What we’ve learned: 8 key insights from clinicians who use diabetes tech

Want to get a better understanding of a person’s experiences? Try doing what they do.

We asked 3 health care professionals who use diabetes technology what they’ve learned from it. Personally using diabetes tech has given them a sense of the challenges patients face, the insights they may gain from diabetes tech, and how to guide patients through tech adoption and support.

Two of these clinicians, Dr Egils Bogdanovics and Gary Scheiner, live with type 1 diabetes and use tech to help manage their own condition. The third clinician, Amy Hess-Fischl, doesn’t live with diabetes but chooses to put many devices through an extended trial run before recommending them to her patients. Here’s what they had to say.

Continuous glucose monitors (CGMs)

Using a CGM to look at my blood sugar after meals and physical activity was a game changer. While I don't personally live with diabetes, I was able to look at surges in glucose the way a person living with diabetes would—putting myself in their shoes and realizing, “Wow, look what happened when I ate that.”

I trained myself to use the CGM like a detective—thinking about cause and effect and how to problem solve with that stream of digital data in front of me. This experience has taught me the mentality that people living with diabetes should develop while they’re managing their glucose day-to-day.

I’ve learned to save myself and my patients a lot of stress by individualizing CGM alerts. Sometimes patients get frustrated because their alerts are constantly going off, and it’s because they’ve reset the CGM to the default settings.

And I understand why: They think they’re doing something good by setting their targets for the recommended glucose range. I live with diabetes, and that's what I aim for too—but my targets may not be the same as those of someone starting with an A1C of 9.

I help them understand which alerts will be relevant for them. Every alert should be customized and actionable for each person. If not, they may get annoyed or just start ignoring the alerts.

For me, using trending arrows with real-time CGM was a revelation. I live with diabetes and have worn CGMs for as long as they’ve been available; looking at my highs and lows has always been helpful for making changes in the big picture. But I was amazed when I started paying attention to the arrows on my CGM display that show whether my glucose levels are stable or trending up or down.

I’ve learned to see those trending arrows as my fortune teller, helping to predict where I’m headed. And that’s really what I want to know when I’m about to start exercising or get behind the wheel of my car. What’s my glucose going to be for the next 30 to 60 minutes?

I always teach my patients how to interpret trending arrows and make a plan so they know what to do when their glucose is rising or dropping. 

CGMs and trending arrows can help people see where their glucose is headed and potentially avoid highs and lows.¹

Connected insulin pens

For most of my life, I’ve taken multiple daily injections (MDI). And I don’t miss many doses, but I wanted to try using a connected pen to take my insulin. I synced it to an app on my phone so I could see every dose alongside my CGM readings, and I used the pen for a few weeks.

Despite all my experience with MDI, I looked back at my reports and was surprised to see some highs that I didn’t correct. That was eye-opening.

Missed or late doses are fairly common for people using MDI therapy.² I’ve worked with many patients who believe they always take their bolus dose when they eat, but we look at the connected pen report and realize it’s not always happening. The digital dose log helps me guide them based on recorded data.

I’ll admit, in the past I’ve given myself “rage doses” when I’ve already taken my insulin and I’m frustrated that my glucose is staying high. In those situations, I want to bring it down, so I end up overcorrecting. That can often lead to hypoglycemia.

I like connected pens with diabetes apps that can show me how much insulin I have on board. They help me avoid stacking insulin doses when I’m trying to correct stubborn highs.

A connected insulin pen with an app that shows the amount of insulin on board may help people avoid giving unnecessary doses.³

Insulin pumps and automated insulin delivery (AID) systems

The first time I wore an insulin pump was 26 years ago. (I used saline, not insulin—don’t worry.) 

It took me 30 minutes just to get the infusion set inserted. I was so nervous that I wouldn’t do it right. It made me realize how scary it must feel to someone with type 1 diabetes who’s putting it in for the first time, because they may be thinking, “This thing is going to keep me alive.”

Even leaving the house, it seemed like everything went wrong—the tubing was flopping around, it got caught on a doorknob, and it yanked off the infusion set. All this reminded me that the first time we do anything, we have to cut ourselves a little slack.

I’ve just recently started using an AID system, and I’m impressed. Since my diagnosis, I’ve been an MDI guy. I’ve always felt, as long as I have a CGM, I can maintain my glucose levels with insulin pens. I thought, “It’s not the plane, it’s the pilot.”

But I really like the consistency I get with the AID. I don’t think I could replicate the precision of the AID’s minor dose adjustments; I’d have to use my insulin pen 20 times a day. With my current system, to make a tiny adjustment, I push a button and it’s done.

It also helps overnight. I used to get up most nights at 3 AM to take my insulin. Even when I tried a sensor-augmented insulin pump, I’d still sometimes get woken up by alerts that my glucose was dropping. Now, unless this AID falls off, I’m not getting up in the middle of the night.

Automated insulin delivery systems may provide improved glycemic control throughout the night.⁴

I like being able to talk with patients about the nuances of each type of device, especially with insulin pumps. Having tried nearly every kind of insulin delivery system on the market, I know the ins and outs of many of them. 

The tech is not the same across brands. Algorithms may function differently, user experiences are designed differently, and some systems may work better for certain people. Does my patient want something that gives them very precise insulin doses but they have to micromanage the settings? Or do they want something simpler? If you’ve tried one, you haven’t tried them all.