Diabetes Focus Area
Research

A lot of research is being done on diabetes including testing methods, diet and exercise, medications and other treatments for conditions related to diabetes. One of the testing methods under investigation is continuous glucose monitoring.

Continuous Glucose Monitoring

Continuous glucose monitoring (CGM) is being studied to see if it can help patients with type 1 diabetes, who have problems controlling their sugar levels. CGM is a test used to record the different levels of sugar that are present in tissue fluids. This type of monitoring is intended to provide a physician with your glucose levels over the course of several days. Seeing the continuous levels allows your doctor to make adjustments to your diabetes management program. However, continuous glucose monitoring does not substitute other practices to manage diabetes.

How You Get to Use CGM

Continuous glucose monitoring devices are available by prescription only and should only be used under the guidance of a physician. At least two devices have been approved by the Food and Drug Administration (FDA): the GlucoWatch™ Automated Glucose Biographer (manufactured by Cygnus Inc.) and the MiniMed™ Continuous Glucose Monitoring System (CGMS; manufactured by MiniMed Inc.).

GlucoWatch

The GlucoWatch is worn like a wristwatch. A sensor that fits against your skin detects the glucose in the tissue below. Glucose measurements are taken every 20 minutes for up to 12 hours. The result is a time-averaged measurement of circulating glucose levels over the 20-minute cycle.

The sensor provides up to 12 hours of readings but must be replaced every time the GlucoWatch is taken off and put back on. The GlucoWatch compares each reading with high and low alert levels set by your physician. An alarm is triggered if the reading is above or below these levels, as well as in the event of rapidly declining glucose readings. Glucose readings are stored in memory and downloaded to a computer for review by your physician.

MiniMed

The MiniMed CGMS uses a glucose sensor that is placed under the skin of your abdomen. The glucose sensor is attached to a sensor wire, which is connected to a monitor the size of a pager. The monitor is worn on a belt. A trained physician inserts the thin, needle-like sensor under the skin of your abdomen. This sensor needs to be moved or replaced every 2 to 3 days.

Measurements of glucose levels in the abdomen are made about every 10 seconds. Your physician puts the information from the device into a computer and then reviews the changes in glucose that have taken place throughout the course of a day. This information can be used to adjust your current treatment for diabetes.

Effectiveness of Continuous Glucose Monitoring

Clinical trials report that the use of continuous glucose monitoring is promising, as it may provide continuous and accurate measurements of glucose levels in tissue fluids throughout the course of a day. However, more research is needed before any definite conclusions about its long-term benefits or impacts on health can be made.

In addition, more research is needed to define those who are most likely to benefit from continuous glucose monitoring. Overall, no definite conclusions can be made about the effect that continuous glucose monitoring has on improving diabetes or reducing complications from diabetes.

Safety and Side Effects of CGM

Continuous glucose monitors are considered to be safe. However, minor complications have been reported, including irritation or bleeding at the site where the sensor is inserted into the abdomen, and minor skin irritation at the site where the sensor contacts the skin. Yet, once the sensor is removed, these problems usually disappear. Since the continuous glucose monitor is used in combination with self-monitoring of glucose and is not used alone to calculate insulin doses, it is unlikely that failure of the device would lead to the wrong insulin dose.

Where You Can Get Continuous Glucose Monitoring

Continuous glucose monitoring is performed on an outpatient basis for patients with type 1 diabetes who cannot control their blood sugar levels despite frequent self-monitoring of blood glucose. Continuous glucose monitoring devices are available by prescription only and should not be used without the supervision of a qualified physician.

Pancreas and Islet Cell Transplantation

Whole pancreas and islet cell transplantations are only suitable for a small number of people with diabetes. These procedures are usually only offered to people who have severe type 1 diabetes and who are not overweight.

Insulin Delivery Devices

Researchers are now developing several new methods for delivering insulin. These include the insulin patch and inhaled insulin. The insulin patch, when placed on the skin, will give a continuous, low dose of insulin. To adjust insulin doses before meals, users will pull off the tab on the patch to release insulin. Inhaled insulin delivery systems will give insulin as a dry power, inhaled through the mouth directly into the lungs where it passes into the bloodstream. This aerosol delivery system will likely be about the size of a flashlight and use rapid-acting insulin.

Study on Exercise and Diabetes

In 2003, the American Diabetes Association announced updated guidelines for exercise and diabetes.

The Recommended Exercise Program

The exercise program should begin with 5 to 10 minutes of warm-up, followed by 5 to 10 minutes of stretching, aerobic exercise (type and duration to be determined by the healthcare team), and ending with 5 to 10 minutes of cool down. Special considerations should be given to exercises that place demands on the feet (running, walking, tennis, basketball, etc.) to make sure the feet are well protected from friction and pressure.

Other considerations recommended in the report include: proper footwear; wearing of a medical identification bracelet, necklace, or shoe tag; proper intake of fluids; healthy meal plan and medication use; and proper evaluation for weight training exercises.

Exercise and Diabetes

The American Diabetes Association recommends:

• Avoiding exercise if fasting blood glucose levels are greater than 250 milligrams per deciliter of blood (mg/dL) and ketosis is present. The fasting blood glucose level is the level of glucose in the blood after 8 to 10 hours of not eating, or fasting.
• Caution if fasting blood glucose levels are greater than 300 mg/dL and no ketosis is present.
• Monitoring blood glucose levels before and after exercise-knowing when to adjust food intake and/or insulin and learning how blood sugar levels respond to various physical exercises.
• Monitoring food intake-adjusting carbohydrate intake as needed to avoid low blood sugar during exercise and keeping carbohydrate foods (apple juice, orange juice, or quick sugar such as candy bars) on hand during and after exercise.