Insulin pumps and implantable chips for diabetics now

A new system which tracks sugar levels every five minutes to get 288 readings per day; a microchip which can |detect the amount of glucose in a person’s blood and then transmit this information to a wireless scanner where it can be easily read by the patient; An insulin pump which can automatically shut-off the supply of insulin, if the patient’s glucose levels drop too low… A whole range of new solutions for diabetics are right here

Dr. Shashank R Joshi

The need to manage and control the rapid rise of diabetes has led to innovations in diabetes monitoring and management therapies to help patients and physicians for maintaining scientific and accurate results. Many significant advances have been made in this context in the past two decades.

Among these have been the developments of improved glucose monitoring techniques and minimally-invasive techniques for sampling blood. New, fast-acting forms of insulin have also been introduced along with novel and more accurate ways of insulin delivery through the use of insulin pumps.

There has also been considerable research in non-injection dosage forms for insulin, such as inhalable insulin, although products are not approved and pending more clinical data. Once approved, this could herald a new era in Insulin Therapy.

Recent Trends in Diabetes Monitoring and Diagnosis:

In patients having diabetes, blood sugar spikes within an hour after any meal. This process goes on throughout the day. So the blood sugar of a person with diabetes is continuously changing every minute of the day throughout the person’s life. Patients may use gluco meters to check blood sugar, but simply checking using Blood Glucose Meters may not be sufficient.

A better way to monitor sugar levels to understand how the blood sugar changes throughout the day is with the help of technology called ‘Continuous Glucose Monitoring System’ (CGMS), which is now available in India also. It reads the sugar levels of the person every 10 seconds and keeps a record every five minutes so that we can get 288 readings per day during the CGMS study period.

This gives the person a clear idea of how much the blood sugar has risen after a particular meal. There are plenty of patients who have high blood sugar at odd times of the day which is not detected by routine tests like Fasting Blood Sugar and PBS (blood sugar after food) or who are unaware that they may be experiencing low blood sugars at night. With this information, the doctor can modify the treatment to gain better control of blood sugar throughout the day. CGMS study is especially helpful in pregnant women who may experience low blood sugar levels at night and which may go unnoticed otherwise.

Another new upcoming diabetes monitoring approach is the use of Implantable Chips. A microchip can detect the amount of glucose in a person’s blood and then transmit this information to a wireless scanner where it can be easily read by the patient.

Insulin Pump Therapy

An excellent alternative to multiple daily injections is Insulin Pump Therapy. By using an insulin pump, patients can match their insulin to their lifestyle rather than trying to adjust their lifestyle to their body's response to insulin injections.

Insulin pumps are commonly being used because of their unique ability to continuously infuse insulin, insulin pumps consist of: (a) the pump (computerised battery operated device); (b) a disposable reservoir to hold insulin; (c) a disposable infusion set, including a soft plastic cannula to be inserted just below the skin). The insulin pump is a small mechanical device that is worn outside the body, often on a belt or in a pocket. The pump delivers insulin directly into the body through the soft, flexible cannula under the skin. Patients generally refill their pump with insulin every two to three days. Another benefit of insulin pumps is improving quality of life, normalising sugars in recalcitrant diabetes, improving sexual function, and relieving the intractable pain of neuropathy.

An insulin pump is an excellent tool for helping improve glycemic control. A pump can help patients avoid hyperglycemia (high blood sugar), which can cause long-term complications and lead to ketoacidosis (causing coma or death if left untreated), and hypoglycemia (low blood sugar), an acute condition that can be very dangerous, particularly while sleeping. Patients using longer-acting insulin with injection therapy must follow rigid schedules of insulin injections, meals and snacks, whereas patients using an insulin pump can programme insulin delivery when they eat, and adjust or stop insulin delivery for exercise or other needs. Patients using pump therapy can eat what they want, when they want. Pumps are also beneficial for patients who are unable to manage their diabetes or related complications.

Advanced Insulin Pump technology like MiniMed VEO, is the world’s one of the new insulin pump which can automatically shut-off the supply of insulin, if the patient’s glucose levels drop too low. The Insulin pump, when used with an integrated glucose sensing technology, monitors the patient’s glucose levels 24 hours a day and can actively protect the patient against the risk of a hypoglycemic event becoming severe, even while the person is asleep. This new technology in India gives greater freedom in eating and sleeping. At the same time, it takes the stress and fear out of diabetes management for its capacity to protect against the dangers of hypoglycemia.

(The writer is President, Indian Academy of Diabetes, Consultant Endocrinologist, Lilavati and Bhatia Hospital, Mumbai)