Throughout the month of August, we will be sharing important milestones from Joslin’s rich history. More than a century after its creation, Joslin continues its legacy as an internationally recognized diabetes treatment and research institution. This month we are celebrating the talented and dedicated individuals who have contributed to and continue to focus on our mission of preventing, treating and curing diabetes.
Sometimes the patient ends up teaching the teacher. Patient Stephanie Edwards recently demonstrated her brand-new continuous glucose monitor (CGM) to Director of Educational Services Jo-Anne Rizzotto, M.Ed., R.D., C.D.E., seeing that model for the first time.
Edwards is among people with type 1 diabetes who embrace advances in diabetes care as fast as they emerge. The CGM provides a continuous record of the patient’s glucose, reported on a digital device worn close to the body. Its sensor, inserted just under the skin, measures glucose in subcutaneous tissue.
“It takes longer for glucose to show up in subcutaneous tissue,” says Howard Wolpert, M.D., who oversees Joslin’s programs centered on incorporating the CGM and the insulin pump into patient care. “So we’ve computed new formulas for people reading their glucose levels on the CGM, verifying and fine-tuning these algorithms in clinical trials.”
The CGM often is used with an insulin pump, which sends out a steady stream of insulin to maintain a basal level, calculated for the person’s individual needs. When more insulin is needed, such as after meals, the patient prompts the pump to deliver more.
In combination, the pump and CGM take the place of the pancreas. Normally, the pancreas detects rising and falling glucose levels and automatically responds. But in type 1 diabetes, those functions have been lost. The patient must become “the brains of the pancreas,” learning these skills from their diabetes education team.
To date, no single device can do both functions. “Research efforts are focused on developing a single closed-loop device, or ‘artificial pancreas,’ that can sense glucose levels and automatically deliver insulin like a normal pancreas,” says Dr. Wolpert. “We’re getting closer to that ideal.”