Professor Jeremy Turner, 26th May 2016

Professor Jeremy Turner, 26th May 2016

On Thursday 26th May the group welcomed Professor Jeremy Turner, Consultant Endocrinologist from the Norfolk and Norwich University Hospital who explained the facts behind some of the new Diabetes Technology that is now available.

Insulin pumps are available with sensor-augmented pump technology (SAP). An integrated sensor-augmented pump therapy is designed to measure glucose levels every few minutes and allow real-time adjustment of insulin therapy. This technology also alerts the user if their glucose levels become too high or low and some systems can automatically suspend insulin delivery when blood sugar levels drop too low. It can make a huge difference to people who, despite their best efforts, are struggling to control their blood sugar levels.

CGMS (continuous glucose monitoring system). With a blood glucose meter, you use blood to do the test whereas continuous glucose monitoring isn't blood glucose monitoring as the sensors with a CGM machine are placed into your body but not into the bloodstream. The sensors measure the glucose in your interstitial fluid - the fluid in and around your body’s cells. The relationship between glucose concentrations in interstitial fluid (ISF) and blood has generated great interest due to the possibility of gaining up to 288 glucose level readings a day without having to do finger pricks. Basically, CGMs are a less invasive technique for measuring glucose, can be used whether you wear a pump or use injections for your insulin delivery, work 24 hours a day and can include alarms to indicate when your glucose levels are too high or too low. The 2015 NICE guidelines covering the management of type 1 diabetes in adults recommends that continuous glucose monitoring is offered to people struggling with hypoglycemia such as a complete loss of hypo awareness or more than one severe hypo per year with no obvious cause.

The artificial pancreas or closed loop system, although at present still at the research stage but progressing well, is a system that measures blood glucose levels on a minute-to-minute basis using a continuous glucose monitor (CGM), and transmits this information to an insulin pump that calculates and releases the required amount of insulin into the body. This system, which is worn like an insulin pump, has been termed the 'artificial pancreas' because it monitors and adjusts insulin levels just as the pancreas does in people without diabetes.

The device has the potential to transform lives, particularly for people who find it difficult to maintain good blood glucose control. By levelling out the peaks and troughs in blood glucose levels, the artificial pancreas will help to avoid:

  • raised glucose levels, which over time contribute to the development of complications.
  • low glucose levels, or ‘hypos’, which can be distressing and in extreme cases can lead to a coma or death.

Blood Glucose Meters.  The Abbott FreeStyle Libre has come as an entirely new concept in glucose monitoring by providing much greater data than blood glucose testing whilst being more affordable than continuous glucose monitors (CGM). The FreeStyle Libre provides ‘flash glucose monitoring’ with glucose readings provided by scanning a sensor rather than pricking your finger.

The FreeStyle Libre works by having a small round sensor applied to your arm, roughly the size of a £2 coin, which is applied to the skin with a handheld applicator and then lasts for fourteen days. Most people that were used in patient trials of the Libre rated the application of the sensor as being painless. Within the fourteen days of usage, the sensor allows you to scan the sensor with the handset which sends data of your sugar levels over the previous 8 hours to the Libre system’s handset. When you scan, you therefore get not just a glucose reading, as you would with a blood glucose meter, but can also see whether your sugar levels are starting to go up, down or are stable.

Due to the way the Libre works, there are a number of benefits: Reduced need to take so many blood glucose tests. Provides graphs of how your sugar levels have been varying - in a similar way to how a CGM does. Scanning the sensor shows how much your results are trending upwards or downwards. More affordable than a CGM. Sensor is waterproof in up to 1metre of water for 30 minutes.

Unfortunately at the moment the Freestyle Libre is not available on the N.H.S. nor is it D.V.L.A. compliant.

At present trials are being carried out on a contact lens which measures glucose in the eye tear fluid with readings provided by scanning the lens and also a meter which measures the glucose in saliva, working on the same principle as a blood glucose meter. Inhaled insulin and oral insulin are also being re-developed with better results hopefully in the near future.