Treatment

Waiting for the Ideal Pump

Integrated Diabetes Services (IDS) provides detailed advice and coaching on diabetes management from certified diabetes educators and dieticians. Insulin Nation hosts a regular Q&A column from IDS that answers questions submitted from the Type 1 diabetes community.

Q: I need an insulin pump that monitors blood sugars, too. My ideal pump would be able to administer Humalog or glucose as needed…….is there such a pump?

A: What you’re wishing for is a “closed loop system,” and we wish there was one on the market now.

A closed loop system is made up of a pump, a continuous glucose sensor, and a sophisticated algorithm that interprets the data and directs the pump’s actions to keep glucose levels within a desired range. Some people call this an “artificial pancreas,” even though the real pancreas makes multiple hormones that are not part of this type of system.

What we do have currently are pumps that display data from continuous glucose monitors right on pump screens. Medtronic’s 530G pump and Animas’s Vibe pump both include this feature. Several other pump companies (including Tandem, Asante, Roche and Insulet) are preparing to offer this feature in their next-generation pumps. It is still up to the user to interpret the data and decide on when/how much insulin to deliver.

Medtronic’s system however goes one step further: it will actually stop delivering basal insulin temporarily whenever a low blood glucose level is detected by the sensor. This is the first step towards a fully-automated closed loop system, but there are still many steps to go. It will likely take several years before a fully-functional closed loop system is ready for prime-time.

In all likelihood, such a system will involve more than just insulin delivery. Studies are already underway to evaluate the infusion of insulin when glucose levels are rising, and glucagon when they are falling to help prevent hypoglycemia. There is also speculation that the hormone amylin may be included to prevent post-meal glucose from spiking too high.

In the meantime, I encourage you to utilize the technology that we have available. Insulin pumps and continuous glucose monitors are excellent tools for allowing a flexible lifestyle and achieving the best possible glucose control.

Have a Question? Insulin-Quiring Minds is a free service of the clinical team at Integrated Diabetes Services LLC. Submit your questions to jennifer@integrateddiabetes.com. All questions will be answered, and yours may be chosen to appear in Insulin Nation.

Integrated Diabetes Services provides one-on-one education and glucose regulation for people who use insulin. Diabetes “coaching” services are available in-person and remotely via phone and online for children and adults. Integrated Diabetes Services offers specialized services for insulin pump and continuous glucose monitor users, athletes, pregnancy & Type 1 diabetes, and those with Type 2 diabetes who require insulin. For more information, call 1-610-642-6055, go to integrateddiabetes.com or write info@integrateddiabetes.com

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Jennifer Smith holds a Bachelor’s Degree in Human Nutrition and Biology from the University of Wisconsin. She is a registered and licensed dietitian, certified diabetes educator, and certified trainer on most makes/models of insulin pumps and continuous glucose monitoring systems. She has lived with Type 1 diabetes since she was a child,and thus has first-hand knowledge of the day-to-day events that affect diabetes management.

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