The insulin pump, the artificial pancreas and the future of diabetes treatment

People with diabetes are always on the lookout for advances in treatments to make living with diabetes as easy as possible. The insulin pump and the artificial pancreas are currently the most popular.

The insulin pump

Insulin pumps have been shown to improve glycemic control by significantly reducing glycosylated hemoglobin, glycemic fluctuations, insulin doses used and significant hypoglycemia. All in all, they improve patients’ quality of life. These advantages have been proven for all ages, including children and infants. Put this way, it would seem that all type 1 diabetics should be treated with an infusion pump, but it is not as simple as it seems.

It should be taken into account that with infusion pumps only fast-acting insulin is injected (duration of 4 hours) and they are connected to the body by a very fine catheter. Well, if the catheter becomes clogged, has a bubble, comes loose, etc., the insulin stops passing and ketoacidosis occurs in 5 hours, therefore, for the person to be able to wear a pump, he/she must have a minimum of 6 to 7 daily glycemic controls and learn to handle all kinds of situations, know how to count rations and have extensive knowledge of how to act in the various circumstances that day-to-day life presents (exercise, fever, alcohol, etc.). In other words, they require a very extensive learning process and a very high level of personal responsibility. And the professional does not always have the time or the means to carry out this type of treatment. Another aspect to be taken into account is the short-term cost involved.

The artificial pancreas

There are people who think that today’s pumps inject insulin by themselves without the intervention of the individual. And I always tell my patients: No! the pumps we use “are dumb”, we have to program the insulin to be injected. Well, the artificial pancreas is a pump that goes beyond that, they are already “intelligent” devices that calculate the doses of insulin (and glucagon) to be injected according to the blood glucose at each moment and, to do so, they require the patient to also have a continuous blood glucose sensor. They are already a reality and will be commercialized in a short time.

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The problems arise from the millimetric calculations that must be made when the sensor and pump catheter are inserted in the subcutaneous cellular tissue, and it is well known that with glycemic oscillations, blood glucose takes a variable time to be reflected in the subcutaneous cellular tissue. This is important in the case of hypoglycemia, because you can have a rapid hypoglycemia that is not reflected in the subcutaneous cellular tissue as quickly as required by the urgency of the case and, therefore, the pump continues to deliver insulin. These types of safety problems are what are complicating its implementation.

The future

If we look to the future, one thing is clear: people with diabetes are waiting for a glucometer that does not puncture your finger… and no matter how much publicity there is in this regard, a reliable meter has not yet been achieved. That will be a very important step and, I have no doubt, it will be achieved. But for the time being, patients must continue to test their blood glucose levels and learn to count carbohydrates and fats in order to adjust their boluses correctly. Education is the basis of good control, without a doubt, and will continue to be the key in the near future.

The artificial pancreas is, in my opinion, an infinite step on the road to diabetes treatment. If it is commercialized this year or next year… it will already be impressive! The rest will be totally obscured: that glucometers attached to cell phones will become widespread, that all glucometers will have bolus calculators, that sensors will last longer without having to be replaced, that the accuracy of the devices will improve, and so on. These are also very important steps that will undoubtedly emerge little by little.