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

of 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

optimize 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 LIBRECGM

▸ 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