Happy Shoot Up readers vote in our latest poll
Well, it’s poll results time again chaps. This month your soaraway Shoot Up asked why should the NHS pay for CGMS for diabetics? For the acronymically-challenged among you, CGMS stands for Continuous Glucose Monitoring System and is a device which checks your blood glucose every five minutes or so and beams the results back to a receiver – resulting in tonnes of useful statistics to help improve your control.
Anyway, getting the NHS to fund a CGMS and its necessary consumables is nigh-on impossible even though they have been proven to help diabetic control; so we wanted to know why the cash-strapped NHS should fork out for your CGMS.
The top answer was simply so you could improve the general quality of day to day life (42%) as CGMS can alarm if you go to high or too low – useful if your hypo symptoms aren’t so good. They can also be used to see exactly how certain foods effect your BG, allowing you to compensate better for them in future. Lovely!
23% voted that the NHS should cough up just ’cause we’re worth it – a great argument if ever there was one. A sizeable 16% want a CGMS because of an inherent lust for shiny technology, which is – after all – one of the few benefits of diabetes. I love shiny gadgets!
15% of voters wanted CGMS to prevent incapacitation through nephro/retinopathy, which is fair enough – that why we all bother looking after our diabetes and CGMS makes this easier to do. And finally, 4% wanted to finger prick less frequently. This was, of course, the trick answer as you still need to finger prick with CGMS so you can calibrate the system. So there
Anyway, this month we’re asking when you think the holy grail of diabetes research (aside from a complete cure, of course) of a closed loop system will be made available to the great unwashed. Closed loop systems are ones in which a super-accurate CGMS is combined with an insulin pump to automatically adjust your blood glucose levels on the fly. It would be pretty damned wonderful, but will we see it in our lifetimes? Give us your vote below on the right!
Those results in full:
- Improve general quality of day to day life (42%)
- Just ’cause we’re worth it (23%)
- Shiny gadgets are cool (16%)
- Prevent incapacitation through nephro/retinopathy (15%)
- Save us having to finger prick so much (4%)
Oh, and thanks to @Teloz for suggesting the poll subject.
Closed loop is probably (IMHO) only a decade or so away, but the biggest problem with it is always going to be liability.
You can see the Daily Fail headline now – Diabetic Killed by Rampaging Insulin Pump. No medical company / PCT is going to put their neck on the line to make our lives a little easier 🙂
As such I vote for 2020 with the caveat that it will exist but be unavailable for reasons other than the NHS.
I don’t think liability is going be the problem; after all a closed loop not much different from technology that’s already available. We both use insulin pumps and they haven’t killed either of us (yet!) because they’ve gone through a shed-load of testing and MHRA / FDA approval.
I do think the pump manufacturers want to create closed loop systems and they don’t really want to kill any of us (though they might want to kill me when I do horrible reviews of their products, but that’s another matter); so it’ll happen sooner or later. I just think we’ve got to wait for the technology to catch up – CGMS just isn’t accurate enough yet.
It depends what you mean by closed loop. For me, true closed loop – ie the artificial pancreas runs my diabetes without input from me – is a long way off. Beyond the need to improve the existing tech, there are a couple of things that jump out at me:
Without a super fast acting insulin, or a connection into a vein to deliver IV insulin, you’ll still need to tell the pump you’re about to eat x carbs so it can put the insulin in. With current drugs and subcutaneous delivery if I didn’t tell an automated system I was planning to eat, it would have to wait for the post meal rise before the CGM noticed and started delivering insulin. That would take an age to bring levels down.
Also, for a truely closed loop you surely need some way of raising blood sugar?Pump+CGM+clever algorithm can lower blood suger. They can also stop the insulin supply if you’re dangerously low. But what if you’re a 5 but have too much insulin on board? True closed loop would mean the pump would be able to do something about that eg infuse glucose/glucagon?
I’m just nit picking really. I do think an artificial pancreas is one of the most promising things on the horizon for better control, but I think it will still require a lot of user input and action. I think what we’ll see is incremental improvements to the existing pumps and CGM tech, with the addition of increasingly clever software over a period of years, rather than a magical moment when the artifical pancreas suddenly arrives.
Didn’t the very earliest pumps also do glucagon?
@Tim I don’t know. I was about 4 when the first pumps came out and they were pretty much bigger than me so I don’t think the parents paid that much attention!
@Alison – and there was me thinking your diabetes-knowledge was limitless.
🙂 Sorry to disappoint
@Tim – they did. And here’s a picture: http://www.picturetrail.com/sfx/album/view/201986
Some other very interesting pictures on there as well of various evolutions of pumps.
@Annette – thanks – that is quite interesting!
Mine was the Mill Hill one on the left. No glucagon with that one, and one for real patients never had glucagon in.
Why don’t we get given that other things which we are missing? Forgotten the name of it…
I have the offer of being allowed CGM with a veo as a ‘special funding’ case. They were shocked anew by my meter readout last Tuesday! Have to decide.