Chronic health conditions affect millions of people every day, each presenting unique challenges and issues. In this installment of “Where It’s AT” we will be focusing on diabetes management. Uncontrolled diabetes can lead to even more medical concerns, such as heart disease, kidney damage, and vision loss. That is why the Where It’s AT Team has put together a list of effective assistive technology solutions to help manage symptoms and side effects commonly associated with diabetes.

What is Diabetes?

Type 1 Diabetes

• What it is: The body’s immune system mistakenly attacks the pancreas, which makes insulin. Insulin acts like a key to let sugar from the blood into the body’s cells for energy.
• Who gets it: Usually begins in childhood, but can start at any age.
• Treatment: Because the body can’t make insulin anymore, people with Type 1 need insulin shots or an insulin pump every day.

Type 2 Diabetes

• What it is: The body still makes insulin, but either not enough or the body doesn’t use it properly. This often happens due to poor lifestyle habits, like not exercising enough or eating too much unhealthy food.
• Who gets it: It usually affects older adults, but more kids are getting it nowadays because of unhealthy habits.
• Treatment: Type 2 can often be managed by eating healthy, exercising, and sometimes taking medicine. Some people might also need insulin.

Gestational Diabetes

• What it is: Diabetes that develops during pregnancy due to insufficient insulin production, causing high blood sugar.
• Who gets it: Pregnant women, especially those with obesity, a family history of diabetes, age over 25, or a history of gestational diabetes.
• Treatment: Healthy diet, exercise, blood sugar monitoring, and possibly medication or insulin.

Diabetes Management

Continuous Glucose Monitors (CGMs) A continuous glucose monitor (CGM) is a device that automatically tracks blood sugar levels throughout the day, providing real-time data without the need for fingerstick tests. The system uses a small sensor placed beneath the skin, which continuously measures glucose levels and sends the information to a transmitter. Check out Byram Healthcare’s list of the top Continuous Glucose Monitors for 2024.

Wearable Insulin Pumps

Patch Pump Devices that deliver continuous insulin through a small tube inserted under the skin, often connected to a CGM. Omnipod® System by Insulet Corporation is a tubeless insulin pump that can be worn for up to three days, providing continuous insulin delivery without the need for daily injections.

Smart Insulin Pens -There are two types of insulin pens: disposable and reusable. Disposable pens come with insulin already in them. Once the insulin is all used up, you throw the device away. Reusable pens allow you to put a cartridge of insulin in them when it runs out. However, there aren’t cartridges available for every type of insulin. The InPen^™ is a reusable smart insulin pen that uses Bluetooth technology to send dose information to a mobile app.

This table provides an easy overview of how different insulin delivery devices cater to various needs and preferences​

Device Type	Key Features	Who It’s Best For	Considerations
Insulin Syringes	Traditional method Low cost	People comfortable with manual dosing Those needing occasional injections	Requires manual drawing and measuring of insulin Multiple injections needed daily
Insulin Pens	Pre-filled or refillable Easier to use than syringes	Those needing consistent daily injections Patients who want simplicity	Still requires multiple daily injections Limited to specific doses
Wearable Insulin Pumps	Continuous insulin delivery Can connect to CGM	Active individuals Those with frequent glucose fluctuations	Requires wearing the device at all times Higher cost and more complex to manage
Patch Pumps	Tubeless, discreet Convenient	Those preferring a more flexible and discreet option	Requires regular refills Limited to certain insulin types
Smart Insulin Pens	Tracks doses via smartphone app Set reminders	Tech-savvy users Those needing help managing doses	Requires a smartphone Not fully automated
Inhalable Insulin	Needle-free Rapid-acting	Those with needle phobia Individuals needing fast-acting insulin for meals	Limited to mealtime insulin Not suitable for everyone (e.g., lung issues)
Implantable Insulin Pumps	Continuous delivery Long-term use	People with severe diabetes Those needing steady insulin without daily management	Requires surgery to implant Not widely available

AI-Enabled Health Coaching

Aria is an AI health coach that personalizes glucose management using data from various sources. Aria learns your unique blood sugar patterns and provides tips for better management. It personalizes insights based on your preferences, like dietary habits and exercise routines. You can choose a program suited to your needs, costing $225/month with CGM or $40/month for the app only.

Foot Care

Managing foot care is crucial for diabetics due to the risk of neuropathy, a condition where peripheral nerve damage causes weakness, numbness, tingling, and pain, especially in the feet. Neuropathy can lead to unnoticed injuries, infections, or ulcers that may worsen without proper care.

Tips include:

• Check feet daily for injuries or swelling. Using a Telescoping Inspection Mirror can make this easier.
• Keep feet clean and moisturized, avoiding moisture between toes.
• Trim nails carefully and avoid walking barefoot.
• Consult a healthcare provider for any foot issues.
• Wear well-fitting shoes with good support. Look for shoes with a wide toe box, orthotic or ergonomic insoles, and extra depth to accommodate possible swelling.
• Proper foot care helps prevent severe complications like infections and amputations.

Smart Footwear for Diabetic Neuropathy like the Siren Care Diabetic Sock and Foot Monitoring System uses temperature sensors embedded in the socks to detect early signs of inflammation, helping to prevent foot ulcers and amputations. By continuously monitoring foot temperature differences, the system provides valuable data that allows users and doctors to address potential issues early, reducing the risk of serious injuries.

Medication Management

AT can help manage diabetes by ensuring medications are stored correctly and taken on time. The 4ALLFAMILY Voyager AUTO Shut Off USB TSA Medication Cooler offers a large refrigerated space for up to 7 insulin pens, maintaining an internal temperature of 36-45°F, with a real-time display. It features auto shut-off and rechargeable capabilities, making it ideal for travel. The Refrigerated Medicine Travel Case with Temperature Display includes cooling gel pads and a hard case to keep insulin cool while on the go. Additionally, Medication Reminder Apps like Medisafe send notifications and track medication intake, while Voice-Activated Medication Assistants such as Amazon Alexa provide verbal reminders, ensuring users take their medications on schedule.

Diabetic Service Dogs

Diabetic service dogs alert their owners to changes in blood sugar through trained behaviors such as pawing, nudging, licking, or bringing a blood glucose monitor. These dogs detect blood sugar changes by smelling chemical shifts in breath, saliva, and sweat. They are trained with sweat samples from their owners during periods of low and normal blood sugar, and are rewarded for identifying low blood sugar levels. Dogs4Diabetics (D4D) is the first accredited service dog provider for insulin-dependent diabetics by Assistance Dogs International, specializing in training these life-saving alert dogs.

Effective diabetes management is enhanced and continues to improve by using assistive technologies like AI-enabled health coaching, medication reminder apps, and diabetic service dogs. These tools provide personalized support, helping individuals maintain better control of their health and daily routines.