Sorry in advance if this is already a topic, but I didn’t see it around…
I just switched to a new doctor who is a professor at Harvard Med and does a lot of research with pumps. Hes a very brilliant man. He is now working on a project at Joslin Diabetes Center, developing an artificial pancreas. Its basically a pump that does everything for you. Tests your blood sugar, makes the calculations, takes care of fluctuations, everything all automatically. I’m pretty sure all you have to do is fill it with insulin and replace the batteries,. Its only in the testing stage, but its evidently working. He projected it should be ready for the market in about 5 years.
I found this incredibly exciting… anybody heard of it?
I like brilliant people and I like technology. In fact I am a process engineer and an automation and instrumentation specialist for a big pharma company and I support large-brained scientific types all the time. While I really like the idea, and have read a little on the subject, I have 2 reservations: 1) current cgm technology is terrible. a new generation of cgm needs to be born first. 2) it’s just not the way your body works - IE you release insulin to cover rising blood sugar… but your liver has the capability to destroy excess insulin and release sugar… and really… IMO… THATS how your body regulates blood sugar so perfectly. How on earth can we hope to write an analog control loop based on today’s cgm as feedback (btw it can be 30 minutes behind reality) and analog insulin that takes 20 minutes to start and can work from 4-6 hours with no ability or take back an overdose?
I have tuned many pid loops in my life and I wouldn’t touch this particular application, with these instruments, with a 10 foot pole. Unless I am smoking dope, you will still have to bolus for carbs manually. Imagine if you were to wait until your bs started to rise before you bolus for a meal, what would happen?
I am not trying to be a wet blanket or to offend - I am very biased of instrumentation because I regularly use instruments that are less than 1% full scale error and only need calibration every 5 years. Our finger stick machine is only good to 20% of reading… our cgm needs calibrations once per day… the news seems like hype. sorry…
I will gladly donate my money or my time or both to the improvement of technology - when I first started we were testing our pee with benedicts solution to see if our blood sugar was ridiculously high 45 minutes ago. We need an “automatic pump, true – real time blood sugar monitoring and liver function machine” very badly.
… an interesting subject and article, Danni. Thanks for posting them. Joe raises a couple of key issues in developing an artificial pancreas, but I have to believe we have the intelligence and the desire to overcome them.
I’m very skeptical too, particularly because of the problem of glucagon- how is that going to work exactly? It makes you sick if you inject it and it can’t be infused in the same infusion set as insulin.
Furthermore, what about the problem of absorption? Insulin injected under the skin has a relatively unpredictable and inconsistent mode of action.
I’m not saying an artificial pancreas is impossible. But the technology and drugs to make it work the way you describe simply do not exist, and are much further out than 5 years if they are even on the horizon at all.
I also was in control research and we were dicussing the possibility of automatic control with a former collegue of mine how developped a novel dead time and gain ajusting adaptive control. Even if you assume perfect pump and super accurate CGM you are still left with the problem of what to do. PID is a bit lacking but you wonder if it would do for adjusting the basal rate with very lax parameters. Of course with small processors any amount of complexity beyond PID can be programmed. Dead time compensation no problem even some gain ( insulin/carb) adjustment possible. I think we would need still carb counting and feedforward control, hard to see how you could handle a super sized fries with feedback and not go into the 300’s. Well anyways the more I explained diabetes to him the more depressed we got about how to do this.
This is funny as my son was saying that in the future there will be automatically controlled jet fighters that will fly circles around the manned ones not being limited by G forces that would kill a human pilot. Even the high performance manned ones now are inherently unstable and if the computer fails you buy the farm.
Also I am starting to believe that the body uses a dual action system. Insulin to reduce BG and glucogon to compensate when it overdoses the insulin.
Actually with all these dificulties it is amazing that most diabetics do so well in controlling BG as we do. With the loosy tools we have. The more so in the last 10 years since the meters have become inaccurate.
We use feedforward (carb counting and ratio), dead time compensation (insulin on board) and cope with varying gain from day to day and wek to week. Some of us still have functioning glucagon system and some do not which is a nightmare.
Compared to the dificulty of an artificial pancreas I guess that an out right cure would be easier. Although it may be that getting older I am turning into a Luddite.
Ive had diabetes most my life since child hood and Even way back 30 years ago when I started to ask questions to my Dr’s. realizing that this disease could kill me Ive been told a cure is just around the corner.My personnel belief now is they tell you this because they want you to have hope.I do think we have hope.When I was little, nothing was the same as today. Syringes were boiled ,testing was just gross needing to pee and then figure out which color its closest to and that’s only some of it.Today we have it so good.I have recently within the last year started pumping and cant believe how much easier this disease is to take care of.I am not a scientist or a engineer so I really don’t know if a artificial pancreas is possible in 5 years, but think how technology today is Its amazing and I truly think if you get diagnosed with diabetes today within your life time there will be a cure.
“We use feedforward (carb counting and ratio), dead time compensation (insulin on board) and cope with varying gain from day to day and wek to week. Some of us still have functioning glucagon system and some do not which is a nightmare”
Luddite be damned =) we rely on the most powerful processor, our brains. I believe interstitial fluid is a lousy feedback. The body must use protagonist and antagonist indicators we are not involving yet to stimulate the liver and pancreas. Maybe it even uses our newer brain which recongizes food by sight and smell. The real research in this machine would exploit these natural signals to decide how much insulin.
No offense taken, haha. I’m a freshman english major, I have no doubt your insight is moooost likely more advanced than mine. I just went on what Mr. DoctorMan told me. Perhaps I’m too optimistic, it would be sweet if it eventually worked, though.
I hope so! I just look at the technological developments that keep popping up and it seems hard to believe that some breakthrough isn’t going to happen soon-ish (a couple/few decades? maybe sooner!).
There may be a Maxwelliam demon shovelling solid insulin into the blood stream to get quick action and you are right the body may be measuring something faster that G in the finger tips. May be the brain recognizes the super size coke and tell the demon shovel like hell.
I just went on what Mr. DoctorMan told me. Perhaps I’m too optimistic, it would be sweet if it eventually worked, though.