By Gary Scheiner MS, CDCES, 2014 Diabetes Educator of the Year
It seems as though everyone is looking for easy answers. From the day insulin was administered for the first time to the use of modern-day AID (automated insulin delivery) systems, the main goal is to cure this F*!#*ing disease or not have to think about it! We all know that the discovery of insulin was followed by the development of better insulins, glucose monitoring systems, and research showing the link between glucose control and the prevention of serious diabetes complications. And the role of the role of the diabetes care and education specialist has blossomed – helping guide patients through the complexities of living successfully with diabetes.
But what about these new AID systems? Do they represent the “cure” we’ve been hoping for? Hardly. Do they eliminate the burden on the user? Once again, hardly. If anything, they have exposed areas of weakness in diabetes self-management that require us, as diabetes care experts, to step up our game.
I can attest that [AID] definitely improves glucose management outcomes without adding more work or complexity to an already cumbersome routine. But it certainly is not going to replace the need for quality DSMES.
While AID systems can compensate for modest glucose excursions without the user’s involvement, they are next to helpless at handling anything that causes a dramatic rise or fall in glucose levels. Users need to have a solid foundation in carbohydrate estimation as well as general nutrition principles – including the time component of digestion and insulin administration. The subtle adjustments made by AID are no match for the challenges posed by most sports/exercise activities. Users must be coached on how to make their own adjustments for preventing hypoglycemia as well as adrenaline-induced hyperglycemia. The various factors that contribute to insulin resistance (illness, infection, steroid meds, emotional stress, etc.) also require user intervention. And of course, proper pump site management is essential for ensuring that insulin doesn’t just flow through a tube, but that it reaches its intended destination.
And none of this touches on the myriad of other self-management topics that AID system users still need to understand and apply: everything from weight management to screening for complications to the latest glucagon options.
Not that all this new technology is useless. I use it myself, and I can attest that it definitely improves glucose management outcomes without adding more work or complexity to an already cumbersome routine. But it certainly is not going to replace the need for quality diabetes self-management education and support (DSMES). If anything, it opens opportunities for new areas of training and expert consultation.
So, embrace AID. It is clearly a step in the right direction. Just don’t relent in providing aggressive DSMES for users of these systems.
Want more on AID?
Listen to episode 89 of The Huddle podcast, Open-Source Automated Insulin Delivery Part 1: The Basics and Benefits to learn about the history of this technology, how it works and the life-changing benefits it offers to people with diabetes. Then continue onto the next episode, Part 2: Practical Considerations and Applications for Healthcare Professionals.
Get the tools you need to help people with diabetes understand insulin management at DiabetesEducator.org/InsulinDelivery.
ADCES Perspectives on Diabetes Care
The Association of Diabetes Care & Education Specialists Perspectives on Diabetes Care covers diabetes, prediabetes and other cardiometabolic conditions. Not all views expressed reflect the official position of the Association of Diabetes Care & Education Specialists.
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