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Automation in Diabetes (AID)

“Artificial Pancreas”: a potential cure?1,2

It’s a bit of a stretch to call the artificial pancreas, more recently renamed “automated insulin delivery system,” or “AID” a cure. But for those who have tested them, these devices can be a game changer, particularly in the right setting.
The goal of these products is to reduce or eliminate hypoglycemia and reduce hyperglycemia – especially overnight, a major concern if you’re diabetic.
The development of automated insulin delivery has one goal: using continuous glucose monitors (CGM) and smart algorithms that automatically adjust insulin delivery via pump.

How does a continuous glucose monitor (CGM) work?3

A CGM works through a tiny sensor inserted under your skin, usually on your belly or arm. The sensor measures your interstitial glucose level, which is the glucose found in the fluid between the cells. The sensor tests glucose every few minutes. A transmitter wirelessly sends the information to a monitor. The monitor may be part of an insulin pump or a separate device, which you might carry in a pocket or purse. Some CGMs send information directly to a smartphone or tablet.

When thinking about AID systems, it’s often helpful to think in stages.4

Stage 1: The most basic AID system might shut off the insulin pump from delivering insulin whenever your CGM readings drop below a certain number, such as 70 mg/dl, to prevent severe hypoglycemia.
Stage 2: The AID system could predict when glucose is going to go low and automatically reduces or stops insulin.
Stage 3: The AID system may be able to automatically adjust the insulin dose depending on whether your glucose is trending up or down. At this stage, you would still have to manually take insulin doses when you eat, in addition to correction doses.
Stage 4: The AID systems will be able to deliver correction doses when glucose values are high.
Stage 5: The systems will be able to detect meals and automatically deliver the proper insulin doses to prevent high blood glucose.

2020 is a huge year in automated insulin delivery, where the FDA has approved breakthrough innovations, aiming at making your diabetes management easier and safer.

References: 1. Wood J, Peters A. The Type 1 Diabetes Self-Care Manual [Internet]. American Diabetes Association; 2018 [cited 14 October 2020]. Available from: http://main.diabetes.org/dorg/PDFs/living-with-diabetes/T1DSelfCareManual.pdf. 2. Automated Insulin Delivery [Internet]. diaTribe. 2020 [cited 14 October 2020]. Available from: https://diatribe.org/automated-insulin-delivery. 3. Continuous Glucose Monitoring | NIDDK [Internet]. National Institute of Diabetes and Digestive and Kidney Diseases. 2017 [cited 14 October 2020]. Available from: https://www.niddk.nih.gov/health-information/diabetes/overview/managing-diabetes/continuous-glucose-monitoring#artificial. 4. Tech on The Horizon: Automated Insulin Delivery Systems Coming In 2020 [Internet]. diaTribe. 2019 [cited 14 October 2020]. Available from: https://diatribe.org/tech-horizon-automated-insulin-delivery-systems-coming-2020#what

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