Continuous glucose monitors a game changer
In Type 1 diabetes, the pancreas no longer produces insulin, the hormone needed to turn food into energy. That means patients need injections of insulin at levels that vary based on the individual, what they eat, and how active they are. Continuous glucose monitors (CGMs) can take some of the guesswork out of how much and how often a person needs insulin, says Pavithra Ravinatarajan, a practising pharmacist and Director, Strategy and Key Accounts, for Manulife Group Benefits.
Ravinatarajan notes that before insulin (closed loop) pumps and CGMs (devices that can act independently but sometimes communicate with each other in a hybrid loop system), people with Type 1 diabetes generally had to use syringes to inject themselves with a mixture of long-acting and short-acting insulin three or four (or more) times daily to manage blood sugar levels in day-to-day life. They’d also have to plan to have regular snacks, glucose tablets or something to treat a low blood sugar handy, and they’d have to organize activities carefully for low versus high-energy days and times of day – to avoid low or high blood sugars as much as possible.
“If you ran track and field or anything like that, you’d have to be very cognisant of checking your blood sugar with a prick [of the finger to draw a drop of blood] half an hour before you’re going to run, right before you’re going to run, and after,” Ravinatarajan says from her Manulife office. “But as technology has advanced, we’ve come to CGMs – a device you can either put on your arm or on your abdomen [with a tiny needle that stays in place just under the skin] that measures glucose levels in interstitial fluid. It’s not always as accurate as if it were to hit blood, but it’s very similar,” says Ravinatarajan.
Critically important for parents of young children is the fact that CGMs provide monitoring 24/7, including overnight. Some CGMs can automatically send alarms to a caregiver’s phone so they can quickly get to their child to treat a low blood sugar event before it becomes an emergency, even if the child is sleeping.
Ravinatarajan notes the costs of different insulin pumps and CGMs are similar, but she says it’s important to choose the best one based on individual preferences. The size of the pump and how it’s worn can matter to a child, based on clothing preferences (e.g., so the pump is less noticeable) and day-to-day activities (e.g., if they’re involved in sports activities).
Emergency kits are “plan B”
Low blood sugar, known as hypoglycemia, is the biggest immediate danger for people with Type 1 diabetes. Left untreated, it can cause light-headedness and fainting, leading to coma and death, because a lack of glucose in the bloodstream causes the brain to shut down. A low blood sugar emergency kit can therefore be a life saver.
Ravinatarajan says some pharmacies will assemble an appropriate emergency kit. Most components, such as glucose pouches (i.e., gel packs) and tablets, are inexpensive and available without a prescription. However, an injectable, like the one Scott wishes she’d had on hand, requires a prescription.
There’s good reason to include an injectable in an emergency kit, says Ravinatarajan. While older children can start to recognize Type 1 diabetes symptoms of low blood sugar and reach for juice, a cookie, or a glucose tablet to treat it, it still takes three to five minutes for their bodies to metabolize what they’ve eaten before it reaches the bloodstream. If the body doesn’t metabolize the food in time, they may feel faint and lose consciousness. Once someone is unconscious, Ravinatarajan warns they could choke on any drink or food you try to put into their mouths, so an injection that delivers glucose directly into the bloodstream, such as glucagon, could be the only option.
Even with an injectable on hand, Ravinatarajan emphasizes that, post-administration, it’s essential to call 911 to get that person to the hospital so doctors can make sure they’re stable.
Tools empower children and parents
Children with Type 1 diabetes and their parents have an extra layer of work to do every day – but also when something out-of-the-ordinary comes along. For example, when children with Type 1 diabetes get a viral infection with vomiting or diarrhea, it’s important they stay hydrated – as would be the case with any child – but also vital to monitor blood sugar levels and adjust insulin doses when food isn’t staying down. These additional concerns mean advice from a physician is often needed when a child with Type 1 diabetes is ill.
Insulin pumps, CGMs and emergency kits available through group plans – like the ones Manulife administers – allow older children “to be more empowered in their own lives to manage this condition so it doesn’t impede them from doing anything in life that they enjoy,” says Ravinatarajan.
They also help parents who, for example, no longer need to check in with the daycare, school, or babysitter to see how their child is doing. Instead, they can see their child’s interstitial fluid glucose levels in real time, and they can even set up notifications on their mobile device that alert them when glucose levels drop to unsafe numbers.
“Are [teens] indulging in something they’re not supposed to? It helps [parents] have those conversations with their children – whereas previously you wouldn’t know if this was happening,” Ravinatarajan says.
Ravinatarajan suggests employers can support employees with children who have Type 1 diabetes by offering a generous number of personal days and sick days, and understanding parents may need to attend more than the average number of doctor’s appointments with their children or respond quickly to an alert on their phone or a call from the school.
Diabetes support through the group benefits plan
Beyond openness and awareness, she recommends employers look at what their benefits plan covers and doesn’t cover. When applying maximums, consider that making tools/devices available to parents has the potential to pay for itself in reduced absenteeism and presenteeism.
Today, both of Scott’s children are healthy grown-ups who manage Type 1 diabetes for themselves. She vividly remembers some scary and painful moments, like giving her two-year-old daily needles that made him cry and watching her eight-year-old have a seizure after swimming at the cottage used up too much energy (fortunately, apple juice and a visit to the cottage hospital emergency department resolved the situation). But she’s grateful that her sons are now knowledgeable adults who have access to the tools they need to check their blood sugar levels easily and often so they can manage them accordingly.
“When people have young children with [Type 1 diabetes], it’s devastating and can be quite scary,” Scott says. “I try not to be a helicopter mom – I don’t want to insert myself into [my adult sons’] lives too much. But I do think about them with concern for their health and how they’re managing their diabetes in terms of their own ongoing worry and time spent, as well as the financial implications.”
