Technology is defined as ‘the application of scientific knowledge for practical purposes’. Living with type 1 diabetes mellitus (also called Juvenile diabetes or Insulin dependent diabetes) is difficult. Apart from restrictions in diet and lifestyle, the patient is dependent on insulin for survival. Though inhaled insulin are now available, they are hardly used and subcutaneous insulin is still the mainstay of type 1 diabetes therapy in India. This is combined with the fact that they need to check their glucose regularly using glucometer. Though use of insulin and glucometers has become less painful these days, there are a lot of children and parents who still have ‘needle phobia’. Because of this many type 1 diabetics are still on premixed insulin ! Premixed insulin SHOULD NOT not be used in type 1 diabetics. This article explores on how we can make Type 1 diabetes, virtually painless using technology and devices which are available in India. Unfortunately many patients and doctors are not aware of the availability of this technology in India and hence donot use it.
Can’t take 4 shots a day … How about 1 shot in 4 days ?
Subcutaneous indwelling catheters can be placed in the skin and changed once every 2-4 days. One such device which is available in India is iPORT. The iPORT is applied and changed once every 2-4 days. The patient can inject INTO the iPORT without injecting into the skin. Additionally it is not very costly and costs just about Rs. 800/- . Hence the patient needs to take just one shot of insulin instead of 4 shots a day. You can talk to your Endocrinologist about iPORT and similar Subcutaneous indwelling catheter devices. The use of these devices is completely safe and has endorsement from ISPAD (International Society for Pediatric and Adolescent Diabetes).
I don’t want to check blood glucose 4 times a day. Any solution for that ?
Type 1 diabetics are encouraged to perform SMBG which is self-monitoring of blood glucose. Regular self-monitoring helps the doctor have more data on the blood glucose pattern. However, children and parents often bail out on checking blood glucose and hence end up with poor blood glucose control. The modern glucometers come with lancing devices which make the process painless. I often demonstrate the using of these devices to my patients in my clinic to show them how painless the process it. Yet, they often skip on checking the blood glucose. Newer technology makes checking of blood glucose easier and pain-free. Free style libre is a new device which is a cross between a glucometer and continuous glucose monitoring device (CGM). Unlike other CGM devices, it does not require calibration with glucometer values. There are two components of this device, the sensor and the reader. The sensor is applied and changed once every 15 days while the reader takes data from the sensor via Near field communication (NFC). This means after applying the sensor once, you don’t need to prick for checking your BG for 15 days !! Additionally, this gives blood glucose reading once every 15 minutes !!
Conclusion
These two devices which are available in India, make management of type 1 diabetes mellitus pain-free. It is sad that not many people are aware of this but with better and increased use of these devices will make the life of the type 1 diabetics in India easier. You can consult your Endocrinologist for more information.