I’m reminded of technology every day. This isn’t because I’m a patent attorney. It’s because it keeps me alive. As someone living with type 1 diabetes in 2020, I’m fortunate to have an insulin pump, a continuous blood glucose monitor and an app on my iPhone to tell me my blood sugar levels throughout the day. I live a normal life. The same hasn’t always been true for those with diabetes. For World Diabetes Day this year, I’ve been reflecting on the impact of the most significant developments in type 1 diabetes care and what these have meant to people like me.
Diabetes - What is it?
Type 1 diabetes is an auto-immune disease which causes your pancreas to stop producing insulin. Insulin controls blood glucose and, without it, excess sugar will build up in your blood before then passing into your urine. In an attempt to expel the excess sugar, your body fast begins to lose a tremendous amount of fluid. Left untreated, this can lead to life-threatening dehydration and a diabetic coma.
Looking back through the decades
Back in 1920, before insulin had been discovered, type 1 diabetes was fatal, with the life expectancy of someone diagnosed with the condition being of the order of months, and possibly weeks. This changed in 1921 when Sir Frederick Banting and Charles Best co-discovered insulin.
In the 1920s and 30s, treatment was life-saving, but by today’s standards crude. The insulin was extracted from the pancreases of cows and pigs, diets were limited, and ways of checking whether you were administering the right amount of insulin were basic. For children, diabetes carried a particularly unwelcome stigma. For adults, the poor life expectancy of people with diabetes made this a virtual block to employment.
Life with diabetes in the 1940s and 50s meant sharpening and sterilising your own needles. Once-a-day urine testing, involving boiling your urine with Benedict’s solution, was the mainstay of monitoring diabetic control. Allergic reactions to animal insulins weren’t uncommon, and rigid diets were the order of the day. The life expectancy of a 10 year old diagnosed with type 1 diabetes in 1945 was around 45 years. My own father was diagnosed with the condition in 1954.
Come the 1960s and disposable syringes and urine test strips were introduced, and in the 1970s the first biosynthetic human insulin arrived. Three big steps forward. No more boiling urine or sterilisation and sharpening of needles, and allergic reactions to animal insulins were consigned to history. At this time, a typical regime would involve two injections a day of a mixed long and short acting human insulin. Blood sugar control was better, though a rigid schedule for meals and activity would still need to be followed. If snacks or meals were missed or eaten late, or the time of physical exertion varied, there was a significant risk of your blood sugar going low. Depending on its severity, such hypoglycaemia results in dizziness, confusion or a loss of consciousness.
In the 1980s home blood glucose meters arrived on the scene, making accurate and frequent blood glucose monitoring accessible. Insulin pens, designed to be discreet and portable, also appeared. Pen needles, shorter and thinner than those of hypodermic syringes, made injections more comfortable and less damaging to the skin. These insulin pens helped introduce flexible insulin therapy. This involved one single, long acting (basal) insulin injection each day and several injections of fast or rapid acting (bolus) insulin for each meal. More injections, but much more flexibility. By 1990, when I was diagnosed, this was the standard treatment in the UK, along with blood glucose monitoring on your own meter. This meant I could be relaxed about timings for meals. Studies have shown that the use of basal-bolus insulin regimes significantly improve life expectancy.
Turn of the century innovation
New, improved insulins arrived in the 2000s and 2010s. Faster acting insulins for meals meant peaks in blood sugars after eating could be minimised, and better long acting insulins with flatter release profiles reduced the risk of hypoglycaemia as well as the need to have snacks at a set time each day. Insulin pumps were becoming more common too. These wonderful devices can deliver fast acting insulin every few seconds of the day and in very precise amounts. With a pump, if you want to exercise you can dial down the insulin; if you’re ill and need more insulin you can dial it up. Meal times are completely flexible, and regular snacking to top up blood sugar levels isn’t needed.
Continuous blood glucose monitors were also introduced. These monitor your glucose levels throughout the day, rather than just 4 or 5 times with a finger prick. The pump and 24 hour data collection of these CGMs provide better control, and using them also involves less than 200 jabs into your skin each year, compared to the few thousand that an insulin pen and conventional blood glucose meter can require.
2020 and beyond
Self-adjusting insulin pump systems have also been introduced over the last few years. These use data from a CGM and artificial intelligence to adjust the delivery of insulin automatically, which is a crucial step closer towards fully automated, closed-loop ‘artificial pancreas’ technology. In 2020 life expectancy for someone with type 1 diabetes is shorter than those without the condition but to a far less dramatic extent than before.
Introducing technology to people with diabetes
Technology matters. It’s based on the work of scientists and innovators, and the devices are developed and sold by companies. But the way it’s always been introduced to me is by a specialist nurse. It’s the nurse who has always told me about the new insulins and devices that have become available. They’ve talked me through how the new developments will help me, and discussed any concerns I might have over changing away from a regime that I have grown to trust and rely on. They’ve then set me up on the new system and helped me fine tune it. This year, World Diabetes Day aims to raise awareness around the crucial role that nurses play in supporting people living with diabetes. Nurses do a lot of things. One of those is helping technology get accepted. And that matters, too.
Gareth Fennell is a partner in our Tech group. He advises clients on patent strategy in the medical device and software sectors.