The Love/Hate Relationship with Tech.
Recap of the 2022 ADCES Diabetes Technology Conference
Last week I attended the second annual ADCES Diabetes Technology conference in Chicago. It was my first diabetes conference in nearly 3 years (!) and it was lovely to see so many familiar faces again. Having conversation about diabetes technology reminded me of how much I appreciate the advancements we’ve made in the last 5-10 years (especially compared to where we were when I was diagnosed almost 30 years ago).
I also found it interesting to realize how much I think of diabetes management as a relationship - which perhaps should come as no surprise, since I am a Licensed Marriage and Family Therapist. But instead of always focusing on the relationship between a couple or a family, when I work with individuals with diabetes, the focus becomes their relationship with their body, food, their self-perception. But we’ll get into that more later…
Benefits of Technology
Back to the conference! Diabetes technology has some really great benefits. A few things Gary Scheiner mentioned include:
we can customize insulin needs to insulin sensitivity changes from stress, activity, illness, or macro content (ie high fat).
we can change the rate of delivery to better match digestion.
we can delay or skip meals entirely without worrying about severe hypoglycemia
we can graze and dose without worrying about stacking insulin because our devices can track “insulin on board.”
A benefit of wearing an insulin pump is that we are now able to see how exactly different factors impact our blood sugars. As Jennifer Trujillo shared in her slides, we can get a more accurate picture of just how high BGs can go and for how long.
But there are still some cons, right? Diabetes technology still involves quite a bit of involvement from us, the patients who use these systems. And despite the advancements in technology, the majority of people with diabetes are still not meeting recommend targets for A1C or time-in-range, so we have a lot we need to improve. In Aaron Kowalski’s welcome address, he talked about the need for the balance between improved diabetes health outcomes and quality of life and “diabetes happiness.”
(This is a big reason why we created the Diabetes + Mental Health Conference - and registration is now open!).
Technology Distress
Even though technology can have so many awesome benefits, it can also create an enormous burden for people with diabetes (and their loved ones). There are a lot of reasons for this, primarily because we as PWDs are still the main drivers of the technology). Even the “automated insulin delivery” insulin pumps are not fully automated. They require a lot (!) of user input!
A few other reasons that were presented by Amy Hess-Fischl include:
not trusting the data
alarm fatigue
the number of devices being used
skin irritation or physical interference
information overload
Some strategies for dealing with tech distress include:
getting support for managing skin issues
setting alarms that are both helpful, realistic and compassionate
understanding lag time on CGMs and developing appropriate decision-making strategies with CGM info
getting additional training and support on the systems (especially new ones)
taking a tech break (it can sometimes instill a new appreciation)
These are just some of the reasons why people might not be meeting recommended targets, because there are a lot of barriers to optimal use, and there are also a lot of barriers to even getting the devices. Systemic racism and implicit bias was mentioned several times, with faculty noting the disparities in technology and clinical outcomes between White PWDs and BIPOC PWDs.
Optimizing AID and manual insulin pumps and CGMs
There were a lot of great suggestions about how to optimize our use of diabetes tech to see improvement in A1C, time-in-range and other health outcomes.
Gary Scheiner’s tips include:
optimize your pump settings (basal, bolus, and correction factors), even if you’re wearing an AID. AID pumps still rely heavily on all these settings.
bolus timing is important
make sure CGM data is accurate (calibrate or replace if it’s inaccurate)
be conservative when treating a low on an AID pump, it already cuts your basal
take care of insulin quality (keep it cool) and absorption (location, frequency and type of site).
know when to turn it off (some features that are only available in manual mode may be preferred over the AID algorithm)
In Raylan Lal’s presentation, he gave a detailed overview of how each system operates and which setting inputs are most important (for example, Omnipod and Medtronic don’t rely on pre-set basal rates after the first few days). Understanding these features as patients is crucial because it helps us to know what is out of our control and what we can manipulate or how we should respond when our BGs aren’t in target. He emphasized that things like forgetting to bolus or having overly aggressive basal or bolus ratios can make it difficult for the system to operate properly because these settings are now doing things in a way that they aren’t designed.
My biggest takeaway from the weekend was that even thought our systems are becoming 1) more accurate 2) more adaptable and 3) more synchronized, there is still a lot of involvement on the patient side. This means we still need to help people make more compassionate, data-driven diabetes decisions, especially if we want to see the percentage of people meeting target A1Cs increase. It’s not enough to just hand a device to the patient and assume that’s its completely intuitive (the number of repeated questions in Facebook groups proves otherwise!).
We need to do better. Our diabetes health and happiness depends on it!
I have seen this firsthand in the years I have coached people with diabetes. Most of my clients do not receive the training they need to understand how to optimize their decision-making, and are using antiquated ideas of carb counting and dosing to operate these newer, advanced systems. We need a process for making sense out of what we are seeing so we can make better decisions and have more flexibility and less anxiety. Which is why I am launching…
Diabetes Decoded: your roadmap to understanding and responding to your body’s patterns so you can make more compassionate and attuned diabetes decisions.
Before I can open the doors, I need beta testers to take for it a spin!
Who can be a beta tester?
Someone who has diabetes (or care for someone does)
Someone who wears a CGM and uses insulin
Someone who wants a deeper understanding and connection with their body, who to feel more empowered to respond compassionately and less reactively, and who wants more freedom and flexibility in how they live.
Is this you? Save the date: Doors will open for just 48 hours on January 2nd and 3rd to join as a beta tester at a heavily discounted price (75% off!). You’ll get:
full access to the entire five module course
a group coaching call in January
bonus trainings on basal, bolus and correction factor testing
Another options, if you don’t want to just be a beta tester, is to actually join as a 1-on-1 client. Anyone who joins as a 1-on-1 client this month will also get access to Diabetes Decoded. Your coaching program won’t start until January, but you need to apply and be accepted in December, so don’t delay. Coaching apps are over here.