Type I diabetes, formerly known as juvenile diabetes, occurs as a result of the pancreas’ loss of the ability to make insulin. Insulin facilitates the movement of glucose from the bloodstream into cells where it is metabolized to create energy. Without insulin, the glucose accumulates in the blood. Current thinking is that in Type I, the person’s own immune system is activated by some as yet unknown viral infection to attack the Islets of Langerhans, the cells in the pancreas that make insulin. Treatment of Type I has long been problematic, in part because of human nature. By that I mean that it occurs in teens and young adults who may not take the disease seriously. Doing stupid things and thinking that you are immortal is part of being a teenager. Not too long ago, treatment of this disease involved frequent insulin injections and frequent blood sugar checks. The amount of insulin required was determined by the blood sugar level and a rough estimate of future food consumption. The goal was and still is to maintain a glycosylated hemoglobin, or HgA1c, level of 7.0% or lower. Sadly, that goal is achieved only by less than 20% of Type I diabetics in the U.S. Controlling diabetes helps stave off its deadly effects, which include heart, circulatory, kidney, and eye disease.
Not too long ago, the treatment of type I diabetes was revolutionized by the introduction of implantable insulin pumps. Closed-loop systems, which work in conjunction with a smart phone, have been able to raise the number of diabetics reaching HgA1c goals, but these systems involve inputting a lot of data. While insulin delivery is partly automated, required data that must be uploaded include basal insulin rates, insulin-sensitivity factors, carbohydrate-to-insulin rates, and the total daily insulin dose. This data is uploaded at initialization. Then, with each meal, the user must upload the number of grams of carbohydrates. Then, once uploaded, the systems often require a warm-up period before automation may begin. Recently, Beta Bionics introduced the iLet bionic pancreas. This system does not require the uploading of any data other than the user’s body weight. Information from previous insulin regimens is not required, and there is no warm-up period. The user merely indicates the anticipated carbohydrate content of the next meal (“usual for me”, “more”, or “less”) as compared with a typical meal of that type (“breakfast”, “lunch”, or “dinner”). The algorithms used in the bionic pancreas constantly adapt to the user to become fully automated.
In a study from Massachusetts General Hospital, published in the New England Journal of Medicine in September, use of this bionic pancreas resulted in greater improvement in HgA1c as compared to standard care. While this device did not cure the patient, any regimen that can forestall the side effects of this disease is certainly beneficial. Plus, I truly believe that with emerging stem cell therapies, replacement of pancreatic cells, and other technological advances, a cure for diabetes, especially type I, is not far off.
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