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This article leaves us hanging; the initial motivator for developing the system is to prevent instances of overnight hypoglycemia - but we reach a conclusion ta

This article leaves us hanging; the initial motivator for developing the system is to prevent instances of overnight hypoglycemia - but we reach a conclusion talking about how it can autonomously deliver insulin to correct for hyperglycemic events. Were they ever able to make the algorithm robust enough to predict low blood sugars in the future and "shut off" or reduce delivery of basal insulin to mitigate these events? New pumps by Medtronic are equipped with an auto-off feature that suspends insulin delivery if the user's blood sugar is below a certain threshold [1], however this is a rear-facing indicator and the patient will still experience a hypoglycemic event. I assume the next logical steps towards making these systems fully autonomous is to remove the idealogical separation of basal and bolus insulin; instead, the system would register increases and decreases of blood sugar and take systematic steps towards bringing them back into a healthy range - much like a healthy pancreas does, either by increasing or decreasing the amount of insulin being delivered at a given time. That way a patient can eat, exercise, and live a "normal" lifestyle while the pump takes care of delivering the correct amount of insulin. [1] http://www.medtronicdiabetes.com/products/minimed-530g-diabetes-system-with-enlite http://www.medtronicdiabetes.com/products/minimed-530g-diabe...

mkesper 11y ago
Are there systems feeding sugar in such an event? That would be the only thing really preventing a - possibly lethal - hypoglemic event, no?
- barely_stubbell 11y ago
  Preventing these situations entirely by predicting these events and reducing the administered basal insulin would be ideal, but humans don't exist in a vacuum. I don't think a system autonomously feeding sugar would be the optimal solution however; patients who utilize CGM's today are still instructed to monitor blood glucose through traditional means for calibration and confidence in system accuracy, so I don't think it would be an additional burden for them to continue to carry a source of sugar for emergency hypoglycemic events. I think predicting and preventing lows through lowered basal rates, in combination with on hand sources of glucose for emergency situations, would be best. Even a reduction in the amount of hypo- (and, hyper-) glycemic events would be a big win for patients and educators. I think the quality of care would vastly increase with such systems in place. Additionally - the human body has systems in place to bring blood sugars back into a safe range when it feels it is in an emergency situation. I do not claim to be an expert on this matter, but it is my understanding that the liver is able to release glycogen into the system to spike blood glucose levels back up if they have fallen low [1]. This is why some diabetic patients may experience high blood sugars in the mornings if they have experienced a hypoglycemic event overnight and slept through it. I don't believe this would be a good solution to depend on, however. [1]http://www.diabetes.co.uk/body/liver-and-blood-glucose-levels.html http://www.diabetes.co.uk/body/liver-and-blood-glucose-level...
  - terminalcommand 11y ago
    I've had type 1 diabetes for 9 years. In the first 3-4 years my liver continued to produce glucagon. I experienced highs resulting from the down syndrome over night. But after that it just stopped. Now I automatically wake up if my blood sugar is below a certain threshold. It's a survival instinct. Sometimes though it gets very scary. I can't scream, know that I need to get up and eat something, but I just can't. The downside is that I am very paranoid. I wake up at least once a week at night (around 3 am) and check my blood sugar levels. Even though they are usually in the expected range, I still get that feeling of 'being low'. If I don't act on it, I might die.
centro 11y ago
The github repo https://github.com/openaps/openaps https://github.com/openaps/openaps includes a description of some of the things the project can do. One of them is "predict - Can make predictions about what should happen next." All diabetics ever have is a rear facing indicator, fortunately it's not really true that you can't predict the future when it comes to blood glucose. The simple equation is `exercise + carbs + current blood glucose level + insulin on board` along with all the attributes that make your body respond to artificial insulin the way it will. The system doesn't really need to predict the future to be a massive improvement on where diabetics already are thanks to slow moving organizations like the FDA. With appropriately cautious buffers around when to shut the insulin pump off a huge majority of diabetics will rarely see a low blood sugar. The technology is here, we just have to summon up the will to move medicine forward.

mkesper 11y ago

Are there systems feeding sugar in such an event? That would be the only thing really preventing a - possibly lethal - hypoglemic event, no?

barely_stubbell 11y ago
Preventing these situations entirely by predicting these events and reducing the administered basal insulin would be ideal, but humans don't exist in a vacuum. I don't think a system autonomously feeding sugar would be the optimal solution however; patients who utilize CGM's today are still instructed to monitor blood glucose through traditional means for calibration and confidence in system accuracy, so I don't think it would be an additional burden for them to continue to carry a source of sugar for emergency hypoglycemic events. I think predicting and preventing lows through lowered basal rates, in combination with on hand sources of glucose for emergency situations, would be best. Even a reduction in the amount of hypo- (and, hyper-) glycemic events would be a big win for patients and educators. I think the quality of care would vastly increase with such systems in place. Additionally - the human body has systems in place to bring blood sugars back into a safe range when it feels it is in an emergency situation. I do not claim to be an expert on this matter, but it is my understanding that the liver is able to release glycogen into the system to spike blood glucose levels back up if they have fallen low [1]. This is why some diabetic patients may experience high blood sugars in the mornings if they have experienced a hypoglycemic event overnight and slept through it. I don't believe this would be a good solution to depend on, however. [1]http://www.diabetes.co.uk/body/liver-and-blood-glucose-levels.html http://www.diabetes.co.uk/body/liver-and-blood-glucose-level...
- terminalcommand 11y ago
  I've had type 1 diabetes for 9 years. In the first 3-4 years my liver continued to produce glucagon. I experienced highs resulting from the down syndrome over night. But after that it just stopped. Now I automatically wake up if my blood sugar is below a certain threshold. It's a survival instinct. Sometimes though it gets very scary. I can't scream, know that I need to get up and eat something, but I just can't. The downside is that I am very paranoid. I wake up at least once a week at night (around 3 am) and check my blood sugar levels. Even though they are usually in the expected range, I still get that feeling of 'being low'. If I don't act on it, I might die.

centro 11y ago

The github repo https://github.com/openaps/openaps https://github.com/openaps/openaps includes a description of some of the things the project can do. One of them is "predict - Can make predictions about what should happen next." All diabetics ever have is a rear facing indicator, fortunately it's not really true that you can't predict the future when it comes to blood glucose. The simple equation is `exercise + carbs + current blood glucose level + insulin on board` along with all the attributes that make your body respond to artificial insulin the way it will. The system doesn't really need to predict the future to be a massive improvement on where diabetics already are thanks to slow moving organizations like the FDA. With appropriately cautious buffers around when to shut the insulin pump off a huge majority of diabetics will rarely see a low blood sugar. The technology is here, we just have to summon up the will to move medicine forward.