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The past is behind, learn from it. The future is ahead, prepare for it. The present is here, live it. Thomas S. Monson
Glucose Monitoring
anTcient method modern method
Glucose Monitoring
First Glucose Meter
Glucose Monitoring
Home blood glucose meters measure the glucose in whole blood, while most lab tests measure the glucose in plasma. Plasma glucose levels are generally 10%15% higher than glucose measurements in whole blood. Most of the modern meters on the market give results as "plasma equivalent," even though they are measuring whole blood glucose. Sample sizes vary from 30 to 0.3 l. Test times vary from 5 seconds to 2 minutes.
Glucose Monitoring
CGMS
Continuous Glucose Monitoring System
test glucose in the IF every few minutes for up to 7 days alarm system warns if glucose rapidly changes real time results
by analyzing the trends, the patient or the physician can adjust insulin leads to better glycemic control
Insight
No clue what to do
Benefits of CGMS
Increased security from alarms & alerts Immediate feedback - look and learn BG trend provides more information than static readings
Control + safety
Limitations of CGMS*
Interference with glucose readings by sensor can occur with certain substances
- i.e.gluthatione, ascorbic acid, uric acid, salicylates can cause
co-oxidation, which will lead to overestimation of glucose levels
Lag-time for up to 15 minutes when glucose changes rapidly Overall percentage of error near 15%
Guardian REAL-Time 17% DexCom 11-16% Navigator 12-14%
* E. Cenzic, MD and William tamboriane, MD. A Tale of Two Compartments: Interstitial Versus Blood Glucose Monitoring. DIABETES TECHNOLOGY & THERAPEUTICS. Volume 11, September 2009.
sends insulin through the skin , using high pressure mechanism an option for people with severe needle phobia
The prototype of the first pump that delivered glucagon as well as insulin, backpack style, was in the early '60s.
provide continues insulin delivery infusion site needs to be changed only every 2-3 days
Pump Advantages
More reliable, precise insulin action Fewer missed doses Less insulin stacking Fewer lows, especially at night Easier to exercise Less glucose exposure and variability Less insulin Matches variable basal insulin need Fewer social limitations Better data access for providers and patients
1) 1 hr temp basal at 0% 2) 2.5 hr temp basal at 60% 3) temp basal at 85% overnight
Future
Closed Loop?
Still needed: Faster insulins Better CGM accuracy Less sensor lag time Glucose control algorithms that wont fail Closing the loop will come in small steps over time
SmartCell, which was originally developed at the Massachusetts Institute of Technology.*** - When glucose rises in the bloodstream, the structure of the SmartCell will be eaten away. This breakdown of the
SmartCells protein matrix facilitates the release of insulin
*Martinac K, Metelko Z. Nanotechnology and diabetes. Diabetologia Croatica 2005; 34(4):105-110. ** Fritas RA. Current status of nanomedicine and medical nanorobotics. http://www.nanomedicine.com /Papers/NMRevMar05.pdf accessed January, 2010 ***Aaron K. Outsmarting Diabetes. Cornell Engineering Magazine 2003. http://eng-2k- web.engineering.cornell.edu/engrMagazine/magazine.cfm?issu..., accessed January, 2009
**** Pickup JC, Zhi ZL, Kan F, et al. Nanomedicine and its potential in diabetes research and practice. Diabetes Metab Res Rev 2008; 24(8):604-610.
21 December 2009 University of Western Ontario Tears of Joy for Diabetics The non-invasive technology uses extremely small nanoparticles embedded into the hydrogel lenses. These engineered nanoparticles react with glucose molecules found in tears, causing a chemical reaction that changes the color of the lenses.
Clinical aspects:
Quality Improvement:
In collaboration with: Carmen Schmidt, RN; Angela Babayev, RN; Dahlia Rizk, DO; Steven Bergmann, MD; Jacqueline Lagazo-Guia, NP; Phillip Schmidt, MD
Diabetes: Diagnosis, Classification, Management. Controversies and News. * By Dr. Leonid Poretsky, Chief, Division of Endocrinology and Metabolism, Beth Israel Medical Center. (September 15th, 2009) Insulin therapy in outpatient and inpatient settings. * By Dr. Agustin Busta. (December 1st, 2009) Medical Nutrition Therapy for Diabetes. Does a perfect eating plan exist? * By Jennifer Regester, RD, CDN. Diabetes Technology Update. * Marina Krymskaya, ANP, CDE. (January 26, 2010)
* Slides available at www.friedmandiabetesinstitute.com
Thank You!