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Personal perspective
by Dr Stuart Bootle

Diabetes and the mHealth Grand Tour

In May 1983, I developed Type 1 diabetes whilst training to become a doctor. Twenty nine years on, I still find myself learning new things that help me maintain the right balance, so I can "take control" and live an "active life" whilst protecting my body from the damage that diabetes does over time.

Following my diagnosis, I was started on insulin and used a glass syringe to give two injections per day. Self monitoring of blood glucose was in its infancy and there was little opportunity to adjust my insulin dose in relation to variations in day-to-day life.

Not long after starting insulin, I remember going to France cycling round the Dordogne, exploring the countryside and visiting the vineyards. I quickly learned the impact of regular exercise on my glucose levels, and not in a good way. Lots of low blood sugars and embarrassing moments - a frustrating and scary experience for me, my wife and friends!

I was new to diabetes and didn't understand what was happening to my body at the time. On reflection, it was obvious... going from doing no regular exercise to cycling 50+ miles per day had dramatically increased my insulin sensitivity, meaning that I needed less insulin. I didn't have the knowledge, skills or technology to make the appropriate changes to my insulin doses.

Thankfully, there have been significant advances in pharmaceutical, diagnostic and device related technology. Modern insulins, self monitoring of blood glucose, continuous glucose monitoring and insulin pump technology now make it possible to make appropriate adjustments and fine tune insulin delivery to meet the body's needs and maintain near normal glucose levels in a variety of different situations.

However, helping people get the most out of this evolving technology presents significant challenges for many healthcare systems. There is a real opportunity for "mHealth solutions" to address this gap in healthcare provision and help people with diabetes "take control".

So, does all this technology mean I could do the mHealth Grand Tour? Well, I now realise that it is no longer determined by my diabetes. Like anyone considering endurance exercise, it comes down to desire, commitment, training and planning...what do you think?

Dr. Stuart Bootle
sb@hcuk.co.uk

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