Concerns - Diabetes Technology, pens, pump, meters etc....

[Lasher]

Felt the urge to post, firstly to vent my spleen slightly and also to see if there is anyone out there involved with Diabetes technology that can answer a few questions for me...
Being fairly tech-savvy it's come to my attention that much of the technology we seem to be using to assist in coping with our condition (I'm a type 1 insulin dependant diabetic btw) seems to all be like something out of the 1970's - I was diagnosed at the age of 18, I'm 42 now and most of the kit seems to have made very little improvement - excuse the slight rant and please allow me to go into a little more detail....
First off - Insulin Pumps. After being advised ny my diabetic nurse that an insulin pump would be "more conveinient" I started to look into the matter. Now I've always assumed that seeing as an insulin pump requires you to have a canular inserted, i.e. a constant connection to your bloodstream, that an inslulin pump would, of course be monitoring your blood sugar and changing the insulin level as required - much lika a small artificial pancreas. I was somewhat surprised to discover that they do no such thing - you still have to manually measure your sugars and dial the required amount into the pump. How is this in any way easier than using, for instance, a Novopen and manually injecting? Plus I don't have the added unpleasantness of a constantly inserted canular?
Is it not possible for an insulin pump be designed to read blood sugar levels, and if so why exactly not?- it has direct access to as much blood as it requires.

On a similar note - blood glucose meters. Why, do they all have to be the size of a small office block and why is there this constant reliance on "test strips" of some sort. The strips always come in bulky cylinders, doubling the size of the required pouch to carry it and need a constant supply.
Can anyone tell me the mechanic of why disosable strips are required and not just some sort of in built reader? My suspicions would be that the only reason for "test strips" is so that part of the meter is a consumable therefore providing a constant (and I'm sure lucrative) need for the strips and a stream of revenue for the meter manufacturers. (You'll have to excuse my cynisism here but if you've ever bought test strips without a prescription you'll see exactly what I mean)
With the current level of technology would it not be possible to contruct a stripless meter - preferrably built into the housing of a finger clicker allowing you to prick your finger and thebn dab it onto a pad on the same device to obtain a reading?
In fact could this whole thing not be incorporated into something around the size of a novopen - insulin deliver device, meter and finger pricker?
It may sound like i'm asking a lot, but when you examine the size of the elctronics required for this kind of thing I'm really not asking for a hoverboard here - just modern, well engineered solution to make it more portable for us all.
I know that smaller technology is obviously more expensive, but with what your average smartphone is now capable of it really seems to me that we're being left in the dark ages here for no good reason whatsoever.
If anyone has feedback on why any of this is not possible I'd be most interested.

 

[sugar2]

Re: Concerns - Diabetes Technology, pens, pump, meters etc..

HI, I am by no means an expert, but, as far as I am aware...

pumps.

Yes, I was surprised that they don't react toyour BG automatically. Some can be fitted with a CGM, but these are expensive, and by no means common place. I hope that this will become more common place...but not yet. Pumps (in my opinion anyway) do have huge advantages over pens and what not, as, you can at least react to what you monitor is saying, ie turn theinsulin down if required. Sure, if your BG is high, it is pretty much the same, but you can at least plan ahead,,,and if like me, you suddenly realise that you actually need to run round the supermarket, dash around the office, walk instead of drive, you can reduce your insulin accordingly, rather than having to eat, because you had some long acting insulin 6 hours ago whch is still in your system.

BG monitors
well, they make their money selling you/NHS the strips.
Also, it is not like the new iphone, these things are medical devices and therefore need to undergo lots of testing etc...no excuse, but does helo to explain why progress is slow. Depends how you see prgress I guess, but when I was diagnosed 34 years ago, all we could so to tell what our sugar was (note not blood sugar) was to pee on a stick...so I am at leats thankful for that progress! I do agree with you though..waiting for the next step change seems to be a long wait!

 

[AMBrennan]

Re: Concerns - Diabetes Technology, pens, pump, meters etc..

Are you a biochemical engineer? I'm not so all I know (from Wikipedia, of course) is that modern glucose test strips are based on enzymes specific to glucose which, presumably, are used up in the test; and reusable things like centrifuges aren't sufficiently portable. The problem of the kind of big breakthrough needed here is that they are, by definition, quite rare.

 

[randomange]

Re: Concerns - Diabetes Technology, pens, pump, meters etc..

Pumps: The main issue here is that pumps do not connect directly to your bloodstream - the cannula is inserted into subcutaneous fat i.e. the same place you inject. It has no information on the glucose level in your blood. Actually having a canulla inserted into the blood stream would be much more difficult than sticking one into subcutaneous fat. There are currently several systems on the market that allow a continuous monitoring of the glucose levels (GCMS), however, these sensors read the level in the extracellular fluid and not the blood, and so are about 15 minutes behind what the actual blood levels are. That problem, combined with the delay in action of insulin due to absorption, peak times etc is why there is currently no artificial pancreas. There are people working on it however, these things take time as they are medical devices. In my view, the advantage of pumps is that ability to fine tune the insulin delivered - I can set many different basal rates throughout the day, I can turn this up or down and see results much more quickly, I can adjust the way a bolus is delivered to match the food eaten. It also means less injections, and the canulla is not at all uncomfortable.

Meters: AMBrennan has hit it right on the head.

 

[copepod]

Re: Concerns - Diabetes Technology, pens, pump, meters etc..

Test strips don't always come in cylinders, bulky or otherwise eg Optium Xceed strips are indivividually wrapped in foil, so you can take as many or as few as you want.

 

[slimtony]

Re: Concerns - Diabetes Technology, pens, pump, meters etc..

My current meter is certainly much smaller, quicker, more reliable, and more convenient than the original test meter I had back in the early 90s.

I'm not saying it was large, but it had a towing eye and a wheel on each corner. And it required one of the world's rarest and most expensive batteries, which could only be bought from camera shops high in the Andes mountains. And only if they had them in stock. Which was mostly never.

However, once you and several burly friends had maneuvered it into position and powered it up, it was surprisingly easy to use. You simply provided it with blood. Lots of blood. This meant milking your finger until you went slightly light-headed. Any blood left over once you'd covered your hands, face and shoes would hopefully find its way onto the test strip. After exactly 1 minute, you'd wipe the blood off and put the strip in the meter. Then all you had to do was wait for THE REST OF TIME for the result. At which point (assuming you hadn't died of a hypo or old age by now), it would beep loudly, flash "Error" on its display, and then turn itself off. Which was clever.

You were then left to take the strip out of the meter and manually check it with the colour chart on the side of the strip tub. Your reaction to the test result all depended upon which insulin you used. If, like me, you were using Mixtard 30, then you said either "did I do my jab twice?" or "so that's why I feel so thirsty".

Happy days.

 

[james28]

the global continuous glucose monitoring market was valued at USD 0.37 billion in 2012 and is expected to grow at a CAGR of 13.6% from 2013 to 2019, to reach an estimated value of USD 0.91 billion in 2019.

Browse Global Sterilization Equipment and Disinfectants Market Report with Full TOC at http://www.transparencymarketresearch.com/continuous-glucose-monitoring.html

Continuous glucose monitoring systems (CGMS) are real time glucose monitoring devices that measure and display the glucose level of the interstitial fluid in the skin cells of the patient. These devices help patients manage diabetes (Type 1 and Type 2) in a more efficient manner. CGM devices typically comprise a sensor, transmitter and a receiver. The sensor is placed underneath the skin for monitoring glucose levels and is attached to the transmitter that relays the information to the monitor. Until recently, management of diabetes involved the use of conventional blood glucose meters that provided a single time snapshot of the patient's blood glucose level. However, demand for real time monitoring, minimally invasive and effective diabetes management solutions led to the advent of CGM devices. Rise in the incidence of diabetes globally coupled with increasing awareness of such devices that possess the ability to detect hyper and hypoglycemic events in real time will fuel the growth of this market during the forecast period.

CGM is a rapidly evolving market supported by increasing adoption of these systems by hospitals and individual practitioners who further encourage their patients to use these devices. However, CGM systems are not meant to be replaced by the traditional diabetes management devices. Hence, the technology still requires innovation in terms of accuracy and precision. Reimbursement issues, high cost of devices and low market penetration rates are some of the factors that are expected to hinder market growth in the near future. Medtronic's Guardian Real Time CGM System accounted for the largest share of the global marketin 2012, accounting for a share of over 40%. The product's first mover advantage in the market, proper positioning and marketing of the product, and ease of convenience and usability helped it achieve this leadership position. Dexcom's fourth generation product, namely, Dexcom G4 Platinum is anticipated to witness the highest market growth at a CAGR of 22.6% during the forecast period. G4 Platinum is the most recently launched device (2012) and is the most technologically advanced, offering more accuracy and reliability as compared to other commercially available devices. In addition, integration of this device with insulin pumps from various other manufacturers like Johnson & Johnson and Tandem Diabetes Care would also drive the growth of this market segment.

Geographically, North America captured majority share of the global continuous glucose monitoring market in 2012. Increase in type I diabetic population along with rise in geriatric population which will in turn spur the demand for regular monitoring of glucose levels will fuel the growth of this market. Major players of this market are domiciled in this region, which allows easy market penetration and will also contribute towards market growth. The European CGM market is in a rapidly evolving state and contributed the largest share of the total CGM market revenue in 2012. Asia-Pacific is expected to witness tremendous increase its market share and emerge as the fastest growing region, reporting a CAGR of 16.9% during the forecast period. Economic developments, presence of a large patient pool, rising patient awareness, increasing disposable income and changing lifestyle are some of the significant factors that are poised to increase the demand for CGM systems in this region.

 

[gregoryblack]

I had to give my BG Star meter back to my medical practice as I could not read the menus on the display, i don't think my eyes are particularly bad as I can read moall library books I have without any bother I have reverted to my Contour M meter as this is just about readable, I am 67 years old and my eyesight is not what it was does any one know of a more readable meter?

 

[michaeldavid]

I developed diabetes 30 years ago. And I mostly still use what was available then.

The modern meters I find to be very good. But I only need to use them once or twice a day.

The rest of the time, I use visually read strips. (http://www.betachek.com/uk/) And I still cut them with scissors, just as I was advised to do 30 years ago.

I tried using a pen-injector once. But the're far too lumpy and clunky. I found the thing so big and fat, I couldn't properly see the injection site.

Accordingly, I still use disposable syringes, just as I did almost 30 years ago. (Initially, I was given one of those large glass syringes, which one had to store in methylated spirit; the 'modern' pen-injectors remind me of them.)

I believe that the real problem lies not with the technology as such. (As I say, the meters are very useful; but the cost per test is around 20 times the cost per test using visually read striplets!) I believe the real problem is what might be called 'reverse Luddism': people accept things, and believe they must be good, just because they're modern.

For gregoryblack: I use the OneTouch Ultra meter, which I find perfectly easy to read.

 

[novorapidboi26]

I think the technology exists it just the cost to make it widely available is a little too much at the moment......

I believe there is research taking place that will allow non invasive blood glucose monitoring. Firing a certain type/frequency of light through the blood or something, so still early days, but lots of potential, especially for integrating into a pump etc.

I also heard about a reservoir implant that is installed with surgery and is housed inside some kind of gel that detects blood sugar levels and then releases the insulin as and when needed, you can then refill the reservoir with a tube that hangs from your body...[not to keen on that, but would fight past the fears if I could lead a normal life..]...

It all boils downs to money as you know..........when will that change? who knows, not any time soon anyway.......

 

[noblehead]

I also heard about a reservoir implant that is installed with surgery and is housed inside some kind of gel that detects blood sugar levels and then releases the insulin as and when needed, you can then refill the reservoir with a tube that hangs from your body...[not to keen on that, but would fight past the fears if I could lead a normal life..]...

How good would that be........

 

[Jaylee]

I developed diabetes 30 years ago. And I mostly still use what was available then.

The modern meters I find to be very good. But I only need to use them once or twice a day.

The rest of the time, I use visually read strips. (http://www.betachek.com/uk/) And I still cut them with scissors, just as I was advised to do 30 years ago.

I tried using a pen-injector once. But the're far too lumpy and clunky. I found the thing so big and fat, I couldn't properly see the injection site.

Accordingly, I still use disposable syringes, just as I did almost 30 years ago. (Initially, I was given one of those large glass syringes, which one had to store in methylated spirit; the 'modern' pen-injectors remind me of them.)

I believe that the real problem lies not with the technology as such. (As I say, the meters are very useful; but the cost per test is around 20 times the cost per test using visually read striplets!) I believe the real problem is what might be called 'reverse Luddism': people accept things, and believe they must be good, just because they're modern.

For gregoryblack: I use the OneTouch Ultra meter, which I find perfectly easy to read.

I remember the glass syringe back in the mid/late 70's with the disabled car blue screw cap surgical spirit container to keep it in.. The container had a removable flute base so you could stand it upright... You have no idea how many times that glass shattered in transit....
I much prefer my Novopen....

 

[michaeldavid]

I have have a vivid mental picture of the same wretched blue thing. (I never noticed that the base was removable.)

What a relief when, a week or so later, I was prescribed a pack of disposable plastic syringes. (The modern ones are excellent, but they haven't needed to change much in all that time.)

Using a simple plastic syringe made me feel relatively normal.

 

[AlexMBrennan]

How is this in any way easier than using, for instance, a Novopen and manually injecting?

It's not, which is why your nurse made no such claim; fact is that insulin pumps allow for a insulin regime that is closer to insulin produced by a healthy person (e.g. You can lower basal rate for exercise rather than having to eat tons of carbs, and the pump simply automates what is essentially equivalent to you injecting a small amount of Novorapid every hour).

Is it not possible for an insulin pump be designed to read blood sugar levels, and if so why exactly not?- it has direct access to as much blood as it requires.

Insulin pumps don't inject insulin directly into the bloodstream but rather into subcutaneous fat much like you inject Novorapid into fat rather than via IV.
What could be done is linking data from a CGM to the pump, and as I understand it various "combos" do just that.

On a similar note - blood glucose meters. Why, do they all have to be the size of a small office block and why is there this constant reliance on "test strips" of some sort. The strips always come in bulky cylinders, doubling the size of the required pouch to carry it and need a constant supply.
Can anyone tell me the mechanic of why disosable strips are required and not just some sort of in built reader? My suspicions would be that the only reason for "test strips" is so that part of the meter is a consumable therefore providing a constant (and I'm sure lucrative) need for the strips and a stream of revenue for the meter manufacturers. (You'll have to excuse my cynisism here but if you've ever bought test strips without a prescription you'll see exactly what I mean)

Because it takes more than a good idea for a device to magically poof into existence.
Simply put, glucose meter strips use encymes to react with the glucose in the blood sample in a way that can be analysed by the small meter; this saves you carrying around a mass spectrometer the size of an office cubicle.

By the way, this is hardly the only test where reagents are consumed in the process.

With the current level of technology would it not be possible to contruct a stripless meter - preferrably built into the housing of a finger clicker allowing you to prick your finger and thebn dab it onto a pad on the same device to obtain a reading?

The answer is evidently no, but you are welcome to prove me wrong by patenting just such a device.

 

[Osidge]

Info on the availability of an "artificial pancreas": http://newsroom.medtronic.com/phoenix.zhtml?c=251324&p=irol-newsArticle&id=1859361

There is certainly work continuing on developing new generation APs

Regards

Doug

 

[Osidge]

On the metre front, this is what I use: https://www.accu-chek.co.uk/gb/products/metersystems/mobile.html

Regards

Doug

 

[Jaylee]

I have have a vivid mental picture of the same wretched blue thing. (I never noticed that the base was removable.)

What a relief when, a week or so later, I was prescribed a pack of disposable plastic syringes. (The modern ones are excellent, but they haven't needed to change much in all that time.)

Using a simple plastic syringe made me feel relatively normal.

The plastic ones were smoother in the action as opposed to the glass.. But normal for me? No. I was caught "using" at college..
& the rumours went on their merry way....

 

[ElyDave]

Re: Concerns - Diabetes Technology, pens, pump, meters etc..

Are you a biochemical engineer? I'm not so all I know (from Wikipedia, of course) is that modern glucose test strips are based on enzymes specific to glucose which, presumably, are used up in the test; and reusable things like centrifuges aren't sufficiently portable. The problem of the kind of big breakthrough needed here is that they are, by definition, quite rare.

my meter is based on eletrical charge/conduction. Enzymes are by no means quick enough for the 5 second readout.

I would have thought that the main reason for individual test strips is to prevent cross contamination and false readings, as you'd need a very effective/efficient cleaning process which in itself could not affect the next test

 

[mo1905]

Much of it is down to cost. An iPhone is approx £600. If we were prepared to pay this sort of money for a BG meter, I think there would be more money from business and advancements would be quicker. Also, as others have said, there's too much money to be made selling strips so why would the manufacturers want to change such a lucrative market.


Sent from the Diabetes Forum App

 

[ElyDave]

Much of it is down to cost. An iPhone is approx £600. If we were prepared to pay this sort of money for a BG meter, I think there would be more money from business and advancements would be quicker. Also, as others have said, there's too much money to be made selling strips so why would the manufacturers want to change such a lucrative market.


Sent from the Diabetes Forum App

I'd be happy to make a contribution to a one-off purchase of a "meter for life" with no strips attached.

But when you look at it, even if it were £600, what's the cost of a minimum 50 strips a week for the next 40 years?

Currently £23 a tub on one site, I make that a minimum £1200 a year.

But we're worth it