What’s Upcoming In Insulin Delivery?

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The race is on in diabetes technology. Looping or shooting or some combination? Bigfoot or Beta Bionics or enriched MDI? Will you prefer a closed loop insulin pump using one of several CGM options combined with an algorithm that coordinates glucose readings and insulin doses? Will control be enhanced by combining insulin with glucagon, amylin, or a GLP-1? Might you inject insulin from a smart pen connected to a CGM that offers an enhanced dosing advisor? Or will it be something we don’t even know about yet?

As diabetes technology advances, questions and concerns also arise. Research suggests that only 50% of current insulin pump settings have a reasonably appropriate carb to insulin ratio. Some pumpers don’t use the bolus calculator and others prefer to use a default setting, such as 1u for 15 grams. Basal rate settings are also widely dispersed. Prior to starting an artificial pancreas system, pump settings have to be reasonable to succeed. Who is going to do this as the number of AP wearers continues to rise? Will the increasing utilization of plastic disposables and throwaway batteries in pumps and CGMs add to environmental damage? Lots of diabtech questions remain to be answered.

For early insight, here’s a comprehensive review from Diatribe that reports on the products and approaches for insulin delivery discussed at the Children with Diabetes Conference in July, 2018.

Author

  • John Walsh, PA is a Physician Assistant and Diabetes Clinical Specialist with Advanced Metabolic Care and Research. He has provided clinical care for patients with diabetes for more than 30 years, including thousands of people on insulin pumps. He is the co-author of Pumping Insulin, now in its 6th edition, Using Insulin, STOP the Rollercoaster, and The Pocket Pancreas. President of the Diabetes Mall, he is also the webmaster of diabetesnet.com, a highly trafficked source of diabetes information and technology, and opensourcediabetes.org. John is a consultant and advisory board member for pharmaceutical and device corporations and a frequent speaker on diabetes, insulin pump therapy, bolus calculators, infusion set design, glucose management, and the future of smart pumps, meters, and continuous monitors. His recent research, published in the Journal of Diabetes Science and Technology, explores the dosing and behaviors that lead to successful glucose outcomes by pump wearers. John has worn nearly every insulin pump and CGM available and is a sub-investigator on numerous research studies on diabetes drugs and devices.

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