Watching Your Glucose with the GlucoWatch

283 THE INTRODUCTION of home glucose monitoring in the 1980s represented a major advance in diabetes care. It allowed patients with diabetes to graduate from inconvenient, inaccurate and messy urine testing to precise glucose measurements at specific points in time. However, it must be remembered that there are 1,440 minutes in a day and even those patients who are testing much more than the national average, which is less than two times per day, are only seeing their blood sugars a fraction of the time. Most people with diabetes and especially those with type 1 diabetes have a very difficult time keeping their blood sugars on an even level and furthermore, many do not realize the wide fluctuations that are occurring on a day to day basis. The nonphysiologic combination of subcutaneous insulin coupled with different activities, meals, stresses and other variables that affect blood sugar control all contribute to the difficulties experienced in diabetes management. The GlucoWatch represents a tremendous advance in diabetes management, as it is the first real time glucose sensing device where the person living with diabetes can see the results almost immediately and alter behavior accordingly. The GlucoWatch is a superb device to discover patterns and detect trends in home glucose values throughout the day. Although it is not meant to replace traditional home glucose monitoring, it will enlighten patients with diabetes and their caregivers to what happens to their blood sugars during the day and night in response to different meal times and amounts, varied activities and stress. Every time I wore the GlucoWatch as part of a clinical trial, I learned something new about my diabetes despite having lived with this disease for over thirty years. Shortly after I wore the GlucoWatch for the first time, I made changes in the basal rate on my insulin pump during the nighttime because of asymptomatic hypoglycemia. I also discovered that I have fairly severe gastroparesis, which now definitely explains many of the very high blood sugars that I would get several hours after eating a large meal. For individuals with hypoglycemia unawareness, the GlucoWatch represents a potentially life saving safety blanket. Alarms can be set individually for low blood sugar detection, and due to the potential inaccuracies of the GlucoWatch, as well as the other meters on the market, in the low and high glucose ranges, one can set the low alarm at a higher rate in order to reduce the false negative detection rate. For those diabetic mothers with young children at home and individuals who must be on the highways as part of their daily existence, the GlucoWatch represents a previously unavailable level of security that will help them avoid injuring themselves or others. The high glucose alarm will also allow people with diabetes to be notified when their blood sugars are rising above the desirable range. Recent data indicates that Americans are in the postprandial state approximately 11 hours a day, and this number is probably greater for people with diabetes. If an individual with diabetes has access to frequent blood glucose results and has the knowledge to act on these results, then supplementing themselves with extra