The Danie Diaries

Diabetes can be a taxing disease to live with. Fortunately there is a new hope on the horizon in the form of the APS (Artificial Pancreas System) – a magical conception being brought to life by the Johnson and Johnson Corporation with funding from several charities including Diabetes UK and JDRF. With a release date set for the next 7-10 years it is truly a feasible piece of technology well ahead of its time.

 
Whilst attending the 1st European Bloggers Summit 2012 I was lucky to be a part of a talk by Dr Brian Levy on the feasibility of the APS, how far it has come and how much further it still needs to go. Many surprising and un-thought of aspects (maybe exclusive to me) came to light and were discussed – limitations still remain in the development of the system but we are ever closer to having a wonderful feat where imagination meets creativity; where dreams dare be tested and people with Diabetes can see a light at the end of many years in the “tunnel”.

 
Firstly I would like to highlight the technical magician that is going to be the “hypoglycaemia/hyperglycaemia minimiser” (HHM). An amazing concept in theory is being brought to life; the HHM is a CGM with the ability to predict where your BG is going, estimating insulin increases to combat the highs and having the ability to shut off the insulin flow during hypos. Wouldn’t you just give your right hand for that right now? If your BG levels are as unpredictable as mine then the answer you’re screaming at the screen right now is “YES!”

Dr Brian Levy suggested that the HHM can already “predict a rise or fall in blood glucose levels” but that it is not fool proof. There is no doubting that already the minimiser is considered to be of great help although currently it is “not good enough in aspects such as vigorous exercise and special occasions such as holiday-eating”. Tweaks are very much needed yet the overall projected outcome is nearly too good to be true! Currently through testing the HHM has proven its worth, when considering a BG level of 5mmol/L (90mg/dl) a calculation of 85.7% less basal insulin was “pumped” to keep the patient’s BG stable. Very clever indeed! A “comfort zone” has been identified through patients, carers and relatives of 3.8mmol/L (70mg/dl) – 9.9mmol/L (180mg/dl) suggesting that the APS also needs to consider individualised management levels. Also mentioned was the “automated basal hybrid” – a closed loop system which rather than being based on the traditional personalised range currently being set on pumps to achieve a particular level will aim for an exact number – for example 5.5mmol/L (100mg/dl). It should be noted that the APS will have an option to be overrode by the user for the confidence of the patient and/or carers and relatives should they be unsure of any calculations, after all handing your complete control over to a machine would be hugely daunting after months/years of controlling everything yourself.

 
Another aspect which I was surprised to hear during the discussion was that of insulin and the improvements needed in its basic composition. Dr Levy suggested that the insulin’s currently available on the market require some adjustments, such as having an insulin/non-insulin (glucagon for example) combination – more akin to the non-diabetes person. Insulin alone can decrease the effect and production of other hormones and this is something which Dr Levy feels would be best addressed in the future. “Insulin’s are not perfect, insulin is absorbed at different rates not infused at a standard each time” – Dr Levy. A simple outlook but a very valid one.

 
Dr Levy likened the progress in technology to a “game of chess”; every move made in the development of the APS is based upon past moves made and at each opposition a recalculation of the next move must be made. Dr Levy closed by stating that public data lags behind what is actually being done internally within the company – a comforting message.

 
The APS is effectively going to be made up of a CGM (continuous glucose monitor), advanced pump technology, improved insulin and a closed loop (control algorithm).

 
Exciting times are ahead and within reach in our lifetime, I will be watching with great interest the progress of this amazing system. Maybe now I can dream a little of a future filled with freedom and not as many calculations! Math was never my strongest point!

Diabetes care is evolving, are you ready?