By Gary Scheiner MS, CDCES

Automated insulin delivery (AID) can help with some of the work that comes along with managing a person’s diabetes, kind of like a vacuum cleaner alleviates the need to pick all the dirt from the floor by hand. But someone still has to do the vacuuming, and even with the latest AID technologies, there is still user work involved. As we work with people with diabetes who may be interested in these systems, it’s important to consider what they can and can’t do.

AID systems can, and do, adjust insulin delivery in subtle ways when glucose levels are trending in the wrong direction.  While this does not immediately fix the problem, it does reduce the magnitude of, and time spent with, high and low glucose levels. While the insulin delivered by the pump still takes a few hours to have a major impact, automated insulin adjustments do lessen some of the burdens of living with diabetes and help to keep glucose levels within a reasonable range more often, with less micro-management by the user. 

Without user engagement, the best one can hope to accomplish with an AID system is an average glucose in the mid-to-high 100s and about half the day within one’s target range. In order to achieve quality glucose management, users need to:

• Manage the pump and infusion sites properly.
• Troubleshoot hyperglycemia in a timely manner.
• Make sure the CGM is functioning correctly (including calibrating when necessary).
• Ensure that the programmed basal settings and bolus dosing formulas are appropriate.
• Quantify food and match it to the optimal doses of insulin.
• Time bolus insulin doses properly.
• Make adjustments for increases (and decreases) in physical activity.
• Utilize temporary “override” features for special circumstances.
• Download and analyze data for self-adjustment.

It’s important to note that these points only pertain to day-to-day glucose management. We know there is a lot more to living with diabetes than just managing blood sugar! Here are a few of the other responsibilities and concerns that we as health care professionals should be touching on even if a person with diabetes is using AID:

• Preparing for, preventing and properly treating hypoglycemia
• Applying protocols for “sick days”
• Employing coping skills for emotional health
• Addressing mental health concerns
• Ensuring adequate quality sleep
• Screening for long-term complications
• Practicing proper foot care, oral health and heart disease prevention
• Achieving and maintaining a healthy body weight
• Preparing for crisis/emergency situations (including backup plans and hospitalizations)
• Navigating health insurance and supply distribution channels
• Screening family members for potential autoimmune conditions
• Incorporating ancillary medications in diabetes treatment
• Educating family members and other loved ones on the nuances of diabetes

Automated insulin delivery systems are nice, but they aren’t necessarily the end all be all. As diabetes care and education specialists, it is our obligation (and opportunity) to ensure people with diabetes are properly trained in these areas and understand the capabilities of systems like AID so that they can live long, healthy lives.