The Bionic Pancreas
Kelly's transformative experience wearing an artificial pancreas for five days.
I'm now exactly eleven days out of the five-day Boston University/Massachusetts General Hospital bionic pancreas1 trial that I took part in. I can't quite talk about it too directly, without my eyes starting to fill up. So dramatic, I know! But I feel forever changed, having been part of this research study, and now knowing (albeit only for a week) what "normal" life was like before diabetes — not having to carb count, not experiencing any hypoglycemia, not feeling tired all the time, and not having diabetes on my mind every five minutes. In short, I felt like a whole new Kelly. You can see some of the pictures and videos I took on our diaTribe twitter.
What is this study exactly? Well, Dr. Edward Damiano (the engineering genius from BU), Dr. Steven Russell (a star endocrinologist at MGH), and a slew of colleagues have built a system over the last decade to make life with type 1 diabetes much, much easier. The system uses an iPhone running a control algorithm, two Tandem t:slim insulin pumps (dosing insulin and glucagon), and a Dexcom G4 continuous glucose monitor. This bionic pancreas (also called an "artificial pancreas" or "closed loop") takes glucose data from the Dexcom CGM and runs it through a control algorithm on the iPhone. The algorithm then processes the data and automatically directs insulin and glucagon dosing — in a word, magical. This dosing happens every five minutes, so the system automatically makes many very small adjustments to keep glucose levels in range. The bionic pancreas only needs your weight to start up, and the algorithm adapts and learns over time from its performance — in other words, if I become very insulin resistant for a few days (e.g., little sleep, stress, less than my normal amount of exercise), it will robustly adapt and increase the amount of insulin it gives. How cool is that!
What was also so impressive about Drs. Damiano and Russell's study was how very real-world it was. Unlike most studies in the past that confined bionic pancreas research participants to a hospital bed, I was able to roam around a three-square mile area of Boston. I could eat what I wanted (restaurants were encouraged!), exercise as I wanted, and sleep by myself in a hotel room. Just in case anyone was ever close to danger, the study had three teams of nurses following me and making sure I stayed safe, even to the point where I wore an IV at night and they followed my minute-to-minute blood glucose readings on a screen next door. Big picture, it was fantastic to see what wearing a bionic pancreas would be like in more of a daily life setting. The study's goal is to assess the safety and effectiveness of the bionic pancreas, so its performance was compared to five days of my own "standard" care without the bionic pancreas.
I knew it would be cool to be part of the trial. I'm one of about 30 participants who get to take part in it, one of the first closed-loop trials in the world to take place outside the hospital setting. I love new technology, I love clinical trials, and I love the hope that accompanies early-stage research.
So when they told me that I might be quite depressed when I had to give back the bionic pancreas (a little box that the research team kept calling "your pancreas," as in "Oh, don't forget your pancreas!," "Don't drop your pancreas…", etc.) I felt "Oh right! Come on. This is so exciting being part of this trial. How could I ever be depressed!"
Apple Cartwheels Spaghetti and Turkey Meatballs Mushroom Barley Soup Fresh Peach Tart Lightly Spiced Baked Custard Stuffed Spinach Tomatoes Tuna Barley Casserole Enlitened's Reduced Carb Apple Cobbler Raspberry Cheese Spread Gobetti alla Boscaiola
Well maybe not so much a furor as a controversy. The question, bluntly put, is whether or not a single HbA1c reading should be sufficient and adequate to diagnose diabetes — and whether the conditions under which the test was conducted should have any bearing on the diagnostic or non-diagnostic value of the test. The lede from