A Smart Artificial Pancreas Could Conquer Diabetes (ieee.org) 58
IEEE Spectrum reports on the progress being made to develop a "smart artificial pancreas" that senses blood glucose and administers insulin accordingly. An anonymous reader shares an excerpt from the report: The artificial pancreas is finally at hand. This is a machine that senses any change in blood glucose and directs a pump to administer either more or less insulin, a task that may be compared to the way a thermostat coupled to an HVAC system controls the temperature of a house. All commercial artificial pancreas systems are still "hybrid," meaning that users are required to estimate the carbohydrates in a meal they're about to consume and thus assist the system with glucose control. Nevertheless, the artificial pancreas is a triumph of biotechnology.
It is a triumph of hope, as well. We well remember a morning in late December of 2005, when experts in diabetes technology and bioengineering gathered in the Lister Hill Auditorium at the National Institutes of Health in Bethesda, Md. By that point, existing technology enabled people with diabetes to track their blood glucose levels and use those readings to estimate the amount of insulin they needed. The problem was how to remove human intervention from the equation. A distinguished scientist took the podium and explained that biology's glucose-regulation mechanism was far too complex to be artificially replicated. [Boris Kovatchev, a scientist at the University of Virginia, director of the UVA Center for Diabetes Technology, and a principal investigator of the JDRF Artificial Pancreas Project] and his colleagues disagreed, and after 14 years of work they were able to prove the scientist wrong.
It was yet another confirmation of Arthur Clarke's First Law: "When a distinguished but elderly scientist states that something is possible, he is almost certainly right. When he states that something is impossible, he is very probably wrong." [...] Progress toward better automatic control will be gradual; we anticipate a smooth transition from hybrid to full autonomy, when the patient never intervenes. Work is underway on using faster-acting insulins that are now in clinical trials. Perhaps one day it will make sense to implant the artificial pancreas within the abdominal cavity, where the insulin can be fed directly into the bloodstream, for still faster action. What comes next? Well, what else seems impossible today?
It is a triumph of hope, as well. We well remember a morning in late December of 2005, when experts in diabetes technology and bioengineering gathered in the Lister Hill Auditorium at the National Institutes of Health in Bethesda, Md. By that point, existing technology enabled people with diabetes to track their blood glucose levels and use those readings to estimate the amount of insulin they needed. The problem was how to remove human intervention from the equation. A distinguished scientist took the podium and explained that biology's glucose-regulation mechanism was far too complex to be artificially replicated. [Boris Kovatchev, a scientist at the University of Virginia, director of the UVA Center for Diabetes Technology, and a principal investigator of the JDRF Artificial Pancreas Project] and his colleagues disagreed, and after 14 years of work they were able to prove the scientist wrong.
It was yet another confirmation of Arthur Clarke's First Law: "When a distinguished but elderly scientist states that something is possible, he is almost certainly right. When he states that something is impossible, he is very probably wrong." [...] Progress toward better automatic control will be gradual; we anticipate a smooth transition from hybrid to full autonomy, when the patient never intervenes. Work is underway on using faster-acting insulins that are now in clinical trials. Perhaps one day it will make sense to implant the artificial pancreas within the abdominal cavity, where the insulin can be fed directly into the bloodstream, for still faster action. What comes next? Well, what else seems impossible today?
smart (Score:2)
Here we go with the 'smart' marketing again. Let me guess, its so smart that it can be hacked wirelessly to deliver a lethal dose, right?
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Of course. If someone accidentally dies due to a software bug they need to blame this on Russian Haxxors as a scapegoat.
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You know what they say: "Smart devices are for dumb consumers." /s
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/whoosh [google.com]
Re:smart (Score:5, Insightful)
To put that in perspective, insulin is by far the most complicated self-administered medicine we ask people to take. When a child is diagnosed with Type 1 diabetes, parents attend days of classes to learn to test their kids 4 times a day at a minimum, and adjust insulin dose based on a number of complicated, interrelated factors. As the kids themselves grow into adulthood (which they didn't used to do), they may attend "diabetes camps" to learn the skills to *literally* survive when they go to college.
Even so, the chances of making a mistake over a lifetime is high. If you're feeling weird and loopy because your blood sugar is off, and you make a mistake, you can die. If you put yourself into an insulin coma, and nobody's around who can recognize that and knows the correct first aid, you can die. If you have a little ADHD and you aren't that great at maintaining a rigid schedule, you can die. Things that other people don't have to think about you have to pay almost continual attention to for the rest of your life. That really sucks.
Sure, anyone can design a system with security flaws that will put patients at risk, which is why designing medical systems isn't a job for amateurs. But a proficient system architect with hardware and an algorithm that can reproduce what a natural pancreas does can increase the life expectancy of many people, and just as importantly improve their quality of life.
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This is - after all - a simple control. Industry had these for ages (see the centrifugal controller).
It doesn't need any "smart" this or that - a 5-segment indicator for battery status and a 5-segment indicator for remaining insulin is plenty enough.
You end up with a device that doesn't connect to anything and does all it needs to do. Add a buzzer for "low battery" and "low insulin" and you're good to go.
No need for the "artificial pancreas" to connect to your mobile phone to send you reminders, or to order
Re:smart (Score:4, Informative)
This. I am 42 and have had Type I diabetes since age 13. I am on a pump and have been for around 15 years (with the exception of a 9 month stint of unemployment when I could not purchase the supplies).
If I am left on my own with my self-imposed, rigid schedule, my A1C is great. Testing 4-6 times a day, tight calculation of consumed carbohydrates, boluses on time. Factor in kids, on-the-job chaos, wife, and my own undiagnosed ADHD, and I sometimes hit that realization when I take a reading at dinner that I missed 3 other glucose tests earlier in the day. Or even worse, I drank a regular soda or ate a quick snack and did not take a bolus dose of insulin because I was busy with a deadline. Or my kid's car broke down and I missed a meal and insulin dealing with that emergency.
There should be no excuse, I do realize that, especially after living with this disease most of my life. The pump does make it easier so you're getting SOME insulin at a basal rate, even if you missed a bolus. But chaos happens. It sucks taking a blood glucose reading all the time. It sucks having to calculate carbohydrates and figure out your bolus (if you have no pump that calculates that for you). And that is all before life chaos. When everyone else is ready for dinner, I have to go take a blood glucose reading. We're leaving the house, I have to check my insulin supply in my pump (oh! wait! I have to refill it really quick!) or I have to make sure my meter bag is ready.
There are worse diseases to suffer through, for sure. But diabetes sucks. I'm sick and tired of dealing with it and its cost on my life and my wallet.
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I'm all for improvements in medical science. I'm not a fan of the 'smart' marketing pushed at us constantly for devices that really are not smart.
You're right, a closed loop control of insulin would be great for a lot (and an increasing number) of people, I get it.
But to call this device smart and then to state:
> All commercial artificial pancreas systems are still "hybrid," meaning that users are required to estimate the carbohydrates in a meal they're about to consume and thus assist the system with gl
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But to call this device smart and then to state:
> All commercial artificial pancreas systems are still "hybrid," meaning that users are required to estimate the carbohydrates in a meal they're about to consume and thus assist the system with glucose control.
So, its not actually smart after all (yet, might be some day), but we are going to call it 'smart'. Smart has nothing to do with anything here, it just trashy marketing.
Being able to interact with my phone or my voice does not make anything smart. Not one of these 'smart' devices is smart in any way.
That's not true at all. Current gen insulin pumps have feedback loops from continuous glucose monitoring systems and they dynamically adjust the basal rate based on that data, including predictively stopping the basal insulin if you are going to get too low.
Yes, you still have to enter estimated carbs when you eat, but that's why they are called hybrid systems vs. a full-on artificial pancreas.
Interestingly, there is a non-commercial, open-source, DIY system that gives full auto-mode without having to enter
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>The commercial insulin pumps are a few years behind them.
But you'll stand behind the 'smart' marketing? Fuck that. Its a work in progress and *maybe* one day will be more than that. Sticking software inside things does not make them smart or 'smart'.
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Type 1 diabetes (Score:4, Informative)
Re: Type 1 diabetes (Score:1)
... congratulations, you identified the correct response. Good job.
For bonus points, name another recent gene therapy that behaves similar to the one for Type 1 diabetes above.
Re: Type 1 diabetes (Score:2)
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Re: Type 1 diabetes (Score:3)
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Agreed, but this is a specific case of a more general problem.
Modern medicine is designed to treat symptoms, not to prevent illness.
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Not that many have Type 1 dibetes: Type 2 is 20 times as common: Type 1 requires insulin and is is much more difficult to control.
Re:Type 1 diabetes (Score:4, Insightful)
I'm going to claim second-hand authority in (slightly) arguing this point with you with you - my wife is a diabetic and is also an RN and diabetes educator.
They are actually rethinking the whole type 1 versus type 2 paradigm, and many people who have been living for years diagnosed as "type 2" - including my wife - are now believed to be a variant of type 1. So it's not clear what the divide is between type 1 and type 2, or if it even makes sense to think that way anymore.
But back on topic... my wife does really love having her CGMS + pump system, now that it's finally approved for use in the US. But man, every time I read about the crap level of "security" companies like Medtronic use in their code, I get nervous. She doesn't seem to understand that you don't have to be targeted - there are people who will mess with these things for the lulz.
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I'm staring at the American Diabetes Association defintions at https://www.diabetes.org/blog/... [diabetes.org]. "Rethinking the paradigm" is a very popular political hobby right now, so I'd be cautious what a committee might come up with.
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Some people can manage with just changing their diet, avoiding high carbohydrate foods and especially those foods that cause spikes in blood sugar. Some people choose to have some blood glucose probe implanted for continuous testing to see what works with their metabolism and what doesn't.
Some people can manage by also exercising on top of changing diet. Apparently there's some amazing correlations between fat around the pancreas and insulin r
Way to go (Score:5, Informative)
"Open source" insulin pumps exist. Hackers like Scott Hanselman, who has diabetes already had those machines tuned to work like a fully automated artificial pancreas:
This is from 2016: https://www.youtube.com/watch?... [youtube.com]
I personally met the guy. He is really nice, and he is one of the "good ones" in Microsoft. As he is the open source advocate there. And is diabetic. I would recommend reading up his blog on this matter: https://www.hanselman.com/blog... [hanselman.com]
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Yep. This. Hackers have been modding existing insulin systems to suck considerably less for ages now. This is just business catching up with what some people have already shown a strong desire for. Good game, you read a Forbes article about hacking insulin pumps from 2013 and made a "real thing". #NotANewInvention
https://www.forbes.com/sites/e... [forbes.com]
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See also Dana Lewis and the OpenAPS movement [openaps.org]. Dana gave a talk at the NZ LinuxConf a few years back:
https://www.youtube.com/watch?v=p76hGxv3-HE [youtube.com]
Re: corporate health at its best (Score:4, Informative)
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Type 1 is, mostly, an auto-immune problem that destroys the cells that make insulin. That's why there are some theories about creating a vaccine, which have neer succeeded. There are other causes, such as cystic fibrosis, or Klinefeldter's Synderome, or cancer that requires removal of much of the pancreas. But they're far less common.
I'd give a year's salary without blinking for a good artificial pancreas, or even for a non-invasive constant glucometer to control an insulin pump. Not for me I've been diabet
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Type-1 is congenital, youre born with it.
I really wish there was a "-1. Factually Incorrect" mod.
You *can* be born with it. In other cases, it manifests itself much later in life. Opinion is changing as we realize that many cases have been misdiagonsed, by medical professionals, because of the mistaken assumption that it's either congenital, or a childhood disease.
My brother has type I diabetes. He literally went on vacation fit as a fiddle and came back with diabetes. He started feeling something was very, very wrong while he was there. By the ti
Re: corporate health at its best (Score:2)
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Nothing can improve your chances of good health like a balanced diet and moderate exercise.
This really depends. In many cases, nothing can improve your health like penicillin. In those cases I would heavily not recommend a balanced diet and moderate exercise as a cure.
Re: corporate health at its best (Score:1)
Um... (Score:5, Interesting)
Try a Tandem pump with a Dexcom G6 Sub-Q CGS.
Wife loves it.
She's been on pump therapy for almost 30 years - Wayy before Medtronic F'd up Minimed. Bastards *owned* the market - and sat on their asses for 20+ years.
As for a "cure" - being hooked up to a machine isn't a cure. Especially if it can't manufacture the key component itself. It's just automating shots - which is still an acute solution to a chronic condition. And before you pedantic jackoffs start spouting off about a pancreas is just automating shots... one important detail - a pancreas manufactures it's own insulin and self-regulates blood glucose levels via closed-loop negative-feedback analog wetware computer.
Try finger pricks 8x / day and deciding what you're going to eat - all day - at 7A when you mix up your N & R insulin for your first shot of the day before breakfast.... then another R at lunch... and another at supper. Then a final shot of N before bed - praying that you didn't take too much, and have enough carbs in reserve. Otherwise you might not wake up in the morning to start all over. No breaks. No vacation from this crap. She did that for 18 years before her first pump. And no, my math isn't wrong. She'll be getting her Joslin 50-year medallion next year. Before anyone starts whining about a flu or COVID shot. At last count, she's had 70,000+ shots.
A cure is an actual biological pancreas. It can create it's own insulin, and regulate bg's on it's own.
Rest of this is just an automated syringe.
Re: Um... (Score:2)
Does not seem like a cure at all, so far it just showed a slight change in HbA1c levels .. hardly a cure.
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Superhype Clickbait Bullshit (Score:5, Insightful)
This is not an "artificial pancreas". It's just another pump, which has been around for years. It's an improved pump to be sure, but still just a refinement of what we already have. A real artificial pancreas would be surgically implanted and make its own insulin. Like a real pancreas does. This is a clickbait story, comparable to the kind of bullshit you see on Vice or Buzzfeed or Yahoo. Fuck you, clickbait writers and editors, for getting my hopes up for my young son that suffers with Type 1.
Which diabetes? (Score:2)
Seeing as most diabetes in the US seems tol be self-inflicted type 2 that stems from insulin resistance I foresee a lot of expensive surgery that will do nothing to ease the problem.
Then again it's not like dumping more insulin on an already overloaded system wasn't already the goto option.
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Its not that simple. The criteria for type 2 is an A1c value -- if you have that then you are 'afflicted'. The part that gets swept under the rug is that this number is a statistical norm, not a standard. And there is plenty of literature from the pharmaceutical companies that medication can induce hypoglycemia even with good controls. So while there is a tendency to declare Type 2 as a lifestyle choice.. the price of 'sin', the medical evidence is more coincident than causal. And the largest user of glucos
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It is best to think of metabolic syndrome as a collection of closely related symptoms - obesity, hypertension, diabetes, and athersclerosis among others. These are all related. They also are typically related to, but not necessarily caused by lifestyle and environmental factors, some of which are within a person's control, and others of which are not.
Lifestyle improvements will improve metabolic syndrome for many people, but not all.
I don't look to judge or blame. Only to try to make things better.
But th
Already exists (Score:2)
Tandem + Dexcom G6 as someone commented earlier already does this. It has been life changing for people I know with Type 1 diabetes. They used to have terrible HbA1c levels until they got on it. The only thing Tandem oughta do is also enable injecting of glucagon because some Type 1 diabetes cannot produce glucagon. Anyway, the Tandem + Dexcom G6 solution is not the ideal cure since you have to keep buying insulin .. plus it is like some external device with a wire to your insides that sounds a bit wonky l
Interesting but not needed (Score:1)
Diet is everything, particularly in this case. End of story. How many diabetics would be out there, if everyone did not abuse carbs?
All these advances only serve to discourage people from changing their lives. Same as all the illnesses, really. Well, everyone is allowed and bitches against smoking....rightfully so and I say this as a former smoker, but Bob forbid we tell people to exercise, decrease the carbs and increase walking outdoors. Body positivism and veganism disagree, yay! So take that pill, strap
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Excess carbs are a huge problem. Especially those that are metabolized largely via the liver (sugars in nontrivial amounts) and/or that cause exaggerated spikes in insulin, leptin and ghrelin, eventually leading to resistance to some or all of these.
But keep in mind that excess fats can cause liver damage and that excess protein can damage kidneys. You don't really want an excess of any of these.
I do advocate a much lower than usual amount of carbs, and especially high-glycemic ones.
But I also recommend a
Glucagon (Score:2)
A smart artificial body (Score:1)
This is not a real closed loop system (Score:2)
Re: This is not a real closed loop system (Score:2)
Yes that is superior and Tandem may eventually do that, but not every Type 1 needs glucagon. Still, I think the best solution is encapsulated beta cell solutions that various companies like ViaCyte and also universities are researching. ViaCyte PEC-Encap VC-01 seems closest to commercial.
tl;dr -- This is not a cure / nor a conqueror (Score:1)
All,
This is Jeff from Tulsa. Long time listener, first time caller.
I have Type 1 diabetes, and have since 1981, just before my 12th birthday. (Ronald Reagan had just become Pres, and the US hostages from Iran were just arriving on American soil.) That's 40+ years.
Facts -- The tech surrounding diabetes HAS gotten more useful and life-extending. However, none of it is a cure.
Insulin pumps (with some auto-dosing capabilities) are a wonderful thing. Continuous Glucose Monitors (even though invasive) can al
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