In this second video in the series, we explore some of the newer technologies that are available for management of Type 1 Diabetes.
(lively music)
– Hi, I'm Dr. Haley Brown.
And in this video,
we continue our discussion
about the artificial pancreas
and automated insulin delivery systems.
We are talking with the Simon family,
about their daughter Leslie,
and their search for
strategies to improve control,
as Leslie's honeymoon period ends.
(lively music)
A functioning pancreas, produces hormones
responsible for keeping
your blood glucose levels
within a fairly tight range.
Two of the main hormones are insulin,
which lowers blood sugar levels,
and glucagon, which increases blood sugars
if they become too low.
A functioning pancreas
can automatically start to
make more insulin after you eat
when it senses your
sugar levels are rising.
It can also decrease or
stop insulin delivery,
when it senses your
sugar levels are falling.
In cases of hypoglycemia,
Leslie's pancreas does not
produce enough glucagon.
For this reason,
she carries a medicinal form with her
in case of hypoglycemic emergencies.
Let's talk more about the process
of automated insulin delivery.
Continuous glucose monitors,
or CGMs like Leslie's,
are able to check her glucose
levels every few minutes.
An insulin pump,
which would replace the
insulin pens Leslie uses now,
give you a slow, steady
infusion of fast acting insulin
through a small infusion
site, just under the skin.
As long as there have been
insulin pumps and CGMs,
people have been trying to get the CGM,
to tell the pump if a person
with diabetes sugar levels
are rising or falling,
when your sugar levels are
rising above a target range,
the pump might start giving
you more insulin automatically.
And when your sugar levels are falling,
it might decrease your insulin
delivery automatically.
Hence the term automated insulin delivery.
Technically, an artificial
pancreas would be able to do more
than adjust your insulin automatically,
based on your blood sugar.
A true artificial pancreas,
would give you the
right amount of glucagon
when your blood sugar drops,
and give you the right amount of insulin,
following the meal.
A true artificial pancreas
would recognize when you're going to eat
and react to it quickly and accurately,
so you never have a high blood sugar.
But today's devices
aren't quite there yet.
So the preferred term
to artificial pancreas
is automated insulin delivery device.
If you want to get even more technical,
we could call them hybrid
closed loop devices.
A hybrid closed loop device
is a combination of an
insulin pump, and a CGM.
It's designed such that
the two devices can
communicate with each other,
and automate the rate
of delivery of insulin.
Because it does this based
on a computer algorithm,
so that you do not need to approve
every minute to minute
change that it makes,
it is thought of as a closed loop,
because it has taken
the human factor largely
out of the decision making loop.
Some user interaction is necessary though,
both to dose at mealtimes
and to evaluate any situation,
in which blood sugar
levels are far out of range
for extended periods.
Thus these devices are thought
of as hybrid closed loops,
as opposed to fully closed loops.
In our next video,
we will discuss the two
hybrid closed loop systems
that are FDA approved today,
Medtronic's 670 G and Tandem's t:slim pump
with their control IQ algorithm,
which includes its X2 pump,
and Dexcom's G6 sensor.
(guitar music)

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