Originally published at: https://boingboing.net/2015/02/06/hacking-diabetes-the-open-art.html
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Can someone explain to me why the artificial pancreas is not yet a reality (assuming just the glucose control aspect of the pancreas). We know how to quickly measure blood sugar. We know how to release insulin into the blood. We know how to give dextrous solution for hypoglycemia. Those three items combined should be even better than a pancreas (which cannot even release glucose, the loser).
Is it just fear of lawsuits? Regulatory issues? The pharma-industrial complex fearing loss of profits? Some other competing biological process?
I really don’t understand.
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fingerprick blood sugar testing is instant, interstasal blood testing (which is how we do continuous glucose testing) is 20 mins delayed. Fast acting insulin still reaches it’s peak about 45 mins after injection and can last for hours - for me, it is effective until about 4 hours after.
So you are balanced two things, with different delays, and with the artifical pancreas not knowing what you are doing or planning to do.
In my mind, what would make an artifical pancreas take off would be if a new insulin was developed which was very quick acting with a very short duration. That would really open the doors to effective artifical pancreas.
I have a spare pump now so i am very keen to start playing with a pi and seeing what is possible now, but i don’t see it truely viable for a while.
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Random thought. What about using some faster online measurements, use available slow (okay, they call it fast but it is still slow) insulin as the slow part of the control loop, and immediately acting glucose as the other, fast-acting part to balance out the slow part?
Edit: The thought is essentially about maintaining what would be a controlled mild hypoglycemia with insulin, and compensate it with glucose. The difference between optimal and provided insulin level is the slack that the glucose compensates for (the supply can be withdrawn quickly, to compensate for e.g. dietary intake). That way we have a fast-acting control that can go both sides, albeit with a limited range in one of the directions.
Not insisting it is a good idea, though, or that it could actually work.
The pancreas and its function in maintaining blood glucose at a healthy level is more complex than you are aware of. The pancreas has alpha cells that release glucagon which signals the liver to release glucose into the blood. It also has the beta cells that produce insulin to push blood glucose into storage in your cells as fat. These two hormones are released into the portal vein of the liver. Insulin injected subcutaneously enters the blood stream at a rate about a thousand times slower.
Between meals the beta cells accumulate insulin to meet the demand that occurs when you eat. There are more hormones that help your system cope with the difference between eating a sugar coated doughnut or a steak. Trying to replicate all the functions of the glucose regulatory system is more difficult than just determining that the blood glucose is high and squirting some insulin into the system.
Diabetics who eat a low-carb diet make the regulatory task easier but it requires checking blood glucose at least 8 to 10 times a day. Tight blood glucose control means a battle with a medical establishment that thinks tight control is un-necessary or impossible. I had one doctor who wouldn’t believe I was diabetic because my hemoglobin A1C was a normal 5.2. Another was sure I was going to kill myself with a hypo. The truth is that people with poorly controlled blood glucose lose the ability to sense what level their blood glucose is at and are the ones most in danger of a lethal hypo.
I think that a biological solution to regenerate the beta cells will be better and may happen sooner than the artificial pancreas.
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That is a great explanation.
I am intrigued by your mention of a “biological solution to regenerate the beta cells” being possible before an artificial pancreas. Care to elaborate or link? Thanks.
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