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Diabetes breakthrough hailed as Australian boy given artificial pancreas

Discussion in 'Parents of Children with Type 1' started by miss_behave, Jan 21, 2015.

  1. miss_behave

    miss_behave Approved members

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    Ok so it not exactly an artificial pancreas as they are saying, but it's definitely another step closer. The Minimed 640g also appears to have quite a few Cozmo-like features.

    http://www.theguardian.com/society/2015/jan/21/australian-boy-given-artificial-pancreas-to-help-manage-type-1-diabetes


    A four-year-old Perth boy is the first person in the world to be fitted with an artificial pancreas to help manage his type 1 diabetes.


    Xavier Hames is one of more than 122,300 Australians living with the autoimmune disease that destroys the ability to produce insulin, which helps regulate blood sugar levels.


    His new insulin pump system, which was developed through nationwide clinical trials, mimics the pancreas’s ability to predict low glucose levels and stop insulin delivery. The pump helps prevent hypoglycaemia attacks, which often occur at night when a person is asleep and can result in a coma, seizures and even death.


    More at the link

    http://www.minimed.com.au
     
  2. nebby3

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    I have to say stories like this really bother me because invariably some we meaning friend or family member is going to come to me all excited about it and I have to burst their bubble and tell them it is not an AP, just a new fancy pump, and definitely not a cure. I hate journalism like this.

    Plus I am wondering if I would want insulin delivery suspended for lows very much. Seèms like it's too little too late and will lead to increased highs later.
     
  3. miss_behave

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    It shuts off based on predicted lows, before they happen, then restarts itself when the blood sugar starts to rise.
     
  4. Nancy in VA

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    This sounds like the Medtronic pump that is available here now with low shutoff. Doesn't sound nearly like what an artificial pancreas actually is.
     
  5. miss_behave

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    Its definitely not an artificial pancreas but it is the next generation pump from the Minimed Veo/530g as it suspends and restarts insulin delivery based on predicted lows/highs to avoid them happening. It's also a complete redesign of the Minimed pumps. It has a remote, light adjusting colour screen, is waterproof etc and has some nice features such as reminders for checks/boluses/site changes, preset boluses etc.
     
  6. joshualevy

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    Except that this new pump shuts off before you go low, so actually prevents lows. And it does NOT increase highs later. Lots of testing has shown that. Plus, of course, it will prevent "dead in bed", which is a huge benefit, even if it did nothing else.

    The pump available now shuts off after you have gone low. This pump shuts off because you will go low in the future. It's a big difference on the path to a fully functional artificial pancreas, although (obviously) it's not there yet. One way to look at it, is that an AP would need to do three things: prevent lows before they happen, prevent highs before they happen, and handle meals (unless that's a duplicate of handling highs). This device does #1, so depending on how you measure it, that's either 1/3 of the way there, or 1/2 there.

    You can read a more sophisticated view of the path to an artificial pancreas here:
    http://jdrf.org/research/treat/artificial-pancreas-project/
    Using their terminology the available device is a "step 1" AP, and the new device is a "step 2" AP, and there are a total of 6 steps (although I'm not sure all of those steps will actually be needed to create a high quality AP.)

    I just posted on APs in general, on my blog, here:
    http://cureresearch4type1diabetes.blogspot.com/

    Joshua
     
  7. Nancy in VA

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    Thanks for the explanation, Joshua. From the post above, it sounds like the screen / interface is also better. The Medtronic I saw back in April had the low shutoff but the screen was still the original "DOS looking screen" (not my term, one of the teenagers description of why didn't like it). I definitely believe an upgrade in the screen / interface will go a long way.

    I guess I get annoyed, as many do, when these "sensational" headlines are out there. This is not an artificial pancreas - its far from it. I would consider 1 and 2 a lot closer to an AP, even if we have to have manual intervention for food.
     
  8. Snowflake

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    Sorry to go off-topic: Does anyone know if other pump and CGM manufacturers have plans to offer low suspend or predictive low suspend anytime soon? Would this be part of Dexcom's announced integration plans with the other pump makers? Or will that simply aggregate data on a single screen?
     
  9. Christopher

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    With all due respect, I think this is a huge leap to make this definitive of a statement. Since the cause of DIB is often not completely understood or determined, saying that this pump will prevent it, to me, seems misleading. If there is evidence that proves that this pump will prevent DIB I would love to see it. If not, you may want to consider prefacing your statement indicating that this is your opinion or your assumption and not fact.
     
  10. joshualevy

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    I think that if you look at the last 5-10 years, there is consensus that DIB is cause by low BG over a long period of time. My opinion is based on research such as Tanenberg's 2010 paper and Buckingham's 2008 paper, which you can read here:


    Tanenberg's paper is particularly chilling, as it contains a BG trace from a CGM worn by someone who was found "dead in bed". The trace shows their BG rates dropping until they died. I have not put that chart in this posting, because I found it so awful, but you can see it in the Tanenberg paper if you want.

    If you look at the trace, you can see very clearly that he died because he was very low, and his basel insulin continued to push him down. When he went below 30, his body pushed him back to 40, but the basil pushed him down to 30 again, and the body again pushed him up to 45. The third time, the body had run out of glucagon, and he slowly dropped to 10. It's clear (to me) that if he had a step 2 AP, it would have cut off the basil about 4+ hours before he died (when his BG dropped below 70, and he would not have continued to drop to his death.

    He did not die because of a bolus of insulin. He last bolused around 11am, and was still alive after 2am. In fact, when that bolus finished, he was at about 30. Dangerously low, to be sure, but alive. A step 2 AP would have already shut off basel insulin 30 minutes earlier, when he dropped below 70. However, over the next 4+hours his BG continued to drop slowly, and this is what either a step 1 or step 2 AP would have prevented, and this is what killed him.

    Buckingham's paper deals with four people who had seizures in bed (not dead in bed). Three of those people were in low BG for 4 hours before the seizure; one was low for over two hours. What this tells me is that a low BG suspend (or prevent) would have had lots of time to stop the drop that caused the seizure.

    The key point in both papers, is that damage from low BG at night take a lot of time. People don't spike low and die. Rather, they drift low, and stay there for hours while their body generates glucagon, and generally tries to raise their BG. For me, this is strong evidence that a low BG suspend would be highly effective in preventing these deaths and seizures.

    But I do agree with you that it is my opinion, although I do think it is the dominant one amoung researchers now.

    Joshua
     
  11. Zivile

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    If we can call this new pump AP, so we do use similar one AP - Medtronic Paradigm VEO with low suspend function :) Of course it gives me some kind of piece of mind at night - even once it saved my son from low - I overslept alarm (for me it is super silent if covered with blanket and I dream about monitor near my bed...) and then found pump was suspended for 2 hours, that was enough to come back in range for my son. As for suspend if it is predictive low.... I guess now you can do some similar thing if you set your low suspend at higher numbers because prediction is just counting fall rate and time to reach low limit with that rate, so in "real world" it is just possibility if it really gets to low. For example I set it higher at 3,5 mmol, so if there is no IOB it can be enough to stop at 3. Sometimes I even change it for 4 at night - I would say thanks to Medtronic if they made posible to set several different numbers for different times. If there is lots of IOB I guess carbs is the only way to raise it.
    As for AP definition in my opinion this described pump can not be called so. It need at least one more component - glucagon - to raise blood sugar, hope we will get such one day...
     
  12. Brenda

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  13. Christopher

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    Thank you.

    The main reason this is an important distinction for me is that DIB is something that I think most parents have in the back of their mind and I would not want a parent to read your original comment and think that by using this pump it means that it "will" prevent DIB from happening. That is simply your opinion.
     
  14. caspi

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    My concern with these types of pumps that suspend insulin is the accuracy of the CGM. From what I understand (and I may be wrong), the Medtronic CGM is far less accurate than the Dexcom. But I agree it's a step in the right direction.
     
  15. MomofSweetOne

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    I completely agree. We had a sensor with an awful start yesterday. It ranged from LOW (100 points off) to HIGH (200) to LOW (50 points off) and then LOW again (70 points off). Today it's doing great, but yesterday was an "I would never want to entrust my kid's life to this sensor without verification" sort of day.
     
  16. joshualevy

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    I'm using the term "prevent" in the same way that people say "seatbelts prevent car deaths". A person driving fast enough can still die even while wearing a seatbelt, but it is much harder and more rare. Using a seatbelt will prevent deaths from happening. Step 2 APs will prevent DIBs from happening.

    Now, I do want to be clear that a step 2 AP is not going to prevent all deaths at night. People die at night for all kinds of reasons, and that includes type-1 diabetics. If a type-1 happens to have a stroke at night, they will be found dead in bed, just like a non type-1 who happens to have a stroke at night. When researchers talk about Dead In Bed as a problem for people with type-1 diabetes, they are specifically talking about extra deaths: the fact that people with type-1 diabetes are noticeably more likely to die at night and be found the next day without a known cause of death. The evidence so far is that these extra deaths are caused by low BG, and would be prevented by a step 2 AP. The CGM traces of low BG for hours before death make that pretty obvious.

    Of course, new evidence might come up, which shows something different. Once we get data from real use of the device, we will be able to see if people using it actually are found DIB, and that will be the strongest possible evidence. However, with the evidence available now, stage 2 devices will prevent it. You can always argue that we don't have enough evidence, that we should wait for more. And more studies are better, but at the moment, the evidence we have is pretty clear and one sided.

    Joshua
     

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