Artificial Pancreas is going live

In the Netherlands the Artificial Pancreas is going live.

Greetings

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This seems like a cool idea until you read more about it. It appears you need 2 insertions in your skin to get insulin and to get glucagon. It also has to be disconnected if you get near water. This seems half baked and a backward step from the Tandem X2 and G6. I love the idea that you have something that could raise your blood sugar, however having to refill it every day is nuts. Also, think of the costs to fill the glucagon and then throw it away every day or every few days.

Shelf-stable glucagon is now available, so it would not need to be discarded as frequently as the older stuff that needed to be mixed. The older stuff only lasted a few days. Gvoke lasts for like a year or whatever. (Maybe does not last that long in a pump, but in the syringe it has an expiration of over a year.)

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Cool. You guys let us know how it goes. Maybe I can come over and buy one.

They need to introduce that in Europe too. That would make it so much better.

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The iLet concept has been around for some time. But as many have pointed out there are some issues. I do not mind the two sticks, i think the ILet requires two sticks every two days. Unfortunately, the last time I talked to them, the cost of stable glucagon more than tripled the cost of insulin.

We can hope that someday this might be small enough, cheap enough, and available enough to get insurance to pay for it.

It looks gigantic where the bionic looks like a standard pump.
However I see the trials going on are insulin only trials for the bionic pancreas so I don’t know if they might drop the glucagon portion. I don’t know

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Yeah, it’s quite bulky compared to regular insulin pumps, but they’re developing a new version that is 45% smaller.

I saw the unit about two years ago and it was indeed about 2.5 the size of the regular insulin pump. It was not something I would wish to carry around.

What i saw was that the two cartridges require two brains, two cartridges, and one large screen.

I honestly do not know how they could decrease it in one unit. More to be announced no doubt.

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I feel you can’t call something an artificial pancreas unless it is able to actually work just like the pancreas does. Everything should be automatic, and you should be able to eat and have it automatically control BG. That is pretty much impossible currently, as insulin just isn’t fast enough, delivered subcutaneously at least.

The pump is in controle of your sugers. You cann’t inject self your insulin with the pump. Here is a link of how the pump works;

Oooh. I don’t like that interface. It seems so retro for something that’s supposed to be such an advancement.

I guess I’m spoiled with my Tandem pump and having all that information right there on the home screen. I have heard criticisms, though, that the information is too small for those with visual impairments. I think I would be annoyed beyond belief to have to always go digging for my vitals, though

It reminds me of what I’ve hated about Windows after windows 98. Everything used to be accessible, and then they started dumbing everything down to be more “accessible” and “user friendly”, and hiding the information that was important to me. That’s exactly what they’re doing with this interface. A green screen means NOTHING to me… Show me the numbers! And that’s some straight up 15+ year old flip-phone button navigation, too.

I really hope they get more user-feedback before they roll forward with that design. I know I wouldn’t feel comfortable moving “forward” to that.

To understand this correctly, let me ask…

Suppose you eat a piece of cake. Are you saying you can’t take insulin for it? You have to wait for your blood sugar to rise, wait for the pump to recognize the blood sugar rise, and then let the pump give you insulin?

Seems that way. There’s no bolus button anywhere.

Though really, it’s not that surprising someone would make that leap first. The need to bolus is the major difference between a fully closed-loop system and the hybrid-closed loop systems currently available. Whoever gets it to market first will really be breaking ground.

Scares the heck out of me, though. I don’t think we’re there yet on the insulin front. Lyumjev is remarkably faster than Humalog and Novalog, but not readily available and comes with pretty big side effects. Without the ability to pre-bolus, I fear they’re going to exploit the first hour of insulin peak activity with big boluses, then cancel out the lingering tail with glucogon… resulting in a much higher daily dose of insulin, increased cost of operation, and side effects like weight gain.

I’m always one of the first to jump on new technology when available… But I think I’d have to wait to see how these systems play out.

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@Eric2 and @displayname,

The only thing you have to do is to keep your Insulin and glucagon in the pump and chance 1 or 2 CGM’s if they are foulty .

You have 4 connections on your body. One for insulin one for glucagon and 2 for the CGM. The inventor says one CGM is none.

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@Robyn_H

The inventor of this device is waring his device for 1 year and dit not have 1 Hypo. I think he is using Humalog. Novorapid was to slow. I do not know if is using Fiasp or Lyumjev now.

This is the Menzis press release translated from Dutch. (Note: Most of the pre-translated English is sometimes odd - but the last bit was translated via Google Translate, so that resulting English is…well, you’ll see.)

Start Inreda AP in project with Dutch insurer Menzis adults with type 1 diabetes.

6 October 2020 – Inreda is starting a project with Dutch health insurance company Menzis: the artificial pancreas (the Inreda AP) will be used by 100 adults with diabetes type 1.

The project starts in October and concerns patients who experience substantial problems with controlling their regulation. The artificial pancreas itself regulates continuously the blood sugar levels by measuring 24/7 the blood sugar values. Unique feature is that not only insulin is administered but also glucagon. It is expected that using both hormones will lead to more balance in the blood glucose values of people with diabetes, that their diabetes treatment and their health will improve and that they will experience more freedom.

As a patient with diabetes type 1, Robin Koops searched for a solution that would lower the limit of the fluctuations of the glucose values. He invented the artificial pancreas: the Inreda AP. With the support of the Dutch Diabetes Foundation (Diabetes Fonds) he was able to continue the development of this device.

Inreda, who obtained the CE certification in February this year, now starts a project in cooperation with Dutch Health Insurer Menzis and five hospitals in the Netherlands. The aim of the project is to see how the Inreda AP performs when used by 100 adults. Internists and diabetes nurses in these hospitals select patients who meet the criteria and who are insured by Menzis. The project starts in October. Robin Koops, inventor of the artificial pancreas, is happy about this cooperation: “When the Inreda AP has shown that it also functions adequately when used by a large group of patients, the system can be used on a larger scale. That is what it is all about: to make a dream come true, for a lot of people. To improve our lives and to get our freedom back. This is almost reality now!”

Health insurer Menzis was soon interested in the Inreda AP and willing to invest in its interest of its policyholders. Ruben Wenselaar, Chairman of the Board of Directors at Menzis: “Menzis likes to contribute to innovative projects that add value to the improvement of the quality of care for our policyholders. The first studies give hopeful results, we expect this project to show that with this innovative device the number of hospital admissions actually decreases, but above all life for a large group of people with a chronic condition becomes a lot more pleasant. That is in line with our mission where we in addition to good, accessible and affordable care, also especially strengthening the vitality of everyone find people important. ”

In addition to Menzis, there are now also discussions with other health insurers and the Diabetes Fund

2021 possible follow-up projects to start.

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What is the target glucose level for the device?

Saying “did not have 1 hypo” does not mean much. I could run high and also not have any hypo’s.

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5.5

I think more important than target is the average glucose.
And more than that, how often does it go low?

I would love to see 24 hour graphs. The idea is exciting.
I really want to see what comes of it after 5 years.