Dr. Ilana Halperin explains automated insulin delivery (AID), its devices, and the concept of do-it-yourself AID. She also provides highlights from Diabetes Canada’s position statement on DIY AID, along with the associated research.
Speaker: Dr. Ilana Halperin, MD, MSC, FRCPC
Speaker: Dr. Ilana Halperin, MD, MSC, FRCPC
0:00
foreign0:06
Candice and I am from diabetes Canada if0:09
you are new to our video series thank0:11
you for joining us if you have been0:13
enjoying this series welcome back0:15
this video series is designed to go0:17
beyond the surface of General diabetes0:19
information we are diving deeper into0:22
different areas of diabetes management0:23
by featuring Dynamic and engaging guests0:27
with knowledge or live experience on the0:29
topic we hope to spark continued0:31
interest and learning and leave you with0:33
practical tips and tools that you can0:35
easily use0:36
a new video is shared every month so0:39
subscribe to our YouTube channel and0:41
click on the notification Bell to be0:42
notified about new content you can also0:45
check us out on social media to find out0:47
when the next one will be posted on our0:48
YouTube channel0:50
thanks to those who have subscribed and0:52
for your support of our video series0:54
in this episode we are going to shine a0:56
light into the world of automated0:58
insulin delivery also known as aid for1:01
short specifically the conversation will1:03
focus on a Hot Topic in the world of Aid1:05
better known as doing it yourself or DIY1:08
Aid you will hear from Dr Ayanna1:11
Halperin who will take us through an1:13
explanation of Aid what devices are1:16
involved and what it means to do it1:18
yourself1:19
she will share some highlights from an1:21
upcoming diabetes Canada position1:22
statement on DIY Aid as well as the1:25
research that has informed the position1:27
statement1:29
after watching this video we hope that1:31
you will understand what Aid is and1:34
recognize what devices are involved1:36
understand the differences between1:38
commercial Aid systems and DIY Aid1:43
know the benefits and risks of1:45
commercial and DIY Aid systems1:48
feel comfortable with approaching your1:50
healthcare provider with questions about1:52
DIY Aid and know where to find more1:56
information about DIY Aid1:59
while this is a very interesting and2:01
emerging topic we recognize that the2:03
content in this video may not be2:04
relevant for everyone and will depend on2:07
what your experience with diabetes is2:09
and what devices are available to you2:11
where you live if you have specific2:13
questions about Aid please reach out to2:16
your Healthcare team2:18
these videos are for educational2:19
purposes only the content discussed in2:22
this video is not intended to be medical2:24
advice and to the extent that medical2:26
advice is required you should consult2:28
with a qualified medical professional2:30
the information discussed in this video2:32
cannot replace consultations with a2:35
qualified health care professional to2:37
meet your individual medical needs2:39
the views and opinions expressed in this2:41
video are those of the speakers that do2:43
not necessarily reflect the views or2:45
positions of diabetes Canada2:48
Dr Halperin is a staff physician at2:50
Sunnybrook hospital and an assistant2:52
professor at the University of Toronto2:55
as the quality and Innovation lead for2:57
the division of Endocrinology she leads3:00
a group of Physicians committed to3:01
improving quality and safety for3:03
inpatients and outpatients with diabetes3:05
and other endocrine diseases Dr Halperin3:09
has a large type 1 diabetes practice and3:12
believes strongly in the potential for3:14
continuous glucose monitoring to improve3:16
diabetes related outcomes and the3:18
experience of living with diabetes3:21
as always we hope that this video Sparks3:23
your interest in learning more about3:25
diabetes management and now over to Dr3:27
HalperinWhat is Automated Insulin Delivery3:29
hey I'm Dr Lana Halpern and I'm really3:31
excited to be here today to talk about3:33
our new do-it-yourself automated insulin3:36
delivery position statement that will be3:37
out in the July 2023 issue of the3:40
Canadian Journal of diabetes3:44
so let's start by talking about what is3:46
automated insulin delivery3:48
automated insulin delivery utilizes two3:51
Advanced diabetes Technologies3:52
continuous glucose monitoring and an3:55
insulin pump and then a control3:57
algorithm which can be embedded within3:59
the pump itself or on an app on a4:01
smartphone is used to have the insulin4:05
modulated based on the glucose sensor4:08
and it's different from using regular4:10
injections or just the pump and open4:12
loop because if you live with diabetes4:14
you know that no two days are the same4:16
and as much as you can fine tune your4:18
settings there's still days where your4:19
glucose are going to go high and low4:21
because of all the variability in your4:22
day-to-day activities but when you have4:25
a control algorithm modulating their4:27
insulin delivery you can stay in range4:30
more often4:31
and long before we had commercial4:34
systems available there was a community4:36
of individuals living with diabetes or4:39
caring for people living with type 14:40
diabetes who decided to not wait and4:44
they got together and did it themselves4:46
and that's what DIY automated insulin4:49
delivery is using a commercially4:51
available insulin pump and continuous4:53
glucose monitor but a open source4:56
control algorithm which is available on4:58
the internet to help modulate your5:00
insulin delivery5:02
this is a screenshot from one of my5:05
patients using a commercial automated5:07
insulin delivery system5:09
and so I'll Orient you because I think5:11
it's very illustrative to what I'm5:13
talking about this is the target range5:15
of glucose between 4 and 10 and this is5:17
the sensor glucose you can appreciate5:19
that this person is spending over 905:21
percent of their day in the green zone5:24
where we want to be not too high not too5:27
low5:28
in order to do that the insulin pump is5:31
continually adjusting the basal insulin5:34
and when it looks like the person's5:36
glucose is going to drop below our5:37
desired range the pump suspends that's5:40
what these pink lines are5:41
and then in order to as the glucose5:44
levels start to climb the basal insulin5:46
delivery goes back up then the person5:48
wakes up and decides to eat breakfast5:49
and this is where a person living with5:51
diabetes still has to interact with the5:52
pump and say I'm going to eat5:54
approximately 30 grams of carbs it tells5:57
the pump it's eating carbs and the pump5:59
delivers a bolus of insulin but that6:00
wasn't quite right maybe the person6:02
underestimated their insulin or took it6:04
a little too late and so the pump6:06
delivers small correction doses without6:08
the person having to do anything and the6:10
glucose comes back into range then lunch6:13
time the next time a person living with6:14
diabetes should have to think about6:16
their diabetes bolus again this time the6:18
bolus is bang on and the glucose barely6:20
Rises until about four in the afternoon6:22
when maybe you had a stressful event at6:24
work or you grabbed a cookie with your6:26
coffee and forgot to bolus no big deal6:28
the pump delivers a correction bolus and6:30
you're back in range dinner goes well6:33
but as you get closer to bedtime the6:34
glucose starts to drop maybe there was6:36
an after dinner walk or are you over6:38
bullish for dinner either way the pump6:40
suspends and keeps the person living6:42
with diabetes in range6:43
and we know that diabetes Canada wants6:46
most adults living with type 1 diabetes6:48
to spend about 70 percent of their time6:50
in that target range of 3.9 to 106:52
millimoles per liter but with automated6:54
insulin delivery it's very possible to6:56
achieve goals above this with greater6:59
than 70 time and range and much less7:01
than four percent hypoglycemiaDIY Systems7:05
so when we talk about DIY systems7:08
they're part of a larger way of thinking7:10
about insulin delivery options we have7:13
multiple daily injections continuous7:15
subcutaneous insulin otherwise known as7:18
insulin pumps and automated insulin7:20
delivery7:21
and automated insulin delivery comes in7:23
different forms commercial and DIY and7:26
we should be thinking that our patients7:28
should have choices along this various7:30
Spectrum from the yellow to the blue to7:31
the teal here and that whatever makes7:33
sense for you and how you want to manage7:35
your diabetes your team should be7:37
supporting you in7:40
so what automated insulin Delivery7:42
Systems are available in Canada today7:45
the first is the Medtronic 670g system7:48
which we're going to see less and less7:49
of because now the Medtronic 780g system7:52
has been approved and this system is7:55
used with a Medtronic sensor and allows7:59
for individualized targets between 5.68:01
and 6.7 millimoles per liter there's8:04
also the control IQ system which allows8:07
people to use a Dexcom and a tandem pump8:10
and has a control algorithm that adjusts8:13
to a range between 6.2 and 8.9 but then8:17
we have the do-it-yourself automated8:19
insulin Delivery Systems and these8:21
systems are meant to8:23
be a little bit more flexible8:26
people have different options in terms8:28
of which pump and CGM they want to use8:31
and they can build the system right off8:33
of their phone and of course8:36
um the uh targets are also much more8:39
personalized8:40
um of course there is no licensing8:44
so as I mentioned before there's at8:46
least three different DIY automated8:48
insulin delivery options out there for8:50
you today and these are the ones that we8:51
discuss in detail in the position8:53
statement8:55
so why are people with diabetes choosing8:58
to use DIY this is a survey from a9:00
colleague of mine named Kate Farnsworth9:02
who surveyed people using DIY automated9:06
insulin Delivery Systems across Canada9:08
and what she found was that people9:10
choose to use these systems because of9:12
transparency and interoperability they9:14
like the idea of Open Source software9:16
that can be quickly iterated without9:19
having to wait for regulators9:22
in addition it for many people it's the9:25
only kind of automated insulin delivery9:26
available where they live due to9:28
barriers related to insurance coverage9:30
and some people believe it's safer than9:33
other systems because it's built by9:34
people living with diabetes who really9:36
understand what it's like to experience9:38
hypoglycemia and for many it's an issue9:41
of affordability9:44
so although people are choosing to do it9:46
themselves they're rarely doing it alone9:48
because the DIY Community is quite9:50
established and when I recommend these9:53
systems to my patients I direct them to9:56
trusted online resources like the DIY9:58
Facebook groups called Loop and10:02
um I know that they will get good10:03
information there because the Facebook10:04
group is moderated by somebody I know10:06
and trust and that will help them on10:09
their journey to starting to use their10:11
own insulin automated insulin Delivery10:14
Systems10:16
so what about evidence there is evidence10:18
supporting DIY Aid use and this was an10:23
article published in the New England of10:24
Journal about a New England Journal of10:26
Medicine back in the fall of 2022 which10:29
was showed that people were randomized10:32
to either using just an insulin pump and10:34
a CGM or the open source automated10:37
insulin delivery system10:39
and what happened was not surprisingly10:41
the people using the automated insulin10:43
delivery system spent about 10 percent10:45
time more in range across the study10:47
compared to the control group which had10:49
no improvements in their time and range10:51
that resulted in more three hours and 2110:54
minutes a day in the optimal range which10:57
means more time doing other things and11:00
less time worrying about your diabetes11:04
so where can I find more information as11:07
I mentioned I often direct patients to11:09
trusted online resources like the looped11:12
Facebook group or if you're more11:14
interested in understanding11:16
um things about the Android APS system11:18
because perhaps that's the type of11:19
smartphone you use you can find11:21
information about their systems as well11:23
here and all of this will be available11:25
in the publication that's coming out11:28
um in the in the next month11:32
so another thing you might be wondering11:34
is what should I ask my Healthcare team11:37
so we know that one of the reasons11:38
people don't use DIY Aid is because11:41
they're worried their Healthcare team11:42
doesn't support them11:43
are diabetes Canada position paper makes11:46
a strong statement that for diabetes11:49
professionals who support aid meaning11:51
they're comfortable enough with insulin11:53
pumps and continuous glucose monitors11:55
and so they're ready to prescribe11:58
commercial systems they should also be12:01
supporting patients using DIY they're12:03
actually quite similar and we should12:05
support our patients autonomy and their12:09
ability to choose the system that's best12:11
for them in managing their complex12:12
chronic disease12:14
but if your Healthcare professional does12:16
not support DIY Aid maybe they can make12:19
a referral to a team that does12:21
perhaps they haven't had a patient12:24
before but they're willing to learn with12:25
you certainly I learned the most from my12:29
patients who are using DIY Aid even12:32
before there were commercial systems12:33
available such that once the commercial12:35
systems came along and became available12:37
in Canada I was able to take some of my12:39
early learnings and apply those to my12:41
patients using commercial systems and12:43
there's more similarities and12:44
differences between these different12:46
control algorithms so usually a12:49
practitioner who's comfortable with the12:50
general automated delivery system will12:53
be comfortable you can also let them12:55
know because maybe they don't know that12:56
the diabetes Canada position paper and12:58
Healthcare users guide has been12:59
published in cjd and that they can get13:02
lots of useful tips and tricks to help13:04
support you13:07
it's important to recognize that it's13:09
not the job of the health care13:10
professional to build the app for you13:12
that is why it's called DIY13:16
if you're using a commercial system you13:18
can call a 1-800 number if you're having13:20
technical support if you're using a DIY13:22
system the technical support is your13:24
online community however these online13:26
communities have grown so significantly13:28
that sometimes you can get better13:29
support at three in the morning because13:31
there's someone from Australia who13:32
happens to be on Facebook then you can13:34
from the 1-800 numbers I'm not13:37
recommending one system over the other13:38
I'm just recommending that our patients13:40
with living with type 1 diabetes should13:42
have the choice to choose between the13:44
DIY and the commercial systems13:46
it is really important that the13:48
healthcare team continue to support you13:49
in optimizing your settings to help meet13:51
your personal goals and decrease the13:53
diabetes burdenEducation13:55
so education remains an important part13:58
of all Aid systems and having an aid14:01
system doesn't mean you don't need to14:03
know the basics because technology fails14:05
whether it's commercial or the DIY14:07
systems insulin pump sites can fail and14:10
you need to know how to go back how do14:12
you troubleshoot for ketones how do you14:14
calculate the doses that you need if14:16
your pump has failed and you need to go14:18
back to manual injections those are14:20
important learning points that are14:21
Universal and should be reviewed14:22
regularly with your Healthcare team14:25
so when it comes to navigating DIY Aid14:28
to optimize settings there's tons out14:31
there and way outside the scope of this14:34
short video but it's important to know14:36
that there are lots of growing resources14:38
there's a full hour and 20 minute14:40
webinar that I put together for our14:43
Healthcare practitioners to learn more14:45
about this but we talk in general about14:48
understanding how the system calculates14:51
insulin how the system adjusts insulin14:53
what to do when the system stops working14:56
educating on essential management points14:59
like I already mentioned and how to15:00
share the data and that's actually15:02
really important point for you if you're15:04
somebody living with type 1 or a family15:06
member of someone living with type 1 is15:08
your Healthcare team does want to have a15:09
look at the data so figure out what15:11
system works for them there's more than15:13
one but that way when you get back15:15
together in clinic if you've started15:17
using one of these systems they can15:18
review how the insulin Delivery Systems15:20
are working for you and help you to make15:22
changes to your settings to optimize15:23
your glucose outcomes15:26
as with all insulin Delivery Systems15:29
whether they be injections or automated15:32
insulin delivery there's a risk we know15:35
that insulin is a high alert medication15:36
and when given in excess can result in15:38
hypoglycemia but with DIY there's less15:42
parameters than with the commercially15:44
available systems so it is important to15:46
work with your Healthcare team to set15:49
the right Max bazel maximum bolus and15:52
suspend threshold15:54
these are detailed settings that you15:56
will learn more about if you want to15:58
watch our longer webinar and or if you16:00
want to dive into Loop docs and start16:02
building the system for yourself16:04
in general however continuous glucose16:06
monitoring which is recommended by16:08
diabetes Canada for all adults living16:10
with type where all people actually16:11
children and adults living with type 116:13
diabetes16:14
are very helpful to prevent significant16:18
hypoglycemia because alerts and alarms16:20
will prompt you before you've gone too16:22
low16:25
so in summary there are four key16:27
messages I'd like to leave you with16:29
we feel that DIY Aid can be effective to16:33
help individuals with t1d improve16:35
glycemic outcomes while reducing the16:37
burden of day-to-day diabetes16:38
self-management16:40
we also feel strongly that diabetes16:42
Healthcare team has an obligation to16:44
discuss all available treatment options16:46
that have evidence of benefits and that16:48
includes DIY Aid16:51
Healthcare practitioners should connect16:53
interested people with diabetes to16:55
trusted online social media and16:57
in-person resources but they're not16:59
obligated to build the systems for the17:01
patients in fact it's best when patients17:03
build these systems on their own or17:05
using the support of the online17:06
committee uh community so they know how17:09
to troubleshoot it when things go wrong17:12
Healthcare practitioners should continue17:14
to provide ongoing support and education17:16
to people with diabetes who choose to17:18
use the DIY Aid systems including17:21
assisting with optimizing pump settings17:23
and coaching on the behaviors that are17:25
linked to decreasing glucose variability17:27
all of this is so that people with17:29
diabetes can live full and enjoyable17:32
lives and minimize the burden of17:34
managing t1d17:36
thanks so much for joining me on this17:37
deep dive video today17:40
thank you so much for joining us to dive17:42
deeper into the world of DIY automated17:44
insulin delivery and how it can support17:46
diabetes management17:48
again this topic may not be relevant to17:50
everyone living with diabetes but we do17:52
hope that you found it interesting and17:54
learned something new17:56
please take the opportunity to let us17:57
know what you learned what you liked and18:00
how we can do it better18:01
you can do that by posting a comment in18:03
the comments section below or by18:05
clicking the link to the feedback survey18:07
in the description box18:09
if you have other ideas for other topics18:11
you'd like to learn more about you can18:13
include that in the comments or feedback18:15
survey as well18:16
Dr Halperin mentioned that other18:18
educational resources will be available18:20
soon if you are interested in the18:22
upcoming position statement and webinar18:24
please stay tuned to the diabetes Canada18:27
website and the description box on18:29
YouTube for this video as we will post18:31
links to those resources when they are18:33
available18:34
in the meantime you can check out some18:36
additional helpful resources related to18:38
this topic from diabetes Canada18:41
if you are looking for more resources18:42
about diabetes management please visit18:45
our website at diabetes.ca you can also18:48
email us at info diabetes.ca or call our18:51
info line at 1-800-banting that's18:57
1-800-226-8464 and speak to one of our18:59
information and support Specialists who19:01
can address your needs thanks again for19:04
joining us and see you next time19:07
[Music]
foreign0:06
Candice and I am from diabetes Canada if0:09
you are new to our video series thank0:11
you for joining us if you have been0:13
enjoying this series welcome back0:15
this video series is designed to go0:17
beyond the surface of General diabetes0:19
information we are diving deeper into0:22
different areas of diabetes management0:23
by featuring Dynamic and engaging guests0:27
with knowledge or live experience on the0:29
topic we hope to spark continued0:31
interest and learning and leave you with0:33
practical tips and tools that you can0:35
easily use0:36
a new video is shared every month so0:39
subscribe to our YouTube channel and0:41
click on the notification Bell to be0:42
notified about new content you can also0:45
check us out on social media to find out0:47
when the next one will be posted on our0:48
YouTube channel0:50
thanks to those who have subscribed and0:52
for your support of our video series0:54
in this episode we are going to shine a0:56
light into the world of automated0:58
insulin delivery also known as aid for1:01
short specifically the conversation will1:03
focus on a Hot Topic in the world of Aid1:05
better known as doing it yourself or DIY1:08
Aid you will hear from Dr Ayanna1:11
Halperin who will take us through an1:13
explanation of Aid what devices are1:16
involved and what it means to do it1:18
yourself1:19
she will share some highlights from an1:21
upcoming diabetes Canada position1:22
statement on DIY Aid as well as the1:25
research that has informed the position1:27
statement1:29
after watching this video we hope that1:31
you will understand what Aid is and1:34
recognize what devices are involved1:36
understand the differences between1:38
commercial Aid systems and DIY Aid1:43
know the benefits and risks of1:45
commercial and DIY Aid systems1:48
feel comfortable with approaching your1:50
healthcare provider with questions about1:52
DIY Aid and know where to find more1:56
information about DIY Aid1:59
while this is a very interesting and2:01
emerging topic we recognize that the2:03
content in this video may not be2:04
relevant for everyone and will depend on2:07
what your experience with diabetes is2:09
and what devices are available to you2:11
where you live if you have specific2:13
questions about Aid please reach out to2:16
your Healthcare team2:18
these videos are for educational2:19
purposes only the content discussed in2:22
this video is not intended to be medical2:24
advice and to the extent that medical2:26
advice is required you should consult2:28
with a qualified medical professional2:30
the information discussed in this video2:32
cannot replace consultations with a2:35
qualified health care professional to2:37
meet your individual medical needs2:39
the views and opinions expressed in this2:41
video are those of the speakers that do2:43
not necessarily reflect the views or2:45
positions of diabetes Canada2:48
Dr Halperin is a staff physician at2:50
Sunnybrook hospital and an assistant2:52
professor at the University of Toronto2:55
as the quality and Innovation lead for2:57
the division of Endocrinology she leads3:00
a group of Physicians committed to3:01
improving quality and safety for3:03
inpatients and outpatients with diabetes3:05
and other endocrine diseases Dr Halperin3:09
has a large type 1 diabetes practice and3:12
believes strongly in the potential for3:14
continuous glucose monitoring to improve3:16
diabetes related outcomes and the3:18
experience of living with diabetes3:21
as always we hope that this video Sparks3:23
your interest in learning more about3:25
diabetes management and now over to Dr3:27
HalperinWhat is Automated Insulin Delivery3:29
hey I'm Dr Lana Halpern and I'm really3:31
excited to be here today to talk about3:33
our new do-it-yourself automated insulin3:36
delivery position statement that will be3:37
out in the July 2023 issue of the3:40
Canadian Journal of diabetes3:44
so let's start by talking about what is3:46
automated insulin delivery3:48
automated insulin delivery utilizes two3:51
Advanced diabetes Technologies3:52
continuous glucose monitoring and an3:55
insulin pump and then a control3:57
algorithm which can be embedded within3:59
the pump itself or on an app on a4:01
smartphone is used to have the insulin4:05
modulated based on the glucose sensor4:08
and it's different from using regular4:10
injections or just the pump and open4:12
loop because if you live with diabetes4:14
you know that no two days are the same4:16
and as much as you can fine tune your4:18
settings there's still days where your4:19
glucose are going to go high and low4:21
because of all the variability in your4:22
day-to-day activities but when you have4:25
a control algorithm modulating their4:27
insulin delivery you can stay in range4:30
more often4:31
and long before we had commercial4:34
systems available there was a community4:36
of individuals living with diabetes or4:39
caring for people living with type 14:40
diabetes who decided to not wait and4:44
they got together and did it themselves4:46
and that's what DIY automated insulin4:49
delivery is using a commercially4:51
available insulin pump and continuous4:53
glucose monitor but a open source4:56
control algorithm which is available on4:58
the internet to help modulate your5:00
insulin delivery5:02
this is a screenshot from one of my5:05
patients using a commercial automated5:07
insulin delivery system5:09
and so I'll Orient you because I think5:11
it's very illustrative to what I'm5:13
talking about this is the target range5:15
of glucose between 4 and 10 and this is5:17
the sensor glucose you can appreciate5:19
that this person is spending over 905:21
percent of their day in the green zone5:24
where we want to be not too high not too5:27
low5:28
in order to do that the insulin pump is5:31
continually adjusting the basal insulin5:34
and when it looks like the person's5:36
glucose is going to drop below our5:37
desired range the pump suspends that's5:40
what these pink lines are5:41
and then in order to as the glucose5:44
levels start to climb the basal insulin5:46
delivery goes back up then the person5:48
wakes up and decides to eat breakfast5:49
and this is where a person living with5:51
diabetes still has to interact with the5:52
pump and say I'm going to eat5:54
approximately 30 grams of carbs it tells5:57
the pump it's eating carbs and the pump5:59
delivers a bolus of insulin but that6:00
wasn't quite right maybe the person6:02
underestimated their insulin or took it6:04
a little too late and so the pump6:06
delivers small correction doses without6:08
the person having to do anything and the6:10
glucose comes back into range then lunch6:13
time the next time a person living with6:14
diabetes should have to think about6:16
their diabetes bolus again this time the6:18
bolus is bang on and the glucose barely6:20
Rises until about four in the afternoon6:22
when maybe you had a stressful event at6:24
work or you grabbed a cookie with your6:26
coffee and forgot to bolus no big deal6:28
the pump delivers a correction bolus and6:30
you're back in range dinner goes well6:33
but as you get closer to bedtime the6:34
glucose starts to drop maybe there was6:36
an after dinner walk or are you over6:38
bullish for dinner either way the pump6:40
suspends and keeps the person living6:42
with diabetes in range6:43
and we know that diabetes Canada wants6:46
most adults living with type 1 diabetes6:48
to spend about 70 percent of their time6:50
in that target range of 3.9 to 106:52
millimoles per liter but with automated6:54
insulin delivery it's very possible to6:56
achieve goals above this with greater6:59
than 70 time and range and much less7:01
than four percent hypoglycemiaDIY Systems7:05
so when we talk about DIY systems7:08
they're part of a larger way of thinking7:10
about insulin delivery options we have7:13
multiple daily injections continuous7:15
subcutaneous insulin otherwise known as7:18
insulin pumps and automated insulin7:20
delivery7:21
and automated insulin delivery comes in7:23
different forms commercial and DIY and7:26
we should be thinking that our patients7:28
should have choices along this various7:30
Spectrum from the yellow to the blue to7:31
the teal here and that whatever makes7:33
sense for you and how you want to manage7:35
your diabetes your team should be7:37
supporting you in7:40
so what automated insulin Delivery7:42
Systems are available in Canada today7:45
the first is the Medtronic 670g system7:48
which we're going to see less and less7:49
of because now the Medtronic 780g system7:52
has been approved and this system is7:55
used with a Medtronic sensor and allows7:59
for individualized targets between 5.68:01
and 6.7 millimoles per liter there's8:04
also the control IQ system which allows8:07
people to use a Dexcom and a tandem pump8:10
and has a control algorithm that adjusts8:13
to a range between 6.2 and 8.9 but then8:17
we have the do-it-yourself automated8:19
insulin Delivery Systems and these8:21
systems are meant to8:23
be a little bit more flexible8:26
people have different options in terms8:28
of which pump and CGM they want to use8:31
and they can build the system right off8:33
of their phone and of course8:36
um the uh targets are also much more8:39
personalized8:40
um of course there is no licensing8:44
so as I mentioned before there's at8:46
least three different DIY automated8:48
insulin delivery options out there for8:50
you today and these are the ones that we8:51
discuss in detail in the position8:53
statement8:55
so why are people with diabetes choosing8:58
to use DIY this is a survey from a9:00
colleague of mine named Kate Farnsworth9:02
who surveyed people using DIY automated9:06
insulin Delivery Systems across Canada9:08
and what she found was that people9:10
choose to use these systems because of9:12
transparency and interoperability they9:14
like the idea of Open Source software9:16
that can be quickly iterated without9:19
having to wait for regulators9:22
in addition it for many people it's the9:25
only kind of automated insulin delivery9:26
available where they live due to9:28
barriers related to insurance coverage9:30
and some people believe it's safer than9:33
other systems because it's built by9:34
people living with diabetes who really9:36
understand what it's like to experience9:38
hypoglycemia and for many it's an issue9:41
of affordability9:44
so although people are choosing to do it9:46
themselves they're rarely doing it alone9:48
because the DIY Community is quite9:50
established and when I recommend these9:53
systems to my patients I direct them to9:56
trusted online resources like the DIY9:58
Facebook groups called Loop and10:02
um I know that they will get good10:03
information there because the Facebook10:04
group is moderated by somebody I know10:06
and trust and that will help them on10:09
their journey to starting to use their10:11
own insulin automated insulin Delivery10:14
Systems10:16
so what about evidence there is evidence10:18
supporting DIY Aid use and this was an10:23
article published in the New England of10:24
Journal about a New England Journal of10:26
Medicine back in the fall of 2022 which10:29
was showed that people were randomized10:32
to either using just an insulin pump and10:34
a CGM or the open source automated10:37
insulin delivery system10:39
and what happened was not surprisingly10:41
the people using the automated insulin10:43
delivery system spent about 10 percent10:45
time more in range across the study10:47
compared to the control group which had10:49
no improvements in their time and range10:51
that resulted in more three hours and 2110:54
minutes a day in the optimal range which10:57
means more time doing other things and11:00
less time worrying about your diabetes11:04
so where can I find more information as11:07
I mentioned I often direct patients to11:09
trusted online resources like the looped11:12
Facebook group or if you're more11:14
interested in understanding11:16
um things about the Android APS system11:18
because perhaps that's the type of11:19
smartphone you use you can find11:21
information about their systems as well11:23
here and all of this will be available11:25
in the publication that's coming out11:28
um in the in the next month11:32
so another thing you might be wondering11:34
is what should I ask my Healthcare team11:37
so we know that one of the reasons11:38
people don't use DIY Aid is because11:41
they're worried their Healthcare team11:42
doesn't support them11:43
are diabetes Canada position paper makes11:46
a strong statement that for diabetes11:49
professionals who support aid meaning11:51
they're comfortable enough with insulin11:53
pumps and continuous glucose monitors11:55
and so they're ready to prescribe11:58
commercial systems they should also be12:01
supporting patients using DIY they're12:03
actually quite similar and we should12:05
support our patients autonomy and their12:09
ability to choose the system that's best12:11
for them in managing their complex12:12
chronic disease12:14
but if your Healthcare professional does12:16
not support DIY Aid maybe they can make12:19
a referral to a team that does12:21
perhaps they haven't had a patient12:24
before but they're willing to learn with12:25
you certainly I learned the most from my12:29
patients who are using DIY Aid even12:32
before there were commercial systems12:33
available such that once the commercial12:35
systems came along and became available12:37
in Canada I was able to take some of my12:39
early learnings and apply those to my12:41
patients using commercial systems and12:43
there's more similarities and12:44
differences between these different12:46
control algorithms so usually a12:49
practitioner who's comfortable with the12:50
general automated delivery system will12:53
be comfortable you can also let them12:55
know because maybe they don't know that12:56
the diabetes Canada position paper and12:58
Healthcare users guide has been12:59
published in cjd and that they can get13:02
lots of useful tips and tricks to help13:04
support you13:07
it's important to recognize that it's13:09
not the job of the health care13:10
professional to build the app for you13:12
that is why it's called DIY13:16
if you're using a commercial system you13:18
can call a 1-800 number if you're having13:20
technical support if you're using a DIY13:22
system the technical support is your13:24
online community however these online13:26
communities have grown so significantly13:28
that sometimes you can get better13:29
support at three in the morning because13:31
there's someone from Australia who13:32
happens to be on Facebook then you can13:34
from the 1-800 numbers I'm not13:37
recommending one system over the other13:38
I'm just recommending that our patients13:40
with living with type 1 diabetes should13:42
have the choice to choose between the13:44
DIY and the commercial systems13:46
it is really important that the13:48
healthcare team continue to support you13:49
in optimizing your settings to help meet13:51
your personal goals and decrease the13:53
diabetes burdenEducation13:55
so education remains an important part13:58
of all Aid systems and having an aid14:01
system doesn't mean you don't need to14:03
know the basics because technology fails14:05
whether it's commercial or the DIY14:07
systems insulin pump sites can fail and14:10
you need to know how to go back how do14:12
you troubleshoot for ketones how do you14:14
calculate the doses that you need if14:16
your pump has failed and you need to go14:18
back to manual injections those are14:20
important learning points that are14:21
Universal and should be reviewed14:22
regularly with your Healthcare team14:25
so when it comes to navigating DIY Aid14:28
to optimize settings there's tons out14:31
there and way outside the scope of this14:34
short video but it's important to know14:36
that there are lots of growing resources14:38
there's a full hour and 20 minute14:40
webinar that I put together for our14:43
Healthcare practitioners to learn more14:45
about this but we talk in general about14:48
understanding how the system calculates14:51
insulin how the system adjusts insulin14:53
what to do when the system stops working14:56
educating on essential management points14:59
like I already mentioned and how to15:00
share the data and that's actually15:02
really important point for you if you're15:04
somebody living with type 1 or a family15:06
member of someone living with type 1 is15:08
your Healthcare team does want to have a15:09
look at the data so figure out what15:11
system works for them there's more than15:13
one but that way when you get back15:15
together in clinic if you've started15:17
using one of these systems they can15:18
review how the insulin Delivery Systems15:20
are working for you and help you to make15:22
changes to your settings to optimize15:23
your glucose outcomes15:26
as with all insulin Delivery Systems15:29
whether they be injections or automated15:32
insulin delivery there's a risk we know15:35
that insulin is a high alert medication15:36
and when given in excess can result in15:38
hypoglycemia but with DIY there's less15:42
parameters than with the commercially15:44
available systems so it is important to15:46
work with your Healthcare team to set15:49
the right Max bazel maximum bolus and15:52
suspend threshold15:54
these are detailed settings that you15:56
will learn more about if you want to15:58
watch our longer webinar and or if you16:00
want to dive into Loop docs and start16:02
building the system for yourself16:04
in general however continuous glucose16:06
monitoring which is recommended by16:08
diabetes Canada for all adults living16:10
with type where all people actually16:11
children and adults living with type 116:13
diabetes16:14
are very helpful to prevent significant16:18
hypoglycemia because alerts and alarms16:20
will prompt you before you've gone too16:22
low16:25
so in summary there are four key16:27
messages I'd like to leave you with16:29
we feel that DIY Aid can be effective to16:33
help individuals with t1d improve16:35
glycemic outcomes while reducing the16:37
burden of day-to-day diabetes16:38
self-management16:40
we also feel strongly that diabetes16:42
Healthcare team has an obligation to16:44
discuss all available treatment options16:46
that have evidence of benefits and that16:48
includes DIY Aid16:51
Healthcare practitioners should connect16:53
interested people with diabetes to16:55
trusted online social media and16:57
in-person resources but they're not16:59
obligated to build the systems for the17:01
patients in fact it's best when patients17:03
build these systems on their own or17:05
using the support of the online17:06
committee uh community so they know how17:09
to troubleshoot it when things go wrong17:12
Healthcare practitioners should continue17:14
to provide ongoing support and education17:16
to people with diabetes who choose to17:18
use the DIY Aid systems including17:21
assisting with optimizing pump settings17:23
and coaching on the behaviors that are17:25
linked to decreasing glucose variability17:27
all of this is so that people with17:29
diabetes can live full and enjoyable17:32
lives and minimize the burden of17:34
managing t1d17:36
thanks so much for joining me on this17:37
deep dive video today17:40
thank you so much for joining us to dive17:42
deeper into the world of DIY automated17:44
insulin delivery and how it can support17:46
diabetes management17:48
again this topic may not be relevant to17:50
everyone living with diabetes but we do17:52
hope that you found it interesting and17:54
learned something new17:56
please take the opportunity to let us17:57
know what you learned what you liked and18:00
how we can do it better18:01
you can do that by posting a comment in18:03
the comments section below or by18:05
clicking the link to the feedback survey18:07
in the description box18:09
if you have other ideas for other topics18:11
you'd like to learn more about you can18:13
include that in the comments or feedback18:15
survey as well18:16
Dr Halperin mentioned that other18:18
educational resources will be available18:20
soon if you are interested in the18:22
upcoming position statement and webinar18:24
please stay tuned to the diabetes Canada18:27
website and the description box on18:29
YouTube for this video as we will post18:31
links to those resources when they are18:33
available18:34
in the meantime you can check out some18:36
additional helpful resources related to18:38
this topic from diabetes Canada18:41
if you are looking for more resources18:42
about diabetes management please visit18:45
our website at diabetes.ca you can also18:48
email us at info diabetes.ca or call our18:51
info line at 1-800-banting that's18:57
1-800-226-8464 and speak to one of our18:59
information and support Specialists who19:01
can address your needs thanks again for19:04
joining us and see you next time19:07
[Music]
Category Tags: Blood Sugar & Insulin, Management, Research;