Device helps diabetics better monitor disease

For 13-year-old Britain Buxton, sleepovers were out of the question. Every night came with a risk that he might slip into unconsciousness and - if not monitored by his mother - never wake up.

Andrew Nook, 31 and an avid cyclist, seldom took trips more than a few miles from his home. A blood-sugar "crash" could sap his energy and leave him stranded on the side of the road.

Those days are gone for these two Colorado Springs residents and hundreds of other Type 1 diabetics thanks to a new device, the continuous glucose monitor, that is revolutionizing management of the incurable disease. A landmark study released earlier this month by the University of Colorado and other institutions promises to pave the way for widespread insurance coverage of the device and a mainstreaming of the technology.

The device gives dozens of readings per hour of blood sugar levels, and perhaps more importantly, sounds alarms when they start to go too low or high. The study showed it improved the overall health in adult patients, who tend to use the monitor more effectively than children and teens.

Without the device, Type 1 diabetics - who don't produce the hormone insulin that regulates glucose in the blood - are left to manage one of the body's most vital biological processes manually. They prick their fingers a few times a day to test blood sugar levels, then address those levels through eating or insulin injections. The continuous glucose monitor checks the levels every one to five minutes and, by calculating trends, sounds increasingly urgent alarms when levels fall out of whack.

The additional data is life-changing, say patients and experts.

"It makes me a normal person again," said Nook, who now goes on bike rides up to 70 miles by using the monitor. When the device warns him his blood-sugar is falling, he can drink juice or take a tablet to turn it around rather than waiting for the symptoms.

Type 1 diabetes is a disorder usually diagnosed in childhood, with about 15,000 new cases annually among children, according to the Centers for Disease Control and Prevention.

There is no known cause, and in recent years cases have inexplicably been on the rise, according to experts.

 Although not as common as Type 2 diabetes - an insulin resistance that usually occurs in adulthood and is often associated with obesity - Type 1 diabetics share in a dangerous dilemma. The best way to avoid serious complications such as blindness and organ damage is to rigorously control blood-sugar levels, according to research.

But in doing so, they risk hypoglycemia, or low blood sugar, which can lead to lethargy, seizures, unconsciousness or even death if no one is around to help them out of it.

A 1993 study found that tight control of blood sugars reduces complications by more than half, but it triples the likelihood of a hypoglycemic event.

Finger pricks show just a few snapshots a day; a lot can go wrong between those checks. It isn't unusual for diabetics to pass out without much warning while driving cars, working, or participating in other activities.

The continuous glucose monitor, through a sensor under the skin, reports levels almost in real time.

Leigh MacHaffie, nurse practitioner and a certified diabetes educator with Memorial Health System, said it is like going from photos to video when it comes to revealing what is going on.

The alarms give patients a chance to drink juice or take a sugar tablet and turn the trend around.

Buxton's mother, Lynn Page, said the monitor's safeguards now allow her son, who was diagnosed when he was 8, to spend the night with friends and to participate in new activities.

Before, his friends' parents would have required an extensive lesson in diabetes treatment for her to allow that.

"It's honestly the first time that I, as a parent, could sleep through the night knowing that my son was being watched over by this device," said Page, who is also the Colorado Springs branch manager of the Juvenile Diabetes Research Foundation. Her son was one of 322 patients included in the study.

Nook, who was diagnosed at 13 and rigorously controls it, said he started on the monitor five months ago and found a "night-and-day difference." The monitor has shown him personal patterns in his blood-sugar levels, helped him keep those levels in a normal range and kept him from the highs and lows that can be so damaging to the body.

"I feel better than I ever have since being diagnosed with diabetes," said Nook, who dreamed of such an invention when he was a child.

The study on the monitor revealed that a key measure of a diabetic's overall health - a hemoglobin level that reflects how well blood sugars are staying within range - actually lowered after 26 weeks of use.

Dr. Peter Chase is a professor of pediatrics who helped lead Colorado's involvement in the study at the Barbara Davis Center for Childhood Diabetes at the University of Colorado School of Medicine. He said although children and teens did not show significant improvement in their hemoglobin level, that's likely because they tend to be more casual about managing their diabetes.

MacHaffie said one of her child patients on the monitor who is disciplined in diabetes management saw similar improvement to the adults in the study.

Chase said the study will likely lead more insurers to pay for it. The device costs $1,000, and a $37 sensor is needed every three to five days.

The monitor may also be the start of an even bigger development - a bionic pancreas, he said. Someday the monitor might work in conjunction with an insulin pump to restore some of the automatic control of insulin most people experience.

Jim Goss, 50, a shop teacher at Irving Middle School, also took part in the study. He would sometimes wake up to the faces of paramedics in the middle of the night after his wife called them for his hypoglycemia.

The monitor, he said, has kept away the paramedics. It is a far different scenerio than when he was diagnosed 44 years ago, a time when the best tests available showed levels that were two hours old.

"That whole notion of, ‘You can't do that, you're diabetic,' is going to go away," Nook said.