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FDA Approves Wearable "Artificial Pancreas"

kkleiner writes "The FDA has approved a device that acts as an "artificial pancreas", which both continuously monitors a patient's glucose levels and injects appropriate amounts of insulin when needed. When blood-sugar levels become low, the device from Medtronics warns the wearer and will eventually shut down. The MiniMed 530G looks to offer an on-the-go solution for the growing number of people suffering from Type 1 diabetes who have to test their blood and inject insulin throughout the day. The company plans to improve the device to make a fully automated version down the road."

21 of 119 comments (clear)

  1. Re: What? by DamienGreathouse · · Score: 3, Informative

    The current the pumps do not adjust the insulin levels. Instead the user and the doctor program it to pump different amounts at different times. The current sensors just log the blood sugars to the pump for easier downloading and analysis at the doctors office.

  2. Re:Insulin levels flucuate, just like blood pressu by demonlapin · · Score: 2

    It is for type I diabetics, whose distinguishing characteristic is that they can't make more than trace amounts of insulin.

  3. Re:What? by demonlapin · · Score: 2

    The integrated glucometer.

  4. Insta-death by girlintraining · · Score: 5, Interesting

    As has been covered before, airport full body scanners tend to kill medical devices like this. People have had devices like these, along with pacemakers and other equipment die after being subjected to high energy bursts of EMI; which is exactly what airport scanners do. While the goverment claims they're phasing these out, they are still in the field -- high power portable x-ray and 'mwave' scanners that are being used at customs checkpoints, or on unsuspecting civilians on the road. And then there's those pesky aircraft carriers that carry gigawatt radar scanners that on several occasions have locked people in their cars, garages, etc., due to EMI when they were passing by.

    All of this kind of unregulated and largely unmonitored technology poses a very real danger to technology like this; And with so many people having diabetes, this could mean that entire towns' worth of diabetics drop dead while the government claims "it's a mystery why everyone with implantable medical devices died after we irradiated them..."

    My point is; The laboratory environment these things were designed (and approved) in is very different from the environment they're going to be used in. And there's no evidence the FDA has taken this into consideration from what's provided here. Indeed, they have a poor track record of having an impartial approval process; I do not believe that 'FDA Approved' means much more than 'Scientology Approved' these days -- but this is to be expected when the FDA's income is derived directly from the companies' whose products they approve -- companies literally pay for approval. Anywhere else, this would be a clear conflict of interest. But when it comes to the safety of our food, drugs, and medical supplies... it's business as usual.

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    1. Re:Insta-death by ColdWetDog · · Score: 4, Informative

      Funny, you don't see many dead diabetics in the waiting area, do you? You'd think with all of the media coverage given to people who just get stared at wrong by the TSA we would see a couple more of these sorts of disasters on CNN.

      I'm not any friend of Medtronic - they seem to do a barely adequate job on a day to day basis. But give the engineers a bit of credit - they don't just stick these things on a bunch of rabbits and then go out to the bar (the engineers, not the rabbits). The certification process actually does include running the devices by airport scanners these days. Who would have guessed?

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    2. Re:Insta-death by girlintraining · · Score: 3, Informative

      Funny, you don't see many dead diabetics in the waiting area, do you?

      You don't see many terrorists either, but few people would suggest they aren't out there simply because they aren't wearing their "I'm With the Taliban" t-shirts while going through customs.

      You'd think with all of the media coverage given to people who just get stared at wrong by the TSA we would see a couple more of these sorts of disasters on CNN.

      You'd think, from watching CNN, that only pretty, underage, white girls get kidnapped too. Unfortunately for minorities, boys, and ugly people, they get kidnapped too.

      But give the engineers a bit of credit - they don't just stick these things on a bunch of rabbits and then go out to the bar (the engineers, not the rabbits).

      Well, actually that's exactly what they do... prior to human testing, they test on animals. And it wouldn't be rabbits, it'd be pigs, who possess a more similar liver to our own than a rabbit does.

      The certification process actually does include running the devices by airport scanners these days. Who would have guessed?

      Well, you would have, for one. Perhaps a citation would help in establishing your credibility regarding this claim? Let me show you how: If you google "diabetic airport scanner", and click on the first link, and they said this: "Medtronic has conducted official testing on the effects of the new full body scanners at airports with Medtronic medical devices and have found that some scanners may include x-ray. If you choose to go through an airport body scanner, you must remove your insulin pump and CGM (sensor and transmitter). Do not send your devices through the x-ray machine as an alternative. To avoid removing your devices, you may request an alternative screening process."

      This would seem to suggest that the certification process does indeed now include airport scanners... principally in the "don't do this" column of the report.

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    3. Re:Insta-death by cgriffiths · · Score: 2

      Can a diabetic keep ingesting enough sugar with juice or soda or candy to keep their blood sugar up for brain function, even if the insulin dose is overwhelmingly high? And the insulin, according to the last diabetic I met, only lasts a few hours: it's not a long-term effect, even with a huge amount injected, right?

      As a type 1 diabetic from experience and research on the matter if by accident all the insulin in the pump was delivered, even a quarter of it could easily be enough to put somebody into a coma or kill them. It can appear that insulin acts over a few hours as this is the rate which the body reacts to it and the quantities involved relating to the glucose in the system and the insulin.

      In the UK insulin injections tend to be 100 "units" per ml or 10 microlitres per unit and my insulin injections contain 3ml of insulin which are injected according to dosage. To me a unit is equal to 5 grams of carbohydrates being eaten but having such a huge amount of insulin will very negatively affect the person rendering them either unconscious or completely unable to function properly. If left like that on their own for too long then ultimately it is unlikely that they will wake up ever or they would have lost a lot of brain function, this would be a lot worse taking such a huge amount of insulin from a malfunctioning pump in their sleep.

      I'd imagine that when all the glucose has been acted upon by the insulin in the system, the insulin will remain in the body as more glucose is being introduced which will be acted upon again until the insulin runs out. Luckily though if you are with someone with plenty of experience or who are trained and have fast acting glucose at hand in a high enough quantity it may be possible for it to be managed without going to hospital. There are of course other people who have "brittle diabetes" which react much more strongly to small amounts of insulin which could be deadly or people who get need less insulin per gram of carbohydrate.

    4. Re:Insta-death by levork · · Score: 3, Insightful

      My wife is a long term Type One Diabetic and has worn a pump and CGMS for years, so I'm somewhat qualified to answer here:

      If the insulin pump fails to deliver insulin, won't the diabetic notice with their next glucose test?

      Yes, the diabetic will notice. In fact, the CGMS (continuous glucose monitoring system) itself will notice and should alarm (and the article is about a pump with a CGMS built in). Keep in mind that the pump can actually fail to deliver insulin because the tubing is kinked, or the injection site is occluded - so this can be a more common occurrence than you think and isn't actually directly due to pump failure.

      Don't most travel with spare insulin and a few syringes, in case of pump failure, at least for long distance travel?

      Yep. My wife's diabetic medical supplies easily take up half of her carry on baggage.

      Conversely, what happens if the insulin is all delivered at once? An insulin pump holds what, typically, a few days of insulin? Can a diabetic keep ingesting enough sugar with juice or soda or candy to keep their blood sugar up for brain function, even if the insulin dose is overwhelmingly high?

      This is the scary scenario. It's never happened to my wife, and the pump manufacturers had better go to great lengths to ensure it never happens. The type of insulin used in a pump is fast acting, so if all the insulin is delivered at once she will pretty much immediately need to eat a lot of sugar or go into a coma. We're talking entire bags of cookies within minutes.

  5. Not as 'artificial pancreas' as it seems by Anonymous Coward · · Score: 5, Informative

    Currently, I'm using a Dexcom continuous glucose monitor, and an Omnipod insulin pump. The advantage of being able to automatically turn down one's basal rate is an advantage, yes. I do this manually for myself, based on my Dexcom readings. But it isn't all that your pancreas does. If your blood sugar is diving too quickly, you have to supplement with sugar orally to make up for the fact that your pancreas isn't secreting hormones to make your liver release stored glycogen, or you may go too low and pass out. Often if I engage in unexpected exercise (moving boxes, changing a tire, spontaneous run) shortly after bolusing for a meal, my sugar will crash because my body becomes more responsive to the insulin I've taken, and once I've taken it, I can't un-take it. Kills spontaneity.

    Your pancreas also supplies you with insulin automatically based upon your blood sugar fluctuations... this product doesn't. You have to manually calculate your mealtime boluses and make the pump give it too you.

    This bionic pancreas is the technology I'm excited about, and can't wait for it to come to market. It automatically calculates and releases both insulin AND glucagon in measured amounts to keep your blood sugar levels as close to normal as I've ever seen.

  6. Re:Disappointed the article doesn't answer... by Anonymous Coward · · Score: 5, Interesting

    Having worked at Medtronic, but not at the Minimed division, I would guess that it doesn't really have an OS. The HMS Plus and Magellan devices didn't contain a RealTime OS or anything similar and the Magellan was originally programmed by a pacemaker engineer before I got on the project, so they use C to make embedded software, but there's no underlying OS like VxWorks, etc.

  7. Re:Insulin levels flucuate, just like blood pressu by Jjeff1 · · Score: 4, Informative

    My brother has a normal insulin pump. They work by continuously pumping in "fast acting" insulin into you (the basal rate), if you eat a meal, you have to calculate by hand the amount of extra insulin needed and press buttons on the unit to deliver the required amount. And yes, it knows that at different times of the day, you need more insulin than others. This is totally separate from the slow acting insulin that type 2 users sometimes take an injection of once or twice a day. If for whatever reason, the insulin delivery doesn't work properly, he'll start to have problems quickly, under a couple hours.

    His also has a blood meter which starts beeping if his insulin level falls below a certain level. What his pump doesn't do is automatically change the amount of insulin delivered on the fly. Any change in insulin delivery has to be programmed. If he eats an apple, he has to press buttons to dose himself. If his body chemistry changes and that basal rate needs to be adjusted, it has to be programmed. My understanding from him is that the blood glucose measurement isn't especially accurate, though I can't remember why.

    This is just the next generation of those same components. The generation after this, expect to see a unit that does a lot more dosing automatically. I think the technology is there, we just need to clear the regulatory hurdles.

  8. Re:Insulin levels flucuate, just like blood pressu by VanGarrett · · Score: 4, Informative

    Typically insulin pumps deliver insulin in two modes: Basal and Bolus. While a bolus is a large injection provided as quickly as reasonable, the Basal is a rate of delivery which can be instructed to vary over the course of the day. I would imagine that the device described in the article likely organizes injection in this fashion, with the added feature that if your blood glucose spikes, it will react to that automatically.

    I had an insulin pump for a number of years (from the same manufacturer that made the device in this article, in fact), so I am familiar with the usage. I, personally, had problems using it (I sweat too much for the catheter to stay in reliably), but I think that they're a great technology for those who can use them. This growing automation is certainly a good thing.

  9. No. This is not an artificial pancreas. by PongStroid · · Score: 2

    We've had insulin pumps for decades, and continuous glucose monitoring systems for many years. This is just a small iteration on top of that. The new thing? If the CGMS thinks your blood glucose is low, the pump is instructed to stop giving insulin.

    This ain't an artificial pancreas by any measure - even the manufacturer says as much.

  10. Re:And... by girlintraining · · Score: 2

    When MT says they plan an 'improved device', they mean it's ready now - just waiting for certification . . .

    Alternatively, they've already identified potential design limitations but as the certification process takes longer than the development of a new model, they have opted to complete the certification process and begin getting a return on investment, while pursuing parallel development of a replacement model.

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  11. Re:Insulin levels flucuate, just like blood pressu by lesliev · · Score: 2

    Also if the probe is the same as the one they currently sell, its crazy expensive, has to be replaced every 3 days and has an enormous needle. Too bad they don't mention any of that in the article.

  12. "I didn't see it on CNN, so it didn't happen!" by Rujiel · · Score: 2

    Your problem is that you're looking to television to inform you. The purpose of tv is to entertain and sell. That's it.

    1. Re:"I didn't see it on CNN, so it didn't happen!" by girlintraining · · Score: 2

      Your problem is that you're looking to television to inform you. The purpose of tv is to entertain and sell. That's it.

      A television is just a device. It's a tool, like a hammer, a screwdriver, or a car. It has no innate purpose; it is up to the user to create purpose in it. While a TV, and televised material as a whole, is often used for entertainment and marketing, it is neither exclusively used as such, nor should we encourage it to only be used in that capacity.

      "They say that ninety percent of TV is junk. But, ninety percent of everything is junk." -- Gene Roddenberry, creator of Star Trek

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  13. Re:Cool by Chrontius · · Score: 4, Insightful

    It's probably cheaper than any other method of managing their condition like amputation, disability payments, and nursing homes.

    Keeping diabetes from going from the "cheap to manage" to "terribly expensive" stage is probably, like most other healthcare things, a net savings once you get to even the medium term.

  14. Re:Insulin levels flucuate, just like blood pressu by Impy+the+Impiuos+Imp · · Score: 2

    > I'm sure the scientists involved - who are much smarter than you, of that I have no doubt - thought of that. Dipshit.

    Why aren't you on 4chan co-surfing with the Breaking Bad finale?

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  15. Re:Insulin levels flucuate, just like blood pressu by iluvcapra · · Score: 2

    My understanding from him is that the blood glucose measurement isn't especially accurate, though I can't remember why.

    It's hard to make a closed-loop control because most continuous blood glucose monitors don't measure the blood, but the residual glucose in the intersitial fluid, and this lags blood glucose by several minutes, which can be a big deal, depending on the food type.

    Blood sugar doesn't have a linear-time-invariant response to food input, different macronutrients can create different contours in blood sugar level over spans of time. Generally, a pump can't guess how many units to move in the bolus unless it knows specifically what you ate, it's not just a matter of dose, it's a matter of how long -- different foods require a more time-release bolus, sugars require a spike, all-at-once bolus.

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  16. Re:Cool by Andy+Dodd · · Score: 2

    And go figure, you're posting this drivel on an article about a device specifically targeted at Type I (autoimmune) diabetics... A device which, among other benefits, will help a Type I diabetic manage weight better by enabling them to maintain tight bloodsugar control without excessive hypoglycemia incidents. (Common problem for a Type I - eat a meal, take insulin, and then exercise without properly reducing your mealtime insulin dose to compensate. End result - hypoglycemia which requires you to eat more. A CGMS makes it a lot easier to properly plan insulin deliveries without overcorrections/oscillations.)

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