Which Technology Would Be Best In Managing A Patient’s Diabetes

Strategies For Improving Care

Recommendations

• A patient-centered communication style that incorporates patient preferences, assesses literacy and numeracy, and addresses cultural barriers to care should be used. B

• Treatment decisions should be timely and based on evidence-based guidelines that are tailored to individual patient preferences, prognoses, and comorbidities. B

• Care should be aligned with components of the Chronic Care Model to ensure productive interactions between a prepared proactive practice team and an informed activated patient. A

• When feasible, care systems should support team-based care, community involvement, patient registries, and decision support tools to meet patient needs. B

Patient And Clinician Perspectives On The Use Of Diabetes Technologies

Studies have found that diabetes technologies in general do not seem to decrease diabetes distress scores, nor do they increase them. However, as technology becomes friendlier and more effective for performing automatic tasks, users do report a reduced sense of burden of diabetes and an increase in quality of life.

Most patients consider adaptability of diabetes devices a key desirable characteristic. In interview studies, users describe an effective diabetes device as the one that will easily become a part of their own selves in their daily lives. Also, a diabetes technology or device should provide enough advantages, for it to be worthwhile considering the learning curve required to incorporate its use on a daily basis and other potential costs. Potential advantages include discretion, safety, precision, and availability of more glucose and performance information. When these advantages can be provided by a device or technology and the individual feels the learning curve is affordable, then it is the right device for them and adherence is more likely to be achieved.

The Evolving Digital Health Regulatory Environment

Current FDA guidance for digital health review includes the following categories:

1. Mobile Wellness Apps: No regulatory oversight is required for these health and wellness apps. The vast majority of apps are in this category.

2. Lower Risk Mobile Apps/Medical Devices: The FDA labels this category of apps as enforced discretion and includes a much smaller number of apps in the following subgroups:

• tools to organize and track health information
• tools to access health information and communicate with health providers and
• tools that automate simple health care providers’ tasks.

3. Mobile Medical Apps Connected to a Class 2 Medical Device: The few apps in this category require FDA oversight because they’re intended to be used as an accessory to already regulated medical devices or transform a mobile platform into a regulated device.

In 2017, the FDA unveiled its Digital Health Innovation Plan that includes the following components:

• Precertification Program. A pilot program looking to certify companies that demonstrate good quality and regulatory compliance in product development, thus not requiring review of each iteration of their products .
• Entrepreneurs in Residence. The FDA is recruiting a team of entrepreneurs to help identify requirements and offer input for a new digital health paradigm.
• Clinical Decision Support Guidance. The FDA issued draft guidance on clinical decision support software in 2017.

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How Often Do I Need To See My Primary Diabetes Healthcare Professional

In general, if you are being treated with insulin shots, you should see your doctor at least every three to four months. If you are treated with pills or are managing diabetes through diet, you should be seen at least every four to six months. More frequent visits may be needed if your blood sugar is not controlled or if complications of diabetes are worsening.

Is A Pump Right For You

If your doctor determines that a pump is a good option for you, it’s important to check with your insurance provider before you buy anything. Most insurance providers cover pumps, but sometimes they may not be covered and pumps can be expensive. In addition to cost, some considerations to consider when it comes to getting a pump are lifestyle, commitment, and safety. Learn more about the pros and cons of insulin pumps, and if they may be a good fit for you.

Remember, using a pump doesnt mean you no longer have to check your blood sugar. And it can take some getting used to, from setting it up and putting it in to managing it day-to-day. Make sure youve spoken with your diabetes care team about how to use your insulin pump correctly and how to check if its working properly.

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Anxiety And Stress Apps

Chronic conditions can be incredibly stressful and difficult to deal with, and, to make matters worse, stress can have a profound, negative impact on your physical health. Recent research has found that anxiety and depression are more common in people who have chronic conditions, such as diabetes, than in people who dont. Further, the findings also show that anxiety and depression make it more difficult for people to control their condition, can lower their overall physical health, and can decrease their quality of life.

To keep yourself as healthy and happy as possible and to make it easier to treat your diabetes its absolutely vital to take care of your mental health. A healthy diet, regular exercise, therapy, and medication are all useful tools for maintaining your mental health, but you can also add anxiety and stress reduction apps to your toolbox. They cant replace professional treatment, but they can help make a difference in your mood and mindset.

Popular anxiety, stress, and mindfulness apps include:

• Calm: This free mindfulness app offers guided meditations, soothing nature sounds, and bedtime stories to help you meditate, relax, and sleep. They offer shorter meditations for beginners and longer ones for seasoned experts. This app is available for both Apple and Android

Continuous Glucose Monitoring Minus Calibration

Abbott’s continuous glucose monitoring system , FreeStyle Libre, requires no patient calibrationneither by fingerstick or manual data entry.1 This newest approach to continuous glucose monitoring can replace the traditional blood glucose finger prick check. Instead, blood glucose levels are read through a sensor worn on the back of the upper arm. The sensor can be left in place for up to 10 days, according to the manufacturer.

Among the perks of the FreeStyle Libre versus other CGMs is that it has just two components, the sensor and the reader. Other systems typically also have a transmitter. The FreeStyle Libre user captures glucose readings by passing the hand-held reader over the sensor for a second. It’s also possible for the user to follow personal blood glucose trends and review glucose levels history over eight hours. 1

Getting rid of finger pricks is welcomed by nearly all people with diabetes, Dr. Ahn says. So much so that he predicts this technology, aimed first at those with type 1 diabetes, will soon be embraced by the type 2 diabetes market.

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Can Diabetes Cause Hair Loss

Yes, its possible for diabetes to cause hair loss. Uncontrolled diabetes can lead to persistently high blood glucose levels. This, in turn, leads to blood vessel damage and restricted flow, and oxygen and nutrients cant get to the cells that need it including hair follicles. Stress can cause hormone level changes that affect hair growth. If you have Type 1 diabetes, your immune system attacks itself and can also cause a hair loss condition called alopecia areata.

Insulin Pump Training And Support

Our educators can help you decide if pump therapy is right for you and help take the fear out of using an insulin pump. They can also provide insulin pump guidance on usage on all major insulin pumps. In collaboration with healthcare providers, our educators can also help pumpers improve their control by helping them fine-tune pump settings and problem solve fluctuations in blood glucose as well as other pump and infusion site issues along with their physician.

In addition to pump therapy, our educators can also teach people with diabetes how to use a continuous glucose monitor . The CGM reads out blood glucose data every 1 to 5 minutes and shows whether a persons glucose is rising or falling. Combining CGM with pump therapy can provide a method to monitor and manage blood glucose levels. The information obtained can also help to fine-tune the pump settings.

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What Types Of Diabetes Require Insulin

People with Type 1 diabetes need insulin to live. If you have Type 1 diabetes, your body has attacked your pancreas, destroying the cells that make insulin. If you have Type 2 diabetes, your pancreas makes insulin, but it doesnt work as it should. In some people with Type 2 diabetes, insulin may be needed to help glucose move from your bloodstream to your bodys cells where its needed for energy. You may or may not need insulin if you have gestational diabetes. If you are pregnant or have Type 2 diabetes, your healthcare provider will check your blood glucose level, assess other risk factors and determine a treatment approach which may include a combination of lifestyle changes, oral medications and insulin. Each person is unique and so is your treatment plan.

Diabetes Nutrition & Diet Tracker

That camera on your smartphone is also a barcode scanner. Use it with the Diabetes Nutrition & Diet Tracker from Fooducate to scan your food at the grocery store. This iOS app will then give your groceries a nutrition grade of A, B, C, or D using an algorithm developed by scientists, dietitians and parents. The app also explains what’s inside each product, offers healthier alternatives and helps you plan meals in order to better manage your diabetes. There’s also an exercise tracker.

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What Is Hyperglycemic Hyperosmolar Nonketotic Syndrome

Hyperglycemic hyperosmolar nonketotic syndrome develops more slowly than diabetic ketoacidosis. It occurs in patients with Type 2 diabetes, especially the elderly and usually occurs when patients are ill or stressed.If you have HHNS, you blood glucose level is typically greater than 600 mg/dL. Symptoms include frequent urination, drowsiness, lack of energy and dehydration. HHNS is not associated with ketones in the blood. It can cause coma or death. Youll need to be treated in the hospital.

What Are The Symptoms Of Diabetes

Symptoms of diabetes include:

• In women: Dry and itchy skin, and frequent yeast infections or urinary tract infections.
• In men: Decreased sex drive, erectile dysfunction, decreased muscle strength.

Type 1 diabetes symptoms: Symptoms can develop quickly over a few weeks or months. Symptoms begin when youre young as a child, teen or young adult. Additional symptoms include nausea, vomiting or stomach pains and yeast infections or urinary tract infections.

Type 2 diabetes and prediabetes symptoms: You may not have any symptoms at all or may not notice them since they develop slowly over several years. Symptoms usually begin to develop when youre an adult, but prediabetes and Type 2 diabetes is on the rise in all age groups.

Gestational diabetes: You typically will not notice symptoms. Your obstetrician will test you for gestational diabetes between 24 and 28 weeks of your pregnancy.

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Combined Pump And Cgm Systems

There are now insulin pumps and CGMs that work together to help a person optimize diabetes control. These still require input from the patient. Patients are the brains behind the operation!

Some pumps can give micro-boluses to bring blood glucose down when the sensor reading is trending high, or pause insulin delivery if there is low blood glucose. This is called artificial pancreas or closed loop technology, but is not an actual fake pancreas as people may assume from the wording. As of now, the pump and the sensor are still separate devices worn on 2 different sites on the patients body. This is a rapidly changing area in the diabetes world and new advances are occurring frequently.

Some patients worry about what others will think if they see them wearing a diabetes device. This is a very personal choice. Pumps and CGMs can be worn discreetly or more visibly. Sometimes wearing a pump can be an easy way to meet other people in the diabetes community! There have been Olympians, Miss America contestants, musicians and many others who benefit from wearing diabetes technology.

All devices have pros and cons and it is important to make an informed decision with your family and your care provider as to which type will best fit your childs needs. Technology availability is dependent on each patients insurance provider. Your childs care team will work with you to find the best solution based on coverage and medical need.

What Is Continuous Glucose Monitoring

Advancements in technology have given us another way to monitor glucose levels. Continuous glucose monitoring uses a tiny sensor inserted under your skin. You don’t need to prick your finger. Instead, the sensor measures your glucose and can display results anytime during the day or night. Ask your healthcare provider about continuous glucose monitors to see if this is an option for you.

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Why Is My Blood Glucose Level High How Does This Happen

The process of digestion includes breaking down the food you eat into various different nutrient sources. When you eat carbohydrates , your body breaks this down into sugar . When glucose is in your bloodstream, it needs help a “key” to get into its final destination where it’s used, which is inside your body’s cells . This help or “key” is insulin.

Insulin is a hormone made by your pancreas, an organ located behind your stomach. Your pancreas releases insulin into your bloodstream. Insulin acts as the key that unlocks the cell wall door, which allows glucose to enter your bodys cells. Glucose provides the fuel or energy tissues and organs need to properly function.

If you have diabetes:

• Your pancreas doesnt make any insulin or enough insulin.

• Your pancreas makes insulin but your bodys cells dont respond to it and cant use it as it normally should.

If glucose cant get into your bodys cells, it stays in your bloodstream and your blood glucose level rises.

What Should I Expect If I Have Been Diagnosed With Diabetes

If you have diabetes, the most important thing you can do is keep your blood glucose level within the target range recommended by your healthcare provider. In general, these targets are:

• Before a meal: between 80 and 130 mg/dL.
• About two hours after the start of a meal: less than 180 mg/dL.

You will need to closely follow a treatment plan, which will likely include following a customized diet plan, exercising 30 minutes five times a week, quitting smoking, limiting alcohol and getting seven to nine hours of sleep a night. Always take your medications and insulin as instructed by your provider.

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Can Diabetes Kill You

Yes, its possible that if diabetes remains undiagnosed and uncontrolled it can cause devastating harm to your body. Diabetes can cause heart attack, heart failure, stroke, kidney failure and coma. These complications can lead to your death. Cardiovascular disease in particular is the leading cause of death in adults with diabetes.

Mobile Technologies Changing Models For Diabetes Management

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In the past, health care providers have often been puzzled by how bestto optimize treatment for diabetes and improve diabetes self-management forpatients. Now, with the exploding popularity of smartphones and increasedInternet access, some might say: Theres an app for that.

Any software application that can be used on a mobile phone is nowbeing termed a mobile application. The advantage of mobile technology is thatit is anywhere and everywhere and is becoming ubiquitous to all socioeconomicgroups and all geographies, Malinda Peeples, RN, CDE, vicepresident for clinical advocacy at WellDoc, told Endocrine Today.

In the realm of diabetes care, this ubiquity allows providers to expandtheir sphere of influence and maximize the results of their care, according toCharlene C. Quinn, RN, PhD, assistant professor at the University ofMaryland School of Medicine.

Charlene C. Quinn, RN, PhD, of the University of Maryland School of Medicine, said emerging research provides evidence that mobile health interventions improve patient diabetes care.

Physicians and nurse practitioners dont have time to dolifestyle coaching when they are seeing a patient. While these tools andtechnologies cannot replace providers, they can serve as an adjunct to theclinical therapies that they are providing, Quinn said in an interview.

Basics, benefits of mobile health

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Practical Considerations For Dentists Treating Diabetic Patients

Identifying the Diabetic Patient

In order to optimally treat diabetic patients, the first challenge for dentists is to identify those individuals who have diabetes. The most obvious way to accomplish this is to ask patients about their health status. Those who say that they have received a diabetes diagnosis should be asked which type they have. However, a negative response cannot be considered conclusive. The CDC reports that 27.8% of Americans with diabetes are undiagnosed, ie, more than 8 million diabetic Americans are unaware of their condition.1

Additional questions on the medical history form may help to alert dental office personnel to undiagnosed diabetes. These should include asking if patients have recently been tested for diabetes, if they have a first-degree relative with diabetes, how often they get up in the night to urinate, how much water they drink daily, and how quickly they become hungry again after being fully satiated . Female patients who have children should be asked if they ever developed gestational diabetes while pregnant, a significant risk factor.

Assessing the Diabetic Patients Glycemic Control

Treating the Diabetic Patient

What Should My Blood Glucose Level Be

Ask your healthcare team what your blood glucose level should be. They may have a specific target range for you. In general, though, most people try to keep their blood glucose levels at these targets:

• Before a meal: between 80 and 130 mg/dL.
• About two hours after the start of a meal: less than 180 mg/dL.

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