Gary Scheiner is not only a well-known diabetes educator and author of the popular book Think Like a Pancreas, he is also a type 1 diabetic for the past 25 years. He has used every pump and CGM on the market (he's currently rocking a Medtronic pump and DexCom CGM) and has also mastered the art of Symlin, another injectable drug used to manage type 1 diabetes.
He's back as one of our expert judges for the DiabetesMine Design Challenge this year, and today he's chatting with us about all the things he likes — and doesn't like — about current tools for managing diabetes.
DM) You've used pretty much every drug and piece of technology currently on the market for people with type 1 diabetes. What do you think is still missing?
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GS) Rapid-acting insulin is a biggie. What we have now — it's rapid-acting in name only. It's crap compared to what the pancreas produces. It's too darn slow. We need to turbo-charge insulin. That's the Holy Grail at this point. We're not going to get to a closed loop and manage post-meal insulin and exercise-induced lows unless we can get faster insulins.
Lee Iacoccoa, former chairman of Chrysler [editor's note: He's also a supporter of Denise Faustman's research], once said: "Get on board or get out of the way." We need insulin to do its job and then get out of the way.
Of the diabetes technology you've used, what has been the best?
The high and low alerts on CGMs are of real value to me. I have found that they are really important in mimicking the pancreas. You can replace an insulin pump with anything else. When CGM sensors alert us we're going too high or too low, that's a real advantage. A big challenge is when people are sleeping; we don't feel when we're approaching a low or a high. If we can't hear or feel the signal, it doesn't do anything. We need a tool with a big electric shock or something.
But the existing alerts have made a big difference in people who are trying to manage their blood sugars. The CGM is the key in shifting the risk curve over so you can get tighter control and avoid the lows properly.
Education is critical. You can put some features on a fancy device, but if people don't know how to use it properly, then it's just this $5,000 thing.
What do you think is more important, the pump or the CGM?
If I had to choose, I would choose the CGM. I can simulate almost everything with short and long-acting insulin. You can simulate bolusing with injections, but you can't do what a sensor does with finger sticks. There are some things you can't do with injections, like temp basals or square boluses, though you can sometimes use longer-acting insulin like Regular. You also can't download your syringes. Even the Eli Lilly Memoir pen remembers only the last 10 injections you gave.
There is a lot of emphasis on glucose monitoring and prevention of hypos, which is really valuable. What I liked about this year's entries that I didn't see so much in years past is that these devices had practicality. With a little design coaching and technical expertise, these products could actually be developed and work.
I occasionally give talks on new products in development, and at the end of each segment, I take the various products and I rate not only their function but their practicality. Some devices are just not practical. A few years back there was the Lasette, which used a laser to prick your finger. It burned like the dickens and smelled like burned flesh. It wasn't even functional. Why waste money and time with something that isn't functional?
Plus, lancets and syringes today are already pretty pain-free. Give us something we need. The tough thing is calculating carbs and making all the adjustments for our day. The injections are the easy part.
What new technology do you think we might actually see in the near future?
I think we will definitely see the Medingo Solo pump before too long. You can bolus right on the device. It's taking the Omnipod to the next level. I also think we will see the CGM/pump integration more, once it gets past the pain-in-the-ass FDA pipeline. It's just a matter of time. Can we wear two devices and carry two devices? Yeah, but it's a pain.
I don't think we will see a closed loop any time soon. Insulin is just too slow to work as effectively as we need. Plus, each step in building it will have to have to go through Phase 1, Phase 2, Phase 3 before FDA approval. It'll take like 300 years before we ever see it!
Until then... what can we do to get the most of our devices?
Education is critical. In addition to Type 1 University [Gary's Webinar education program], you can work with a CDE who really gets it. Most pump companies and meter companies have good online resources. They have online schools for how to use the tools effectively. Until you really know how to use the devices, all the great technology is a waste.
As an educator, we thought you might say that, Gary! Thank you for work and for Type 1 University, of course.