I live with diabetes

Diabetes is often referred to as a disease without serious repercussions, despite the large number of people who suffer from it and the conditions it can cause in the event of poor self-management of the disease or poor follow-up. Diabetes one of the most common and well-known diseases in people’s day-to-day lives, often talked about in street conversations, family lunches, conversations in waiting rooms, etc. This is evidence that in many cases diabetes has been overlooked and is treated as “a mild disease which I don’t need to pay much attention to because it can’t affect me seriously”[1]. This myth is completely false and it is a disease that should not be underestimated. Today, Diabetes Mellitus (DM) is a chronic disease that requires a very good metabolic control to prevent or slow down possible long-term complications.

But what exactly is diabetes? Diabetes is a metabolic disorder manifested by an abnormal rise in blood sugar levels. This abnormality can be caused by insufficient production of insulin by the pancreas, or by a misuse of this hormone by the body. There are three types:  type 1[2], type 2[3] and gestational diabetes[4].

According to the World Health Organization (WHO) there are currently more than 460 million people suffering from it, and in recent years its incidence has increased. Currently in Catalonia there are around 600,000 diagnosed cases, affecting about 8% of the population over 15 years of age and about 20% of people over 65 years of age.[5]

Among the tools used today by people with diabetes are mobile apps, which help to more accurately monitor the disease, by calculating the level of carbohydrates in meals, glucose levels, doses of insulin to be administered, offering dietary information to ensure the right amount of “sugar” is ingested, providing guidelines on physical exercise, and so on.

These apps offer functions can monitor and record data (blood sugar, weight, medication, etc.), schedule alarms, establish a record of meals, transfer data information between users themselves and even share the information with the healthcare professional.

Many of these features have been revolutionary in controlling this chronic disease. Below is a description of the advantages and new possibilities offered by each of these features.

Control and recording of data

Most, if not all, applications offer this functionality as their primary tool. These apps enable the recording of blood sugar, weight, medication, etc., usually synchronized with capillary blood sugar measuring devices (finger pricks), and they even, allow readings with subcutaneous sensors, thus facilitating data logging and avoiding transcription errors. Having all the data recorded and classified over time makes it easier to read through graphs and reports, enabling a better understanding of the health situation and allowing information to be shared with the corresponding healthcare professional. Usually with the nurse.

• What process does it improve or replace?

This feature makes blood sugar logbooks, used to manually write down the units of insulin administered, the glycaemic levels or the drugs that have been taken (with possible temporal or quantitative inaccuracies), obsolete.

Recording of meals

Monitoring food intake is a key pillar in the control of diabetes. Recording what has been ingested and knowing how many carbohydrates there are in the meal in question is crucial among other things to control the levels of insulin that need to be injected or simply to ensure the intake is in line with the capacity of the pancreas. Today there are apps that allow you not only to manually record the amount of carbohydrates in the meal, but also to take photos and scan barcodes of the food.

• What process does it improve or replace?

The ability to adjust the exact dose of insulin based on intake and blood sugar. This functionality is a significant improvement because previously the recording of this type of data by patients was not consistent enough. Apps can ensure that this is performed constantly, because many of them implement a third feature based on this recoding of meals.

Dose of insulin to be administered

More and more applications can recommend the amount of insulin to be administered based on the parameters mentioned above. Certain apps, already considered medical devices, cross reference blood sugar and intake data along with other biometric and historical data of the diabetes patient, and based on this recommend the amount of insulin to be administered.

•  What process does it improve or replace?

The improvement is substantial, especially in the early stages of the disease when the person does not yet have sufficient knowledge on how to manage their disease. Basing these decisions on rigid protocols and with little specificity.

Some of the diabetes apps that can be found in the different app stores are those that have been evaluated by the TIC Salut Social Foundation in the framework of the certification process of Health Apps which can be consulted on the website in the mHealth section:https://ticsalutsocial.cat/el-tipus/mhealth/

To end this section, we would like to highlight some of the key messages issued by the WHO on 14 November, World Diabetes Day:[1]

• Healthy eating and physical activity are two essential components for the treatment and prevention of the disease. In this regard, it is worth stressing that more than half of type 2 diabetes cases could be prevented.
• Therapeutic education is essential for those affected so they can play active role in their treatment, understand the disease, learn to identify warning signs and have the ability to act correctly in any eventuality.

Some relevant facts also shared by the WHO:

• 1 in 10 people in the world has diabetes.
• 1 in 2 people with diabetes is undiagnosed.
• 1 in 2 people who need insulin cannot access it.

[1] False myths about diabetes: https://www.endocrino.cat/diabetis.cfm/ID/6137/CAT/falsos-mites-sobre-diabetis.htm

[2] https://www.infermeravirtual.com/cat/problemes_de_salut/malalties_trastorns/diabetis#diabetistipusDM1

[3] https://www.infermeravirtual.com/cat/problemes_de_salut/malalties_trastorns/diabetis#diabetistipusDM2

[4] https://www.infermeravirtual.com/cat/problemes_de_salut/malalties_trastorns/diabetis#gestacional

[5] https://canalsalut.gencat.cat/ca/salut-a-z/d/diabetis/

Moltes d’aquestes funcionalitats suposen un abans i un després en el control d’aquesta malaltia crònica. A continuació mirem d’explicar els avantatges i les novetats que suposa cadascuna d’aquestes funcionalitats.

Control i registre de les dades

La major part de les aplicacions, per no dir totes, ofereixen aquesta funcionalitat com a eina principal. Permeten el registre de glucèmia, pes, presa de medicació, etc., normalment acompanyat de la sincronització amb els aparells de mesura de glucèmia capil·lar (punxada al dit), i fins i tot, permetent la lectura de sensors subcutanis, facilitant així el registre de les dades i evitant errors de transcripció. El fet de tenir totes les dades registrades i classificades en el temps, facilita la seva lectura mitjançant gràfics i informes, que faciliten la comprensió de la situació de salut i permeten compartir la informació amb el professional de la salut de referencia. Normalment amb la infermera.

Quin procés millora o substitueix?

Aquesta funcionalitat permet deixar en un calaix les llibretes de registre de glucèmies, on s’apunten de forma manual, les unitats d’insulina administrades, els valors glucèmics o els fàrmacs que s’han pres. Amb les corresponents inexactituds temporals o quantitatives. A banda de que aquestes llibretes són finites i cal anar-les renovant tot sovint.

Registre alimentari

L’alimentació i el seu control és un pilar fonamental en el control de la diabetis. Registrar allò que s’ha ingerit i saber quina quantitat d’hidrats de carboni tenia l’àpat en qüestió és fonamental entre d’altres coses per controlar els nivells d’insulina que cal injectar-se o simplement per fer una ingesta adequada a la capacitat del pàncreas. Actualment existeixen Apps que permeten aquest registre no tan sols per introducció manual de la quantitat de carbohidrats  d’aquell àpat, sinó també mitjançant fotografies o escaneig de codis de barres.

Quin procés millora o substitueix?

La possibilitat d’ajustar la dosis exacta d’insulina en funció de la ingesta i la glucèmia. Aquesta funcionalitat comporta una millora significativa ja que previ a aquesta funció poques persones eren prou constants com per fer aquest tipus de registre. Les Apps ajuden considerablement a fer-lo de forma constant, ja que moltes d’elles implementen una tercera funcionalitat gràcies a aquest registre alimentari. La possibilitat d’ajustar la dosis exacta d’insulina en funció de la ingesta i la glucèmia.

Dosi d’insulina a administrar

Cada vegada més aplicacions suggereixen la quantitat d’insulina que cal administrar-se en funció dels paràmetres que abans hem mencionat. Les aplicacions ja considerades com a dispositiu mèdic, creuen les dades de glucèmia i d’ingesta juntament amb altres dades biomètriques i d’històric de la persona amb diabetis, per fer un suggeriment de la quantitat d’insulina que cal administrar-se.

Quin procés millora o substitueix?

La millora resulta substancial, sobretot en les primeres fases de la malaltia quan la persona encara no té un coneixement prou madur sobre el maneig de la seva malaltia. Basant aquestes decisions en protocols rígids i amb poca especificitat.

Per tancar aquesta secció cal destacar alguns missatges clau que ha fet arribar l’OMS en aquest 14 de novembre [6], dia mundial de la diabetis:

• Una alimentació saludable i la pràctica d’activitat física, són dos components essencials per a la cura i la prevenció de la malaltia. En aquest sentit, cal destacar que més de la meitat dels casos de diabetis tipus 2 es poden prevenir.
• L’educació terapèutica, és fonamental per tal que les persones afectades adoptin un rol actiu en el seu tractament, coneguin la malaltia, aprenguin a identificar els senyals d’alerta i tinguin la capacitat d’actuar correctament davant de qualsevol eventualitat.

També es revelen algunes dades rellevants:

• 1 de cada 10 persones al món té diabetis.
• 1 de cada 2 persones amb diabetis no està diagnosticada.
• 1 de cada 2 persones que necessiten insulina no pot accedir-hi.

[1] Falsos mites sobre la diabetis:

https://www.endocrino.cat/diabetis.cfm/ID/6137/CAT/falsos-mites-sobre-diabetis.htm

[2] https://www.infermeravirtual.com/cat/problemes_de_salut/malalties_trastorns/diabetis#diabetistipusDM1

[3] https://www.infermeravirtual.com/cat/problemes_de_salut/malalties_trastorns/diabetis#diabetistipusDM2

[4] https://www.infermeravirtual.com/cat/problemes_de_salut/malalties_trastorns/diabetis#gestacional

[5] https://canalsalut.gencat.cat/ca/salut-a-z/d/diabetis/

[6] https://canalsalut.gencat.cat/ca/a s/dia-mundial-de-la-diabetis/