Diabetic Home Care and Monitoring (cont.)
What additional monitoring does the doctor do?
Blood glucose
The American Diabetes Association has the set the recommendations for healthcare providers on what they should be doing and what should be available for the optimal care of patients with diabetes. Among these recommendations are the monitoring of blood glucose either by fingerstick or through a venipuncture and lab testing. It should be used to supplement the information obtained from the patients regular home blood glucose readings, and used if the provider feels the patient's
blood glucose level is currently too high to too low in the office. Office testing also allows the physician to see if the patient's results at home are accurate.
Continuous glucose sensors (CGMS)
There are also currently available Continuous Glucose Sensors (CGMS). The first generation of these devices functioned similarly to a
Holter monitor of the heart. A small cannula is inserted into the superficial tissue of the abdomen (the subcutaneous tissue). The needle is removed and the sensor remains. It is taped in place and connected to an external device about the size of a pager. This records glucose values at an interval of roughly 20 minutes over a 72 hour period. At the end of that period, the recorded glucose values are downloaded, and information is reviewed. Patients usually keep a log over the 72 hour period of how they feel, what they eat, and what their fingerstick readings are to compare with the sensor. This data is especially great for athletes, patients who are unpredictable in their
blood sugar highs and lows, and those who can't seem to find a pattern to their fingerstick glucose readings. The draw back to the original sensors was that the data was not available in a
"real time" format. As a result, the patient would have to bring the device into the doctor's office to download and review the data in conjunction with the logs they were keeping.
Glucose sensors have improved dramatically in the last few years, and are an option for patients to gain further insight into their patterns of glucose response to tailor a more individual treatment regimen. The newest generation of sensors allows for a real time glucose value to be given to the patient. The implantable sensor communicates wirelessly with a pager–sized device that has a screen. The device is kept near the sensor to allow for transfer of data, however, it can be a few feet away and still receive transmitted information. Depending on the model, the screen displays the blood glucose reading, a thread of the readings over time, and a potential rate of change in the glucose values. These sensors can be programmed to produce a "beep" if
blood sugars are in a range that is selected as too high or too low. Some can provide a warning beep if the drop in blood sugar is occurring too quickly.
To take things one step further, there is one particular sensor that is new to
the market and that is designed to communicate directly with the insulin pump.
While the pump does not yet respond directly to information from the sensor, it
does "request" a response from the wearer if there is a need to adjust anything according to the patterns it is programmed to detect. The ultimate goal of this technology is to
"close the loop" by continuously sensing what the body needs and then responding by providing the appropriate dose of insulin. While this technology is a few more years in the making, the strides in this direction continue to be significant.
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