Diabetes mellitus is a metabolic endocrine disorder of the pancreas. It is characterized by hyperglycemia (high blood sugar) from the inadequate production or response to insulin. The disorder is seen in two main forms:
- Type 1 Diabetes is where there is reduced insulin production due to the loss of beta cells in the pancreatic islets of Langerhans as a result of immune-mediated cell destruction. This type is of the juvenile kind and occurs in children. Management includes administering insulin along with careful blood glucose monitoring.
- Type 2 Diabetes patients, mostly seen in patients over 50 years old (although more and more young people develop type 2 diabetes). The early stages are characterized by high insulin concentration in the plasma. The various cells of the body are unable to respond to insulin thus leading to insulin resistance. In later stages, the beta cells are unable to produce enough insulin, and at this point type 2 becomes more similar to type 1. Management involves appropriate diet and exercise and the use of oral anti-diabetic drugs and, eventually, insulin to control blood sugar levels.
Some of the most popular insulin administration devices and methods include a syringe, an insulin pen, or an insulin pump. A syringe is the simplest mode of insulin administration where the patients use disposable units to prevent contamination and infection. An insulin pen is an injection device the size of a pen that includes a needle and holds a vial of insulin. The insulin pen can either have replaceable insulin cartridges or can be of the disposable type prefilled with insulin.
The advantage of insulin pens over insulin syringes is that they are easier to transport and use and are less painful than traditional vials and syringes. Patients can repeatedly administer more accurate dosages (especially for patients with visual or motor skills impairments). However, two different insulin solutions cannot be mixed in an insulin pen. Insulin pens are also more expensive than the traditional vial and syringe method.
Insulin pumps are devices worn outside of the patient’s body. The pumps can be programmed to deliver a steady supply of basal insulin throughout the day to support the body’s needs between meals and/or programmed to deliver bolus insulin before or after meals or to cover immediate needs. The main advantage of insulin pumps is that the individuals need not take multiple injections every day, allowing them to continue with their daily actions without any problem.
The main disadvantage of insulin pumps is the high cost of the pump and its maintenance. Furthermore, it is uncomfortable to wear and can be easily disturbed by any kind of strenuous activity. Therefore, it is very important for patients to monitor their blood glucose levels much more frequently, making sure the pump is working correctly and avoiding risks of ketoacidosis.
Blood glucose is measured from a drop of capillary blood using a disposable dry chemical strip and reader device which is an uncomfortable and slow process. Rigorous glucose control requires constant measuring, and different sensors for continuous blood glucose measurement have been under development in the last two decades. Minimally invasive sensors that help to measure glucose in interstitial fluid, more suitable for self-monitoring, have also been developed. Robust, clinically acceptable devices are expected to become widely available in the near future.
Health care practice supported by electronic processes and communication (eHealth) provides new possibilities for revising central parts of the established care models for chronic diseases. eHealth incorporates Information and Communication Technology (ICT) tools and biomedical technological elements of mobile and remote health solutions and thus has an important role in chronic disease management.
eHealth platforms have also enabled the continuous monitoring of diabetes patients specifically during the COVID-19 pandemic. Many mobile apps incorporate connected blood glucose meters and are often developed by device manufacturers. Real-time continuous glucose monitoring and intermittently scanned flash glucose monitoring are increasingly used as adjuncts and alternatives to self-monitoring of blood glucose for making diabetes treatment decisions.
Based on the emerging clinical evidence from several clinical studies, there are increasing efforts to establish tight glycemic control in critically ill and hospitalized patients. Achieving the goal of tight glycemic targets requires extensive nursing efforts, including frequent glucose monitoring, training of patients and carers to handle control algorithms, guidelines with intuitive decision making for both managing diabetes and preventing hypoglycemic episodes.