[Diabetes-Talk] Artificial pancreas

Tue Jan 3 19:29:36 UTC 2017

Hello all, 

Here is some helpful information to keep in mind when talking about the artificial pancreas. It is a tutorial of sorts. This is a lengthy post, so you may want a bookmark handy... 

1. The term artificial pancreas refers to a system of technologies, working together, to regulate the blood glucose of a person with diabetes with no or almost no action of the human. The artificial pancreas automatically makes insulin and/or glucagon dosing decisions without need for the human to think about it, just like a working pancreas. No carb counting, calculating insulin boluses, etc. 

Complaint: I wish companies would not use the term "artificial pancreas" for products that don't work like I described here. By doing so, it confuses all of us about what is meant by the term "artificial pancreas." As Kim Ladd pointed out, Medtronic has a system approved for sale in the US in the spring and they use the term "artificial pancreas," with an added description that is a "hybrid closed loop system." This is misleading to me. The Medtronic system is a nice step forward, but it is not the "artificial pancreas" we all think of when we read the term artificial pancreas. 

2. Several companies are testing artificial pancreas systems, but as of today, no artificial pancreas system has been approved for sale anywhere in the world. Kim Ladd's post had a link to a good article covering which companies are working on this. Some new companies that are not already selling diabetes technology are now testing artificial pancreas systems, so be prepared to hear some new names such as Bigfoot Biomedical and a company producing a system they have named the Islet. The traditional companies are also working this, such as Medtronic, Johnson and Johnson's Animas, T-Slim, and many others. 

3. All artificial pancreas systems rely on use of a continuous glucose monitor system (CGM), such as the Dexcom or similar device. CGM systems use a disposable sensor inserted under the skin to continuously sense the blood glucose and transmit the current reading every five minutes to the part of the artificial pancreas that makes the dosing decisions. CGM systems require some maintenance, to change the sensor every week or so, and to calibrate the systems with real blood glucose readings twice per day. 

If you ever use an artificial pancreas, you must wear a CGM sensor taped to your skin 24 hours a day, seven days a week. Without the CGM, the artificial pancreas cannot make any decisions. Furthermore, not all CGM systems are created equal. Some are measurably more accurate than others, and some have accessible interfaces via the iPhone for calibrating the CGM systems. I speak hear of the Dexcom G5 mobile, which I use independently as a totally blind person. The only assistance I require is when starting a new 3-month transmitter. Otherwise, I use it independently via the iPhone Dexcom G5 app. 

4. All artificial pancreas systems rely on a pump to deliver basal and bolus doses of insulin. One artificial pump system will also use a pump to deliver bolus doses of glucagon. Insulin is a hormone that lowers blood glucose. Glucagon is another hormone that causes the liver to release stored glucose, so Glucagon is used to raise the blood glucose should it begin to go too low. 

If you ever use an artificial pancreas, you must use an insulin pump so the artificial pancreas can deliver the insulin and/or glucagon. Wearing an insulin pump requires you to have the small, disposable  pump cannula inserted under your skin and worn 24 hours a day, seven days per week, usually connected with tubing to the pump itself. Insulin pumps require maintenance every so often, to be refilled with insulin, or to replace the cannula and tubing. For me, I must change my pump cannula and tubing about every two to three days, based on my insulin usage and other factors. 

5. All artificial pancreas systems have a part that takes the readings from the CGM and makes dosing decisions. We'll call this part the brain of the artificial pancreas. The brain automatically adjusts the basal rates of the insulin pump, sometimes many times per day, and also gives insulin boluses. The brain closely monitors the readings from the CGM and determines if a bolus is required or whether an increase in basal insulin delivery is required. The brain also lowers the basal rate, or suspends basal delivery automatically whenever required to prevent lows. Finally, at least one artificial pump will also deliver 
Glucagon, via a pump, as required, to prevent lows. 

6. All of this requires batteries, and for some of the systems, I suspect a smart phone or access to the internet via Wi-Fi will also be part of the system, or, the system will use Wi-Fi or the smart phone, when available, to share data, and perhaps to assist in decision making. 

7. Finally, you may have read in the press about parents and individuals that are experimenting on their own to create artificial pancreas systems - they are not waiting for companies to build them and for the FDA to approve them. They are using standard insulin pumps, CGM systems, and their own very small computer systems and software for the brain. Hard to believe, but there are some already using such home-built devices. There is an online community dedicated to developing the software that makes the decisions for the artificial pancreas, and for helping others purchase what is necessary for the tiny computer and creating the interfaces to the CGM and pump. These are legal to use since they are being built for personal use and are not being marketed for sale. This is not for me :) !. Just wanted to pass this along. I've met some folks using these home-made artificial pancreas systems. They are interesting to talk to. 

Tom Ley

-----Original Message-----
From: Diabetes-Talk [mailto:diabetes-talk-bounces at nfbnet.org] On Behalf Of Bridgit Kuenning-Pollpeter via Diabetes-Talk
Sent: Tuesday, January 03, 2017 12:25 PM
To: 'Diabetes Talk for the Blind' <diabetes-talk at nfbnet.org>
Cc: Bridgit Kuenning-Pollpeter <bkpollpeter at gmail.com>
Subject: [Diabetes-Talk] Artificial pancreas

Veronica,

The artificial pancreas has already gone through rounds of beta testing.
It's finally being released on the market for wide-spread use within the year. My endo is very excited and has nothing but good things to say about it, and he's yet to steer me in the wrong direction, especially in regards to technology, grin. Of course, as we know, even once released on the market, changes will be inevitable and necessary, but so far, it all sounds very promising.

Even though little interaction will be necessary for any user, I still am concerned with accessibility. I don't have a lot of people in my life I can turn to on a daily basis for sighted assistance, so accessibility is a huge factor for me with anything, but particularly when it comes to my diabetes management. There will inevitably need to be some way to access info from the device, and I'm sure at times, human interaction will be necessary, so how easy will this be for nonvisual users; it's yet to be determined. Sad that the lack of accessibility has to hamper the excitement of nonvisual users.

As mentioned before, I switched to the Animas Ping a few years ago after I had to sadly stop using my Cosmo. It's not the same but close. I've not had any major problems with my Animas. However, now being pregnant, it's been annoying because the Animas cartridge holds 100 units less of insulin than the Cosmo cartridge did, and being in my final 2 months, we have had to up my basal ates quite a bit, so I'm going through cartridges every 3 to 4 days as opposed to weekly when I'm not pregnant. Last time I was pregnant, I still had my Cosmo so wasn't expecting this. But this is not a common exception, grin, just pointing out.

Otherwise, my Animas has been comparable and I'm happy with it. But I agree, the Cosmo was the best.

Bridgit

-----Original Message-----
From: Diabetes-Talk [mailto:diabetes-talk-bounces at nfbnet.org] On Behalf Of Veronica Elsea via Diabetes-Talk
Sent: Monday, January 02, 2017 6:11 PM
To: 'Diabetes Talk for the Blind' <diabetes-talk at nfbnet.org>
Cc: Veronica Elsea <veronica at laurelcreekmusic.com>
Subject: Re: [Diabetes-Talk] Your new president...

Bern, I echo the bitter-sweet congratulations. I assure you that we do not expect you to be Mike. <grin> I look forward to seeing how this list and organization will grow under your leadership. And yes, a definite group effort. 
I also look forward to seeing what the new technology will do. In the meantime, I am checking out the current pumps as my beloved Cozmo finally shrieked out its last system fault alarm. Yikes! Someone here mentioned awhile back that there was a blind person using an OmniPod with some sort of app. I found out that he was actually using a KNFB reader to try and read the screen. I'll probably end up with the Animas Vibe but I'm struggling to get around that notion of how much I'm losing compared to what I had. 
As for the artificial pancreas, I hope the technology it's based on is more accurate than what we have now. Eventually it would be nice to have to interact less with stuff, but I'm not so sure I want to be in the first round. <grin> Never say never though. 
In the meantime, boy do I appreciate having a place to share knowledge, to vent, to brag, to whine and to help each other. I really do appreciate all of you and look forward to accomplishing as much as we can together. Onward, onward! Count me in!
Veronica

"Guide Dogs, First Hand", Veronica Elsea's classic album is now available on iTunes, along with other music from her and from the Guide Dog Glee Club. 
To learn more, visit:
http://www.laurelcreekmusic.com
                Veronica Elsea, Owner
Laurel Creek Music Designs
Santa Cruz, California
Phone: 831-429-6407

-----Original Message-----
From: Diabetes-Talk [mailto:diabetes-talk-bounces at nfbnet.org] On Behalf Of Bernadette Jacobs via Diabetes-Talk
Sent: Monday, January 02, 2017 8:45 AM
To: Diabetes Talk for the Blind
Cc: Bernadette Jacobs
Subject: Re: [Diabetes-Talk] Your new president...

Oh Bridgit!

Thank you so kindly for your vote of confidence!! You're like a breath of fresh air!

Only trouble is, for Medicare patients, I think that these things are so hard, as a matter of fact, too hard to get. You shouldn't have to go through denials and appeals and denials and appeals. Too bad the system is so broken!! We should not have to fight this hard to survive. Just makes me sick!! However, I will be anxious to hear more about the artificial pancreas.  I'm always anxious to hear more when it comes. Talk very soon.

Bern

Sent from my iPhone

> On Jan 2, 2017, at 9:50 AM, Bridgit Kuenning-Pollpeter via 
> Diabetes-Talk
<diabetes-talk at nfbnet.org> wrote:
> 
> Bernie,
> 
> Congrats, even though it's a bittersweet congratulations. You will do 
> a fantastic job.
> 
> On a sidenote, speaking of sharing and learning from each other, I 
> just
want
> to say that my doctor continues to bring up the artificial pancreas 
> and
how
> it will be available on the market within the year to all diabetics. 
> He believes this will revolutionize diabetes even more than insulin 
> pumps
have.
> He's eager and excited for the technology and for me to have the
opportunity
> to transition to one. Of course, I'm concerned about accessibility, 
> but nonetheless, this is exciting news, and I'm sure many of us are 
> excited about this technology.
> 
> The device will use a CGM to constantly monitor blood sugars. As it 
> does this, it will automatically adjust insulin as needed. Little 
> interaction will be necessary for the device.
> 
> More info about this is available online, but as I learn more, I will 
> continue to share.
> 
> Happy New Year; may 2017 be fruitful for everyone.
> 
> Bridgit
> 
> -----Original Message-----
> From: Diabetes-Talk [mailto:diabetes-talk-bounces at nfbnet.org] On 
> Behalf Of Bernadette Jacobs via Diabetes-Talk
> Sent: Sunday, January 01, 2017 1:26 PM
> To: diabetes-talk at nfbnet.org
> Cc: Bernadette Jacobs <bernienfb75 at gmail.com>
> Subject: [Diabetes-Talk] Your new president...
> 
> Good Afternoon Everyone!!!
> 
> Happy New Year!!!
> 
> Firstly, I'd like to begin by telling you a little bit about myself 
> for those of you who don't know me.  I'm aware, however that most of 
> you
do.
I
> am Bernadette Jacobs, formerly, about 18 years ago, Bernadette Krajewski.
I
> have been first vice-president now since, I believe, about 2007.  
> Don't hesitate to correct me if somebody out there finds me to be 
> wrong.  At any rate, I did have a one-year break while Sandy Ryan 
> served just last year--2015-2016.  Thank you Sandy.
> Since the unfortunate passing of our illustrious and fearless leader 
> Mike Freeman's passing, I will do my best to serve you as our Diabetes 
> Action Network's president and your list moderator.
> 
> I will warn you.  I can't do this all alone, however.  I need all of 
> you
to
> work with me and teach me as you have done about our conditions for 
> the
past
> so many years.  Most of what I have learned about my own diabetes, 
> I've learned from all of you.  You've been so gracious.  But that's 
> what we're
in
> this thing for.  Right????  Helping each other and taking care of each 
> other.  So, I'd like to say, Welcome home and Happy New Year!!!
> 
> I was diagnosed as a type II diabetic in about March of 1985.  This, 
> of course, was before the age of "pre-diabetes."  I have been insulin
dependent
> since 1999 when My husband Bill and I were first married and I became 
> pregnant with the baby we lost in miscarriage.  I have been a member 
> of
the
> Diabetes Action Network, (DAN) since its inception in 1985.
> 
> My mother was a diabetic and I lost my mother to complications of 
> diabetes at the tender age of 13.  She, herself was only 47.  She had 
> three heart attacks, the third of which, resulted in her passing.  I 
> remember it as if were Yesterday.  When I came into DAN, I told it's 
> then president, Ed Bryant, that my mother was a diabetic and died of 
> complications.  He gave
me
> that gentle kick in the seat of the pants, "And you are diabetic too..."
Of
> course, he also recognized I was in that old familiar river, "Denial???"
Ed
> Bryant, the gentle man he was, took me under his fatherly wing and we
worked
> together up until his passing.  Mike came in and we all continued on.  
> I must say, that his passing on December 24, shocked and deeply 
> saddened me just as it has everyone else.
> 
> Now, everyone, I'd like to take this time to thank you!!  For, it's 
> all of you who've taught me so much about the conditions that we share
together.
> Taught me about insulin pumps, complications, and the heartaches we've 
> suffered together as well as foo the positive bits of news.  There are 
> so many of you that I simply can't wait to hear about something new 
> you've learned, discovered and/or whatever else.  It simply warms my 
> heart to the moon and back to hear from you as I feel like we're such 
> a great big
family.
> Isn't it wonderful???  I think it's phantabulous!!!  SQUEEEEEZE!!!!!  
> i DO hope that all of you will continue to write in with all your 
> things, both good and bad so that we can all continue to share, learn, 
> and work
together.
> I'll miss you if you don't!!
> 
> Until next time, take care and have a great day!!!
> 
> Below, I'll be posting my Email, so that you can write me offlist for 
> anything strictly confidential you might need help with.  I will then
share
> my cell phone with you that we may continue our work together.
> 
> Very Warmly,
> 
> Bernadette M. Jacobs, (Bernie, Bern).
> 
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> 
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