From Maryland, USA:
Our 6 year old daughter was diagnosed seveal months ago with Type 1 diabetes and we have been hearing a lot about non-invasive meters such as the GlucoWatch which uses an interstitial tissue fluid sample to test glucose. We were at a recent support group meeting with a guest endocrinologist speaker who mentioned that interstitial tissue monitoring will not replace blood glucose monitoring because studies have shown that interstitial tissue fluid 'lags behind' blood glucose by about half an hour. This would mean that we will still require an invasive blood glucose check before each insulin injection (because of our sliding scale) even with a continuous interstitial testing device such as the GlucoWatch. Do you agree with this opinion?
The answer to your exact question is not really available yet, certainly not in respect to a six year old child. The concept of non invasive monitoring is beguiling and the Glucowatch is certainly an elegant piece of engineering. First of all, though, the iontophoresis pads only last for about eight hours and after that time they have to be changed and with each change the instrument has to be calibrated against a fingerstick blood sugar. This means two and perhaps three blood sticks a day. The correspondence between the Glucowatch reading and ther actual blood sugar over the twenty-four hours is in fact remarkably good although there aren't yet any analyses of periods of rapid change in blood sugar as after a meal. The instrument moreover is the size of two large men's watches and certainly might be cumbersome for an active six year old. Also it is often the story of devices like this that though adopted with enthusiasm and substantial expense their attractiveness may pall with time and in this respect it has not yet been shown that people who use the Glucowatch diligently for several months actually achieve better control over the long haul.
Another problem is that no one has yet really worked out how to usefully interpret the information from seventy blood sugars in the twenty four hours. The ideal solution will come when a reliable glucose sensor can be electronically and safely linked to a pump; but that still seems to be some years in the future.
Original posting 12 Apr 1999
Posted to Research: Monitoring
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