HealthOctober 20, 2017

From Type 1 to TypeONEderful

Chronic diseases are the leading causes of death, disability, and health-related costs in the United States. Because people with type 1 diabetes (T1D) have to deal with this condition for the majority of their lives, having a solid understanding of the disease and learning how to best manage and take care of themselves can have a huge impact on quality and length of life.

By Angie Newman, MS, RD
Angie Newman is a registered dietitian and senior health communication designer of Emmi programs at Wolters Kluwer.

I spoke with Reva Berman, author of the blog Type ONEderful, to learn about how technology has influenced her experience living with T1D and helped her understand the condition.

An “all consuming” disease

Reva was diagnosed with T1D when she was 12. She wasn’t having any symptoms at the time, so this came as a huge shock and with a very big learning curve. As Reva explained to me, T1D is challenging to manage because there are so many variables that can affect blood sugar. The main day-to-day goal is to keep blood sugar levels within a certain range, and everything from stress to exercise to being sick, and of course food, affects that. She says, “You’re kind of guessing and making corrections all the time.”

During her first year living with T1D, Reva relied on finger pricks to check her blood sugar levels and gave herself shots of insulin to manage them. She described the shots as “so strict” and told me that she would have to plan out (and later stick to) what she would eat for both breakfast and lunch before eating either meal so that she could give herself the correct amount of insulin first thing in the morning. And communication with doctors about day-to-day happenings came in the form of paper log books and fax machines.

Technology has come a long way

After living with T1D for a year, Reva began to use an insulin pump. The pump allowed her to avoid giving herself shots (there’s a small tube that’s put under the skin and it stays there for about 3 days before it’s rotated to a new spot). Reva still had to tell the pump how much insulin to deliver for things like meals or to correct for a high blood sugar. But, she was able to see how she felt at lunch before deciding what and how much she wanted to eat, and dose the insulin accordingly.

With her doctor’s help, the pump was programmed to deliver a “basal rate” of insulin. This is a tiny amount of insulin that’s delivered throughout the day (and night) to help keep blood sugars within range (for times between meals, for example). This helped to fine-tune the amount of insulin needed and prevented Reva’s sugar levels from going too high or too low as often.

About 5 or 6 years ago, Reva began to use a continuous glucose monitor (CGM), which she described as life-changing. The CGM has a sensor that sits just below the skin and stays there for about a week. It takes small blood samples and graphs blood sugar levels in real time. She can read the graphs on the pump and not only see what her blood sugar is right this minute (like a finger poke would accomplish), but also how it’s trending. This allows Reva to better understand what’s causing the highs and lows in her blood sugar, and also avoid some of them all together. Is it on the low side but going up, so no need to grab a snack? Is it high and continuing to go higher, requiring an extra dose of insulin?

Advancements in glucose meters also made it easier to communicate with her healthcare team between appointments. With a USB attachment, she could plug it into her computer and upload and send the data via email. Her doctors could respond within hours and suggest adjustments to help her better manage her diabetes.

More life-changing advances

Fast forward to today. Reva has a brand new pump that can actually read the trend information from the CGM and adjust the basal insulin (the tiny amount of insulin her pump delivers throughout day and night) all on its own. What does that mean exactly? Here’s what Reva had to say about it on her blog: “It means that this first pump of its kind now has the ability to see what my blood sugar is and every 5 minutes, all on its own, give micro amounts of insulin to make sure my blood sugar stays as close to 120 as possible. It means that if my blood sugar is going up, it will give more insulin, and if it’s dropping low, it will give less. ALL ON ITS OWN!!!”

Clearly, you can sense her excitement. The goal of keeping blood sugars within range can become frustrating and Reva admits burnout is a problem amongst people with T1D. But within just a few days of wearing the new pump, Reva’s blood sugars became noticeably more stable. She described seeing “one of the straightest, steadiest, in-range blood sugar graphs” and says she couldn’t help but get emotional. “I’ve been waiting for something like this.”

For a disease that’s both all-consuming and exhausting, technology may very well allow her to relinquish a small amount of the constant management and burden that comes with having T1D.

To find out more about what it’s like to live with T1D, visit Reva’s blog: Type ONEderful.


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