Health & Fitness

Say ‘So long’ to finger pricks, and ‘Hello’ to the latest ways to measure your glucose

At right, Shannon Briggs administers a blood sugar test to her daughter Lala Briggs, a 6-year-old from Clovis.
At right, Shannon Briggs administers a blood sugar test to her daughter Lala Briggs, a 6-year-old from Clovis. Fresno Bee Staff Photo

The days of diabetics having to prick their fingers may be numbered, thanks to apps that monitor you glucose levels.

Some of the latest advancements in glucose monitoring involve small devices that allow real-time data of glucose levels and changes to be accessed remotely.

The continuous glucose monitor (CGM) reads blood glucose levels continually, via a tiny electrode sensor that is implanted beneath the skin and held in place by an adhesive. A small transmitter is fastened on top of the sensor, which allows data to be sent wirelessly to a mobile device, tablet, or Smartwatch. The monitors can be used by those with type 1 or type 2 diabetes.

“The continuous glucose monitor was a complete game changer for us,” says Lauren Glorioso, 50, of Deerfield Beach. Her daughter, Isabella, 10, was diagnosed with type 1 diabetes four years ago.

“One night, prior to getting the monitor, Isabella was sleeping and my ‘mom instinct’ told me to check her blood sugar,” said Glorioso. “It was 40 — very low. That terrified me. It was 10 p.m. and we routinely do night checks at 2 a.m. It’s scary to think about everything that could have happened in those four hours.”

The next day, she phoned Isabella’s endocrinologist at Salah Foundation Children’s Hospital at Broward Health, and she and Isabella were trained on how to use the monitor.

“It has given us so much peace of mind and has helped us countless times to avoid a scary low or a dangerous high,” said Glorioso. “It’s allowed so much more freedom for Isabella than I would have been able to give her without it. She sleeps over at her grandparents’ house, goes to birthday parties, dances on a competitive dance team, and sings in a choir at school. We can monitor her blood sugar no matter where we are.”

Glorioso says the nurse at Isabella’s school watches her numbers on an iPad while she’s at school.

“Using the monitor reduces the amount of finger pokes, it’s very accurate and has been such a great tool helping to adjust insulin requirements,” she said.

According to the American Diabetes Association, more than 30 million Americans — almost 10 percent of the population — have diabetes, according to data from 2015. Approximately 1.25 million American children and adults have type 1 diabetes. Rates of diabetes increase with age: Among those ages 65 years and older, 25 percent have the disease. Each year in the U.S., there are 1.5 million new cases of people who are diagnosed with diabetes and it’s the seventh-leading cause of death in this country.

Those with type 1 diabetes don’t make enough insulin while those with type 2 cannot use insulin properly. When the body doesn’t have enough insulin or cannot use it correctly, sugar builds up in the blood, and could lead to an onslaught of health issues, including kidney failure or stroke.

CGM devices make it easier for type 1 and type 2 diabetics to monitor their glucose levels.

There are different brands of monitors. Some of the more popular ones are the FreeStyle Libre by Abbott and the Dexcom. The glucose sensors for most models typically last for 10 days to two weeks before needing to be replaced.

The transmitter, which sends glucose data from the sensor, lasts 90 days on average. The waterproof unit (sensor and transmitter) comes with a type of button, which, when pressed on the back of one’s upper arm, adheres the sensor. The CGM automatically monitors your glucose throughout the day and night.

“The continuous glucose monitor has been on the market since the 1990s,” said Dr. Heberto R. Valdes, an endocrinologist of Broward Health North, “but required patients to do finger pricks. One of the main complaints patients have is they don’t like to do finger pricks.”

Most of the newer CGM models self-calibrate, eliminating the need to draw blood from your finger and manually enter your blood glucose reading.

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Shannon Briggs demonstrates a sensor device that automatically monitors critical body chemistry to keep her daughter’s diabetes in check on June 25, 2013. Lala, 6, has type 1 diabetes. MARK CROSSE Fresno Bee Staff Photo

It was only last year that the FDA approved the first continuous glucose monitoring system for adults not requiring blood sample calibration. The option for individuals to use their own readers, like mobile devices, was also added.

Valdes said the main benefits of a CGM are that people are more aware of their glucose levels and they tend to improve their diet and lifestyle habits. Another bonus is that specialists can read the reports of their patient’s glucose levels.

“Based on that, we can make adjustments to their regimen,” he said.

The cons of a CGM, he says, is a range of error in the readings of glucose levels, which usually only happens when a patient applies the CGM incorrectly.

“Blood from finger pricks will always be most accurate,” he says.

The CGM transmitters work with Bluetooth to send data and measurements to a company-provided receiver, or a compatible mobile device, which requires the download of a device-specific mobile app. Some CGMs require users to swipe a reader over the sensor to obtain a scan. The scan captures data, like current glucose readings and an eight-hour history of the glucose levels.

Alarms will sound if blood sugar drops or spikes. Users can set their own numbers to be alerted before any sudden increases or decreases in blood sugar.

The American Association of Clinical Endocrinologists (AACE) and American College of Endocrinology (ACE) published guidelines saying that patients with both type 1 and type 2 diabetes and those who are at risk for hypoglycemia and/or have hypoglycemia unawareness could benefit from a CGM.

Insulin pumps, which deliver insulin under the skin through a cannula, are often used along with CGMs.

Vineeth D. Mohan, MD, chairman of the Department of Endocrinology at Cleveland Clinic Florida in Weston, says the technology in insulin pumps and CGMs has significantly advanced over the past few years.

“The hope for a truly ‘artificial pancreas’ combining these two technologies is becoming more of a reality,” he says. “It’s anticipated that more insulin pumps will interact with blood glucose data and alter insulin delivery to avoid severe hypoglycemia and hyperglycemia,” he said. “Still, all patients on insulin pumps require significant training and daily attention so that they manage their condition successfully.”

Many apps are available on mobile devices to help people better manage their diabetes. Glucosio is an app for those with both type 1 and type 2 diabetes. It monitors important criteria such as cholesterol, weight, hemoglobin A1c, ketones, blood pressure, and more. A list of this year’s best diabetes apps for Android and iPhone can be found by visiting: www.healthline.com/health/diabetes/top-iphone-android-apps.

And then there’s technology that connects with patients and their families on an emotional level, offering support and guidance on how to live with, cope and thrive with diabetes.

The Nicklaus Children’s Hospital hosts monthly online chat rooms for teens with type 1 diabetes and a parent support group, starting in December, for parents of toddlers and preschool age children who have diabetes. In the spring, the hospital offers an “Off to College with Diabetes” seminar for college-bound teens. There is also a Technology Day during the first week of November so families can learn about the latest in glucose tracking tools, like insulin pumps, CGMs, and phone apps.

Awilda Valdes, a diabetes nurse clinician at Nicklaus, said the hospital aims to make it more convenient for patients and their families to find support, resources and to talk with others who struggle with the disease.

“We decided that this would be a way to get more families involved from the comfort of their home,” she said. “There is definitely a need for support in our community.”

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Lizbeth Ramirez, 20, of Homestead, is the chat room group leader.

Lizbeth Ramirez, 20, of Homestead, is the chat room group leader. She says being able to talk with others her age who are going through the same thing helps her feel better. She was diagnosed with type 1 diabetes when she was 15.

“Being in the meetings helped because type 1 diabetes is a life changing disease,” she says. “So having kids your age that can relate to having it really lifts up your mood,” she says.

Some of the topics she and her peers discuss, she says, are healthy food choices, carb counting, going off to college, and how to deal with diabetes on a daily basis.

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