Approximately 30 million Americans are living with diabetes. Blood sugar monitoring is unfortunately a part of life for people with diabetes, but new technology is making it easier.
In the past, blood sugar testing involved a painful pinprick up to nine times a day, followed by a dose of insulin or another medication based on those numbers. Basically, the patient’s life revolved around their blood sugar levels. But new devices make it more convenient and less painful.
In this episode of San Diego Health, host Susan Taylor and guests Athena Philis-Tsimikas, MD, an endocrinologist and corporate vice president of the Scripps Whittier Diabetes Institute, and Tyeisha Smith, a mother of five who has been dealing with type 1 diabetes for almost two decades, discuss what led up to Smith’s diagnosis, how she got educated about her condition and the clinical trial that transformed her life.
Cutting-edge technology, like the continuous glucose monitoring system Smith uses, checks a patient’s blood sugar level every few minutes, then transmits that data to the user’s cell phone as well as to the cloud so the doctor can check it remotely, even when the patient is not in the doctor’s office.
There are also now disposable insulin pumps, insulin pens that communicate with the user’s phone and an inhaled insulin device for people afraid of needles.
Before Smith enrolled in the study at the Scripps Whittier Diabetes Institute, she felt hopeless and worried she wouldn’t live long enough to see her children graduate. But since her glucose monitoring device was implanted, she has regained control of her life and now looks forward to watching her grandchildren grow up.
Dr. Tsimikas: Diabetes essentially is when the blood sugar [levels] are higher than normal in someone's body. That occurs because of two different reasons. One is the beta cell in the body that produces insulin might decline in function or stop functioning altogether. The other is that the muscles in our body may become resistant to the effects of insulin and we need much more insulin to bring those blood sugars down. And if you're not producing quite enough, then those blood sugar levels again become too high.
Dr. Tsimikas: Type 1 diabetes is an autoimmune function where our body turns against that beta cell that produces insulin and destroys it, usually over a fairly quick period of time, maybe within a couple months. Type 2 diabetes is a combination of a decline in the function of that beta cell together with that [insulin] resistance causing again the effects of high blood sugars to occur.
The scary part about [diabetes] is that there may be no symptoms. It occurs so slowly that people don't even realize that it's occurring. More commonly though, we might see frequent urination, someone that feels very thirsty. They might be waking up at night to go to the bathroom where they otherwise wouldn't. And combined with that actually is eating a little bit more to try and overcome some of the effect of this.
Smith: When I was first diagnosed with diabetes, I was out of control. I didn't know anything about diabetes. I didn't know anybody that had diabetes at the time. I was sinking really fast. I had frequent urination, I had excessive thirst and I was dropping weight really, really fast, just losing a lot of calories. So I went to the doctor [who told me] I had diabetes, and it just progressively got worse. I just couldn't get a handle on it. My blood sugars were still going up. My A1Cs were really, really high. My blood sugar [levels] were ranging in the 400 and 500s all day, which is very dangerous.
Dr. Tsimikas: That's pretty high. If it continues to get even higher than that you can eventually go into a coma from that. But we know that high blood sugars also attach to different parts of our body. They can attach to the back of the eye, to vessels around our heart, in our kidneys, in our nerves, and can lead to some of the complications of diabetes that we know commonly occur as well. So for all those reasons, it's dangerous.
Smith: I was very depressed. I couldn't get out of the bed and leave the house for more than an hour at a time. At night, I felt like I was dying. My body literally felt like it was shutting down. I had muscle pain. I had back pain, the eye pain from my blood sugar being so high, and I literally felt like I was not going to make it. And every night I would kiss my kids goodnight and tell them that I loved them because I didn't think that I was going to be able to see them the next day. I felt like there was no hope, and I was trying to hold on, but quickly giving up.
Dr. Tsimikas: So the usual routine is that you have to use a small needle that sticks your finger. We ask patients to check two, three, four, and if you have type 1 diabetes, sometimes eight to nine times a day. [Insulin is given based on blood sugar read]. You use that [blood sugar] value. It's important because it tells us how much medication you should be taking, how you should be adjusting really so much of your lifestyle, exercise, food that you're eating, so many things.
So we have some really high-tech ways now that we can monitor your blood sugar levels. Tyeisha, do you want to show them how you're doing it?
Smith: Well, I am using the Dexcom G5, which is here. It is a CGM, continuous glucose monitoring system, and basically what it does is it monitors my blood sugar every five minutes without me having to do any of the finger sticks, and it transmits onto this little device here. And also with technology these days, now it also transmits onto my phone as well. It alarms me if it's going too high, if it's going too low, if I'm in the danger zone. So this little baby has definitely made my life easier. I can't even imagine not having it at this point.
Dr. Tsimikas: The nice thing about this [CGM] device is they just came up with an updated version that doesn't require calibrations [fingersticks]. It's the G6, and it does not require calibrations.
Dr. Tsimikas: So, we have yet another device that delivers insulin in a different way. There's a couple different ways. Tyeisha is wearing an insulin pump right now, and she's wearing it up here on her arm. It's called an Omnipod.
Taylor: So that's automatically delivering insulin to her on a 24-hour basis?
Dr. Tsimikas: It is. And then when you eat you have to deliver an extra dose.The latest device is the 670G hybrid closed loop, which automatically makes some adjustments, although you still have to give yourself a dose when you eat. It turns itself off when your blood sugars are too low, and it increases insulin when your blood sugars are too high.
Dr. Tsimikas: So if someone wants a little bit lower-tech and doesn't really want to use the pump and still uses a pen to deliver their insulin, this pen is nice because after you dose it, you dial up your dose, you give your injection. It actually communicates to my phone immediately what the dose was and how much I gave, what time I gave, and then I can put in the amount of carbohydrates I just ate as well, and it will tell me if that dose was enough or not, if I need to give a little bit more or not.
Taylor: When you talk about this being a pen, it's actually something that you inject, right?
Dr. Tsimikas: Correct. [It's a] really, really small needle, yet another improvement that they've made.
Smith: So tiny. It doesn't even hurt. It doesn't hurt.
Taylor: And now there's also an inhaled insulin device?
Dr. Tsimikas: There is. So if you didn't want to take the injection, you've just eaten some food or your blood sugars are high, you could take an inhaled puff of insulin with this device. It requires just popping a cartridge in here with the dose. You pull off cap. You take your inhalation, and it starts to work right away.
Smith: Well, I went from not being able to leave the house for more than an hour at a time to where now I can go out. I can be active with my children. We go to amusement parks. I work a job without feeling down and depressed. It's changed my life. It has definitely changed my life.
It is so convenient. I can get up and go. I can shower with it and everything. I don't have to take it on and off. You can get in the pool with it. I mean, it has definitely changed my entire life.
Dr. Tsimikas: Prediabetes is a condition where you're at risk for developing diabetes in the future. We have a few warning signals for it. But if you intervene early, you might actually be able to prevent the onset of type 2 diabetes.
Dr. Tsimikas: Project Dulce is a program in underserved communities here in San Diego focused really on Latino and other racial-ethnic groups that are at higher risk for diabetes. We went into community clinics and partnered with them and delivered and developed programs to educate and better manage their diabetes [cases]. We, interestingly, transformed the curriculum of that into a texting program, and we [found] that if you text people these educational comments and then they send you back what their blood sugars are, you could improve their outcomes.
Smith: I think the advice that I would give for other people is: diabetes is hard. It's a very hard disease to control, but it's not impossible, and just to let people know that you are not alone. You don't have to do it alone. Scripps is here. They have the resources and the technology, and if they did it for me, they can do it for you.
Dr. Tsimikas: I think the best advice is to get educated around your disease. We've seen from Tyeisha how much she's learned and the motivation she has now to manage her own disease, and that's really important.