Artificial pancreas successful in type 2 diabetes tests

Medical researchers from Cambridge University have completed successful trials of an artificial pancreas that they say is nearly ready for commercial use by outpatients with type 2 diabetes – and it's even automated. In a paper published in Nature the team said their device halved the amount of time patients spent with high …

[Neil Barnes]

To be honest

I was hoping for an organic working replacement for the failing organ...

(Sulking because I have recently started using insulin injections, and it's a pain. Though since moving to Germany a couple of years ago a change in medication from the NHS treatment led to the loss of fifteen kilos in three months, which was a surprise to all concern and required me to buy new trousers. The change to injected insulin has led to a small weight gain, I suspect because sugar in the blood is now being glommed onto by the liver, as it should, and safely tucked away as far, instead of just being peed out at (very) regular intervals.)

[Pascal Monett]

Re: To be honest

I wish you the best of luck. Diabetes is a pain because, although it is not painful in itself (as far as I know), it can kill you pretty quick.

In any case, I think this artificial pancreas has a great future in store and I hope it will help everyone afflicted with this condition.

[LybsterRoy]

Re: To be honest

Its only (mildly) painful when you use finger prick for blood tests and occasionally when for some weird reason the injection site hurts.

[CrazyOldCatMan]

Re: To be honest

it can kill you pretty quick

I was at colledge with a T1 diabetic (developed in his late teens) who was deeply resentful of it and couldn't be bothered doing proper management. Had regular hypos (injecting too much insulin because he couldn't be bothered to carb-count and adjust the dosage). We got into the habit of checking his room regularly and several times found him in a diabetic coma.

He left halfway through the term - presumably to get treatment.

[LybsterRoy]

Re: To be honest

As I found out the tablets I was prescribed for Type II also acted as an appetite stimulant. At the same time the dietitian was telling me not to eat as much.

My solution, that worked whilst still living "down south", was lots of salads. This solution failed with a move to the Highlands with the nearest source of salad bags a mere 15 mile drive away.

[CrazyOldCatMan]

Re: To be honest

As I found out the tablets I was prescribed for Type II also acted as an appetite stimulant

Mine don't that effect fortunately (metformin[1], Jardiance and gliclazide)..

[1] AKA metfartin due to the effects on the bowels if you take over a certain dose..

[TiredNConfused80]

Not being Picky but....

I think this is also being rolled out to certain Type 1 patients as well. At least the hospital I attend as an out patient for Type 1 is saying so...

I have been tempted to try the home brew method of this ("looping" with OpenAPS) but having an android phone calculating doses of a drig that can kill me is a step to far for me (probably comes from working in IT!) A lot of people do have great success with it though more info here if anyone is interested https://openaps.org/ (would make a link but i'm in a rush!)

[Anonymous Coward]

Re: Not being Picky but....

I had to change hospital clinic to access a pump friendly team and have recently started with a funded hybrid closed loop system.

These systems are now part of a set of NICE guidelines that are out for consultation so hopefully more will be able to access them.

So far it is doing a better job of keeping my glucose levels in range than I was able to

[LybsterRoy]

Re: Not being Picky but....

-- keeping my glucose levels in range than I was able to --

I know that feeling very well. I've just been switched to a CGM system and I still have no idea why my blood glucose does what it does most of the time.

[lglethal]

As with everything medical, the answer to what causes Diabetes Type 2 is probably "due to a number of factors"...

I'd certainly believe that a large number of cases could be avoided if people took the weight off after the initial diagnosis. But then I would also believe that, for an equally large number of cases, taking the weight off would not have an effect, because the Diabetes was caused by some other effect (e.g. smoking, or predisposition to developing the disease).

Still if people were immediately put on a crash diet after diagnosis, then that would be a good start, and for those for whom weight loss doesnt cure the disease, then a device like this would be an excellent helper, for keeping them safe and healthy.

Multiple solutions for multiple factors...

Good work Boffins!

[Caver_Dave]

Diet

As a T2 who has done a lot of amateur research in the condition I can agree with what you have said.

My family has a genetic disposition, both active parents (outdoor manual jobs) had it for years, and my brother was diagnosed within a few months of me, (who at the time was digging trenches by hand all day long).

I had to take a compulsory (Desmond) course run by the NHS when I was diagnosed. I was the youngest attendee by about 2 decades and the lightest by at least 6 stones. When I was checked a couple of months before diagnosis, I was 5% body fat!

The biggest factor in the prevalence of T2 Diabetes is the NHS advice to cut down on fat. This has led to the population's diet becoming carbohydrate heavy, which leads to the extra weigh and places too much strain on the Pancreas causing it to become less efficient or stud down. It's the same as any engine - run it too hard and it will not last as long!

[Anonymous Coward]

Re: Diet

Keep in mind that most of the diabetes medications that you take will encourage weight gain. Be prepared for your doctor to list you as 'non compliant' when you don't lose weight or the medications don't lower your sugars long term. Also be informed about what your doctor is prescribing. They tend to go the more drugs = more better route. I expect to be on daily insulin for the rest of my life because I trusted the experts. The general consensus is that my pancreas no longer produces insulin.

Having changed doctors several times over the years, something new doctors just won't listen to is: obesity didn't cause my diabetes. Diabetes caused obesity. I wasn't significantly overweight when I was diagnosed pre-diabetic. One year on Actos changed that.

The biggest factor in the prevalence of T2 Diabetes is the NHS advice to cut down on fat. This has led to the population's diet becoming carbohydrate heavy, which leads to the extra weigh and places too much strain on the Pancreas causing it to become less efficient or stud down. It's the same as any engine - run it too hard and it will not last as long!

The low fat movement is a major cause of the outbreak of diabetics over the last 40 years. Having more carbs in our diets wouldn't have been so bad, if it weren't for the fact that food producers replaced fat with sugar. You can't just say "I've switched to diet soft drinks, I'm good". Look at the amount of sugar in any bottled juice. And for bonus points, check out the sugar in a serving of Ketchup. For most people, just wandering the aisles at the grocery store looking at the labels on 'healthy' food would shock them.

While this tech would be wonderful for helping manage the sugar roller coaster, I don't think we'll get past this until the food industry is reformed. There needs to be better options for people who aren't wealthy or chefs. Also, as someone else mentioned, having worked a career in IT I'm skeptical about using just any device to manage insulin.

[LybsterRoy]

Re: Diet

Also don't forget that for some people the artificial sweeteners can have an effect on blood glucose levels. Something I've recently become aware of after moving to a CGM.

[CrazyOldCatMan]

Re: Diet

artificial sweeteners can have an effect on blood glucose levels

It seems divided into two categories - stuff derived from natural substances (Xylitol, steviol and, mostly, sucralose[1]) have a negligable access because your body can either deal with them easily or, in the case of sucralose, ignore it almost completely and just excrete it.

Whereas the stuff that is entirely artificial (saccarin, aspartame etc) does seem, in some people, to have a noticable effect on BG.

[M.V. Lipvig]

Re: Diet

As I understand it, the tongue is the first alert the body gets that sugar is coming. When you taste something sweet, the pancreas gets ready to crank out insulin. But, when the sweet is fake sugar the body sends insulin to deal with sugar that isn't there. Too much insulin drops your blood sugar, and that makes you hungry. Eventually the pancreas no longer sees a sweet taste as a trigger, and your system starts seeing spikes and drops in sugar levels, then the pancreas starts working overtime trying to keep up, and we all know what happens to machinery that is overworked - it breaks.

Mind you, I could be talking out my backside here, but then I may not.

[CrazyOldCatMan]

Re: Diet

One year on Actos changed that

Actos is pioglitazone.. I was on a combined metformin/pioglitazone for about 10 years. I did gain weight but nowhere enough to be considered obese. It probably did contribute to the heart attack I had a few years ago though.

I lost 15kg when I went back to plain metformin after the heart attack - some was undoubtedly from not eating much for several weeks but I suspect the major part was from stopping the pioglitazone.

One thing being T2 taught me - read the nutrition information of food very carefully[1]. There are breakfast cereals that are about 50% sugar (I refuse to have anything above about 15%). We also (mostly) cook our meals from scratch because, that way, we know what's in it. Yes, it's a bit more works but, fortunately, I enjoy cooking - I'm by no means a chef but wy wife seems to like what I cook..

[1] It baffles me that people complain that they are so hard to read - it's a simple table that breaks the food down into relative levels of fat/carbs/sugar. It's not rocket science!

[CrazyOldCatMan]

predisposition to developing the disease

Or having a mother where pretty much all of her siblings developed early-onset diabetes. As did her mother, and one of her sisters died from complications.

I got it in my late 30's when I was doing a very stressful job - somethiing I suspect that didn't help.

Still if people were immediately put on a crash diet after diagnosis

Been there, did that, had no effect. But then I didn't develop it as the result of lifestyle or excess weight (ironically, one the the drugs I ended up on (pioglitazone) was known to cause weight gain.

[Anonymous Coward]

I am a T2. Definitely lifestyle reasons for me. I had a back injury that means I am not able to exercise and I became T2 within 18 months despite a 1200KC maintenance diet. After more than a decade I am around 8 pounds heavier than before the injury, but the muscle bulk has changed to visceral fat :-( The diabetes medication has cost many more times what the operation to fix my back would have cost (replacement disk and rods to hold it all in place), but NHS risk/benefit calculations were 50:50 at the time and the consultant was not inclined.

I use a Freestyle Libre2 to constantly monitor my blood sugar and find that the correctness of general advice on food types depends on the person and the type of day. However, £100/month is not something everyone is able to pay for :-( For instance, the Oat Porridge that is suggested by the experts has a similar effect on me to any other cereal, and bread, of any type, will raise my blood sugar by 2 for the rest of the day.

My boss, T1, tried an artificial pancreas in the Netherlands last year, but found that its AI/control loop would not adjust to the speed his body dealt with the sugar and had to give up.

[Anonymous Coward]

food types

"I use a Freestyle Libre2 to constantly monitor my blood sugar and find that the correctness of general advice on food types depends on the person and the type of day."

Tim Spector and his book Food for Life and his Zoe company might be worth a look. He's all over individual advice about food types, because of microbiome differences etc.

[WanderingHaggis]

Exciting news

As a MODY (https://www.diabetes.org.uk/diabetes-the-basics/other-types-of-diabetes/mody#:~:text=MODY%20is%20a%20rare%20form,of%20inheriting%20it%20from%20them.) and a teckie I look forward to not having to do endless calculations for injections to then end up for some reason (weather, wind direction, mood ...) having them go wrong. It definitely gets harder to control as you get older.

[vtcodger]

Re: Exciting news

FWIW, I've been monitoring my blood glucose daily for over a decade, and my conclusion is that blood glucose level is far more complicated than just diet and exercise. Far more complicated than most medical folk think -- which means that consulting "experts" won't necessarily get those of us with abnormal blood glucose metabolism good or even useful advice.

I'm fortunate in that my blood glucose levels are currently adequately controlled by diet and Metformin. I was on insulin for a few years and let me tell you, that stuff is scary. One mistake or bad guess or just a day when the body decides to behave abnormally and you're on your way to the emergency room ... or the funeral home.

The good news is that with modern Continuous Glucose Monitoring technology, I think diagnosis and treatment of glucose metabolism abnormalities will become much more sophisticated and nuanced. The bad news? It'll probably take a few decades to sort it all out.

[ITS Retired]

Metformin

Metformin is been known to damage the kidneys in many people.

[Neil Barnes]

Re: Metformin

And yet I believe many in the US use it as a hopeful life-extension drug, even without diabetes.

Might explain the kidney stones? Though they've been behaving recently, I'm pleased to say.

[vtcodger]

Re: Metformin

As I understand it, Metformin doesn't cause kidney damage, but if one's kidneys are damaged, they may fail to metabolize Metformin. Metformin then builds up in the blood and eventually causes lactic acidosis which can be a life threatening problem. But I'm depending on the Internet for information here. Could be really wrong.

[LybsterRoy]

Re: Exciting news

The first recorded reading I took was 9/10/1998 (UK not US date style) and I can fully endorse "blood glucose level is far more complicated than just diet and exercise".

I do think you're a bit OTT regarding errors in the amount of insulin injected - I've been there and just drank lots of orange juice and ate lots of white bread until it went way up again.

Its a shame that blood glucose doesn't go up as fast as it goes down though - that would make a hypo much less scary.

[TSM]

Re: Exciting news

I'm a LADA which seems to be not well understood yet, hooray. Diagnosed a couple of years ago. Despite going from 8 to 12 units of insulin since I last saw my endocrinologist my levels are higher than ever... maybe the metformin is not working as well, or maybe my pancreas is starting to give up the fight. My immune system already killed off my thyroid years ago so it has form for this sort of thing (and at the time of that diagnosis my doctor warned me that I'd be at increased risk for other auto-immune diseases, so here we are).

CGMs have just gone onto the subsidy list here in Australia for people with Type 1 so it might be worth looking into. Kinda squeamish about the idea though.

[Captain Scarlet]

which uses an algorithm

Quick run before marketing changes it to AI

[duhmb]

Wow, you can buy these off the shelf.

OMG :-) this is a research project??? You have been able to build these at home for years :-D. There are at least two you can buy off the shelf. British scientists at their best.

[CrazyOldCatMan]

Some of us..

.. have T2 diabetes because we were unfortunate to have a mother who came from a family that had the gene for early-onset diabetes. I am not, and never have been, overweight. I eat sensibly, do regular exercise and yet I'm T2 diabetic and have been for 20 years.

It does annoy me at times that I (and others like me) get lumped in with the people who develop diabetes by not doing any of the above things.

(I use Freestyle Libre monitoring patches - they are read by NFC, last two week and pretty much continuously monitor your BG levels. The downside is that they cost £49 each - but at least are VAT free.)