Lauren Buckman was diagnosed with type 1 diabetes as a toddler. Her memories of childhood include set-in-stone daily schedules based on meals, fingersticks, and shots.
“It was really hard,” Buckman recalls.
And while she’s personally experienced advances in her own diabetes care over time, particularly with her switch to a continuous glucose monitor (CGM), the enormity of the change didn’t hit her until the unthinkable happened: her infant daughter, Ella, was diagnosed with type 1 diabetes, and later, her toddler son, Jack.
However, the silver lining was noticeable from the start. Advances in care, especially those in technology, have made Ella and Jack’s life with diabetes more carefree and even more “normal” than hers.
Buckman and her children aren’t alone in this experience. Many people with diabetes in today’s world are living a much different life than they would have in the not-so-distant past.
Daniel DeSalvo, MD, director of strategic collaboration at Texas Children’s Diabetes & Endocrine Care Center, can see this progress from two points of view.
Diagnosed with type 1 diabetes 20 years ago, he knows firsthand the way diabetes can affect a life. As a provider, he sees it in his patients as well.
“This is such an important time,” he says. “The last 10 years have represented a revolution in care.”
“The beauty of technology is that it’s adaptable,” DeSalvo says. “Diabetes is different for every person. And even for the same person, what works today may not work tomorrow.”
From fingerstick blood glucose meters that would deliver glucose information just a handful of times a day to CGMs that automatically pass along 288 readings per day, the daily care choices for people with diabetes are in an entirely new technological age.
Continuous glucose monitors (CGMs)
Completed in 1993, the wide-reaching Diabetes Control and Complications Trial followed more than 1,400 people with diabetes. It found that good glucose management is key to preventing many diabetes complications.
By the mid-2000s, largely thanks to national clinical studies funded by JDRF, CGM technology began to appear on the market.
The pre-CGM era was like “living in the dark,” DeSalvo says. “Now, having CGM shine a light on what happens with blood sugars has been illuminating.”
Today, people with diabetes can choose from a variety of CGM systems and keep closer track of their diabetes using insulin pens and multiple daily injections with their CGM.
CGMs highlight trends, produce spreadsheets, and give alarms when a person may begin to fall toward a dangerous low level.
That comes down to many benefits, including:
- Less structure. More freedom in everyday life is perhaps the most obvious benefit of using a CGM.
- Easier dosing calculations. Many pump devices now help do the math to count carbs and can even inform the user about suggested insulin dosing when paired with a CGM.
- More safety. Constant monitoring and alerts for glucose levels have been a huge benefit for people with diabetes and their partners, parents, and caretakers, particularly for overnight safety.
- Many, many more blood glucose readings. Without a CGM, the average person with diabetes tests their blood sugar with fingersticks four to six times a day. With a CGM, a person gets 288 readings a day.
- Better data for the doctor. Long dependent on handwritten glucose log books for diabetes treatment decisions, doctors can now access CGM data to help find clues to better care.
“With all that information comes an extra amount of alerts,” DeSalvo says. For that reason, he’s careful to set a plan that’s tailored to each person using a CGM.
There are, of course, limitations.
“I say this all the time: Technology is not foolproof. You have to know your backup. You have to understand how to treat diabetes without the technology as well,” Buckman says.
Today, more and more often, CGMs are being used by people with type 2 diabetes. People with type 2 diabetes will be the next big boost in CGM use, many experts believe.
While CGMs were available to many people by 2010, it wasn’t until 2017 that Medicare CGM coverage became available, mostly thanks to people with diabetes advocating to make it happen.
Today, CGM systems are covered by Medicare for eligible beneficiaries.
Movements like JDRF’s #CoverageToControl are continuing the fight for Medicare coverage of all devices as they come to market.
Better, more discreet pumps
The first pumps to actually treat people with diabetes outside of a clinical setting were affectionately called “the blue brick” by users.
Despite being clunky and difficult to lug around, they were so revolutionary in how they bettered the lives of those using them that developers knew to move forward and find a way to make them more user-friendly.
“I was 33 years old before I tried my first insulin pump,” Buckman says. “That opened my eyes to what life could be like going forward.”
Today, newer pump designs are sleek with touch screens and smart tools, such as:
- memory to save and suggest insulin dosing for a favorite meal
- multiple basal settings for different background insulin profiles based on the activities of a planned day
- communication with a paired CGM
Innovative creations, many invented by pump users themselves, are available to make wearing a pump more comfortable and discreet, and sometimes even more fashionable. These include:
- tubeless pumps
- specially designed pouches
Wearing a pump has also become less stigmatized. In 2014, Miss America semifinalist Sierra Sandison, Miss Idaho, walked the stage during the bathing suit section on national TV with her insulin pump proudly clipped to the side of her pink bikini bottoms.
In response, the pump-wearing world rejoiced and #ShowMeYourPump was launched, an international social media trend to encourage being proud of your diabetes technology.
Today, people with diabetes can choose a pump that pairs with a CGM to build a system that not only constantly tracks blood sugars and shares that data with the pump, but goes on to make decisions on behalf of the user.
This is called a “closed-loop system” or an “artificial pancreas.”
With automatic insulin adjustments comes less thinking — and living with diabetes already comes with a lot of thinking — and more stability. People are reporting that overnight glucose levels, in particular, are steadier with closed-loop systems.
In 2016, the
Medical care has advanced as well. Today’s treatment plans can be as unique as we are, guided by better blood glucose data and medical guidelines that emphasize highly personalized care.
Faster-acting insulins have given people with diabetes more flexibility not just in correcting higher blood sugars but in what they choose to eat. It also gives them the freedom to snack whenever they wish.
Before rapid-acting insulins, a person with diabetes would need to plan a meal, inject a half hour before, and wait before eating. Today, they can spot a snack, choose to have it, and dial up and inject insulin in that moment.
New treatment choices
A new generation of diabetes medications has shown promise for people who have other health issues related to the heart and kidneys. These include:
- sodium-glucose cotransporter-2 (SGLT2) inhibitors
- glucagon-like peptide-1 (GLP-1) receptor agonists
Doctors primarily prescribe these medications to people with type 2 diabetes, and they’ve completely changed the treatment landscape.
These medications can help lower difficult-to-treat high blood sugar levels and may reduce the need for insulin in some people. They may also provide additional protection against diabetes complications.
Severe low blood sugars are perhaps the top concern of every person taking insulin. In emergency situations, the only option used to be the classic, clunky injectable glucagon. It had multiple steps and was often confusing to use while trying to help the person in need.
Today, there are a few new options to manage severe lows. One example is an easy-to-use glucagon powder that’s given through the nose, which was
Another new injectable glucagon, also approved by the FDA in 2019, can be kept at room temperature and doesn’t require any mixing before use.
Another big change in diabetes care may sound basic, but it’s a strong foundation for anyone dealing with type 1 or type 2 diabetes: Support is now a tap of the keys away.
Born in the early era of social media, the Diabetes Online Community, or DOC, refers to all people who engage in online diabetes-related activities.
This may look like blogs or social groups but also includes larger efforts from national organizations, such as:
- American Diabetes Association
- Children with Diabetes
- Endocrine Society
- Taking Control of Your Diabetes (TCOYD)
For parents like Buckman, this unprecedented access to other people and families living with diabetes makes a difference.
Thanks to social media and support programs of all kinds, people with diabetes can compare notes, share strategies, and in the simplest way, help one another not feel so alone.
Nearly 100 years ago, insulin was discovered and made available to people with diabetes. In the 1970s and early ’80s, research advances informed the field that tighter glucose management would extend lives.
By the early 2000s, faster insulin and better glucose meters began helping people manage diabetes, as did the advent of pumps.
And in the last 10 years, new technological innovations have continued to improve care, with expanded insurance coverage for CGMs making access to lifesaving technology a reality for many.
For people with diabetes, that’s all good news.
“I honestly cannot imagine what we did before this, even though I did it,” Buckman says. Today, she’s able to make meals when she wants, live more freely, and worry less about her kids thanks to modern technology.
For DeSalvo, the outlook is also positive: Technology, better insulin, and better standards of care are all combining to make life with diabetes more manageable.
“I will never say diabetes is easy. It’s not,” he says. “But it’s getting better.”