A lot of new things have happened in the last few years, which have improved the management of diabetes. There has been an improvement in the monitoring systems. Newer glucometers are available in India, which need smaller quantities of blood, give quicker results and some of them also allow you to check the blood sugar from the forearm.

Newer methods of checking blood sugar level

Recently newer methods for checking blood sugar have become available in some countries. Glucowatch is one of them. It measures the blood sugar without a needle prick. It draws fluid from the subcutaneous tissue, which lies under the skin and measures the glucose level in it. The glucose in the subcutaneous fluid correlates well with the blood glucose level. It does not work very well with sweat; hence its use may be difficult in a tropical country like India. This device is not available in India.

Continuous glucose monitoring system (CGMS): This is a device, which provides continuous, automatic monitoring of glucose in the subcutaneous tissue. A tiny, sterile, flexible electrode is inserted just under the skin. The sensor measures glucose values every 10 seconds, up to 3 days. These readings can be downloaded on a computer. It is not possible to know your blood sugar level throughout the day with a glucometer. The CGMS records up to 288 glucose values automatically each day. Exercise, meal plan and insulin dose adjustments can be made on the basis of multiple readings obtained. This device is available in India for use by doctors.

New insulin delivery systems have become available. Disposable pens, syringes with short needles have made insulin administration easier and less painful. More recently the insulin pumps for delivering insulin have become available in India.

An insulin pump can provide effective, safe and predictable insulin absorption for many diabetic patients, making it easier for them to keep their blood glucose levels within a near-normal range, offering both short and long-terms health benefits. Pump therapy can replace insulin shots for many of them, allowing them to live a more flexible lifestyle, free from rigid meal, exercise and sleep schedules necessary for those taking insulin shots. Diabetes patients, who are using a pump, can eat what they want, when they want, by manually adjusting the infusion rate to account for changes in their blood glucose levels.

What pump is available in India?

In India & South Asia Medtronic Minimed offers the Model 508 Pump. This pump has been used in USA and Europe for a number of years.

What is an Insulin Pump?
An Insulin Pump is a small, battery-operated device (about the size of a pager) for delivering insulin and it can replace insulin injections for insulin dependent diabetes patients.

How does an Insulin Pump work?

The pump delivers insulin from a reservoir inside the pump, through a thin plastic tube (called an infusion set), to the body. Most infusion sets are worn in the abdominal area and use a tiny, flexible tube, called a cannula, which is inserted easily into the skin using an insertion device. Patients generally refill their insulin and change their infusion sets every two to three days.

A pump is easy to program and automatically delivers a constant rate of insulin – called a “basal rate” – to keep blood glucose in the desired range between meals and over night. Guided by a physician, the user creates a customized basal pattern, with the goal of closely matching individual needs. Pump users can easily adjust the pump for changes in lifestyle needs, and can program insulin delivery at mealtimes.

What are the benefits of pump therapy?

• It helps achieve “tight glucose control”. Diabetes patients can easily adjust insulin to keep glucose levels within a near-normal range.
• Action closely mimics the pancreas. A healthy pancreas delivers insulin every 10 to 14 minutes The Insulin Pump closely mimics the pancreas by delivering insulin effectively, continuously round the clock and. with minimal variability.
• Precision and accuracy: It delivers insulin precisely and accurately in 0.1 unit increments, which is nearly impossible for people using traditional injection therapy.
• Allows flexibility of life style: Unlike patients using longer-acting insulin with injection therapy who must follow rigid schedules of insulin shots, meals and snacks, patients using an insulin pump can program insulin delivery when they eat, and adjust or stop insulin delivery for exercise or other needs. Patients using pump therapy can eat what they want, when they want – something almost unheard of in patients treating their disease with traditional insulin injections.
• Secrecy of therapy: The pump remains hidden under the clothes. Diabetes patients can use a small, hand-held remote programmer to discreetly program insulin delivery without accessing the pump.

How effective is an insulin pump in treating diabetes?

The insulin pump is an excellent tool for improving glycemic control. Tight glycemic control is important for good health. The Diabetes Control and Complications trials (DCCT) showed that patients who maintained near-normal glycemic control had a significantly reduced risk of long-term complications. The risk of diabetic eye disease decreased by up to 76 %t, nerve disease was reduced by up to 60 %, and kidney complications were reduced by up to 56 %. In addition, a DCCT follow-up study revealed that near-normal control could delay the onset of complications from diabetes by an average of 15 years and prolong life an average of five years.