Diabetes Beginner

The Artificial Pancreas

Understanding the Artificial Pancreas (AP)

The artificial pancreas (AP) is a groundbreaking system designed to help manage blood glucose levels automatically, integrating a continuous glucose monitor (CGM) with an insulin pump. Here’s everything you need to know about AP systems:

What is an Artificial Pancreas? An artificial pancreas, also known as a closed-loop or automated insulin delivery system, combines a CGM and an insulin pump. The CGM continuously monitors glucose levels under the skin and sends this information to the insulin pump. Using advanced algorithms, the pump then adjusts insulin delivery as needed to maintain stable blood glucose levels throughout the day and night.

Stages of Development:

  1. Stage 1: Low Glucose Suspend (LGS)
    • This feature suspends insulin delivery when the CGM detects low glucose levels (e.g., below 70 mg/dL). It helps prevent severe hypoglycemia by temporarily stopping insulin for up to two hours.
    • Included in systems like the Medtronic 770G and Tandem t-slim
      X2 with Control-IQ.
  2. Stage 2: Predicted Low Glucose Suspend (PLGS)
    • Predicts when glucose levels will drop below a certain threshold and halts insulin delivery beforehand to prevent hypoglycemia.
    • Found in systems such as the Medtronic 770G and Tandem t-slim
      X2 with Control-IQ.
  3. Stage 3: Partial AP (Hybrid Closed-Loop Systems)
    • These systems automatically adjust basal insulin delivery based on CGM readings, but still require users to input meal boluses (insulin doses taken before meals) and correction boluses for high glucose levels.
    • Examples include the Medtronic 670G, 770G, and upcoming 780G, as well as the Tandem t-slim
      X2 with Control-IQ.

Currently Available Systems:

  • Medtronic/MiniMed Systems:
    • The MiniMed 670G adjusts basal insulin every five minutes based on CGM data, targeting a glucose level of 120 mg/dL. It includes features to prevent lows during exercise.
    • The MiniMed 780G, expected in 2021, will offer automatic correction boluses for high glucose levels and a customizable glucose target down to 100 mg/dL.
  • Tandem
    X2 with Control-IQ:
    • This system uses Control-IQ technology to adjust basal rates and deliver automatic correction boluses for high glucose levels. It aims to keep glucose values between 112.5 and 160 mg/dL, enhancing “time in range” by an average of 2.6 hours per day.
    • Features include modes for sleep and exercise, adapting insulin delivery to different activity levels.
  • Omnipod 5 (OP5)
    • This is the only completely tubeless insulin pump system.
    • Uses an automated mode which calculates basal insulin based on total insulin needed
    • Pods are waterproof and durable which allow for use while swimming and bathing.

Advantages of Using an AP:

  • Improved Glucose Management: AP systems help maintain stable blood glucose levels throughout the day and night.
  • Reduced Risk of Hypoglycemia: Features like LGS and PLGS prevent severe lows, providing peace of mind, especially during sleep.
  • Increased Time in Range: Users typically spend more time within their target glucose range, promoting better long-term health outcomes.

Considerations When Using an AP:

  • Learning Curve: Users receive comprehensive training from healthcare teams and device manufacturers to effectively use AP systems.
  • Integration with Lifestyle: Users still need to input meal boluses manually, as current insulin action times require human input for mealtime insulin doses.

The artificial pancreas represents a significant advancement in diabetes care, offering automated insulin delivery to enhance glucose control and quality of life. If you’re considering an AP system, discuss your options with your healthcare provider to find the best fit for your diabetes management needs.

Diabetes Beginner