Is a "closed-loop" CGM and Pump a Cure?

Thanks for the reminder, Crystal and Sarah! The discussion is actually still open - until midnight tonight. Just posted my question there.

 

Hey, since you started all this why would you refrain from commenting? Come on now.....

 

I had thought the door was closed, but from reading some of the questions, maybe I should have asked some myself. I am sure Darryl's question will cover everything I need to know. I hope Dr. K. answers his question. There are so many other inane ones to choose from......... P.S. from reading the posts, seems like most PWDs are entirely supportive of the project, only one positive reference to JDRF & J&J partnership for the AP. I wonder if the parents on this board are a good sample of the Parents of CWDs in general? It does not seem as if the parents who answered on Facebook share many of my concerns.

 

Some might want to read this interview with Dr Kowalski prior to the chat tomorrow

http://www.diabetesmine.com/2010/01...on-the-artificial-pancreas-answered-here.html

 

Well that did answer a lot of questions I had. DN would definitely have problems using it because they are using EXISTING Dex sensor technology. Dex has twice been dangerously off two separate lows (Dex normal, DN in the 30s). And she has not been in the 30s for years; we were trusting Dex readings. Has beeped for lows repeatedly when her BS is normal but in that instance AP would not be as dangerous. Sis is going to want to use this, though, I know...... I guess you could use it and just keep checking at night so you can double-check the AP.

 

Yes, most people are filled with "hope" about this device, but unaware of the realities.

 

I had not seen this before... quoting from the interview:

I believe that we can use DexCom?s existing technology, but as the project evolves there is no doubt that
newer technologies will be incorporated if and when they are developed.

That's quite a revelation and not something I'd stake an $8M investment on if I was the one making decisions
at the JDRF... IMO The investment should go to sensor development, and nothing else, until a suitable sensor
technology is designed and proven.

 

Have you contacted JDRF yet and given them your input?

 

Only via posting a question for Dr. K. for tomorrow's online conference. Looking forward to seeing if he will address the issue.

 

If I don't make it to the chat, would someone please find out if JDRF is funding research for a bioartificial using, for example SPF (specific pathogen free) porcine glucose responsive islet cells?

 

Closed Loop System

In response to someone asking about the inclusion of glucagon, see

http://www.dlife.com/dLife/do/ShowContent/diabetes_news/research_update/jdrf/jdrf_march_07.html

You can search Google and find more information on work performed by Ed Damiano at Yale (he has a son with type 1).

More at http://www.diatribe.us/issues/13/conference-pearls.php

 

I didn't read this entire thread so I may be repeating someone else.

All advancements in care are a wonderful thing. That being said, my child will not be cured until I do not have to make her bleed, poke needles in her body, force sugar in her, force water in her, have 504 meetins with the school, etc... I could go on and on. A cure is completely severing my family from Diabetes!

 

Thanks Brenda. I have tremendous respect for Ed Damiano and his work. I'm baffled by what Aaron Kowalski had to say here.

http://www.diabetesmine.com/2010/01/aaron-kowalski-your-questions-on-the-artificial-pancreas-answered-here.html

Any thoughts about incorporating glucagon or another substance to raise blood sugars into the pump? (simply turning off the pump to correct lows is often much too slow to raise blood sugar immediately)

We are funding two world class labs (one in Boston and one in Portland) that are studying the use of glucagon in an artificial pancreas. The initial results have been amazing. Great control is achieved. That said, there are challenges that make this research much likelier to take longer to realize than an insulin alone approach. First, as everyone here knows, glucagon currently comes as a powder. This is because glucagon is not nearly as stable as insulin and breaks down over time. So, to have an insulin/glucagon system we need new glucagon and unfortunately not much work is happening on this front and having an FDA-approved, stable, pumpable glucagon will take time.

Second, there are no dual-hormone pumps and this is not a big area of research ? in fact almost nobody is working on it. As you can imagine, there are not too many people willing to wear two pumps. So, we need a new type of pump to be developed. That said, this approach is a goal of the JDRF APP and these are areas of research we are likely to support in the very near future.

Many people have highlighted that we can?t prevent all lows without glucagon or obviously with food. My feeling is: let?s take what we do today and improve upon it. While we may not be able to prevent all lows, I would argue that any lows that we automatically prevent would be a very good thing. Initial research in the Consortium suggests that many/most of overnight lows could be prevented by turning down or off insulin delivery. I think that is huge! We shouldn?t be comparing this system to a fully functioning pancreas but looking for improvements from the challenges that people with diabetes currently experience every day.

 

I agree that our current CGMS, Pumps, and Insulins may not be ready for a complete AP type product. However, you have to remember that everything has to start somewhere.

I think we can all agree our insulin pumps are vastly different now, then they were years ago. I doubt people would have thought this 'rocket pack' would someday fit in your pocket, or even more...be 'tubeless'. When I see this picture, I do think of Rocketman (http://www.youtube.com/watch?v=CWt3FF909Wc ) :





While the first generation AP will not be perfect. It is just that, the first generation. They will see as they go along what does not work, and what needs improvement. I do believe they will develop a sensor that will be very, very accurate. I honestly don't feel it will be that long before they do.

I can't wait to see where this goes. Especially, with nanotechnology .

 

There was mention of glucagon in Minimed's closed loop system. It says they are in phase 3 of their closed loop.. says multiple trials are going on.. Doesn't say if they are ALL in phase 3 but does mention glucagon in the trials.

 

Ellen, I think the idea here was that the low would be prevented upfront through the temporary slower or haulted release of insulin (ala "Nip it in the bud"), not that this was a way to TREAT a low in progress. That was my take AK's comment.

 

I would be really curious how that works.. doesn't glucagon have a very short shelf life once mixed? Nevermind how expensive it is...

 

I imagine $8million + the other $ million or so could have been used to help develop a double cartridge pump since in Aaron's words "almost nobody is working on it" and to develop a fluid to keep glucagon stable in solution too.

I was pleased to hear Ed Damiano's work acknowledged and not dismissed.

 

If you missed it earlier you can hear Dr. Kowalski's talk here

http://www.ustream.tv/recorded/4256828

 

It is a shame that a double cartridge pump is not being worked on by itself. I don't know much about Symlin and the research being done on glucagon with the closed loop, and supplimental cpeptide. But couldn't a double cartridged pump potentially be used in a variety of ways to benefit a PWD?