Using Technology to Help Manage Diabetes

Managing diabetes is a 24/7 job. The latest tech makes it a little easier (and less worrisome) for teens—and their parents. 

teen with diabetes

Photo by Augustus Butera

Photo by Augustus Butera

Eden periodically checks that her continuous glucose monitor is properly calibrated by pricking her finger and testing her glucose herself. 

Between trying to pass physics class, going on first dates and, ugh, acne, adolescence is hard enough. But for teens with diabetes, it’s an even more challenging time. They get hit with a double biological whammy: Not only are their bodies having trouble producing or using insulin to process sugars in their blood, but surging teenage hormones can also cause a roller-coaster of blood sugar highs and lows. Plus, what teen wants to check their glucose levels multiple times a day in front of friends? Thankfully, smart technology is helping teens with diabetes stay on top of their chronic illness, sidestep complications and, well, just be kids again. 

When she was 10 years old, Eden Karp had a nearly fatal incident at sleepaway camp. Undiagnosed at the time, she progressed to a late stage of diabetic ketoacidosis, where acids dangerously build up in your bloodstream. She had a full recovery, but her parents worried about her being away from home at night, when her blood sugar could dip hazardously low. What’s more, routine finger pricks only give people with diabetes a snapshot of their glucose levels and zero information on how to proactively handle blood sugar highs and lows. So this Westfield, NJ, kid stopped going to sleepovers and put sleepaway camp on pause—until she started wearing a continuous glucose monitor (CGM) months later.

“Camp wasn’t an option since my parents worried about my glucose levels overnight, but now we all get real-time readings.”

Eden, age 13

Eden’s monitor gives her blood sugar readings anytime on her smartphone. The Dexcom device uses a super-thin sensor wire inserted just under the skin to detect glucose in the surrounding tissues every few minutes. It also shows where her numbers are headed, so she can adjust her medication to stay within a safe range. Teens can share their data wirelessly with parents, school nurses, coaches and doctors—meaning more adventures for kids and peace of mind for adults. “My parents can check their phones to see how I’m doing,” says Eden. 

Even though newer models like the Abbott’s FreeStyle Libre (the size of two stacked quarters) are more discreet, some with diabetes would rather not wear a device. But Eden feels safer with hers. “I don’t have to stress about my blood sugar,” she says. “I’m so thankful for that.”

Determining the correct insulin dose requires math—a lot of math—before every meal and snack. It’s also restrictive. “If you give yourself an injection, you’re committing to eating that amount of carbs to match your insulin dose,” explains Francis Selldorff, 17, from Boston. You can’t just eat a few extra chips. 

Once you figure out how much of the hormone you need, then come the stares. Pulling out a syringe or insulin pen while at a restaurant or party can be embarrassing. “When I was on shots, I had to stop and take insulin no matter what I was doing,” says Katie Dean, 17, of Wetumpka, AL. “I looked weird when I pulled out my needle.” 

Insulin pumps, for those on daily insulin therapy, have the power to do away with anxiety and awkwardness. “You enter your number of carbs, press a button and it calculates your dose based on your ratios,” says Francis. “You can account for how little or how much you eat.” And no more injections. Another plus: With his pump attached to his body, Francis doesn’t have to take off his hockey pads to give himself a shot. His pump does all the work until it needs to be refilled (every three days).

With new algorithms that automatically stop insulin when glucose levels are predicted to drop, pumps are becoming even smarter. The only downsides: They can be expensive (depending on your insurance), and some people with diabetes don’t want to be attached to a device 24/7. 

“Using syringes—sometimes during hockey practice—was awkward. But now I don’t ever need to take off my pads for a shot.”

Francis, age 17

The Future of Diabetes

diabetes

Photo by Augustus Butera

Photo by Augustus Butera

With Eden’s device, reviewing her glucose levels is as easy as opening an app.

Diabetes technology is rapidly evolving. Take a look at three exciting innovations in the works.

The artificial pancreas
Just as self-driving cars sense their surroundings and navigate without human input, an artificial pancreas automatically keeps blood sugar in check, even during mealtimes. No more checking numbers or fiddling with the pump before eating—just set the device and forget it. “It’s the Holy Grail of diabetes technology,” says David T. Ahn, MD, program director of the Mary & Dick Allen Diabetes Center in Newport Beach, CA. Researchers are getting closer to making this a reality, with the NIH funding four major research efforts to test fully automated systems last year. 

An implantable CGM
Researchers have developed a continuous glucose monitor so small it can be placed entirely under the skin in adults. The pill-sized Eversense sensor by Senseonics is the world’s first implantable CGM sensor and was approved by the FDA in June. The sensor is inserted by a doctor into your upper arm. Then a slim, removable, water-resistant transmitter is placed over it to send glucose data to your smartphone app. (It also vibrates if glucose levels spike or fall too low.) The best part? The Eversense sensor can be left in place for 90 days. Say goodbye to the hassle of switching CGM sensors every 7 to 14 days. 

Insulin pills
For years needles have been the only way to administer insulin. Scientists struggled to figure out how to create an insulin pill that could survive the stomach’s harsh environment. Now Harvard researchers have found a promising solution. They covered a pill in a special coating that dissolves only in the small intestine and allows insulin to pass into the bloodstream. So far, it has lowered blood sugar in animals. But more research is needed before human clinical testing can begin, hopefully in the next three to five years. 

Before You Download That Diabetes App 

Find out where it was developed. Regulations vary, so skip apps not created in the U.S. or by a reputable company. Be wary if it gives diagnoses or medical advice. Apps that calculate insulin doses or medication require FDA approval—and a prescription. Check your phone’s privacy settings and turn off access to apps that aren’t necessary for the app to do its job.

diabetes

Photo by Augustus Butera

Photo by Augustus Butera

Eden uses this applicator to insert a transmitter for her continuous glucose monitor.

“I used to use a pen and paper to keep track of my shots. Now it’s automatically digitally updated for me.”

Stephanie, age 17

If you think keeping a food diary can be a drag, imagine logging every single insulin shot—up to 10 times a day. Diabetics who prefer multiple daily injections without a pump (as most do) may have tracking constantly on their minds. 

Thankfully a new generation of smart insulin pens and caps track the date, time and dose of insulin and create an electronic logbook on your smartphone. “My diabetes isn’t a chore anymore,” says Stephanie Landesman, 17, from The Woodlands, TX. She tried using a pump but ditched it because she didn’t like being tethered to something all day and night. “The pen logs and calculates everything for me and fits my lifestyle,” says Stephanie. 

Not only does this help teens stay on top of their insulin therapy, parents can also rest assured their child isn’t forgetting a shot. Some devices, like Gocap—a smart cap that snaps onto an insulin pen—remind you when it’s time for an injection while tracking your shots. InPen, the first FDA-approved smart insulin pen, takes this one step further. It sends data to an app to update you on how much insulin you still have on board and helps calculate your next dose. It also sends an alert if you miss a shot, if your insulin is expired or if it’s stored in too-hot or too-cold conditions. 

“This is a brand-new category that’s exciting and going to be a big deal,” says David T. Ahn, MD, program director of the Mary & Dick Allen Diabetes Center in Newport Beach, CA. Since these devices are new to the market, they may be free (with insurance) or $150 and up.The downside? You still need to take insulin at mealtimes, calibrate the system and regularly change the pump and CGM sensor. But it’s definitely a promising first step, and other hybrid closed-loop systems are currently undergoing clinical trials.

“Managing multiple devices was tough, but my self-adjusting system makes my life easier.”

Mia, age 13

Sometimes diabetes can feel like a big puzzle. You piece together numbers from your CGM or glucose meter, meals and insulin doses, and use your best guess to avoid glucose spikes and crashes. It’s stressful, especially at night, when blood sugar lows can be dangerous.

With new gadgets like the Medtronic MiniMed 670G system, parents and teens can coordinate multiple diabetic devices. These so-called hybrid closed-loop systems allow CGMs and insulin pumps to talk to each other wirelessly and make micro-corrections every few minutes in response to glucose fluctuations—without you having to do a thing. “The algorithm does a pretty good job of keeping your blood sugar levels flat between meals or while you’re sleeping,” says Ahn.

For Mia Gualdoni, 13, a type 1 diabetic from Palo Alto, CA, and her parents, that means fewer middle-of-the-night wake-ups for blood sugar checks. Plus, Mia doesn’t constantly think about her numbers. “It gives me more independence to manage my care. It’s less stressful to correct my highs and lows because the system helps me. I’m not doing it on my own,” she says. “When I’m playing volleyball or with friends, I don’t spend as much time worrying about my diabetes.”