The Artificial Pancreas For Diabetics Is Nearly Here

the_newsbeagle writes: It's the tech that type 1 diabetics have long been waiting for: An implanted "closed-loop" system that monitors a person's blood-sugar level and adjusts injections from an insulin pump. Such a system would liberate diabetics from constant self-monitoring and give parents of diabetic children peace of mind. Thanks to improvements in glucose sensors and control algorithms, the first artificial pancreas systems are now in clinical trials.

Comments

Awesome

[MightyMartian]

Pretty amazing advance. Now I wish they'd do the same for the thyroid. My wife had hers removed due to cancer nine years ago, and has to manage her thyroid levels via synthetic thyroid hormone pills, which, while effective, are crude and require regular testing to make sure she's not hyperthyroidic or hyothyroidic.

Re:Awesome

[cdrudge]

require regular testing to make sure she's not hyperthyroidic or hyothyroidic.

How regular is regular though? Taking a test once every 3 months and adjusting your medication up or down a fraction of a milligram is an inconvenience. But it's a lot better then having to test 4-8 times a day and making significant changes to the dosage level due to what was ate, activities planned, illness, and how the body reacts to all of that. As a diabetic myself, I'd trade in an instant having to deal with hyper/hypo-thyroidism over diabetes any day.

Re:Awesome

[ColdWetDog]

You would need a lot more research that (I don't believe has been done) on how often you really need to adjust your thyroid. As cdrugde mentions, thyroid testing is done infrequently - on the order of months. To have an implantable system that fired off that infrequently is probably not really worth it. Dogma is that thyroid hormones don't change that much - at least a clinically noticeable values.

Most of the thyroid replacement research these days seems to be around the issue of 'minor' thyroid hormones, mostly T3. Even with this issue, we don't have good data. And T3 is produced at about 10% of the rate of T4 (the traditional thyroid hormone) so it isn't some scarce little molecule.

But if you really look closely at how much we know about things like this, it's pretty disappointing. This sort of research is slow and very expensive. Given that thyroid pills are pennies and that people do 'pretty well' on that treatment, the impetus to improve things is small.

No thanks.

[BarbaraHudson]

Even forgetting the security issue, going around with a pump and injection line connected all the time is a lot more of a pain in the ass than current methods. Also, it can't make judgements based on future activity - you might want less insulin than normal because you're about to embark an on 3-hour bike ride, which if you take your regular dose, will make you hypoglycemic, pass out, and wake up in an ambulance or the hospital (insulin efficiency increases with activity level, which is why you need less insulin when you're about to be active for any period of time).

Re:No thanks.

[Mashiki]

My sister would disagree with your assessment, and she's been a diabetic since she was 4 years old(31 years of shots now). If my great aunt was still alive, she'd be jumping for it too since she'd been a diabetic for ~70 odd years. There are plenty of methods to avoid hypoglycemia from working out, this in itself is a huge step in the current pump a needle in you every 2/4/6/8 hours that exists now.

The biggest problem is with kids and getting them to do monitoring, tests, etc., since many of them don't understand not doing something like that will kill you. It's a concept that a 4 year old can't get, no matter how simple you explain it to them.

Re:No thanks.

[h4rr4r]

Why would this device not just adjust your glucose levels during the bike ride? I am pretty sure that is exactly what it would do in that situation.

I get the feeling someone did not RTFA.

Re:No thanks.

[CastrTroy]

My understanding is that there isn't a direct relation between what's being read from the sensor and what is actually in the blood. The glucose sensor just senses the amount of glucose in the blood. So if it gives a reading of x, and then gives a dose of y units of insulin to counteract, it doesn't know that you're going to start running in 1 minute which will decrease the glucose levels further than it expected to based on the amount of insulin delivered. So, now you're going to be low on glucose. The only way to do that is to add glucose to the blood. Assuming this system does this, it can bring the blood sugar back up. However, it also doesn't know about the chocolate bar you just ingested which will again add glucose to your system in the near future.

For a system like this to work, it has to make constant tiny adjustments to your insulin and glucose levels to ensure that it always remains in a certain safe zone. Scott Hanselman did a pretty good write-up a few years back. It's really kind of depressing when you look into the current state of affairs. The diabetes industry seems to be more concerned with making money than actually solving people's problems.

Re:No thanks.

[danlip]

A normal functioning pancreas can't predict the future either. All it can do is react to what it is sensing, just like the artificial one. It may be more finely tuned, better sensors, better algorithms, etc, but none of that represents anything that couldn't be incrementally improved in the artificial pancreas.

Re:No thanks.

[BarbaraHudson]

Yes, there are methods of avoiding hypoglycemia when working out - but they're reactive, not anticipatory. Until they also include a sugar pump, forget it.

Re:No thanks.

[tirerim]

Um, insulin pumps have been around for about 30 years, and very common for the past 15. They're already a huge improvement over injections. This level of "artificial pancreas", though, not so much. The glucose sensing technology, though dramatically improved from its debut a decade ago, is still primitive: it uses interstitial glucose, and lags behind actual blood glucose, requiring regular calibration with fingersticks. Combine that lag with the fact that a non-diabetic pancreas starts producing insulin even before food hits the bloodstream, and it's impossible for the system to react to food in a timely way. Worse than that, though, is the fact that insulin effectiveness isn't constant. It's less effective when you're eating a lot of fat, and it's more effective when you're exercising (and for some time after). Just measuring glucose levels isn't enough to tell the system how to react. Maybe eventually they'll manage to combine this with enough other sensors to actually be a real artificial pancreas, but I think that's a lot farther off, and we'll probably have effective islet cell transplants without immune rejection by then.

Not a pancreas

[jklovanc]

Since it does not produce it's own insulin it is not an artificial pancreas. It is an automatic insulin pump. It still has to be refilled with insulin periodically. It is an improvement but is not a replacement for a pancreas.

Re:Not a pancreas

[jklovanc]

The pancreas produces several hormones. The automatic insulin pump deals with only one. Therefore an automatic insulin pump is not a replacement for a pancreas. The heart moves blood and that is all. An artificial heart replaces that function. The other think is that artificial hearts are not a permanent solution. They get replaced with organic hearts.

That may not seem like a big deal to you,

I never said it was not a big deal.

It is an improvement but is not a replacement for a pancreas.

Re:Not a pancreas

[jklovanc]

I suppose that they should have really called it an "artifical Isles of Langerhans", but that's pretty clumsy.

Sorry but still incorrect. The Islets of Langerhans produce all the hormones and not just insulin. Even the specific type of Islets that produces insulin produces another hormone.

Beta cells producing insulin and amylin

What you call pedantic others call accurate. It is unnecessary to hype a significant advancement by over stating what it is.

But is it hackable

[penguinoid]

Just wondering, can it be modified to work with caffeine?

It's not an artificial pancreas

[Anonymous Coward]

It's a self regulating insulin pump. That's a wonderful for type 1 diabetics, but the pancreas produces more than just insulin.

Glucagon is the primary axis hormone to insulin. A true artificial pancreas would monitor both hormones to optimize that relationship.

Re:Let's all hope

[Dunbal]

You must be new here.

Re:Insulin Resistance

[Chris Mattern]

Well, actually, there are two kinds of diabetes. In one type (adult-onset diabetes or Type 2 diabetes) the body becomes less and less responsive to insulin. This is the kind associated with obesity, and the pump won't help this much. The other type (juvenile diabetes or Type 1 diabetes) is caused by the body stopping production of insulin, generally because the insulin-producing cells of the pancreas die off. The body remains completely responsive to insulin; the problem is that there isn't any any more. This will be a godsend for people with Type I.

Re:Insulin Resistance

[russotto]

They are at their furthest apart still symptoms of the same lifestyle problems.

No, Type 1 diabetes is an autoimmune disease, not a symptom of a lifestyle problem. It's not caused by lifestyle either.

Re:Insulin Resistance

[Anonymous Coward]

I did just recently have a doctor lecture me that they are no longer differentiating as strongly between type 1 and type 2 diabetes in their treatment approaches. They are at their furthest apart still symptoms of the same lifestyle problems.

I would not trust a doctor that believes that type 1 (pancreas not producing the insulin hormone because its cells die from an autoimmune reaction, often at a young age) should be treated in the same way as type 2 (where the pancreas has to make extra insulin, because the cells becomes less responsive to it)