I have always made sure that I don’t stray into the realms of CPD in this column. Firstly, although I am quite good at one subject, there are more qualified people than me to write CPD articles, and secondly, you tend to turn to opinion pieces for some light relief. However, this month I have become more knowledgeable than I ever wanted to be about human diabetes, because a few weeks ago my 12-year-old son developed diabetes, so I thought I’d pass some interesting information on. I won’t give you his full story but having access to your own urinalysis lab can be useful, and we now have in our practice one of the few student vet nurses ever to diagnose diabetes in a human. Turns out he wasn’t just skinny due to having a growth spurt, and the diagnosis also explained a certain lack of joie de vivre he was displaying over the last month, especially after a two-hour winter surf the day before diagnosis. Rest assured he was rapidly transferred from the care of the veterinary team to the local NHS hospital. Thank goodness it wasn’t 2020 when this happened. Parents were allowed to visit, but not siblings.
What I thought you might find useful is a brief review of some of the diabetes tech that is here and what is coming. Rather like teaching kids outdoor pursuits when you don’t give them the latest GPS gear but make them learn map and compass work, our son is currently doing the human pin-cushion routine with finger-prick blood glucose and four to five times a day injectable insulin. In addition, we have also been given the “Freestyle Libre 2” on prescription. This is the device you hear about on vet forums and mentioned in CPD occasionally, and some of you may be using them already on your patients. It is about the size of an old 50p piece and stuck on the arm. It is put on with an applicator that fires it in with a metal stylet, then leaves it there with a plastic cannula just under the skin. The application is, I am told, as painful as it sounds. So, for our patients, some topical anaesthetic may be a good idea. Once in place, the patient is fairly unaware of its presence. They last about 10 days and are waterproof. They can be read with a mobile phone or its own handheld device which captures a point blood glucose (BG) and the last eight hours of BG data. This is a “flash monitor” as you need to scan the monitor. The mobile phone automatically uploads it to the website whereas you need to plug the handheld device into a PC, and you can then study the glucose curves. Both phone and device have low and high alarms and these can also be sounded on following mobile phones, which can then be relayed to a smartwatch, etc. So mid-consults, I am now pinged to my wrist his spot reading of the BG when he is at school, and if I look at my phone I can see his daily curve. The website then has all the days’ curves and loads of stats. This is extremely useful as a parent but if you are thinking of using it on a patient be aware that it will raise lots of questions from your clients as they study the daily information.
The next level up from flash monitor is a “continuous glucose monitor” (CGM) that relays via Bluetooth directly to either the personal diabetes monitor (PDM) or mobile phone. Similar to the above, data can be relayed to various platforms. What is really exciting and still fairly new is the integration of this data, via software, to a glucose pump. This is a “closed loop system”. With some systems, you can input carbohydrates eaten and tell it if you are about to do exercise, and the software then drives a pump. And for pumps, again you have a range from stick-on ones the size of a small matchbox that last three days, to tubed pumps that you carry in a pouch (about the size of a small mobile phone).
The future will be a small pump with the software in it that talks directly to the CGM. So, you just need to wear two stick-on items and input the carbohydrates you are about to eat, exercise plans, etc on your phone when necessary. Beyond that, there is work being done on combined glucagon and insulin pumps.
The technology of diabetes management is changing rapidly in the human field. How much of this technology will be appropriate to veterinary practice will depend on a variety of factors, not least getting things to stick to pets and stopping them chewing them off and eating them!
