Thank you for taking the time to review the second part of this series on Diabetes and Technology. Today I will concentrate on APPS used in diabetes management and how to choose one that might suit your needs. However, before I start talking about APPS I want to say a few words on flash glucose monitoring and continuous glucose monitoring. No doubt you have heard these terms being used more frequently in today’s diabetes management world.
Flash Glucose Monitoring-is a new approach to monitoring glucose that may benefit some patients who are looking for a bit more convenience or don’t need intensive glucose monitoring. A sensor is implanted in the arm that you can scan with a specialized reader. This system does not require calibration by the user as compared to continuous glucose monitoring systems. It does not continuously measure blood glucose or does not alarm for high or low events, but it does provide a result when the sensor is scanned. It does and can provide a record of an individual’s glucose levels, trends and patterns up to 14 days. This system measures the sugar in the interstitial fluid, the fluid around the cells, so the reading may lag behind that of an actual blood glucose check. If blood glucose values are changing fast, then it is recommended to do a blood glucose check with your meter. A strip can be used in the reader to get a blood glucose value so that is a nice option to confirm accuracy. If you wear an insulin pump this device lacks the ability to connect with the pump. You can download your 14 day results or longer if you wish and the doctor/diabetes care team can have easy access to what is happening on your behalf. To my knowledge, there is only one brand marketed in Canada at this time and it is called The FreeStyle Libre System so you may want to check their website if you are interested. (note: I am not promoting this product but felt you needed to know where to look for information),
Continuous Glucose Monitoring(CGM)- automatically tracks blood sugar (glucose) levels 24 hours a day. You can see your blood glucose (BG) level at a glance as well as your glucose trends over a period of time very easily.
For CGM a tiny sensor is inserted under your skin, usually the belly or arm. This system too, like the flash glucose monitoring, is measuring the interstitial glucose level. The sensor tests glucose every few minutes. You also wear a transmitter which wirelessly sends the information to a monitor. The monitor may be an insulin pump or another device you carry in your pocket/purse. This system does require calibration. Depending on which system you purchase replacing the sensor is unique to each device but this will be reviewed with you when teaching occurs. Results can be downloaded for easy viewing and shared with your diabetes care team. There are alarms for highs and lows and some of the newer models will suspend insulin delivery when sugars go low. They have advanced so much over the last few years that you need to compare a few of them to see which best suits your needs. Like everything with diabetes, there are the ups and downs of wearing this device 24 hours a day, but we know diabetes never takes a vacation so we can decide on how we what to manage the disease to the best of our ability. Like with all other devices mentioned, if blood sugar levels are changing fast, you need to use your meter to check the actual glucose value since a discrepancy can exist. I have noticed this over the years so it is real and can happen.
There are several CGM devices on the market and my intent is not to recommend any one of them but I do recommend you review the information, contact the manufacturer as they are all very helpful, and have a demonstration before making that final decision.
The CGM Devices are expensive so be sure to check if your insurance will cover the cost or at least pay something toward the cost. Some provinces in Canada have programs to help a young person in the family. Many of the manufacturers will check with your insurance company. You also want to know if the insurance covers the supplies needed to use the CGM/Flash System and if you have a yearly cost limit. I came across this website talking about CGM & Flash Systems available in Canada. I hope you will find it useful.
APPS FOR DIABETES MANAGEMENT
Apps on every topic are exploding the market including those for diabetes management. With so many apps available, it can be overwhelming. Every app has different features so how do you know which one to choose? Many organizations have free apps for public use.
Ideas for selecting an App
1. Ask yourself what you are looking for in an app. Is it to count calories, track glucose levels, reminders for taking insulin or your medications, to lose weight, keep track of daily exercise patterns or perhaps to check healthy recipes? Taking time to review your reasons can help to narrow down your choices.
2. Ask your health care providers if they can suggest an app and if so how they rate the app. Did it meet their expectations? Ask your family or friends if they have a favorite app and why. Don’t always pay attention to the rankings you see in a magazine or online. Everyone has different ideas on what they expect an app to provide.
3. Do you want a free app or pay for it? Be cautious here, as sometimes, the original app is free but then to get special features or a “premium membership” there is a cost.
4. Is the same app available for your ipad, watch, android, smartphone or are there different versions? Think of its compatibility with other devices or to share information with others.
5. Check who the app developer is and have they developed other health apps? Do any reputable health organizations use the app? Is the company still in business? For health apps a program designed by the health profession might be a good selection.
6. Be realistic about what you want to achieve by using the app. The use of an app should not replace individualized medical advice. It should help to make your life easier, not more complicated. Sometimes the simplest is the best.
7. Is the app upgradable or can it be upgraded over time? You want to have the most current information at your fingertips.
8. Can you find any evidence that supports what the app claims to do? I found one study which revealed that out of 18 apps they researched only 4 of them had any evidence to support their claim and five others made false claims. My colleagues blog this week is on How to spot fake news .
9. When you search for an app take a minute to check the screenshots and determine if they are relevant to you.
10. Before downloading any app, read its terms of use. Is your privacy being protected? Before clicking “I agree” be sure to at least browse the information. This information will inform you on how your health data is protected and used. Avoid apps that have no terms of use.
11. Avoid apps that promise too much too fast. We all know that changing habits is a process and we have to be prepared medically, mentally, physically and emotionally to work on that change. It is highly unlikely that any device will do this for us but it may help.
12. Try it out and trust your gut. Does the app include something that doesn’t seem right to you? If you have downloaded a couple of apps, which do you prefer in terms of information, features, and graphics? Does it make you anxious to use? Is it user-friendly such that you will use it on a regular basis? If you answer no to any of the above, then delete it and try another.
Apps can be of value in reaching your goals. Selecting which to use to meet your needs will take some time, discussion with family, friends, health professionals and it should not aggravate the situation. We work hard to manage diabetes so even one extra unpleasant burden should be avoided if at all possible. I realize that technology is confronting us more than some of us might want to believe or like, but if you have true fear and apprehension about its use for reasons only you know, then your health care team has to be aware of this and respect your decision. As long as you provide the information they need, that should suffice. Don’t buy any device or piece of technology just for the sake of having it in your toolbox. If it isn’t used, it is of no value to you or your health care team.
Good luck with your technology choices. Remember to subscribe to the blog and make suggestions for future topics.
References (part I &II):
Canadian Healthcare Network accessed on June 6th,2020- 2010 Diabetes Update: The ABCs of blood glucose meters (www.canada.ca)
Top 10 Best Blood Glucose Meters: Comprehensive Review accessed June 16th,2020
14 Apps for Managing Diabetes: Blood Glucose Trackers, Food and Exercise logs and More
Self-Monitoring of Blood Glucose (SMBG) Recommendation Tool for Health Care Providers Appendix 5 accessed June 16th,2020
How to Choose a Good Health App
How to choose the best health app for you accessed June 26th,2020
8 Tips for choosing a health app accessed June 26th,2020
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