Update on the iLet (bionic Pancreas)


#1

I have been following this pump for a while and listening to Damiano’s presentations at FFL, but there is just something makes me skeptical.

Anyone have other thoughts?


#2

What makes you skeptical, Mila? My only reservation is that they are trialing Fiasp with some adults and other insulins with most of the other adults and children in the group. From what I have read about Fiasp, it probably requires a different algorithm.


#3

LOL, I can just imagine the angst from the anti-tubing crowd, over a pump that has TWO tubings. Personally, I’ve zero interest in having a pump that uses Glucagon to try to maintain the euglycemia range


#4

This is exactly what makes me skeptical, @Willow4


#5

If I could use a system that kept me in the 65-140 mg/dL (3.6-7.8) range 95-100% of the time, 0% hypo, with no carb counting or announced meals, I think I would find that extremely attractive. My diabetes job would be reduced to refreshing my infusion and CGM sites with no cognitive burden. That seems about as good as it could get for any diabetes treatment. Not a cure, but a life that seems like a fantasy to me.

I’m only skeptical because it seems just too good to be true. I don’t want to set myself up for disappointment. In the meantime, I am thankful for my current Loop technology.


#6

@Mila I do ask the same question Diabetics can still produce glucagon unlike insulin so why the need to externally supply it ? But as @Terry4 said if it gets my blood glucose in range all the time why not ?


#7

I’m not sure of the answer but perhaps the number of hypos start to wear out the glucagon response. Maybe we can produce glucagon but the signaling to produce it is not working well. If we were capable of producing all the glucagon we needed, there wouldn’t be a need for an emergency glucagon kit.


#8

i’m guessing that as well.


#9

Have you priced Glucagon lately? DO you know if your insurance (or ANY insurance) will cover the sky-high cost of glucagon? I buy glucagon about every 5-7 years “just in case” and even with insurance it is freaking EXPENSIVE.


#10

I am willing to wait and see what the cost will be, If these trials are successful the system will ultimately succeed of fail based on the cost versus benefit equation. I’m sure the creators have already looked at this equation and feel that the scales are tipped in their favor, why else would they be moving forward with this project.


#11

ah, just because a project goes forward, doesn’t mean there is success in their future. Would you like me to remind you of Apple Newton? :slight_smile: There are countless examples of failed products, ventures, plans, and ideologies.


#12

I thought they were going to use a new version of glucagon, since the current one is a multi-step process to deliver. Whether or not that will be affordable and/or covered by insurance is a different question.


#13

Maybe so, but lets not be so quick to condemn it that is never gets a chance to leave the gate.


#14

I’m not condemning anything. I’m saying that PERSONALLY, I don’t want to be using Glucagon as a solution for good control.

I didn’t say they would fail. If you reread my previous comment carefully, look at the context–it was in response to your comment that presupposes that the makers would succeed because they are “moving forward with this project”. I didn’t say they would fail–I just meant that one can’t infer success because of the intentions of a company to move forward on a project. Hope that clears things up.


#15

I think it’s an interesting idea. I wonder if the glucagon they use can cause scar tissue, and I wonder if the infusion sites are close to each other.

I’m not saying I’d sign up for it, but I can think of a number of situations where this glucagon setup would be really handy. I think the 670g sets the aim so high (120 mg/dl) because of the risk of lows. With a loop like this we might be able to set that target around 100 mg/dl.

I’d switch back to a pump if it could average me at 100 mg/dl and correct any lows before they become severe.


#16

There are pump systems today that can deliver what you would like. They are not commercially produced; they are do-it-yourself projects. What I’m trying to say is that the technology is capable to produce what you want, however, the commercial and regulatory environments will be slow to catch up.

Here are my last 14 days on Loop. The "normal’ range is 65-140 mg/dL. I set my target at 83 mg/dL. None of my hypos were severe.


#17

Insulin and glucagon are both used to treat adverse events – one for hyperglycemia, and one for hypoglycemia. No matter how good our control, there will be times we go hypo or hyper. You use infused insulin to prevent high blood sugar, so what is the objection to using infused glucagon to prevent low blood sugar?


#18

My guess here is that is that few of us have a real good understanding of how glucagon is going to work in this type scenario. For me, I have only heard war stories from those suffering from a dangerously extreme low and being injected with the full dose from a Lilly pen. Those stories basically fall into the “I felt like I was run over by a truck (for the low) and then it slowly backed over me (for the glucagon/recovery)”.

My own feeling is if the insulin/glucagon dual hormone set-up can more closely mimic what the sugar-normal’s body does, then I’m all for it. Still, any external pump using sub-q mechanisms to mimic the body’s dynamic homeostasis is going to have significant variability to it.


#19

Yes, but you rigorously manage your diabetes. The pump simply suspends or reduces basal if you drop too low from an incorrect bolus.

This could theoretically work like a pancreas does- except the insulin is probably still not fast enough.


#20

the better solution is to eat less carbs, use less insulin and stop getting dangerously low in the first place. relying on insulin and glucagon–I can just see it now: taking large amounts of insulin for large meals, hoping that glucagon is going to “save” the day. and who wants TWO tubings? And who wants to pay even MORE for supplies (ie, glucagon costs)?

All in all, I think it’s a crappy idea. You don’t have to agree with me, any more than I have to agree with you, on this topic. Cheers. (I’m a believer in K.I.S.S)