Would you get an artificial pancreas?

[Lana F]

I saw this in the news this morning, Medical breakthrough could help millions of diabetes patients, and was wondering what everyone thought of it? They're talking about the artificial pancreas, kind of like an insulin pump/CGM combo, that Dr. Bruce Bode says, "...takes the human element, and the human error, out of the equation. " The artificial pancreas is "a sensor and insulin pump [that] work together to continually check a diabetic's blood sugar and automatically set it at a normal range." Funny thing is, I don't see how that's any different from what they've got now: an insulin pump/CGM combo! I don't wear an insulin pump, but from what I hear, diabetics don't normally go by what their insulin pumps "suggest" (or recommend), because of that "human element." I think there's more room for device error than human error when it comes to diabetes! Don't more people die from insulin pump malfunctions than accidental overdoses of insulin (or underdoses)? Personally, I'd be more scared to have a device ("smart" as it may be) do my thinking for me! I'd always be worried about malfunctions and errors on the device's part! I know I can trust my own judgment, but I don't know about a device! Besides, I think they're making it a little too easy for people to NOT have to think or work these days -- just let your smart device do all your thinking for you, or those humanoids in Japan do all the work. I think it's one way to brainwash people; not letting them be responsible for their own health and forcing them to live with a device that does all their thinking! Is it that people are so stupid they can't be trusted, or that they're so lazy, they don't want to lift one finger to save their own lives?! Technology is what's making everyone so sick in the first place -- you don't realize how much air pollution all those factories make manufacturing everything we "can't live without these days!" If it weren't for all the pollution (air, water, noise, etc.), we'd be healthier and we wouldn't need some kind of contraption deciding how much insulin we need, for us. It's weird, because instead of doing something positive about the things that make us sick, in the first place, the world is looking for more ways to make us sick, only under the guise of making us "well" and hassle-free! How convenient! All I know is, I've been taking care of my type 1 diabetes for more than 15 years with 2 daily injections and a few finger sticks. And I'm good! No sweat! Maybe if people took care of their health better, and if the world stopped messing with nature so much, there wouldn't be a need for all this medical technology. Hardly anyone would be sick! The scary part is, all these seemingly convenient solutions to our health problems are creating more health problems. But big pharma prefers it that way, because then they can come up with new drugs to treat all the new diseases that get bred! Instead of throwing our money away on developing yet another form of diabetes treatment, why not try back-peddling for a bit and find out what causes some of these diseases, first. Then find a way to prevent them. An ounce of prevention beats a pound of cure! I don't know, am I crazy for thinking this way? They say the artificial pancreas might hit the market soon, with possible FDA approval by 2016. Who wants to be the first to try it?

 

[tim2000s]

I'll be first. I've given a lot of thought as to how an artificial pancreas would work, what the algo needs to look like, and how the safety mechanism might function. Given that T1 has been around for far longer than modern factories pumping out poison, being able to manage it more easily would be fantastic.

Plenty of cash has been chucked at curing as well as treating t1 and while progress is being made, economically, it's no surprise it doesn't get the level of funding of other, far more widely spread, conditions.

 

[phoenix]

I don't think that it is an artificial pancreas for two reasons.
1) it only uses insulin; glucose homeostasis in a normal body relies on the balance between insulin and glucagon. There are devices in the pipeline that will make use of the two such as this one: http://sites.bu.edu/bionicpancreas/publications-2/
2) It doesn't deliver insulin in the 'right' place ie it's subcutaneous rather than directly into the portal vein. Once again that's perfectly possible. There are implanted insulin pumps being used by a few hundred people here in France and there have been for many years. The big problem with them is being able to get a large enough supply of the particular insulin strength that needs to be used. Like conventional insulin pumps, these depend upon people testing, administering boluses and changing basals when necessary
http://www.diabeteshealth.com/blog/a-miracle-technology-for-type-1s-can-it-be-saved/
,Mix the two and you might have something approaching an artificial pancreas.

And yes,I would use it. I don't see any evidence that pumps are susceptible to malfunction and that causes problems. The pumps we use today are subject to user error or neglect and that can have consequences.
Like Tim, I cannot see that T1 or indeed many conditions and diseases are caused by air or other sorts of pollution. This was undoubtedly true in the past, I can remember not being able to see my hand in the last London smog, the the rivers like the Irwell in Manchester where nothing could live . Air pollution hasn't been eradicated but it's far lower than at any time since before the industrial revolution.

 

[Engineer88]

I would be third.

I dont know what its like to not have diabetes but I think this is probably the closes I'll ever get. Your right, currently I have a CGM and Pump but there is no interaction between them other than being displayed on the same device. I trust my pump generally to calculate does much more accurately than me and remember different ratios, ISF and basals for different times of the day. It has improved my life massively.

 

[Diamattic]

I think that would be fantastic, but am a bit skeptical... Sure it will work fantastic for most of the time, but we have all had issues with computers. Computers crash, they reset, some small glitch at some point, they break or just plain can't handle EVERY situation.

I wouldn't want to be one of the first few people to discover the flaws in this device. I think i would wait 3-5 five years until after they release and people start reporting how it actually works.

Their seems to be other 'artificial pancreas' projects that I am more excited about, such as the actual differentiation and implantation of beta cells, which i guess would be a real pancreas lol I think if we push stem cell research we can actually just grow new beta cells, thats my dream on this topic.

 

[JANROU]

Would give it a go provided I could back track if things didn't work out

 

[donnellysdogs]

I wouldn't. I don't think an algorithm could think 5 hours in advance for me to go gardening and the gym. It would be constantly having to pump in glucose.

I have just had two drs tell me this week that they do not know if long term subcutaneous insulin can affect humans...

I would not think that a cartridge of glucose would last very long in dropping levels with an algorithm for me.

Currently I know which shift hubby works, when I'm
Having lie ins, when I'm at work, at the gym etc.. I think I would be permanently running low on glucose!!!

 

[donnellysdogs]

In fact my hospital are offering freestyle libres to people and I even turned this down!!

 

[tim2000s]

I wouldn't. I don't think an algorithm could think 5 hours in advance for me to go gardening and the gym. It would be constantly having to pump in glucose.

I have just had two drs tell me this week that they do not know if long term subcutaneous insulin can affect humans...

I would not think that a cartridge of glucose would last very long in dropping levels with an algorithm for me.

Currently I know which shift hubby works, when I'm
Having lie ins, when I'm at work, at the gym etc.. I think I would be permanently running low on glucose!!!

Morning DD, the Artificial Pancreas is a little more intelligent than simply using glucose. It is using Insulin and Glucagon to manage bg levels and adjusting these to achieve a target bg level. It therefore doesn't need to know five hours in advance because it is predicting what you bg level will be in 15 mins or so and managing your dosing appropriately. (It's a bit more complex than this, but you get the idea)

So whether you are lying in, gardening, going to the gym or doing stuff around your hubbies shifts, it will be merrily making sure your bg remains in the target zone with small doses of insulin or glucagon.

 

[Robinredbreast]

I would give it a try if offered, we aren't going to know how it would work, if we don't try these things. It could be a godsend to one person and a nightmare to another.

I think I have been getting a 'had enough of diabetes' lately, no idea why, but will still fight on

Best wishes RRB

 

[Engineer88]

I would give it a try if offered, we aren't going to know how it would work, if we don't try these things. It could be a godsend to one person and a nightmare to another.

I think I have been getting a 'had enough of diabetes' lately, no idea why, but will still fight on

Best wishes RRB

Bang on RRB x

 

[Jaylee]

the Artificial Pancreas is a little more intelligent than simply using glucose. It is using Insulin and Glucagon to manage bg levels and adjusting these to achieve a target bg level.

...so it kind of does the "liver's job too..? In the sense of the "dump."
Wouldn't be a little like someone with too much basal correcting with Lucozade to stay within range..?
Don't get me wrong. I'm not "neigh saying". Just "layman'izing" the tech.. I love tech. But would rather wait for a "smart insulin" that backs off when there is nothing to work on? rather than a development that sounds similar to the treatment used to lower high potasium levels in kidney failer patients via a "drip"...? (I'm not a doc. But have memories of something like the aforementioned to treat my non D father in law with cancer.)

 

[phoenix]

There's no doubt that people react differently to these things. One of the people on my pump course had had an implanted pump but became scared of it. She was also the only one I know of on that course that gave up the normal pump within a few months; because her husband didn't like it.
Personally, I am just amazed as what medical technology is able to do. A friend's nine year old grand child almost died a year ago after a heart attack during a games lesson at school.(brilliant first aid by the teacher in charge saved him) He now wears a pace maker with a defibrillator that will kick in when his heart stops; and it will. That would scare me but it isn't a new device, it's well tested though more often used with older people .It keeps him alive and able to live a relatively normal life.

 

[tim2000s]

...so it kind of does the "liver's job too..? In the sense of the "dump."
Wouldn't be a little like someone with too much basal correcting with Lucozade to stay within range..?
Don't get me wrong. I'm not "neigh saying". Just "layman'izing" the tech.. I love tech. But would rather wait for a "smart insulin" that backs off when there is nothing to work on? rather than a development that sounds similar to the treatment used to lower high potasium levels in kidney failer patients...? (I'm not a doc. But have memories of something like the aforementioned to treat my father in law with cancer.)

No, it only does the pancreas' job. Alpha cells produce Glucagon, Beta cells produce Insulin. Glucagon tells the liver to convert Glycogen to Glucose. Insulin tells the Liver and muscles to move GLUT4 transceivers into locations where they can remove glucose from the blood and then use it or store it. Given too much IOB, T1 glucagon production is unable to cope, which is why you need the additional from the AP. The role of the Ap is to stop releasing insulin when the BG is heading into too low a level. If the algorithm is any good it will also learn and adjust the rate of dosage to reduce variation from a mean.

This is the normal mechanism that the body undergoes, releasing insulin to handle the glucose addition and glucagon to cause a release of glucose. This is what is being mimicked in the AP.

 

[phoenix]

...so it kind of does the "liver's job too..? In the sense of the "dump."
Wouldn't be a little like someone with too much basal correcting with Lucozade to stay within range..?
Don't get me wrong. I'm not "neigh saying". Just "layman'izing" the tech.. I love tech. But would rather wait for a "smart insulin" that backs off when there is nothing to work on? rather than a development that sounds similar to the treatment used to lower high potasium levels in kidney failer patients via a "drip"...? (I'm not a doc. But have memories of something like the aforementioned to treat my non D father in law with cancer.)

The liver doesn't normally 'dump' glucagon and insulin work together to keep glucose levels at the right concentration for the bodies needs. Insulin as well as allowing glucose into the cell also joins glucose molecules into longer chains for storage as glycogen in the liver and in your muscles. When your glucose falls, insulin levels fall and glucagon then stimulates the gradual release of the right amount of that glycogen. It's a sort of gentle see-saw between the two ( insulin resistance also throws the see saw out of kilter and it requires more insulin to stop the release of glycogen ; one of the reasons for liver 'dumps' )

The trouble with injected insulin is that insulin levels aren't reactive . They can't be because they are formulated to stay in the body for some hours. The half life of natural human insulin is only 4-6 minutes, the half life of Novo injected subcutaneously is 81 minutes.

BUT if you inject regular human insulin into a vein (as they do in DKA), the half life is only 10 min which is one reason it might be better to work on delivery of insulin in a more 'natural' place.

 

[donnellysdogs]

Morning DD, the Artificial Pancreas is a little more intelligent than simply using glucose. It is using Insulin and Glucagon to manage bg levels and adjusting these to achieve a target bg level. It therefore doesn't need to know five hours in advance because it is predicting what you bg level will be in 15 mins or so and managing your dosing appropriately. (It's a bit more complex than this, but you get the idea)

So whether you are lying in, gardening, going to the gym or doing stuff around your hubbies shifts, it will be merrily making sure your bg remains in the target zone with small doses of insulin or glucagon.

Naah can't get my head wrapped round the 5 hours that insilin last in me and the thinkiing I have to do..

Also driverless cars have been crashing... So no way would I entertain until I know a body builder or fellow gardenener has done. I will stick with manging myself..

 

[Jaylee]

@phoenix @tim2000s cheers guys for taking time out to put me straight on the tech. (Let's face it. No Doctor could. & the official "blurb" always looks like a sales pitch on dragons den.)
It's difficult enough to keep the "balls in the air" with this mularkey at the best of times..

I apreciate both your kind council on this.

 

[Engineer88]

Naah can't get my head wrapped round the 5 hours that insilin last in me and the thinkiing I have to do..

Also driverless cars have been crashing... So no way would I entertain until I know a body builder or fellow gardenener has done. I will stick with manging myself..

Actually people have been crashing into driverless cars, the cars themselves havent had or caused any accidents,the the actual other humans on the road are causing problems.

Regarding insulin lasting 5 hours, there wouldnt be enough insulin to last 5 hours if you think about it, you wouldnt be giving bolus doses like we do the algorithm would be acting minute by minute so you would only ever have fractions of units (fractions of fractions even!) released at once.

 

[Jaylee]

BUT if you inject regular human insulin into a vein (as they do in DKA), the half life is only 10 min which is one reason it might be better to work on delivery of insulin in a more 'natural' place.

I agree. But regarding the sites we use now for MDI & pump.
Thinking about potential issues regarding insulin delivery into the vein.? It may have been thought of.? But can "Joe T1 public" be trusted by the professionals to do the job properly? Hence the regime of the injection sites we all know & love...
I know a fair few "professionals" in the past give up locating a vein for a simple blood test..
Thinking from the angle of the perils of the heroin addict. Prolonged constant administering "substances" in this way could lead to "vein collapse" too?

The boffins may have thought it, but realized an issue..
Please shoot me if I'm barking up the wrong tree...!

 

[tim2000s]

I agree. But regarding the sites we use now for MDI & pump.
Thinking about potential issues regarding insulin delivery into the vein.? It may have been thought of.? But can "Joe T1 public" be trusted by the professionals to do the job properly? Hence the regime of the injection sites we all know & love...
I know a fair few "professionals" in the past give up locating a vein for a simple blood test..
Thinking from the angle of the perils of the heroin addict. Prolonged constant administering "substances" in this way could lead to "vein collapse" too?

The boffins may have thought it, but realized an issue..
Please shoot me if I'm barking up the wrong tree...!

My view is that you end up with an internal cannula that is attached to a vein. The interconnect on the skin is very similar to that of existing infusion sets. There are of course, one or two concerns about his approach...!