernardfarrell.com/blog/blogger.html

References:
http://www.businesswire.com/news/home/20100125005596/en/Calibra-Receives-510-Clearance-Finesse™-Insulin-Patch-Pen
http://bernardfarrell.com/blog/blogger.html
http://www.news-medical.net/news/20100726/Calibra-Medicals-Finesse-insulin-patch-pen-receives-FDA-clearance-for-use-with-Novo-Nordisks-Novolog.aspx?page=1

Caring for Elderly vs Youth with Diabetes

Although most people with Type 1 diabetes are diagnosed during their youth, the way they care for their diabetes can change drastically when they reach old age. This is due to changes in their mobility, energy levels etc. I feel as though it is important for health care professionals, care takers, and diabetics to understand these differences in order to better care for elderly diabetics. It is said that oftentimes the best technology is good care, and therefore knowing the differences in caring for the elderly and for the youth is crucial.

Elderly diabetic

First of all, it is important to realize that elderly diabetics are more prone to certain ailments such as heart and kidney disease, stroke, and visual impairment. Caregivers can help their loved one lower their chances of being affected by these problems by maintaining tight control of their blood sugars (see other posts for sample technologies that improve glucose control). As a diabetic, I realize the importance of this since having out of control blood sugars would decrease energy levels even more and create more visual impairment problems. Furthermore, it is important for diabetics to keep their cholesterol and blood pressure under control in order to minimize chances of heart disease, says a diabetic educator, Meg Bayless. It is recommended that elder diabetics take an aspirin a day and have proper nutrition and daily exercise.
In general, it is important for diabetics to watch their nutrition and exercise however oftentimes as one ages, exercise become harder and diabetics become too tired to properly fix healthy meals for themselves. Therefore, I recommend that caregivers find a way to plan out meals for the week that are healthy and find a way to prepare them ahead of time so the patient does not need to do much work. In addition, I would suggest that each elderly diabetic finds a way of exercise that works for them depending on their range of mobility, energy level, etc. By setting aside a specific routine for the patient, it will be easier to create a pattern of healthy habits.

Young diabetic

Elderly diabetics face more even problems than younger diabetics that make them significantly more disabled than the non-diabetic elderly. These problems include depression as they feel isolated from loved ones, increased chances of falling from visual impairment and the dizziness that accompanies low blood sugar, memory problems that can lead the patient to forget to monitor their blood sugar, and pain that diabetics do not talk to their doctors about.

As a diabetic myself, it is concerning to read how much differently (and one could argue, worse) the disease will affect me when I am older. But these facts should not be seen as bad. Knowledge is key, and therefore if older diabetics and/or their caregivers are made aware of these differences, they can take preventative steps to make aging with diabetes as smooth of a transition as possible. In my opinion, the three most important things for elderly diabetics to do to reduce the risk of complications that do not occur in younger diabetics is: 1. have the support and help of a caregiver or family member 2. do not let their old age prevent them from participating in daily exercise and eating healthy 3. staying up to date with doctors appointments and taking the proper medication. These three tips, along with understanding the differences between caring for the elderly and the young, can make a huge difference.


References:
http://www.everydayhealth.com/type-1-diabetes/adults-with-type-1-diabetes.aspx