Individuals with Turner Syndrome face higher risk of developing insulin resistance, glucose intolerance, and Diabetes Mellitus Type 1 and 2. The advancement of technology in medicine can improve management of metabolic disease and enhance long-term health outcomes. This article dives into the various technologies and medications available for individuals with Diabetes Mellitus.
Information presented in this article comes from the webinar “Diabetes: Diagnosis, Management, and Research.”
Why is this important for Turner Syndrome?
Our understanding of diabetes technologies can help individuals with Turner syndrome improve glycemic control. Even for individuals not diagnosed with Diabetes Mellitus, over the counter CGMs can be helpful to track glucose and detect glycemic variability early.
Increased knowledge of glucose control and access to modern medicine technologies can support the TS community improve long-term health outcomes and enhance disease prevention strategies.
Continuous Glucose Monitors (CGMs)
Continuous Glucose Monitors are small sensors inserted on the back of the arm that measure glucose levels through interstitial fluid. Unlike A1C and fasting glucose blood tests that provide only a single snapshot in time, CGMs give us insight into day to day glucose readings.
CGMs have been shown to help improve A1C, reduce hypoglycemia (low sugar), and improve time in target glucose range. While some CGMs do not require calibration, it is always advised to check glucose with a blood glucose meter to ensure accuracy.
Currently available CGMs:
- Freestyle Libre 2 Plus and Libre 3 Plus
- Dexcom G6 (set to discontinue on July 1, 2026)
- Dexcom G7 (10 day and 15 day versions)
- Lingo (Over the Counter)
- Stelo (Over the Counter)
What is Insulin?
Insulin is very important in glucose regulation. It is a hormone produced by pancreatic beta cells to facilitate the uptake of glucose into our cells to use for energy. Diabetes Mellitus Type 1 occurs when our pancreas makes little to no insulin and Type 2 occurs when our cells resist insulin. Insulin is necessary for Type 1 Diabetics but not all Type 2 Diabetics require insulin.
Insulin Injections
Insulin can be administered through injections or a pump. There are mainly two types of insulin: Fast Acting and Long Acting.
- Fast acting insulin is taken approximately 15 minutes prior to a meal to help with postprandial (after meal) glucose spikes. Some common fast acting insulins include Novolog and Humalog.
- Long acting insulin is usually taken once a day for a basal (background) insulin to last about 24 hours. Some long acting insulins include Lantus and Tresiba.
Insulin Pumps
While some individuals prefer insulin injections, insulin pumps have become more popular. Each insulin pump uses a different algorithm to maintain glucose levels in target and reduce the risk of hypoglycemia and hyperglycemia.
Insulin Pump | System | CGM | Key Features | User Input |
Medtronic MiniMed 780G | Hybrid Closed Loop | Instinct sensor, Simplera Sync sensor, and Guardian 4 sensor | Automated Insulin Delivery | Input meals and carbs |
Tandem t:slim X2 | Hybrid Closed Loop | Dexcom G6 and G7, Libre 3 Plus | Automated Insulin Delivery | Input meals and carbs |
Tandem Mobi | Hybrid Closed Loop | Dexcom G6 and G7 | Smallest Pump, Automated Insulin Delivery | Input meals and carbs |
Omnipod 5 | Hybrid Closed Loop | Dexcom G6, G7, Libre 2 Plus | Automated Insulin Delivery, Tubeless | Input meals and carbs |
Omnipod DASH | Open Loop | Does not directly integrate with CGM | Manual basal and bolus delivery, Tubeless | Input meals and dosing |
Beta Bionics iLet Bionic Pancreas | Closed Loop (between Fully and Hybrid) | Dexcom G6 and G7, Libre 3 Plus | No carb counting, Automated Insulin Delivery | Only input weight |
Twiist | Hybrid Closed Loop | Libre 3 plus | Automated Insulin Delivery | Input meals and carbs |
Closed-Loop Systems
Closed-Loop Systems use a CGM, insulin pump, and an algorithm to maintain glucose levels.
- Hybrid Closed-Loop Systems will automatically administer insulin based on CGM readings. However, users still need to input carbs into the pump to bolus before meals.
- Fully Closed-Loop Systems are still being researched as they require algorithms that do not need carb inputs. There is no current Fully Closed-Loop Insulin Pump available for clinical use in the United States, but some companies are continuing to develop and test this system.
- Automatic delivery systems are usually referred to as closed-loop technologies.
- Open Loop Systems require manual input for both basal adjustments and boluses before meals.
Medication
A variety of oral medications are available for Type 2 Diabetes Mellitus. These medications can work alone or in combination, but always consult your physician for therapy adjustment.
Common oral medications include:
- Biguanides (Metformin): First line of treatment in DM Type 2
- Glinides (Repaglinide): Increase pancreatic insulin release
- SGLT2-I (Dapagliflozan, Empagliflozin): Increase urinary insulin release
- Thiazolidineidiones (Pioglitazone): Increase insulin sensitivity in muscle, liver, and fat cells
- DPP-4 (Sitagliptin, Saxagliptin): Increase incretin hormones to regulate insulin and glucagon levels
- Sulfonylureas (Glimepiride, Glipizide): Increase insulin secretion and decrease synthesis of glucose
Injectable medications for Type 2 DM management are administered once a week to reduce A1C, improve glucose control, and in some cases help with weight loss.
Common injectable medications include:
- GLP-1 Receptor Agonists (Semaglutide)
- Ozempic: Type 2 DM
- Wegovy: Weight management
- Dual GLP-1/GIP agonist (Tirzepatide)
- Mounjaro: Type 2 DM
- Zepbound: Weight management
- Oral Semaglutide is also available as Rybelsus and Wegovy.
- A new oral medication, Orforglipron (Foundayo), has been FDA approved for Type 2 DM and obesity.
Future Directions
The future of diabetes management is rapidly evolving with the emergence of Artificial Intelligence. In the coming years, we will begin to see fully closed-loop systems requiring no user inputs and AI-driven algorithms to significantly reduce blood sugar levels in specific scenarios.
Further Reading
References
Home. Abbott. (n.d.). https://www.freestyle.abbott/en-in/home.html
Injection family of Insulins | Humalog® (insulin lispro) | lilly insulins. (n.d.). https://insulins.lilly.com/humalog
Introducing the ilet bionic pancreas. Beta Bionics. (2026, January 7). https://www.betabionics.com/ilet-bionic-pancreas/
Minimed 780G system. Diabetes Management Solutions. (n.d.). https://www.minimed.com/en-us/products/minimed-780g-insulin-pump-system
Rayan MN, Reddy N, Verma N, et al. Monitoring Technologies- Continuous Glucose Monitoring, Mobile Technology, Biomarkers of Glycemic Control. [Updated 2026 Apr 12]. In: Feingold KR, Adler RA, Ahmed SF, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279046/
Simplify life®with Omnipod® 5. Omnipod. (n.d.). https://www.omnipod.com/what-is-omnipod/omnipod-5
Slim X2 insulin pump: Tandem Diabetes Care. t. (n.d.). https://www.tandemdiabetes.com/products/insulin-pumps/tslim-x2-insulin-pump
Tandem Mobi automated insulin delivery system: Tandem Diabetes Care. Tandem Mobi Automated Insulin Delivery System | Tandem Diabetes Care. (n.d.). https://www.tandemdiabetes.com/products/insulin-pumps/tandem-mobi
Templer S. Closed-Loop Insulin Delivery Systems: Past, Present, and Future Directions. Front Endocrinol (Lausanne). 2022 Jun 6;13:919942. doi: 10.3389/fendo.2022.919942. PMID: 35733769; PMCID: PMC9207329.
Weinberg Sibony R, Segev O, Dor S, Raz I. Drug Therapies for Diabetes. Int J Mol Sci. 2023 Dec 5;24(24):17147. doi: 10.3390/ijms242417147. PMID: 38138975; PMCID: PMC10742594.
What is twiist. (n.d.). https://www.twiist.com/what-is-twiis
Written By Simrita Hemrajani, TSF Volunteer Blog Writer and designed by Adrianna Verzolini
© Turner Syndrome Foundation, 2026
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