We live in a century of technological revolution. Like every other sphere of our life, diabetes-related technology is moving forward with lightning speed. New and improved insulin administration devices, increased capacity for monitoring one's blood glucose levels, and the ability to communicate directly with the device supplying insulin as well as with the patient and his or her healthcare provider have changed the landscape of diabetes therapy forever.
However, diabetes technology is progressing faster than healthcare professionals can incorporate these advances into their practices. To bridge this gap, Diabetes Technology provides an historical overview of diabetes technology, addresses the clinical science of new and advancing technologies, and illustrates the use of diabetes technology in different treatment settings. This guide also explores the personal stories of healthcare providers who treat their own diabetes with modern diabetes technology.
"Index", Diabetes Technology: Science and Practice, Boris Draznin, MD, PhD
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Note: Page numbers followed by an f refer to figures. Page numbers followed by a t refer to tables. Page numbers in bold indicate an in-depth discussion.
A1C levels
American Diabetes Association goal for, 301
case study of 57-year-old man with type 1 diabetes, 303, 304
CGM for patient with type 2 diabetes and 9.3%, 215–220, 217f, 218f, 219f
CGM in measurement of, 15, 105
CGM systems and CSII in reducing, 15
coefficient of variation (CV) versus, 50, 51t
diabetes first person account by Burge, 361–362
diabetes first person account by Kowalski, 387
diabetes first person account by Michels, 328
diabetes first person account by Sherr, 372
diabetes first person account by Tridgell, 346
diabetes first person account by Unger, 393
glycemic control improvement with insulin pump settings case study
first visit, 243t
follow-up visit, 159t
limitations of, 106
older patients with hypoglycemia, 263, 265
A1C-Derived Average Glucose study, 105
Abbott FreeStyle Libre sensor, diabetes first person account by Unger, 394
Abbott Libre PRO glucose sensor, 208
Abbott Libreview, 49
Abbott Navigator, 387
Accu-Check Aviva Connect, 79
Accu-Chek Guide app, 79
active insulin time (AIT), 170–171
inpatient policy for insulin pump settings, 173
insulin pump data with, 111, 114
advanced practice providers (APP), 17–18
aerobic exercise
blood glucose levels decreased by, 138
rise in glycemia with, 139
alcoholic beverages, diabetes first person account by Eckel, 312
alternate controller enabled (ACE), 7
ambulatory glucose profile (AGP)
CGM interpretation in report from, 107–108, 107f, 108f
CGM review, 49, 50, 51t
Dexcom Clarity app data, 80, 107f
FreeStyle Libre CGM glucose pattern in, 108f
insulin pump data with, 112f, 113, 115f
Tidepool “Trends” view showing, 115f
usefulness of, 50, 51t
American Association of Diabetes Educators (AADE), 17
American Diabetes Association
A1C goal of, 301
support in hospital for CSII, 165
Animas insulin pump
diabetes first person account by Stephens, 323
diabetes first person account by Tridgell, 345
Animas Ping, 345
Animas Vibe, 345
Apple Health app, 79–80
Apple iPhone App Store, 75
“artificial pancreas system” (APS), 362
assisted monitoring of blood glucose (AMBG), 3–4
automated insulin delivery (AID), 7
apps future with, 86
benefits of, 342
diabetes first person account by Rudolph, 340–343
hybrid closed-loop systems, 293–298, 295f, 296f, 297f
MiniMed 670G hybrid closed-loop system, 293–294
trust in, 342
Auto-Syringe 2C insulin pump, 390f
Auto-Syringe 6C, 390f
Barbara Davis Diabetes Center, 323, 327
basal doses, hybrid closed-loop (HCL)
system settings of, 293
basal insulin delivery, 34–35
basal insulin titration apps, 84–85
basal rate, 166, 170
children’s diabetes pump settings with, 126–127, 126f
definition, 190t
exercise strategies with temporary, 140
retrospective data review with temporary, 132
temporary, 171
total daily dose (TDD) in ratio with, 127
Basal-IQ technology, 110, 169t
Benedict’s Qualitative Test, 350
blood glucose (BG) levels
aerobic exercise decreases, 138
diabetes first person account by Burge, 357, 359, 361–362
diabetes first person account by Edelman, 378, 382
diabetes first person account by Hirsch, 389–390
diabetes first person account by Kowalski, 385–387
diabetes first person account by Rudolph, 332, 333, 338–343
diabetes first person account by Sherr, 367, 371
diabetes first person account by Tridgell, 345–347
diabetes first person account by Unger, 393–394
glycemic control improvement with insulin pump settings case study
first visit, 243
follow-up visit, 249, 258
hybrid closed-loop (HCL) systems settings of, 293
hyperglycemic teenager case study, 227–228, 229f, 230f
physical activity in management of, 137–139, 138f
professional CGM use as predictive technology for, 277–280, 278f, 279f, 280f, 281f
self-monitoring of, 1–2
bolus delivery, 170
bolus insulin delivery, 35–37, 36f, 37f
“brittle diabetes,” 311
Burge, Mark R., MD
A1C levels, 361–362
“artificial pancreas system” (APS), 362
Benedict’s Qualitative Test, 350
blood glucose levels, 357, 359, 361–362
camp counselor job, 359 CGM, 361–362
Chemstrips capillary blood glucose strips, 359–360
Clinitest urine test, 357, 359
Dexcom 7, 361
diabetes diagnosis, 350, 357
dietary recommendations for early years of diabetes, 350
family history of type 1 diabetes (T1D), 349
Burge, Robert William, 351–357, 353f–354f, 358f
Pfund, David Elmer, Jr., 349–351, 352f
family photos, 352f, 353f, 354f, 358f
healthcare costs, 361–362
insulin pump, 360–362
medical school acceptance, 359
Medtronic Paradigm pump, 360
MiniMed 508 pump, 360
OpenAPS, 362
Paradigm 772 pump, 361
photo at age 58, 350f
residency, 360
tenure-track position, 360
Ultralente insulin, 360
University of Oregon, 357
University of Wisconsin, Madison, 360
urinating, 357
weight gain, 361
Burge, Robert William, 351–357, 353f–354f, 358f
diabetes diagnosis, 356
diabetes self-help books, 355, 356f
diabetic coma, 355
family photos, 352f, 353f, 354f, 358f
hypoglycemia, 356–357
Lilly Iletin Regular and NPH insulin injections, 355
medical discharge from Navy, 355
National Park Service work, 355
physical activity, 356
Portland Diabetes Clinic, 355 roadside store, 351
sales representative for Monroe Industries, 355
service-connected disability, 355
University of Oregon, 355, 356
World War II, 351, 355
C8 Optical Glucose Monitoring System, 4
CalorieKing app, 76–77
carbohydrates. See also insulin-to-carbohydrate ratio (ICR)
counting carbohydrates app, 76–77
diabetes first person account by Rudolph, 333–334, 338, 341
need for tighter control for intake of, 121
“phantom carbohydrate intake” case study 10-year-old girl with type 1 diabetes (T1D), 224, 224f, 225f, 226t
case study 17-year-old man with type 1 diabetes (T1D), 221–224, 222f, 223f
power of sample case study with content in diet of, 285
strategies for older patients with hypoglycemia and intake of, 265
cardiac catheterization, hospital policy for insulin pump, 180t
CARE acronym, 294, 297–298
CareLink reports
from MiniMed 670G System, 112f, 113f
“Weekly Review” portion of, 113f
Cellnovo Insulin Pump, 25f
Center for Diabetes Technology (CDT), 1
Center for Medicare and Medicaid Services (CMS)
CGM coverage by, 46, 283, 285–286
SMBG coverage by, 283, 285–286
Centers for Disease and Prevention (CDC), assisted monitoring of blood glucose from, 3
certified diabetes educator (CDE), 17–19
app coaching with, 83
case study of 57-year-old man with type 1 diabetes using, 303, 305
CGM strategies for older patients with hypoglycemia with, 263, 267
examination by American Association of Diabetes Educators (AADE), 17
Chemstrips capillary blood glucose strips, 359–360
children with diabetes
basal rates in pump settings for, 126–127, 126f
case study 10-year-old girl with type 1 diabetes (T1D), 224, 224f, 225f, 226t
diabetes first person account by Eckel, 309–317, 310f, 312f, 317f, 318f, 319f
diabetes first person account by Michels, 329–330, 330f
diabetes first person account by Perlman, 365–366
diabetes first person account by Sherr, 367–368
hybrid closed-loop (HCL) system for 15-year-old adolescent boy, 293–298, 295f, 296f, 297f
initial pump settings for, 126–128, 126f
insulin pump choice for, 123–125
insulin pumps patient selection for, 123
insulin sensitivity factor (ISF) in pump settings for, 126, 127
insulin-to-carbohydrate ratios (ICR) in pump settings for, 126, 127
pump therapy as preferred treatment mode, 122–123
“Pump Vacation” for, 128
pumps and continuous glucose monitoring in, 121–134
retrospective data review for acquiring data for, 130
CGM data, 132–133
insulin pump data, 130–132
purpose of, 129
starting insulin therapy for, 125
strategies for, 226t
teenager with chronic hyperglycemia, 227–232, 229f, 230f
three-step process for starting pump therapy, 125
chronic hyperglycemia, diabetes complications with, 106
Cincinnati Children’s Hospital, 309, 310
CliniPro, 104, 104f
Clinitest tablets, 309, 310, 313
Clinitest urine test, 357, 359
closed-loop insulin delivery
diabetes first person account by Unger, 393
history of, 7–8
management of labor and delivery, 161
in pregnancy, 159–160
coefficient of variation (CV)
blood glucose evaluation parameters, 105
glycemic variability measured with, 49
HbA1c versus, 50, 51t
colonoscopy, hospital policy for insulin pump, 180t
combination bolus, 36f, 37, 37f
computed tomography (CT), hospital policy for insulin pump, 177, 180t
Conformité Européenne (CE), 4
continuous glucose monitoring (CGM), 2–3, 5–6. See also hospital use of insulin pumps and continuous glucose monitoring
A1C measures in, 15, 105
accelerated advancement in management of diabetes with, 122
accuracy of, 106, 198
adjusting insulin in real time using rate of change from, 156t
advances in, 128
advantages and disadvantages for, 89–90
ambulatory glucose profile (AGP) in review of, 49, 50, 51t
American Diabetes Association support in hospital for, 165
automated insulin delivery systems with, 293
benefits of, 92–93, 93t, 203–205, 204f, 205f, 206f
case of burnout with, 203–205, 204f, 205f, 206f
case of type 2 diabetes and A1C of 9.3%
Dexcom G5 CGM trial, 218–220, 218f, 219f
diabetes medications, 216
dietary protein intake, 216–217
patient history, 216–220, 217f, 218f, 219f
postprandial glucose response, 217f
children with diabetes with, 121–134
clinical practice, 43–72
clinical vignettes in interpretation of CV versus HbA1c, 50, 51t
effects of complex meal on glucose levels identified by real-time, 55–58, 57f
exercise-induced hypoglycemia managed with data from, 58–60, 59f
FreeStyle Libre reports’ usefulness in diabetes management, 60–62, 61f, 63f
insulin dose correction using Endocrine Society approach to, 64–68, 66f, 67f
insulin stacking’s causes and effects identified by, 62–64, 65f, 66f
insulin timing and appropriate dosing identified by real-time, 55, 56f
mealtime insulin data guided by real-time, 53–58, 54f, 56f, 57f
MiniMed 670G hybrid closed-loop system, 68–70, 69f, 70f, 71f
prandial insulin dose adjustment identified by real-time, 53–55, 54f
usefulness of AGP report, 50, 51t
usefulness of Daily View Reports in, 50–53, 51t, 52t
diabetes and technology first person account, 331–343, 332f, 334f, 335f, 336f, 337f
diabetes first person account by Burge, 361–362
diabetes first person account by Eckel, 316–317
diabetes first person account by Edelman, 379, 382
diabetes first person account by Hirsch, 390f, 391
diabetes first person account by Kowalski, 387–388
diabetes first person account by Michels, 329
diabetes first person account by Perlman, 365–366
diabetes first person account by Rudolph, 333, 338–340, 342
diabetes first person account by Sherr, 369
diabetes first person account by Stephens, 323–325
diabetes first person account by Tridgell, 345–347
diabetes first person account by Unger, 393–394
exercise-related technologies, 146
FDA approval, 44, 45t, 182
features of, 45t
first-party apps for, 80–81
“flash” glucose monitoring with, 141–142
future directions of pregnancy with, 156–157
glucose monitoring in pregnancy clinical trials using, 153–154, 155t
glucose rate of change trend arrows, 47t
glycemic control improvement with insulin pump settings case study
first visit interpretation, 243
follow-up visit interpretation, 258
Guardian Mobile, 83
healthcare providers (HCPs) in discussion of, 128
hybrid closed-loop systems, 145–146
hypoglycemia decreased rates with, 165–166
implantable sensor for, 128
insulin pump case study with, 144–145
interpretation of, 103–116
A1C-Derived Average Glucose study, 105
AGP report for, 107–108, 107f, 108f
“glucose management indicator” (GMI), 108
ninety-day box-and-whisker plot from Eversense implantable, 109f
management of labor and delivery, 160
mean absolute relative difference (MARD) in data published on, 106
Medicare and Medicaid coverage of, 46, 283, 285–286
parameters to adjust insulin, diet, and exercise in pregnancy, 157t
patient selection, 46–48, 92–93, 93t
hospital use, 171–173, 172t
patient with type 2 diabetes and A1C of 9.3%, 215–220, 217f, 218f, 219f
physical activity, sport, and recreation with, 137–146
physical activity case studies with, 142–145, 144f, 145f
point-of-care (POC) glucose data offered by, 103
practical tips for pregnancy with, 156, 156t, 157t
predictive technology with use of professional
A1C levels, 277, 280
blood glucose (BG) levels, 277–280, 278f, 279f, 280f, 281f
hypoglycemia, 277–280
patient data comparison, 279f
patient data download, 278f, 280f, 281f
pregnancy and management of diabetes with, 151–162
professional and personal categories, 43–44
quick guide to CGM downloads, 156t
randomized controlled trial (RCT) on population with T2D, 215
reducing A1C levels with, 15
retrospective data review, 132–133
starting, 95–100
elements key success of, 95
expectations, 96
instructions for, 95–96
setting alarms and alerts, 96
type 1 diabetes (T1D) case study, 96–97
strategies for older patients with hypoglycemia
A1C levels, 263, 265
carbohydrate intake, 265
certified diabetes educator, 263, 267
CGM report download, 266, 266f, 267f, 268f–276f
daily glucose trends, 265 food intake, 263–264
physical activity, 264 registered dietitian (RD), 65, 263
self-monitoring of blood glucose, 264
simplification strategies, 264t
system selection, 48
three forms of, 106
288 finger-sticks per day equivalent of, 106
type 2 diabetes (T2D), 43, 46, 48, 60–62, 61f
outpatient use of, 165
use in clinical practice, 48–49
use in outpatient setting, 165, 198
weight gain with, 361
Continuous Glucose Monitoring during Diabetic Pregnancy (GlucoMOMs), 153–154, 155t
Continuous glucose monitoring in women with type 1 diabetes in pregnancy trial (CONCEPTT), 153–154, 155t
continuous glucose monitoring system (CGMS), 166
continuous subcutaneous insulin infusion (CSII). See also perioperative CSII
advantages and disadvantages for, 89–90
American Diabetes Association support in hospital for, 165
Bluetooth connectivity, 26
contraindications in hospitalized patients for, 172, 172t
digital technology, 26–27
dosing principles
basal insulin delivery, 34–35
bolus insulin delivery, 35–37, 36f, 37f
combination bolus, 36f, 37, 37f
custom bolus functions, 35
dual-wave bolus, 36f, 37, 37f
easy bolus, 37
extended bolus, 36–37, 36f, 37f
split-wave bolus, 36, 36f, 37f
square-wave bolus, 36–37, 36f, 37f
standard bolus, 36, 36f, 37f
education and testing for, 98t
future of, 38
hospital emergency department protocols for, 179–180
hospital inpatient policy for use of, 173–176, 174f–175f
hybrid CSII inpatient use guidelines, 183–184
increased outpatient use of, 187
insulin pumps used with, 103, 110–111, 114
insulin treatment contributions, 23
interpretation of, 103
medication administration record for, 173, 174f–175f, 176
multiple daily injection (MDI) compared to, 89–90
patient flowsheet for, 175f
patient selection for, 89–93
perioperative
case studies, 198–200
challenge with, 188
management of, 189–198, 190t, 192f, 193f, 194t, 195t, 197f
reducing A1C levels with, 15
transition from IV insulin infusion to, 181
transition from subcutaneous basal- bolus therapy to, 181
transition to IV insulin infusion from, 180
transition to subcutaneous basal-bolus therapy from, 181
transitioning patients from MDI to, 24
treatment outcomes, 37–38
Contour Next One, 79
Contour Next One app, 79
correction dose, hybrid closed-loop (HCL) system settings of, 293
counting carbohydrates app, 76–77
creating food diaries app, 76–77
Creighton University School of Medicine, 327
current total daily dose (TDD), 97
custom bolus functions, 35
cybersecurity, 9–10
Daily View Reports, 50–53, 51t, 52t
Dana Diabecare IIS, basal range, bolus range and features for, 169t
Dana Insulin Pump
photo of, 25f
technical features, 31t
Dario app, 79
Deltec Cozmo insulin pump, 323 Dexcom 7, 361
Dexcom app, 80
Dexcom CGM sensor, 339
Dexcom CGM systems, 44
features of, 45t
glucose rate of change trend arrows, 47t
Medicare and Medicaid coverage of, 46
pregnancy case study using, 209
Dexcom CLARITY, 49
usefulness of Daily View Reports in, 50
Dexcom Clarity app, 80
DexCom Clarity software, AGP report generated by, 50, 107f
Dexcom Follow app., 80
Dexcom G4 CGM
diabetes first person account by Perlman, 366
diabetes first person account by Tridgell, 345–347
Dexcom G5 app, 80
Dexcom G5 CGM
case of type 2 diabetes and A1C of 9.3% using, 218–220, 218f, 219f
systems and features of, 143t
Dexcom G6 app, 80
Dexcom G6 CGM, 106
blood glucose check for, 221, 222f, 223f
coaching insulin pump uploads case study with, 221
diabetes first person account by Tridgell, 347
distribution of basal and bolus insulins for, 223f
systems and features of, 143t
Dexcom G6 CGM sensor, 324
Dexcom sensor, 387
Diabetes and Pregnancy Program, 207
diabetes apps, 9
diabetes burnout, 226t
benefits of CGM for, 203–205, 204f, 205f, 206f
Diabetes Centers of Excellence (DCOE), 16
diabetes clinics and centers infrastructure, 15–20
care providers, 18
certified diabetes educators (CDE), 17–19
Diabetes Centers of Excellence (DCOE), 16
electronic health records (EHR), 17
management software, 17
patient motivation, 19
patient visits and education, 19–20
personnel, 17–18
professional education, 19
technological advances, 15
Diabetes Control and Complications Trial (DCCT), 2, 380, 385
need for tighter control for carbohydrate intake in, 121
relationship of hyperglycemia to microvascular complications of diabetes, 227
type 1 diabetes management as goal of, 301
diabetes first person account
Burge, Mark R., MD, 349–362, 352f, 353f, 354f, 356f, 358f
Eckel, Robert H., MD, 309–317, 310f, 312f, 317f, 318f, 319f
Edelman, Steven, MD, 377–382
Hirsch, Irl B., MD, 389–391, 390f
Kowalski, Aaron, PhD, 385–388
Michels, Aaron, MD, 327–330, 328f, 330f
Perlman, Jordan, MD, 365–366
Rudolph, Justen, MD, 331–343, 332f, 334f, 335f, 336f, 337f
Sherr, Jennifer, MD, 367–374, 369f, 370f, 371f, 372f, 373f, 374f, 375f
Stephens, Elizabeth, MD, 321–326, 322f, 325f
Tridgell, David M., MD, 345–347
Unger, Jeff, MD, FAAFP, FACE, 393–394
diabetes management apps
advantage of, 75
Apple Health, 79–80
Apple iPhone App Store, 75
automated insulin delivery (AID), 86
basal insulin titration, 84–85
CGM first-party apps, 80–81 challenges, 75
counting carbohydrates, 76–77
creating food diaries, CGM
data aggregation, 82–83
future directions for, 85–86
Google Fit, 79–80
improved functionality and configurability, 81, 82f
insulin bolus calculator, 83–84
insulin pumps first-party apps, 80–81
mobile, 75–85
remote health management, 82–83
S Health, 79–80
self-monitoring of blood glucose (SMBG), 77–79, 78f
smartphones appeal and, 76
third-party, 81–83, 82f
“turnaround test” for, 75
wireless glucose meters, 79
diabetes management software, 17
diabetes self management (DSM), teenager with chronic hyperglycemia, 227, 231–232
diabetes self-management education support (DSMES)
CGM strategies for older patients with hypoglycemia with, 263–264
food intake with, 263–264
diabetes technology
future of, 10–11
goals of, 1
history of, 1–10
medical journal focus on, 1
tools widely used in, 1–10
Diabetes Technology Society (DTS), 387
assisted monitoring of blood glucose (AMBG) from, 3
Diabetes:M app, 84
diabetic ketoacidosis
Eckel’s hospitalization for, 310
glycemic control improvement with insulin pump settings case study, 233
Diasend-Glooko, 49
digital health, 8–9
Digital Health Innovation Action Plan, 9
DirecNet, 387
Disetronic insulin pump, 323
doctors of osteopathic medicine (MD/ DO), 17
DTS Cybersecurity Standard for Connected Diabetes Devices (DTSec), 10
DTS Platform Controlling Diabetes Device Security and Safety Standard (DTMoSt), 10
dual-wave and combination bolus, 170 dual-wave bolus, 36f, 37, 37f
duration of insulin action, 190t
easy bolus, 37
Eckel, Robert H., MD alcoholic beverages, 312
birth of home blood glucose testing, 315
“brittle diabetes,” 311
CGM use, 316–317
children, 313, 315, 317f, 318f
Cincinnati Children’s Hospital, 309, 310
Cincinnati College of Medicine, 313
clinical project on relationship between plasma lipids, lipoproteins, and apolipoproteins to microvascular complications of T1D, 314–315
Clinitest tablets, 309, 310, 313
diabetes’ impact on growth and development, 312
early insulin options, 309 early years, 309
endocrine fellow at University of Washington, 314–315
episodes of mild hypoglycemia, 316–317
episodes of severe hypoglycemia, 314
erratic driving with blood glucose, 314
family photos, 317f, 318f, 319f
flexion contractures, 312, 312f
glycemic management, 316
hospitalization for diabetic ketoacidosis, 310
hypoglycemic event during 6th grade, 311
initial hospital experience, 309
junior high school, 311
marriage, 313
medical school, 312, 313
MiniMed 670G, 316
pediatric diabetologist working with, 310
photo at 5 years old, 310f
recollections of early days of injections, 310
sports, 311, 312
transition from globin to Lente insulin, 314
University of Cincinnati (UC), 312
University of Colorado Medical School, 315
University of Wisconsin (UW) Hospitals, 313, 314
Edelman, Steven, MD
barriers to diabetes management, 380–381
blood glucose levels, 378, 382
CGM, 379, 382
complications, 379
diabetes control, 380–382
Diabetes Control and Complications Trial, 380
diabetes diagnosis, 377–378
insulin pump, 379
intensive care unit (ICU), 377–378
Joslin Diabetes Clinic, 380
macular edema, 379
medical school, 379
middle-school, 377
proliferative diabetic retinopathy, 379
residency, 380
self-help and self-advocacy, 382 symptoms, 377
Taking Control of your Diabetes (TCOYD), 380–382
tiredness, 377
trust of doctor, 379
University of California, Davis campus, 379
University of California at Los Angeles (UCLA), 379–380
EKG, hospital policy for insulin pump, 180t
electrocautery, 180t
electronic health records (EHR), 17
electronic medical record (EMR), 176
emergency department
CSII in, 179–180
registered nurse (RN) protocols, 180
University of California–San Francisco improve improvement suggestions, 180
Endocrine Society approach, insulin dose correction using CGM with, 64–68, 66f, 67f
Enlite Sensor
diabetes first person account by Rudolph, 341
diabetes first person account by Tridgell, 345
Eversense system from Senseonic, 44
FDA approval, 106
features of, 45t
glucose rate of change trend arrows, 47t
ninety-day box-and-whisker plot from implantable, 109f
systems and features of, 143t
exercise benefit for type 1 diabetes (T1D), 137
with CGM, 137–146
case studies, 142–145, 144f, 145f
challenges, 144–146, 145f
exercise-related technologies, 146
hybrid closed-loop systems, 145–146
factors affecting glycemic responses to, 138, 138f
during fasting, 138
“flash” glucose monitoring with, 141–142
glycemic management technologies and strategies with, 139–144
hypoglycemia-associated autonomic failure affected by, 138f
insulin pumps features with strategies for, 139–141, 141t, 142t
managing blood glucose with, 137–139, 138f
postprandial glycemic excursions reduced with, 137
preventing exercise-induced hypoglycemia and hyperglycemia, 139
recommendations for managing glycemia during, 138–139
timing of, 138
exercise-induced hypoglycemia, 58–60, 59f
extended bolus, 36–37, 36f, 37f
FatSecret app, 76–77
finger-stick devices, 3
flash CGM (FCGM), 44
flash glucose monitoring (FGM) improved glycemic control with, 283–289, 284t, 285t, 286f, 287f, 288f, 289f, 290f, 291t
self-monitoring of blood glucose (SMBG) compared to, 283, 285, 286, 289
flexion contractures, 312, 312f
fluoroscopy, hospital policy for insulin pump, 177, 180t
FreeStyle Libre, 44
AGP report glucose pattern in, 108f
features of, 45t
glucose rate of change trend arrows, 47t
Medicare and Medicaid coverage of, 46
as only intermittent CGM, 106
personal sensor, power of sample
case study, 286
systems and features of, 143t
type 1 diabetes management usefulness of, 62, 63f
type 2 diabetes management usefulness of, 60–62, 61f
German Diabetes Association, Working Group Diabetes Technology of, 208
gestational diabetes, 151, 153–154
glomerular filtration rate (GFR),
glycemic control improvement with insulin pump settings case study, 233
Glooko, 82
glucometer, 367
“glucose management indicator” (GMI), 108
glucose-responsive insulins, 6–7
GlucoTrack DF-F, 4
Gluco-Watch, 323–324
glycemic control improvement with insulin pump settings case study
conclusion, 260–261
first visit
A1C history, 243t
assessment and plan, 245–248, 247t
blood glucose monitoring, 243
CGM interpretation, 243
complications and pertinent medical history, 234
current regime, 234, 234t, 235f–242f, 243t
glomerular filtration rate (GFR), 233
lab results, 244
medications, 245t
new settings, 247t
nutrition management and current meal plan, 243–244
physical examination, 244–245
state-of-care medical history, 244
follow-up call, 248
follow-up visit
A1C history, 159t
assessment and plan, 259–260, 261t
blood glucose monitoring, 249, 258
CGM interpretation, 258
current regime, 249, 250f–257t, 258t
physical examination, 258–259
glycemic management, diabetes
first person account by Eckel, 316
glycemic variability (GV), 49
AGP report glucose statistics, 107
insulin pump data with, 111
Google Fit app, 79–80
Guardian Connect CGM, 106
Guardian Mobile CGM, 83
Guardian sensor, 345
HbA1c. See A1C levels
healthcare providers (HCPs), CGM in discussion with, 128
Hirsch, Irl B., MD
Auto-Syringe 2C insulin pump, 390f
Auto-Syringe 6C, 390f
blood glucose levels, 389–390
CGM, 390f, 391
insulin pump, 389–391, 390f
medical school, 389
hospital use of insulin pumps and continuous glucose monitoring American Diabetes Association support for, 165
CGM use in hospital guidelines, 182–183
continuing CSII, 173
contraindications, 172t
CSII in emergency department, 179–180
currently available insulin pumps, 167t–169t
daily assessment, 177
hybrid CSII inpatient use guidelines, 183–184
initial assessment, 176–177
inpatient policy for CSII use
electronic medical record (EMR), 176
insulin pump settings, 173
medication administration record, 173, 174f–175f, 176
nursing tip sheet, 173, 176
patient contract, 173
patient flowsheet, 175f
insulin pump overview, 166
patient selection, 171–173, 172t
terminology
active insulin time, 170–171
basal rate, 166, 170
bolus delivery, 170
dual-wave and combination bolus, 170
infusion set, 171
infusion site, 171
insulin type, 166
square-wave and extended bolus, 170
suspend, 171
target blood glucose range, 170
temporary basal rate, 171
transitions from CSII to IV insulin infusion, 180
from CSII to subcutaneous basal-bolus therapy, 181
from hospital to home, 181
from IV insulin infusion to CSII, 181
from subcutaneous basal-bolus therapy to CSII, 181
troubleshooting
hyperglycemia, 177, 178t
hypoglycemia, 177, 179t
radiographic studies, 177, 179, 180t
human placental lactogen (HPL), 210
hybrid closed-loop (HCL) 670G
insulin pump, 110. See also MiniMed 670G hybrid closed-loop system diabetes first person account by Sherr, 371–372
hybrid closed-loop (HCL) systems, 145–146. See also MiniMed 670G hybrid closed-loop system
adolescent boy with type 1 diabetes using, 293–298, 295f, 296f, 297f
assessment for, 294–296, 295f, 296f
CARE acronym
adjust, 294, 297
calculate, 294, 297
educate, 294, 298
revert, 294, 297–298
case study of 57-year-old man with type 1 diabetes
A1C levels, 303, 304
assessment, 303
certified diabetes educator (CDE), 303, 305
chief complaint, 302
current diabetes therapy, 302–303
current labs, 303
history of present illness, 302
lipid levels, 303
management plan, 303
MiniMed 630G system with Enlite Sensor, 303–305, 304t, 305f
MiniMed 670G with Enlite Sensor, 305–307, 306f
past medical history, 302
practical registered nurse (APRN), 303, 305
total daily dose (TDD) data, 303, 304t
glucose levels, 295, 296f, 297f
glucose meter and insulin pump were download, 295, 295f
minimize hypoglycemia in type 1 diabetes with, 301–307, 305f, 306f
optimize time spent in HCL mode, 298
parameters of, 293
strategic insulin dosing with, 298
hybrid CSII, inpatient use guidelines, 183–184
hyperglycemia
causes of, 178t
diabetes complications with chronic, 106
hospital policy for insulin pump with, 177, 178t
Pfund having, 351
preventing exercise-induced, 139
teenager with chronic, 227–232, 229f, 230f
treatment options for, 178t
hyperglycemic teenager case study
blood glucose (BG) levels, 227–228, 229f, 230f
continuous glucose monitor (CGM) use, 228–232, 229f, 230f
diabetes self management (DSM), 227, 231–232
discussion, 230–232
interventions, 227–230, 229f, 230f
hypoglycemia
Burge, Robert William, 356–357
CGM predictive technology case study, 277–280
CGM strategies for older patients with, 263–267, 264t, 266f, 267f, 268f–276f
CGM with decreased rates of, 165–166
diabetes first person account by Eckel, 314–317
diabetes first person account by Kowalski, 385–388
diabetes first person account by Perlman, 366
diabetes first person account by Sherr, 367, 368, 371, 372
diabetes first person account by Unger, 394
hospital policy for insulin pump with, 177, 179t
hybrid closed-loop (HCL) systems with type 1 diabetes and, 301–307, 305f, 306f
preventing exercise-induced, 139
risk with early pregnancy of, 207
hypoglycemia-associated autonomic failure, 138f
iBG Star app, 79
iHealth app, 79
infusion set, 171
infusion site, 171
Insulet Corporation, 110
Insulia app, 84
insulin action time, 293
insulin bolus calculator apps, 83–84
insulin pens, 8
insulin pumps, 23–38. See also hospital use of insulin pumps and continuous glucose monitoring
advantages and disadvantages for, 89–90
alternate controller enabled (ACE), 7
American Diabetes Association
support in hospital for, 165
automated insulin delivery systems with, 293
CGM case study with, 144–145
children taking vacation from, 128
children with diabetes with, 121–134
choosing for children, 123–125
coaching uploads to
case study 10-year-old girl with type 1 diabetes (T1D), 224, 224f, 225f, 226t
case study 17-year-old man with type 1 diabetes (T1D), 221–224, 222f, 223f
components, 25
continuous glucose monitoring system (CGMS) with, 166
CSII dosing principles, 34–37, 36f, 37f
CSII treatment outcomes, 37–38 CSII with, 103, 110–111, 114
diabetes first person account by Burge, 360–362
diabetes first person account by Edelman, 379
diabetes first person account by Hirsch, 389–391, 390f
diabetes first person account by Kowalski, 386–388
diabetes first person account by Michels, 327–329
diabetes first person account by Perlman, 365
diabetes first person account by Rudolph, 332–334, 337–338, 340
diabetes first person account by Sherr, 367–368, 370–374
diabetes first person account by Stephens, 323–324
diabetes first person account by Tridgell, 345
diabetes first person account by Unger, 393–394
digital insulin pump technology, 26–27
education and training recommendations for, 97, 98t
exercise strategies with features of alternate basal patterns, 140
bolus doses, 139–140
case study - age 11, 140–141, 141t
challenges associated with, 141, 142t
postexercise temporary basal reductions, 140
temporary basal rates, 140
extreme temperatures associated with exercise and, 142t
FDA approval, 6
features of, 122
important in selecting pump, 124
first- and second-generation, 24f
first-party apps for, 80–81
future of, 38
hospital hyperglycemia protocol with, 177, 178t
hospital hypoglycemia protocol with, 177, 179t
hospital radiographic studies protocol with, 177, 179, 180t
hybrid closed-loop (HCL), 110
inadequate associated with exercise and, 142t
inconvenience associated with exercise and, 142t
initiating, 95–100
American Diabetes Association recommendations, 97–98
children with diabetes, 125
current total daily dose (TDD) approach, 97
elements key success of, 95
initial settings, 97
three-step process for starting pump therapy, 125
type 1 diabetes (T1D) case study, 99–100
weight-based approach, 97
interest in advancing development, 122
interior of, 25, 27f
interpretation of, 103–116, 111f, 113f
active insulin time (AIT) in, 111, 114
ambulatory glucose profile (AGP) in, 112f, 113, 115f
glycemic variability (GV) in, 111
insulin sensitivity factor (ISF) in, 111, 114
insulin-to-carbohydrate ratio (ICR) in, 111–112, 114
Tidepool data in, 114, 115f
time above range (TAR) in, 111, 113
time below range (TBR) in, 111, 113
time in range (TIR) in, 111, 112f, 113, 115f
total daily dose (TDD) in, 111
management of labor and delivery, 161
MiniMed commercialized first, 110 models and technical features, 28t–33t
patch types, 25f, 27f
patient satisfaction, 165
patient selection for, 90–92, 91t
children with diabetes, 123
hospital use, 171–173, 172t
physical activity, sport, and recreation with, 137–146
pregnancy and management of diabetes with, 151–162
future directions, 159
pump initiation, 158
pump titration, 158–159
pump use postpartum, 159
retrospective data review, 130–132
sensor-augmented pump (SAP), 110
settings adjustments for glycemic control improvement in assessment and plan, 259–260,
261t
conclusion, 260–261
first visit, 233–248, 234t, 235f–242f, 243t, 245t, 247t
follow-up call, 248
follow-up visit, 159t, 248–259, 250f–257t, 258t
tethered types, 25f
three companies marketing, 110
threshold suspend feature was approved by FDA, 110
type 1 diabetes (T1D) use of, 165
type 2 diabetes (T2D) use of, 165
types of, 25–34, 25f, 27f, 28t–33t, 34f
use of, 6
water damage associated with exercise and, 142t
insulin sensitivity factor (ISF), 35
children’s diabetes pump settings with, 126, 127
inpatient policy for insulin pump settings, 173
insulin bolus calculator apps for patients needing, 83–84
insulin pump data with, 111, 114
insulin stacking, CGM in identifying causes and effects of, 62–64, 65f, 66f
insulin type, 166
insulin-dependent diabetes mellitus (IDDM). See type 1 diabetes (T1D)
insulin-to-carbohydrate ratio (ICR), 35, 50, 190t
children’s diabetes pump settings with, 126, 127
hybrid closed-loop (HCL) system settings of, 293
inpatient policy for insulin pump settings, 173
insulin bolus calculator apps for patients needing, 83
insulin pump data with, 111–112, 114
pregnancy case study, 209
integrated CGM system (iCGM), 7
intensive care unit (ICU), 379, 382
intermittent masked CGM, 153–154, 155t
intermittent real-time CGM, 154, 155t
intermittently scanned CGM (is-CGM), 44
interpretation of data from, 106
The International Consensus on Continuous Glucose Monitoring (Diabetes Care, 2017), 108, 215
iSage Rx app, 84
IV insulin infusion
transition from CSII to, 180
transition to CSII from, 181
JDRF, 386–388
Joslin Diabetes Clinic, 380
Joslin Diabetic Manual, 350–351
Kowalski, Aaron, PhD
A1C levels, 387
Abbott Navigator, 387
blood glucose levels, 385–387
brother’s diabetes diagnosis, 385
CGM, 387–388
Dexcom sensor, 387
Diabetes Control and Complications Trial, 385
diabetes diagnosis, 385, 386
Diabetes Technology Society (DTS), 387
DirecNet, 387
family, 385, 387–388
hypoglycemia, 385–388
insulin pump, 386–388
JDRF, 386–388
symptoms, 386
labor and delivery, technology in management of diabetes with CGM, 160
closed-loop insulin delivery, 161
future directions, 161
insulin pumps, 161
laser surgery, hospital policy for insulin pump, 180t
LibreView app, 81
lispro KwikPen, 65
macular edema, 379
magnetic resonance imaging (MRI), 177, 180t
mean absolute relative difference (MARD)
data published on CGM performance, 106
sensor accuracy assessment with, 44
medication administration record (MAR), 173, 174f–175f, 176
Medtronic
hybrid closed-loop (HCL) 670G
insulin pump, 110
insulin pumps made by, 110
Medtronic 506 insulin pump, 333
Medtronic 530G insulin pump
diabetes first person account by Perlman, 365
diabetes first person account by Tridgell, 345
Medtronic 630 G closed-loop pump, 394
Medtronic 670G System. See MiniMed 670G hybrid closed-loop system
Medtronic CareLink software, 49
MiniMed 670G hybrid closed-loop
system reviewed with, 68–70, 69f, 70f, 71f
Medtronic CGM Gold system, 338
Medtronic Enlite 2
features of, 45t
glucose rate of change trend arrows, 47t
Medtronic Guardian Connect Mobile, 44, 143t
Medtronic Guardian Sensor 3 features of, 45t
glucose rate of change trend arrows, 47t
Medtronic Paradigm pump, 360 meters
blood glucose evaluation parameters, 104, 104f
coefficient of variation (CV) in evaluation of, 105
importance of, 103
interpretation of, 103–116
software programs differences with, 104
standard deviation (SD) in evaluation of, 104–105
Michels, Aaron, MD
A1C levels, 328
Barbara Davis Center for Diabetes, 327
career path, 327
CGM, 329
children, 329–330, 330f
Creighton University School of Medicine, 327
diabetes diagnosis, 327
family photo, 330f
fellowship in Diabetes and Endocrinology, 327
insulin pump, 327–329
laboratory success, 330
photo at age 13, 328f
residency, 327
sensor technology, 329
University of Colorado, 327
MiniMed
data published on CGM performance, 105–106
FDA approval, 301 first insulin pump, 110
MiniMed 506, 368
MiniMed 508 pump
diabetes first person account by Burge, 360
diabetes first person account by Rudolph, 337
MiniMed 530G system
basal range, bolus range and features for, 167t
data download of, 111f
technical features, 28t
threshold suspend feature of, 110
MiniMed 630G system
basal range, bolus range and features for, 168t
case study of 57-year-old man with type 1 diabetes, 303–305, 304t, 305f
technical features, 28t
MiniMed 640G system, 29t
MiniMed 670G hybrid closed-loop system, 68–70, 69f, 70f, 71f
accuracy of, 341
adolescent boy with type 1 diabetes using, 293–298, 295f, 296f, 297f
basal range, bolus range and features for, 166, 168t
CareLink reports from, 112f, 113f
case study of 57-year-old man with type 1 diabetes, 305–307, 306f
diabetes first person account by Eckel, 316
diabetes first person account by Rudolph, 340–341
diabetes first person account by Sherr, 371
diabetes first person account by Stephens, 325
diabetes first person account by Tridgell, 345–346
glycemic control improvement with insulin pump settings case study, 233
parameters of, 293
“suspend before low” pump feature, 326
technical features, 29t wearability of, 341
MiniMed insulin pump, 323
MiniMed Paradigm Revel
basal range, bolus range and features for, 169t
technical features, 30t
MiniMed RT-CGM system, 366
Mobile Insulin Dosing System app, 84
multiple daily injections (MDI)
CSII compared to, 89
insulin bolus calculator apps for patients using, 83
transitioning patients to CSII from, 24
type 1 and type 2 diabetes using, 187
type 1 diabetes (T1D) using, 103
MyFitnessPal app, 76–77
mySugr app
certified diabetes educators (CDE) coaching with, 83
self-monitoring of blood glucose with, 77–78, 78f, 80
nonproliferative retinopathy, 346
nursing tip sheet, 173, 176
older patients, CGM strategies for hypoglycemia with, 263–267, 264t, 266f, 267f, 268f–276f
Omnipod Insulin Pump
basal range, bolus range and features for, 166, 167t
coaching insulin pump uploads case studies with, 221, 224
photo of, 25f technical features, 32t
One Drop app
certified diabetes educators (CDE) coaching with, 83
self-monitoring of blood glucose with, 78–79, 78f, 80
OneTouch, 367
OneTouch Verio Sync, 79
OpenAPS, 362
optical noninvasive glucose monitor, 4
pacemaker, hospital policy for insulin pump, 180t
Paradigm 772 pump, 361
patch insulin pumps, 25f
Pendragon Medical noninvasive glucose monitoring device, 4
perioperative CSII
case studies
46-year-old woman with history of T1D, 199–200
23-year-old woman with history of T1D, 198–199
challenges with coordinating communication among all providers, 188
defining successful perioperative glycemic control, 188
fast pace of advances in diabetes technology, 188
impact of procedure on glycemic control, 188
self-management of insulin pump following surgery, 188
definition of common terms for basal rate, 190t
duration of insulin action, 190t
insulin-to-carbohydrate ratio (ICR), 190t
sensitivity/correction factor, 190t target, 190t
temporary basal, 190t
intraoperative period
BG monitoring and therapy, 196
identification and documentation, 195–196
protocol example, 196, 197f
troubleshooting, 196
management of, 189–198, 190t, 192f, 193f, 194t, 195t, 197f
postoperative period
BG monitoring and therapy, 197–198
identification and documentation, 197
preadmission period
CSII placement, 193–194, 193f
CSII settings, 191–192
CSII supplies, 192–193, 192f
diabetes history, 189
hemoglobin A1c, 189
patient preference, 189, 191
procedures for, 194t
preoperative period BG monitoring, 194
identification and documentation, 194
intraoperative glycemic management plan, 195, 195t
Perlman, Jordan, MD
CGM, 365–366
Dexcom G4 CGM, 366
diabetes diagnosis, 365
hypoglycemia, 366
insulin pump, 365
medical school, 366
Medtronic 530G insulin pump, 365
MiniMed RT-CGM system, 366
Pfund, David Elmer, Jr.
Benedict’s Qualitative Test, 350
commercial availability of insulin, 349
diabetes diagnosis, 349
diabetic coma, 349
dietary recommendations, 350–351
hyperglycemia, 351
insulin quality, 350
love of Morel mushroom, 351
photos of, 352f
University of Oregon, 351
World War II, 351
“phantom carbohydrate intake” case study 10-year-old girl with type 1 diabetes (T1D), 224, 224f, 225f, 226t
case study 17-year-old man with type 1 diabetes (T1D), 221–224, 222f, 223f
physical activity
benefit for type 1 diabetes (T1D), 137
Burge’s running, 356
with CGM, 137–146
case studies, 142–145, 144f, 145f
challenges, 144–146, 145f
exercise-related technologies, 146
hybrid closed-loop systems, 145–146
diabetes first person account by Rudolph, 331, 334, 334f, 335f, 336f, 339–340
factors affecting glycemic responses to, 138, 138f
during fasting, 138
“flash” glucose monitoring with, 141–142
glycemic management technologies and strategies with, 139–144
hypoglycemia-associated autonomic failure affected by, 138f
with insulin pumps, 137–146
insulin pumps features with strategies for, 139–141, 141t, 142t
managing blood glucose with, 137–139, 138f
postprandial glycemic excursions reduced with, 137
preventing exercise-induced hypoglycemia and hyperglycemia, 139
recommendations for managing glycemia during, 138–139
strategies for older patients with hypoglycemia, 264
timing of, 138
point-of-care (POC)
CGM glucose data at, 103
glucose checked at, 180
Portland Diabetes Clinic, 355
postanesthesia care unit (PACU), 188
postprandial glycemic excursions, 137
power of sample case study
A1C levels, 283, 285, 289, 291t
carbohydrate content in diet, 285
CGM daily pattern report, 289f
chronic kidney disease, 283
diabetes educator, 286, 287
diet history, 284
fasting blood glucose report, 284t, 285f
FreeStyle Libre personal sensor, 286, 286f, 287f, 288f, 289f, 290f
glargine intake, 283–287
Style Lite meter, 284
powerlifting, rise in glycemia with, 139
practical registered nurse (APRN), 303, 305
pregnancy
case study - 28-year-old woman with type 1 diabetes
Abbott Libre PRO glucose sensor, 208
Dexcom CGM, 209
at 15 weeks’ gestation, 210
Glooko download, 209, 210f
glucose variability, 208, 208f
human placental lactogen (HPL) with, 210
insulin-to-carbohydrate ratio (ICR), 209
post meal and overnight high-glucose values, 209, 211f–212f
preconception period, 209
at 12 weeks’ gestation 12 weeks’ gestation, overnight and post meal hypoglycemia, 209, 213f
CGM for management of diabetes in, 151–162
closed-loop insulin delivery in, 159–160
complications from diabetes in, 151
diabetes first person account by Sherr, 371, 372f
gestational diabetes, 151, 153–154
glucose monitoring in clinical insights using, 152–153
clinical trials of CGM for, 153–154, 155t
future directions of CGM for, 156–157
on-demand, 154
practical tips for CGM for, 156, 156t, 157t
using CGM parameters to adjust insulin, diet, and exercise, 157t
glycemic control’s importance before and throughout, 151
hypoglycemia risk with early, 207
insulin pumps for management of diabetes in, 151–162
future directions, 159
pump initiation, 158
pump titration, 158–159
pump use postpartum, 159
technology in management of labor and delivery
CGM, 160
closed-loop insulin delivery, 161
future directions, 161
insulin pumps, 161
technology-facilitated diabetes
management for, 207–212, 208f, 210f, 211f–212f, 213f
professional CGM, 106
proliferative diabetic retinopathy, 379
pyrroloquinoline quinone (PQQ), 2
radiographic studies, 177, 179, 180t
randomized controlled trial (RCT)
automated insulin delivery systems in, 293
CGM studies in population with T2D, 215
RapidCalc app, 84
real-time CGM (rt-CGM), 44
effects of complex meal on glucose levels identified by, 55–58, 57f
guide to mealtime insulin data using, 53–58, 54f, 56f, 57f
insulin timing and appropriate dosing identified by, 55, 56f
interpretation of data from, 106
prandial insulin dose adjustment identified by, 53–55, 54f
worn continuously, 154, 155t
registered dietitian (RD), 65, 263
registered nurse (RN), 180
retrospective data review
acquiring data for, 130
CGM data, 132–133
insulin pump data, 130–132
overnight trends in, 133
patterns after correction boluses in, 133–134
patterns after meals in, 133
purpose of, 129
response to treatment of low glucose in, 134
temporary basal rates, 132
time in target in, 132
total daily dose (TDD) in, 130
Robert Wood Johnson Medical School, 373
Rudolph, Justen, MD
ankle sprain, 331
automated insulin delivery, 340–343
blood glucose level, 332, 333, 338–343
carbohydrates in diet, 333–334, 338, 341
CGM, 333, 338–340, 342
diabetes diagnosis, 332
diabetes educator, 332
diabetes onset, 331
Enlite Sensor, 341
insulin pump, 332–334, 337–338, 340
insurance coverage, 336–337, 340–341
long-term complications of diabetes, 332
Medtronic 506 insulin pump, 333
Medtronic CGM Gold system, 338
MiniMed 508 pump, 337
MiniMed 670G system, 340–341
Montana Association TourDeCure Event photo, 335f
N and R insulin, 333
photo as college sophomore, 332f
photo while trout fishing, 334f
physical activity
backpacking trip, 339–340
family camping photo, 336f
fishing, 331, 334, 334f
hiking, 334, 336f, 339–340
mountain biking, 331, 334
mountain climbing, 335f
racquetball, 331
skiing, 337f, 340
walking, 334
whitewater kayaking, 334
pizza effect, 334
“quick-bolus” feature on pump, 338
soda drinking, 331, 332
Thanksgiving, 332, 333
University of Montana, 331
vision loss possibility, 332
Rutgers College, 373
S Health app, 79–80
Salas, Dr. Max, 367, 368, 369f, 373
self-monitoring of blood glucose (SMBG) apps for, 77–79, 78f, 80
flash glucose monitoring (FGM) compared to, 283, 285, 286, 289
history of, 1–3
interpretation of, 103 limited information from, 43
Medicare and Medicaid coverage of, 283, 285–286
sensor glucose (SG) information with, 215
type 1 diabetes (T1D) using, 103
sensitivity/correction factor, 190t
sensor glucose (SG) information, self-monitoring of blood glucose with, 215
sensor-augmented pump (SAP), 110
Sherr, Jennifer, MD
A1C levels, 373
blood glucose levels, 367, 371
CGM, 369
childhood, 367–368
children, 373, 373f, 374f
college, 368, 373
diabetes diagnosis, 367
doctoral degree, 374
Dr. Salas, 367, 368, 369f, 373
family photo, 371f
fellowship, 370, 373
glucometer, 367
high school, 367–368
hypoglycemia, 367, 368, 371, 372
insulin pump, 367–368, 370–374
marriage, 370–371
medical school, 368, 369f, 370, 373
MiniMed 506, 368
MiniMed 670G system, 371–372
OneTouch, 367
pregnancy, 371, 372f
residency, 368, 373
Robert Wood Johnson Medical School, 373
Rutgers College, 373
University of Medicine and Dentistry of New Jersey, 373
wedding day, 370, 370f
Yale Graduate School of Arts and Sciences, 375
Yale pediatric diabetes research team, 375f
smart insulins, 6–7
smart pens, 8
Software as Medical Device (SaMD), 9
split-wave bolus, 36, 36f, 37f
sprinting, rise in glycemia with, 139
square-wave and extended bolus, 170
square-wave bolus, 36–37, 36f, 37f
standard bolus, 36, 36f, 37f
standard deviation (SD), 104–105
Stephens, Elizabeth, MD
Barbara Davis Diabetes Center, 323
CGM, 323–325
Dexcom G6 CGM sensor, 324
diabetes diagnosis, 322
endocrine training program, 323
endocrinology fellowship, 323
family photo, 325f
Gluco-Watch, 323
hypoglycemia, 323
insulin pump, 323–324
long workdays, 322
medical school stress, 322
MiniMed 670G system, 325
MiniMed insulin pump, 323
on-call nights, 322
photo at age 24, 322f
“pump holiday,” 325
residency, 322
Tandem T-slim X2 Insulin Pump, 324
University of Colorado, 323
subcutaneous basal-bolus therapy
transition from CSII to, 181
transition to CSII from, 181
Sugarmate app, 81, 82f
suspend, 171
Taking Control of your Diabetes (TCOYD), 380–382
Tandem Diabetes Care, 110
Tandem T:Connect, 49
Tandem T-slim X2 Insulin Pump. See also t:slim X2 insulin pump with
Basal-IQ technology
diabetes first person account by Stephens, 324
photo of, 25f
screen display, 34f
technical features, 31t
target, 190t
target blood glucose range, 170, 173
technological advances, 15
temporary basal, 190t
temporary basal rates, 171
exercise strategies with, 140
retrospective data review, 132
tethered insulin pumps, 25f
threshold suspend feature, 110
Tidepool, 49, 82–83
“Daily View,” 115f
“Trends” view showing AGP, 115f
user-friendly interface, 114
time above range (TAR)
AGP report glucose statistics, 107
insulin pump data with, 111, 113
time below range (TBR)
AGP report glucose statistics, 107
insulin pump data with, 111, 113
time in range (TIR)
AGP report glucose statistics, 107
insulin pump data with, 111, 112f, 113, 115f
total daily dose (TDD)
basal rates in ratio with, 127
case study of 57-year-old man with type 1 diabetes, 303, 304t
insulin pump data with, 111
Tridgell, David M., MD
670G, 345–346
A1C levels, 346
Animas insulin pump, 345
Animas Ping insulin pump, 345
Animas Vibe insulin pump, 345
blood glucose levels, 345–347
blood pressure, 346
CGM, 345–347
CGM first person account, 345–347
Dexcom G4 CGM, 345–347
Dexcom G6 CGM, 347
diabetes diagnosis, 345
Enlite Sensor, 345
Guardian sensor, 345
insulin pump, 345
Medtronic 530G insulin pump, 345
N and R insulin, 345
nonproliferative retinopathy, 346
total cholesterol, 346
t:slim X2 insulin pump with Basal-IQ technology
basal range, bolus range and features for, 169t
FDA approval of, 110
2016 AACE/ACE Consensus
Statement on Continuous Glucose Monitoring, 215
type 1 diabetes (T1D)
benefit of physical activity for, 137
Burge family history of
Burge, Robert William, 351–357, 353f–354f, 358f
Pfund, David Elmer, Jr., 349–351, 352f
case studies
46-year-old woman, 199–200
23-year-old woman, 198–199
CGM predictive technology case study, 277–280, 278f, 279f, 280f, 281f
clinical project on relationship between plasma lipids, lipoproteins, and apolipoproteins to microvascular complications of, 314–315
coaching insulin pump uploads
case study 10-year-old girl with type 1 diabetes (T1D), 224, 224f, 225f, 226t
case study 17-year-old man with type 1 diabetes (T1D), 221–224, 222f, 223f
diabetes first person account Burge, Mark R., MD, 349–362, 352f, 353f, 354f, 356f, 358f
Eckel, Robert H., MD, 309–317, 310f, 312f, 317f, 318f, 319f
Edelman, Steven, MD, 377–382
Kowalski, Aaron, PhD, 385–388
Michels, Aaron, MD, 327–330, 328f, 330f
Perlman, Jordan, MD, 365–366
Rudolph, Justen, MD, 331–343, 332f, 334f, 335f, 336f, 337f
Sherr, Jennifer, MD, 367–374, 369f, 370f, 371f, 372f, 373f, 374f, 375f
Stephens, Elizabeth, MD, 321–326, 322f, 325f
Tridgell, David M., MD, 345–347
Unger, Jeff, MD, FAAFP, FACE, 393–394
glycemic control improvement with insulin pump settings case study, 159t, 161t, 233–261, 234t, 235f–242f, 243t, 245t, 247t, 250f–257t, 258t
hybrid closed-loop (HCL) system for adolescent boy with, 293–298, 295f, 296f, 297f
hybrid closed-loop (HCL) systems to minimize hypoglycemia in, 301–307, 305f, 306f
insulin pumps and CGM use by, 165 insulin pumps initiating case study, 99–100
life-long insulin therapy needed for, 121
multiple daily insulin injections (MDI) used by, 103, 187
prevalence of, 207
starting CGM case study, 96–97
teenager with chronic
hyperglycemia, 227–232, 229f, 230f
type 2 diabetes (T2D)
case studies
41-year-old Asian woman, 203–206
CGM for, 43, 46, 48, 60–62, 61f
CGM for patient with A1C of 9.3% and, 215–220, 217f, 218f, 219f
CGM strategies for older patients with hypoglycemia, 263–267, 264t, 266f, 267f, 268f–276f
CGM studies in population with, 215
insulin pumps and CGM use by, 165
life-long insulin therapy needed for, 121
multiple daily insulin injections (MDI) used by, 187
power of sample case study, 283–289, 284t, 285t, 286f, 287f, 288f, 289f, 290f, 291t
prevalence of, 207
U.K. Prospective Diabetes Study (UKPDS) Trial, 2
Ultralente insulin, 360
ultrasound, hospital policy for insulin pump, 180t
Unger, Jeff, MD, FAAFP, FACE
A1C levels, 393
Abbott FreeStyle Libre sensor, 394
blood glucose levels, 393–394
CGM, 393–394
closed-loop insulin delivery, 393
hypoglycemia, 394
insulin pump, 393–394
Medtronic 630 G closed-loop pump, 394
University of California, Davis campus, 379
University of California at Los Angeles (UCLA), 379–380
University of Cincinnati (UC), 312
University of Colorado, 323, 327
University of Colorado Medical School, 315
University of Medicine and Dentistry of New Jersey, 373
University of Oregon, 355, 356, 357
University of Washington, 314–315
University of Wisconsin, Madison, 360
University of Wisconsin (UW) Hospitals, 313, 314
U.S. Food and Drug Administration (FDA)
accuracy of blood monitoring devices, 4
basal insulin titration apps approval, 84–85
CGM approval, 44, 45t, 182
Digital Health Innovation Action Plan, 9
Eversense CGM approval, 106
glucose-monitoring systems, 208
insulin pump approval, 6
insulin pumps threshold suspend feature approval, 110
MiniMed approval, 301
t:slim X2 insulin pump with Basal- IQ technology approval, 110
Verio Flex, 79
V-Go Patch Pump
photo of, 25f
technical features, 33t
Working Group Diabetes Technology, 208
X-ray, hospital policy for insulin pump, 177, 180t
Yale Graduate School of Arts and Sciences, 375
