Roughly 1.25 million Americans have Type 1 diabetes, so chances are you know somebody whose pancreas is taking the world’s longest lunch break. That person may be you.
As it happens, there has never been a better time to have this chronic disease — not because it’s anything you’d wish on another person, but because medical technology has advanced to the point where managing the disorder has never been easier.
Scratch that. It still isn’t easy (I’m Type 1 myself). But compared to where we’re coming from, these are exciting developments.
For the last few weeks, I’ve been testing a variety of new diabetes-related gizmos, with enough things stuck to my body to make me feel like a voodoo doll.
I had high hopes for the Medtronic 670G insulin pump coupled with the company’s SmartGuard technology. It’s billed as “the world’s first hybrid closed loop system,” which means a continuous glucose monitor is interacting with the pump, automatically telling it to raise or lower your insulin doses depending on your blood sugar level.
My verdict: It’s impressive, but not yet ready for prime time. More on that in a moment.
First, let’s talk about the G6 continuous glucose monitor, or CGM, from San Diego’s Dexcom. The new sensors and transmitters started shipping out to patients this week. I’ve been wearing the G6 for about a month.
This is, put simply, an extraordinary step forward in diabetes care.
I’d used the G4 and G5 versions of the sensor for years. The G6 makes them seem primitive by comparison.
It doesn’t hurt, which is a big deal. I jab my fingers for blood samples multiple times daily, but by far the most painful part of the regimen has been inserting the Dexcom CGM into my abdomen every week or two, depending on how long I could make the sensor last.
With the G6, no pain. If you have kids with Type 1, this is a game changer.
The sensor and transmitter have a flatter profile, making them more comfortable to wear and sleep with. But here’s the real breakthrough: No more finger sticks.
Dexcom and the Food and Drug Administration say the G6 is so accurate right out of the box, there’s no need to calibrate it two or three times a day, as had been the case with the G4 and G5.
I won’t go that far. After approaching the no-finger-sticks thing with a good deal of wariness, I found that it’s still smart to calibrate first thing in the morning, just to make sure your numbers for the day will be on the mark. After that, you can trust the CGM to provide accurate blood-sugar readings for insulin doses.
For the uninitiated, managing Type 1 diabetes is all about data. You need to know your blood sugar at any given moment — highs and lows can be troublesome if not downright dangerous — and you need to count carbs for meals and snacks to determine insulin doses.
Type 1 is the autoimmune, frequently genetic version of the disease. It’s nowhere near as common as Type 2, which is the version typically associated with obesity. Almost 30 million Americans are Type 2
Not only is the G6 painless and highly accurate, it has Bluetooth capability, which means it can feed your numbers into your smartphone for easier access. If you have an iPhone, those numbers in turn can be transmitted from the phone to an Apple Watch.
As I’ve written before, being able to see your sugar level with a flick of your wrist is hugely empowering.
There’s been no official announcement yet from Dexcom or Apple, but I’m hearing that when the next iteration of the Apple Watch operating system comes out in September, it will allow the G6 to send data directly to the watch.
That means you’ll no longer need to carry your iPhone as an intermediary. This can make activities like going to the gym, bike riding and hiking a lot more manageable.
I’m hearing as well, but again not officially, that Fitbit smartwatches also will have Dexcom functionality after September, at a price point well below the Apple Watch.
On the downside, Dexcom has programmed each G6 sensor to shut down after 10 days of use and you can’t restart it. There’s a medical reason for that: The body naturally rejects foreign objects, and the sensor’s effectiveness declines as your body tries to get rid of the part under your skin.
However, past versions of the Dexcom sensor allowed you to keep using it until it went kaput, which usually took about two weeks. Then you’d insert a new one in a different spot. With the G6, Dexcom is resorting to planned obsolescence as a business model, requiring more frequent replacements.
As for the Medtronic 670G, I went into the test with high hopes. I already wear the pump, so it was a matter of also using the company’s Guardian sensor and creating the “hybrid closed loop.”
Medtronic’s sensor is pretty accurate — not as spot-on as Dexcom’s, but not so far off. A check of my blood sugar typically would show that the Dexcom G6 was within just a point or two of the meter reading. The Medtronic Guardian might be off by 10 to 15 points. Close enough.
My hesitancy about the system relates more to the cumbersome nature of the sensor. It takes a dozen steps to insert it into your body and get it up and running (the G6 takes three).
Both the Medtronic and Dexcom sensors stick to the skin with adhesive backs. With Dexcom, you then click the transmitter into place and it stays put. But in an inexplicable design flaw, the Medtronic sensor’s transmitter has to be separately fastened to the skin with not one but two pieces of itchy, irritating tape. If you don’t use the tape — and I asked — there’s a good chance the transmitter will fall off your body.
God knows what Medtronic’s R&D folk were thinking.
Another strange decision: When you go into robopump mode, you lose the ability to extend insulin doses to accommodate high-fat or high-carb meals, such as pizza. In manual mode, there’s what’s known as a dual-wave bolus that allows you to fine-tune doses to reflect different foods or circumstances.
The closed-loop robopump theoretically handles that itself, but I found that if I ate a bunch of cookies or crackers, I’d have enormous spikes in my sugar levels. That wasn’t as much of a problem when I could control doses myself.
Neither the 670G nor the Guardian sensor are Bluetooth-equipped, so you can’t feed numbers into a phone or smartwatch; you have to keep checking the screen on the pump. I’m told upcoming versions of Medtronic’s gear will have Bluetooth, but there’s no word on when they may be released.
In the best of all worlds, the Dexcom sensor would work with all pumps, but that of course is asking for too much. Medical-device makers, their eye ever on the bottom line, want you to be monogamous.
This much is clear, though: Technology for diabetes management is advancing at a dizzying pace. Within a few years, it’s fair to say, tools will exist that will greatly lower one’s odds of experiencing serious complications from the disease.
Getting insurers to cover all this whiz-bang gear? That’s another story.