What I would like to see is an integrated system where the a continuous monitoring device comes with the insulin pump and communicates with it automatically. I want open data as well and good software, but more importantly, I'd like to have a device that learns from my habits and recommends adjustments automatically. It would save me the hassle of having to pore through my glucose readings and think about everything every 1-2 weeks, which is what's required of me now to maintain my health (and which I'm negligent on).
And I'd like my insurance to cover it, but that's an entirely different story.
I know we're a little ways off, but this seems like a great platform to combine with automatic blood sugar measurement. Imagine taking one pill in the morning that measures your blood sugar and internally administers insulin as necessary. There are already externally attached pumps that do both (my father, a type 1 diabetic, uses one) but having an electronic device permanently attached to your stomach is a bit of a hassle.
This could be engineered around--mostly the limitations are liability.
If you, the patient, take a glucose sensor, an insulin pump and tie them together with an app, you don't get to sue somebody if something fails and you die.
If a company takes all three of those, packages them together, and sells them, then that company is now liable when one of the pieces fails and you wind up dead.
The sad part is that AI/ML would be incredibly useful for all this. People could take pictures of their meals, upload their sleep and exercise data, and weigh themselves, feed all that into a cloud algorithm that could determine how you are likely to react and dial your insulin plan into your pump while feeding the glucose readings back to the cloud.
Sadly, I suspect none of this is going to happen in the US due to the liability. Maybe China will pull this off.
I've often thought with today's sensors and wireless tech that there should be an accessory and mobile app that constantly measures your blood sugar, good for diabetics and optimal-nutrition folks alike.
As a type 1 diabetic I'm super excited to see apple working in this space, even if they're focusing it on type 2 to start (a logical move, considering there is something like 30x more type 2 diabetics in the US). I think making it easier to track glucose levels in real time is the number one thing that can be done to improve quality of life for both types of diabetics.
The "CGM" (continuous glucose monitor) has really come into it's own over the last 10 or so years, and I would encourage all diabetics (but especially type 1) to use one. Currently the only 2 real options on the market are:
- http://www.dexcom.com/ - Connects directly to your phone using bluetooth and will send glucose warnings etc as notifications.
Both these options are expensive (even with insurance for many), invasive, and not really tailored towards "casual" glucose monitoring. I think if Apple enters the space with a non-invasive tool it'll be a huge boon for causal glucose monitoring. I also think it could be a more accessible option for people who are interested using a CGM to treat their diabetes but can't/won't use one of the existing options due to cost or inconvenience.
This seems like a win win and I'm excited to see where it goes.
We already have automated continuous insulin injection pumps that work well. It's a big improvement over shots every few hours. But they still need manual setting of pump rate, based on manual periodic measurements.
A noninvasive sensor that measures blood glucose accurately, even just once a minute, would give you the ability to close the feedback loop and remove all human input from the system. No "oh shit I forgot to measure and adjust". Especially for kids it would be a big breakthrough. In essence, you'd have an almost-perfect artificial pancreas.
As a type 1 diabetic I can say this would be a huge improvement over current continuous glucose monitoring systems. No expensive disposable parts. No needing to inject a new sensor each week. No strange, uncomfortable, and (often) painful bulge stuck to your abdomen.
>We’re in discussions with the FDA, but there’s still a lot more work to do to turn this technology into a system that people can use
I'm chomping at the bit. Anyone familiar with process know how soon this could possibly be available?
Couple of points -
Yes, pumps give better control, yes it would be a lot better if it were a closed loop system between a continous monitor and a pump with a human confirmation point with suggested actions. We are a little way off that being supported by insurance/healthcare systems as cost effective, so really I am talking about the table as it is set up right now.
There are a number of biological factors that can make a difference, but for type 1 diabetics, the point should be that you know the ratio of carbohydrates eaten to insulin to take. This can vary, but good data helps you get the ratio right. It can also identify if you have high glucose points that match your circadian rhythm, or if you're becoming hypoglycaemic at a certain point regularly and just haven't mentally joined the dots.
Now, yes, you could do all of this through a log book on paper. I could sit down for a half hour each month and look for trends. But, I take readings on a device with digitised output between 4 and 8 times per day. I don't want to have to go analogue with that, I essentially want the blood glucose equivalent of google analytics. I can account for unusual variations (cycled for 10 miles/got blind drunk/etc.) much better if I have a dataset that demonstrates what the benchmark should be.
I was under the impression that there were already devices on the market that would monitor your blood sugar and dispense insulin as needed. Is that not the case? Or does this system provide some additional functionality?
I'm a programmer and I've had a type 1 diabetes for the last 21 years. It is one of the most complex things in my life to take care of
when all of the insulin therapies don't really work that well and I don't wake up to the nightly hypos. Luckily I'm in the German insurance system and getting an insulin pump first and later a CGM. Already I'm using an NFC chip in my arm giving results to my phone and from there to InfluxDB and Grafana. Later with a proper CGM I also get automatic alarms which wake me and my partner if the sugar gets to low.
There are great open source systems for us technical people, but the tech is very expensive without an insurance and requires you to solder an extra device to get the values to your phone. At least with an NFC device you can wrap a smartwatch over it to get the readings automatically to your phone, rooted of course.
The pump delivers insulin and gets blood glucose readings from a CGM (continuous glucose monitor) over bluetooth. Then the pump can make decisions such as stopping insulin delivery if you're going to go low, doing small correction boluses, and adjusting basal rate.
However it's far from perfect and still needs a lot of management. My wife has T1D and was recently pregnant, which really raises the bar on how tightly you need to control your diabetes. She ended up mostly micromanaging it all herself rather than trusting Control IQ to do the right thing.
The other issue is CGMs are not that accurate, so these systems are making decisions based on not great data.
I've been a diabetic for 14 years and that's exactly how I feel. The only way I can have perfect glucose levels is to live like a robot: wake up every day at the same time, eat exactly the same measured amount of food, check my glucose level every time my alarm beeps and do nothing out of the ordinary.
I'm trying to exercise more and the diabetes is the biggest barrier, I'm like a roller coaster right now.
I don't want to stare at a graph and do even more calculations, I want those calculations done by a machine, which can infuse insuline constantly and use more or less depending on my glucose trend.
There are new technologies out there, like this CGM [1] (continuous glucose monitor) which is very small and wireless (minilink minimed) which IIRC can work with an insulin pump (there is one that's very similar, wireless too, with a reservoir for three days of insulin)
And I'd like my insurance to cover it, but that's an entirely different story.
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