Next capability beyond closed loop?

Type 1 and LADA
#1

This is a theoretical question I want to give more time to develop and study, but I really wanted to hear this communities view on it, if it hasn’t already been discussed.

There are so many ways technology has improved for diabetes management and many more ways it can improve further.

Could one major step forward I see could be, somehow collecting and incorporating a persons daily activity level data which could then be used by pump software to vary insulin delivery.
Just like CGM data is been used by pumps currently with looping software to make insulin delivery decisions.
Would you see this as an improvement, or even necessary?

Like blood sugar levels and IOB , activity levels would be a big variable that could be incorporated by pumps to vary insulin dosages, what other variables could be (at least theoretically) included to improve insulin delivery of pumps?

1 Like
#2

@Garfield1:

Like many folks, I believe that we are really going to see much more sophisticated closed-loop systems in the next few years.

Certainly activity … maybe monitored by a Bluetooth-enabled heart rate monitor … would be a useful addition in my experience. That said, it has been by experience that significant mental activity (of which I am rarely accused) can also have a big impact on BS levels and would likely NOT be caught by a heart rate monitor.

In many respects, I think that the ultimate system may be a dual-channel insulin-glucagon system … although the pump would likely be twice as expensive and require two infusion sets, double the infusion set changes, and, no doubt, unique connectors so you couldn’t “cross-wire” your insulin and glucagon lines.

I expect that we are going to see some exciting advances over the next few years that will make current closed loop systems look like Model T’s!

Stay safe!

John

2 Likes
#3

The no intervention pump is the next great leap. this idea of no intervention pump, meaning you eat or exercise while the pump takes care of blood sugar going high or low and makes self adjustments.

Exceptions would be sustained highs, pump changes and illness. To get there we need three things:

  1. Internal sensors,
  2. Much much more rapid acting insulin.
  3. and rapid acting and self dosing glucagon.

Les than 10 years for certain.

1 Like
#4

Ditto, ditto, ditto !!!

But we are actually already close with tandem and medtronic pumps, and the diy community may continue to get there first putting it all together.

1 Like
#5

Very interesting, thanks

#6

Agree. The long term goal remains to simulate the fabulous loop system each healthy body already has.

I have deliberately stayed away from pumps, figuring someday I would hop on board. I recently changed to FiAsp for my fast-acting insulin, and it really isn’t that fast, as you can see if you go high, dose and watch carefully with your CGM. But a really fast-acting insulin could be quite dangerous if misused or if your device malfunctioned and might have to be managed almost as a lethal medicine. Things get more and more complicated as they get more sophisticated. Much, much better security is needed on the radio connection (typically BT) between CGM and pump. But I am grateful for each incremental step along the way.

#7

I use the 670g and I use humalog. I am looking forward to using the faster acting insulin’s. Still, with the faster acting insulin’s, the skin is still a barrier / speed bump. I say this all the time, but in 1974 when we thought of pumps we thought of them as internal, with internal blood sugar samplers. .

#8
1 Like
#9

So how about all this money being spent on producing better and more “sophisticated” gadgets targeting instead a real cure. Then we won’t need any gadgetry at all.

#10

That’s a common misunderstanding, but it’s very different money sources. The gadget money doesn’t really affect the cure money. People invest in gadgets hoping for a big $ return on their investment. They don’t care about a cure, they care about the innovative gadgets raking in more dollars.

A cure, however, is going to come out of academia… Not any device manufacturer. Academics depend on innovative research for their funding. “Publish or perish”. They win cheritable donations from wealthy sponsors by impressing them with their achievements. It’s a much smaller pool of money to work with, though, so it’s going to move at a painfully slow pace.

There is actually promising research being done… Islet cell transplants, encapsulation techniques, genetic modification, and more.

1 Like
#11

Yup, a lot of promising research. The last cure was for polio. And it was given to the people by Jonas Salk and Albert Bruce Sabin. And before that insulin was given to the people by Banting and Best.

Since then gadgetry and pharmaceuticals have taken over. No altruism left.

To keep abreast of the slow developments in the search for a T1 cure read Joshua Levy at http://cureresearch4type1diabetes.blogspot.com

1 Like
#12

In my opinion, the next major step, by whatever non-implanted gadget you choose, hinges on a delivery method that produces a kinetic profile very close or identical to insulin delivered from a functioning pancreas.

Imagine the possibilities even with the current pump technology if you eliminates the ‘wait and see’ period from dosing to response and where IOB times drop from hours to minutes. No matter what kind of insulin, overcoming the ‘subcutaneous injection’ barrier will be difficult. Afrezza delivers that right kinetics with simple human insulin delivered by inhalation. But there are no precise, continuous dosing methods.

Once you have this, adding the other advances like sensors and incorporating glucagon become relatively less complex.

2 Likes
#13

@Paytone:

You make excellent points!

If you haven’t seen it, some Materials Scientists have just published an article about exactly what you are describing. Here is the news release:

While academic research is a long ways from your pharmacists fridge … it’s an interesting step in the direction you describe.

Stay safe!

John

2 Likes
#14

The problem I see with using activity levels is that just like insulin sensitivity, the glycaemic effect of a given amount of exercise will vary vastly between individuals. To get anything close to useful data out of it the pump would need to know things like your VO2Max and FTP, and also effectively determine where your instantaneous and sustained energy usage puts you in relation to those things. To do that, it would need power meter data as well as heart rate.
On the other hand, I don’t see it as necessary if the closed feedback loop is working effectively. The biggest things that will help with that is insulin with a faster onset of action and shorter duration of action - and dual-hormone pumps. Being able to administer the insulin to the hepatic portal system instead of peripheral circulation would also be a major benefit.

2 Likes
#15

I saw a few really cool studies on clinical trials.gov.
They have a islet transplant one near me also few closed loop pumps, and an encapsulated islet cell transplantation
And an oral insulin tablet.
I applied to the oral insulin and the encapsulated transplant however I also saw one with a vaccine that is suppose to train your immune system to not attack beta cells.
However you need to be under45 and less than 4 years since diagnosis.
So there’s a lot happening.

#16

Fantastic, thanks for the info

#17

+1 to everything above.

Also, seeing that everyone has a phone now, I would like to see the pump interface moved to the mobile phone so you can bolus, adjust etc there. It makes sense as it’s a bigger screen, less clunky and you can do everything discreetly. That way the “pump” is just to hold the insulin and could be much much smaller.

#18

There is already pods. But also Tandem will soon release a stripped down pump that will be controlled by phone.
It has no screen and will be half the size of the t2.
Stil tubed so will be sort of half way between a tuned pump and a pod.

2 Likes
#19

I think Tandem will be moving to phone being able to control pump functions. Their mobile app currently is just stuff you see on the pump, but I’m thinking it is a step towards phone control.
And the study I am in right now does have mobile app capabilities but not activated for this trial. But it would be very cool to not have to pull pump out every time.
This stuff is coming fast and hopefully we will have more options.
And after doing many trials, I firmly believe the cure will be in stem cell research but it will take a long time. I feel I won’t see it in my lifetime :slightly_frowning_face:

2 Likes
#20

And I will definitely not see it in MY lifetime! My Animas Pings had a tested that had remote capability. So there was a good, dependable way to dose without hauling out the pump in public. But, alas, Animas is no more. BTW, not everybody had a pump. I don’t. Living out in the rural boonies with loads of dead spots for cell phones, I never thought it would be in any way advantageous to own one. :face_with_raised_eyebrow: