TO INFINITY AND BEYOND HEMOGLOBIN A1C Hemoglobin A1C TIME IN - - PowerPoint PPT Presentation

TO INFINITY AND BEYOND

DIABETES TECHNOLOGY:

HEMOGLOBIN A1C

▸ Hemoglobin A1C

TIME IN RANGE

TYPES OF INSULIN

▸Rapid acting, short acting or bolus insulin ▸Humalog, Admelog (insulin lispro) ▸Novolog, ultra rapid acting Fiasp (insulin aspart): onset within 2.5 minutes ▸Apidra (insulin glulisine) ▸Long Acting Insulin or basal insulin ▸Lantus, Basaglar and Toujeo (insulin glargine); Toujeo is 18 years and older ▸Levemir (insulin detemir) ▸Tresiba (insuln degludec); starting dose is 75% of Lantus/Levemir ▸Other ▸NPH, regular insulin (not widely used in type 1 diabetes anymore)

INSULIN DELIVERY

▸ Vial and syringe ▸ Pens

▸ Full unit pens ▸ Half unit pens

▸ Insulin pumps (short acting insulin only)

▸ Medtronic ▸ Omnipod ▸ Tandem T-Slim

CONTINUOUS GLUCOSE MONITORS (CGM)

▸ Medtronic

▸ (used with or without artificial pancreas)

▸ Dexcom

▸ (used with or without artificial pancreas)

▸ Freestyle Libre

▸ (18 years and older)

▸ Eversense implantable CGM

▸ (18 years and older)

GLUCOMETER

▸ There are a number of meters that

are able to upload data to an app on a phone.

▸ Dependent upon personal

preferences and insurance coverage

INPEN BY COMPANION MEDICAL

▸ Reusable insulin pen that uses

Bluetooth technology and a smart phone app to calculate and record insulin doses

▸ Use in patients 12 years and older ▸ Can deliver in 1/2 unit increments

up to 30 units total

▸ Compatible with Humalog and

Novolog insulin

IN PEN: AT A GLANCE

▸ This screen shows the patient’s

current status at at glance.

▸ You can see when the last dose

• f insulin was given, active

insulin and previous doses given.

INPEN: DOSE CALCULATOR

▸ The patient enters in blood sugar

reading and carbohydrates and the app will calculate the dose.

▸ Also takes into account insulin on

board/active insulin.

▸ This minimizes the risk of

hypoglycemia from “stacking of insulin”

▸ This is also how insulin pumps

calculate insulin doses

INPEN: DOSE REMINDERS

▸ Can be set to remind patients to

take insulin, check blood sugars, take their long acting insulin dose, check blood sugars after eating and change the insulin cartridge.

INPEN: REPORTING

▸ This report can be shared from the

app with medical providers to

• ptimize glycemic control.

INPEN: TEMPERATURE ALERT

▸ Temperature extremes can affect

insulin potency.

CONTINUOUS GLUCOSE MONITORING

▸ Dexcom ▸ Medtronic ▸ Freestyle Libre ▸ Eversense

DEXCOM CGM

▸ Dexcom G6: reads interstitial blood

sugars every 5 minutes and sends that data to a receiver (iphone, some Android device or a Dexcom receiver)

▸ 10 day wear ▸ No calibration ▸ No interference with Acetominophen ▸ Allows up to 10 people to follow along

(only if using a phone as the receiver)

MEDTRONIC CGM

▸ Medtronic Guardian 3 sensor reads

interstitial blood sugars every 5 minutes and sends that data to the Medtronic 630 or 670G pump

▸ 7 day wear ▸ Requires calibrations ▸ Difficulty for other people to see

the blood sugars in real time

FREESTYLE LIBRE CGM

▸ Libre: consists of a handheld reader

and a sensor worn on the back of the

• arm. Measures readings every

minute.

▸ 14 day wear ▸ Requires the user to actively scan

to get a reading

▸ Not able to be alerted to low or

high blood sugars unless the sensor is scanned

▸ FDA approved for 18+ years ▸ Libre link up app allows

family/friends to view your blood sugars after you scan

INSULIN PUMP

▸ Advantages

▸ Less risk of low blood sugars from stacking insulin ▸ Can give fractions of units ▸ Lifestyle improvements (no injecting in public, can eat more frequently, etc)

▸ Disadvantages

▸ No long acting insulin which raises the risk of DKA with pump malfunction ▸ Cost

TUBING PUMPS AND TUBELESS PUMPS

Tube Pump: Medtronic Tandem Tubeless Pump Omnipod

ALL PUMPS HAVE THEIR PROS AND CONS

ARTIFICIAL PANCREAS TECHNOLOGY

▸ *Patient must wear both and insulin pump and a continuous glucose

monitor

▸ *Automatically administers and withholds insulin based on predicted

blood sugars received from a CGM

HYBRID CLOSED-LOOP SYSTEM

MEDTRONIC 670G HYBRID CLOSED LOOP INSULIN PUMP WITH SMARTGUARD TECHNOLOGY

▸ Auto Mode ▸ Adjusts basal insulin every 5 minutes based on CGM readings ▸ Suspend before low ▸ Stops insulin up to 30 minutes before reaching preset low limit ▸ Automatically restarts insulin when blood sugar recovers ▸ Requires fingerstick calibrations of CGM to stay in Auto Mode

HYBRID CLOSED-LOOP SYSTEM

TANDEM T:SLIM X2 WITH CONTROL-IQ TECHNOLOGY

▸ Automatic insulin

adjustments based on Dexcom G6 readings

▸ Requires no fingersticks ▸ Treatment values are set ▸ Can set sleep and

exercise activity settings

▸ Will leave Control-IQ if

Dexcom and Tandem pump lose connectivity

NON-FDA APPROVED TECHNOLOGIES

▸ RileyLink ▸ NightRider BluCon