Gary Scheiner is an outspoken CDE (Certified Diabetes Educator). That's probably because he's lived with Type 1 diabetes himself for over 20 years. Best known for his insulin-pumping guidebook, Think Like a Pancreas, he's become something of a guru on the best techniques for achieving optimal diabetes control.
Trained at Joslin, he's done extensive volunteer work for the ADA, JDRF, and DESA (Diabetes Exercise & Sports Association). He's authored dozens of articles, and speaks at local and national meetings on diabetes, fitness and motivation. Plus he's received numerous awards for his work, including the 2003 Novo Nordisk Research Grant Award for the study of basal insulin profiles in insulin pump users. In short, Gary's a kind of D-Superman, now running his own private practice near Philadelphia, PA, called Integrated Diabetes Services.
This week, he was kind enough to answer a few penetrating questions for our community here at DiabetesMine.com:
DM) In your view, what was the most important advancement in diabetes care made in 2006?
GS) Definitely NOT inhaled insulin! Talk about good research gone to waste. Hundreds of millions spent on that stuff, and it will barely scratch the surface when it comes to treating diabetes properly. For Type 2s, Byetta made some strong headway -- finally, a medication that improves BG control without "burning out the pancreas", and helps with weight loss. For Type 1s, my vote is for the strong growth of real-time continuous glucose monitoring. There are still improvements to be made, but the technology came a long way last year.
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DM) What's the single most important thing a Type 1 diabetic can do to achieve optimal glucose control?
GS) Hate to quote my book title, but the bottom line is, you've got to Think Like A Pancreas. Regardless of your lifestyle, likes and dislikes, you have to match your insulin to your ever-changing needs. It takes a sound program design, flexibility, and the willingness to experiment and learn from your mistakes.
DM) And a Type 2 diabetic?
GS) Become obsessive about healthy habits, and stop thinking that medication can take the place of a healthy lifestyle. Even if medications manage to get blood sugars down towards normal, you're still at risk for serious health problems unless you take your health and fitness seriously.
DM) How soon do you think continuous glucose monitoring will become "mainstream"?
They are already becoming mainstream... for the rich & famous! Once insurance plans begin to cover the supplies, we'll see many more people using them. Right now, the cost prohibits the average person from being able to afford them. It might take a year or two before the big private insurers start to cover them. Medicare will probably take much longer.
DM) And how will patients and doctors share and utilize all the CGM data?
They probably won't, to be honest. This is the kind of thing that patients need to learn how to use and interpret on their own. It's a very individualized art form, and it can be quite time consuming. If there is one thing we know about medical care in this managed care era is that physicians don't have time to get very analytical or creative when they're forced to see 10 patients an hour. It's going to be up to people with diabetes to come to their own intelligent conclusions. That's going to take some training by CDEs and representatives from the CGM manufacturers.
DM) What's the most exciting thing happening in insulin pumping right now? Powerful new "smart pump" features? Wireless models like the OmniPod? Something else?
GS) It may seem minor, but the "active insulin" or "insulin-on-board" feature has made a big difference in pump therapy. Bolus calculations could be hazardous to one's health if pumps did not have the ability to estimate the amount of insulin still circulating from an earlier bolus, and deduct it accordingly. Unfortunately, every pump on the market handles residual insulin differently, so there is no real consensus as to how to use the data. I also find that downloadable (or is it uploadable? I get confused) pumps allow clinicians like me and patients (like me also) to see a nice graph or summary of blood sugars, insulin doses and carb intake. Since I routinely work with patients from all over the country, pump data downloads make it easy to assess where a client's control is strongest and weakest.
DM) What do you think the world of insulin pumping (continuous insulin delivery) will look like in 5 years? In 10 years?
GS) Everyone is hoping for a continuous glucose monitor that is small and minimally invasive, and accurate enough to rely on, linked to a pump that has the intelligence to deliver insulin automatically without the user having to be involved. While this seems like a dream come true, it may be a long, long, loooooong way off. The insulin delivered into subcutaneous tissue by the pump tends to be too slow to cover most foods, and it takes too long to finish. The same can be said for subcutaneous sensors; their accuracy is limited by their measurement of interstitital fluid rather than blood. What I'd REALLY like to see is a wand that you can wave over any food item and have it tell you the exact carb count! There's this Chinese dish at the place next door to my office that gives me fits...
Thanks so much, Gary! Are you sure you don't want to move to San Francisco and become MY diabetes educator? We do great Chinese food here...