4 ms·

> Is the problem that there is no hardware for dual hormone pumps? All the well-tested pumps (Tandem, Omnipod, Medtronic) are insulin-delivery only.

nahsra 3y ago
Yes, but the "patch pumps" like the Omnipod are small enough you think patients might tolerate 2 of them? Maybe they've already asked, and people wouldn't tolerate it.
- iaresee 3y ago
  Possibly. But it's more than that. You have site issues, even with one pump, that you need to navigate. There are only so many viable places on a body to attach a cannula for good absorptoin and, while small, these things aren't _tiny_ (especially the Omnipods where the site holds the cannula, pump and reservoir). It'll be a while before we see highly reliable and well-tested dual-reservoir systems is my bet. The complexities of balancing insulin and glucagon in a two-pump system are also high. And the feedback loop from sensors that detect BGL aren't super fast. My kid's Dexcom works on a 5 minute sample loop now. So you can't make decisions fast and when you do, you can't course correct a bad decision quickly. I love that people are working on this stuff. The folks at https://wearenotwaiting.net/ https://wearenotwaiting.net/ are amazing and we even use NightScout here, but the fragility of the systems are stark and it'll be a ways to go before it's not just the brave pioneers pushing these frontiers for T1Ds.
haldujai 3y ago
It's not because of pump issues but more glucagon stability and secondarily whether bihormonal is clinically advantageous. Tandem is working on a dual chambered pump. https://diatribe.org/jdrf-and-tandem-diabetes-care-announce-partnership-develop-dual-chambered-pump-artificial-pancreas https://diatribe.org/jdrf-and-tandem-diabetes-care-announce-...
- iaresee 3y ago
  Yea, but "working on" is a bit different than "readily available and trusted to function well". Everything is harder with two delivery pumps.
  - haldujai 3y ago
    The pump isn't the hard part.

nahsra 3y ago

Yes, but the "patch pumps" like the Omnipod are small enough you think patients might tolerate 2 of them? Maybe they've already asked, and people wouldn't tolerate it.

iaresee 3y ago
Possibly. But it's more than that. You have site issues, even with one pump, that you need to navigate. There are only so many viable places on a body to attach a cannula for good absorptoin and, while small, these things aren't _tiny_ (especially the Omnipods where the site holds the cannula, pump and reservoir). It'll be a while before we see highly reliable and well-tested dual-reservoir systems is my bet. The complexities of balancing insulin and glucagon in a two-pump system are also high. And the feedback loop from sensors that detect BGL aren't super fast. My kid's Dexcom works on a 5 minute sample loop now. So you can't make decisions fast and when you do, you can't course correct a bad decision quickly. I love that people are working on this stuff. The folks at https://wearenotwaiting.net/ https://wearenotwaiting.net/ are amazing and we even use NightScout here, but the fragility of the systems are stark and it'll be a ways to go before it's not just the brave pioneers pushing these frontiers for T1Ds.

haldujai 3y ago

It's not because of pump issues but more glucagon stability and secondarily whether bihormonal is clinically advantageous. Tandem is working on a dual chambered pump. https://diatribe.org/jdrf-and-tandem-diabetes-care-announce-partnership-develop-dual-chambered-pump-artificial-pancreas https://diatribe.org/jdrf-and-tandem-diabetes-care-announce-...

iaresee 3y ago
Yea, but "working on" is a bit different than "readily available and trusted to function well". Everything is harder with two delivery pumps.
- haldujai 3y ago
  The pump isn't the hard part.