When Manny Hernandez was diagnosed with Type 1 diabetes 12 years ago, he got used to testing his blood sugar levels several times a day, waiting minutes to get a reading and determine whether his levels were too low, too high or just right.
Now, with today’s technology, Hernandez waits about five seconds —and he also needs a smaller drop of blood.
That’s only one of the advances in glucose monitoring that patients with diabetes have seen over the last decade or so.
But one thing remains the same—if you have diabetes, checking your levels regularly is key.
“It is one of the most important things you need to do,” said Hernandez, co-founder and president of the Diabetes Hands Foundation, a California-based nonprofit. “If it’s low, you may need to have some carbs. If it’s high, you may need to control it with exercise or insulin. But essentially, you need the data.”
Sharon Boggs, a certified diabetes educator and dietician at Baltimore Washington Medical Center in Glen Burnie, cautioned patients against checking their blood sugar only when they wake up.
“People will say, my doctor told me to check it in the morning. But your blood sugar levels change throughout the day,” said Boggs, who recommends patients take a reading before they eat a meal, then two hours after.
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Dr. Rita Kalyani, an assistant professor of medicine at Johns Hopkins School of Medicine and editor-in-chief of the Johns Hopkins Diabetes Guide, said the technology available for patients with diabetes has evolved quite a bit since the days when patients tested their glucose levels through their urine.
Taking a blood reading is much more reliable, Kalyani said.
Today’s glucose meters are also smaller and thinner and the needles are smaller, so there’s left discomfort for patients when they’re taking a reading, Kalyani said.
Other meters are designed for patients with various impairments, and feature large numbers, backlit screens or voice activation.
A lot of meters, too, are also able to store a patient’s daily readings, some of them for up to 90 days. That makes it easier for healthcare providers, as well as patients, to spot trends and troubleshoot problems, Kalyani said.
“We’ve seen a lot of changes in what we can offer a patient,” she said.
In the future, she said, patients with diabetes may even be able to use services such as cellphone apps to monitor their glucose levels.
Dr. Robert Ratner, chief scientific and medical officer for the American Diabetes Association, said the introduction of handheld glucose meters revolutionized diabetes care in the early 1980s. He likened it to being able to look at your car’s speedometer when traveling through a speed trap.
“For the first time, anyone with diabetes could see when they were dipping low, and get an idea of how high they were,” Ratner said.
There is some controversy over the accuracy of some meters, a matter the U.S. Food and Drug Administration is investigating.
“The need for them to be affordable, and accurate, is the balance,” Ratner said. “The question is, how accurate do they need to be given the cost restraints?”
Another major advance in diabetes care is continuous glucose monitoring.
A small sensor is inserted underneath the skin to check patients' glucose levels in tissue fluid around the clock.
A transmitter sends information about glucose levels via radio waves from the sensor to a wireless monitor.
Continuous glucose monitoring devices produced by two companies have been approved by the FDA, which still recommends patients do a blood test before making changes to their insulin dosage, Ratner said. But he added it’s a good step toward the development of an artificial pancreas.
Stephen Shaul of Pikesville, a Type 1 diabetic since 1991, is participating in a clinical trial for an artificial pancreas in Virginia.
Diabetes is an extremely self-directed disease, said Shaul, and it’s up to each individual patient to decide how to control it. He’s used an insulin pump for about four years, and has used continuous glucose monitoring in the past.
Shaul advised others with diabetes to do as much research as they can to determine what method of treatment works for them—and even more importantly, figure out what insurance will cover.
Even with insurance, Shaul's out-of-pocket expenses can be as high as $3,000 a year.
“The cost is astronomical,” Shaul said.