Open Source Artificial Pancreases will become the New Standard of Care for Diabetes in 2019, according to Scott Hanselman of Hanselman.com, 23 April 2019.  And we are already a third of the way through the year. 

What’s the loop? It’s this:

1. Consider my glucose levels, what I’m about to eat, and what I’m about to to (and dozens of other environmental factors)
2. Dose myself with insulin
3. GOTO 1. Every few hours, or every few minutes, depending on the situation.

I do that. Manually. Every diabetic does, and the mental pressure – the intense background psychic weight of it all – is overwhelming. We want to lower the cognitive load of diabetes. This is a disease where you may not live as long if you’re not good at math. Literally. That’s unfair.

The community is “looping” by allowing an algorithm to make some of those decisions for me.

I’ve personally been looping with an open source artificial pancreas for over two years. It’s night and day from where I started with finger sticks and a half dozen needle sticks a day. It’s not perfect, it’s not automatic, but Open Source Pancreas are “Tesla autopilot for diabetes.” It doesn’t always park the car right or stop at every stop light, but it works very hard to keep me in-between the lines and going straight ahead and now that I have it, I can’t imagine living without it.  I sleep through the night while my Loop makes tiny adjustments every five minutes to keep my sugars as flat as possible.

I too have been looping on a do-it-yourself closed loop for over 2 years … and would NOT live with it!  It’s been the most amazing improvement in my 54+ years of living with Type 1 diabetes.

Read more: Closed Loop will become the New Standard of Care

And more on the AP benefits, fresh from the American Association of Clinical Endocrinologists Conference 2019. Novel Hypoglycemia Metrics Detail ‘Artificial Pancreas’ Benefits  by Kristen Monaco of MedPageToday.com, 26 April 2019.  Methods go “beyond the A1c” to show how closed-loop system reduces episodes of low blood glucose

Benefits to a “closed-loop system” for monitoring blood glucose and delivering exogenous insulin in type 1 diabetes went beyond mere reductions in HbA1c, according to a manufacturer-sponsored study presented here. Intensity of hypoglycemia (blood glucose <70 mg/dL) was reduced 43% and its volume by 71% among adults and adolescents with type 1 diabetes, as assessed with a novel composite measure called the “hypo-triad,” according to Robert Vigersky, MD, of Medtronic Diabetes in Northridge, California, and colleagues.

The “hypo-triad” included the area under the curve for blood glucose and frequency and duration of episodes with glucose <70 mg/dL.  The findings were presented at AACE 2019, the annual meeting of the American Association of Clinical Endocrinologists.

The research group also developed a “Comprehensive Glucose Pentagon” — a separate composite that includes mean glucose level, intensity of both hypoglycemia and hyperglycemia, time spent out of range, and coefficient of variation.  Using this method of assessment, hypoglycemia was reduced by 8% in adults and adolescents and 12% in pediatric patients after initiating use of the closed loop system.

IT’S UNDENIABLE!!!

Read more: Novel Hypoglycemia Metrics Detail ‘Artificial Pancreas’ Benefits

And even more, from the “father” of the DIY closed loop system called RileyLink, named after his daughter, Riley, who has Type 1 diabetes. Insulin Pumps, Decapped chips and Software Defined Radios was written by Pete Schamb for Medium/Gadgets, 24 April 2019. 

OK, so this is a complicated article … but it’s here for you to understand all that goes into developing a closed loop insulin delivery system by reverse engineering communications. It was just released in test mode last week … and I immediately switched my RileyLink from Medtronic (old pump) to Omnipod … and am so very thrilled and grateful!  My heartfelt appreciation goes out to Pete, James Wedding (who promised me 4 years ago that someday I’d be looping on pods), Nate Racklyeft, Joe Moran, Eelke Jager, Katie Disimone, Ben West, Howard Look (founder of TidePool) and all others involved in working tirelessly to give us the very best technology.

Because the PDM communicates with the pod using radio and has no interface, it means the pod is entirely controllable over the radio. There was the potential to create a full integration with Loop using just a RileyLink, or a modified version of it.  James Wedding had put up the bounty, and it attracted a lot of attention, and ultimately the right people who would be needed to make progress.

Software Defined Radio: SDRs are awesome tools; they make the hidden world of radio visible. There are all kinds of messages zipping by all the time, and these tools let you poke around, see the messages, and with some work, start decoding the little blips you see there. If you’re looking for messages from a specific device, you need to know what general area to start looking in. That’s where the FCC public filings come in handy.

Read more:  Insulin Pumps, Decapped chips and Software Defined Radios

Little Men Who Live in Omnipods was written by Kerri Sparling on her blog, SixUntilMe.com, It’s really funny but also try.  Add a little humor to your pumping with pods!

Did you know that there’s a little man inside the OmniPod that dances from side to side while he delivers your insulin? There’s a much longer story to this that makes me sound like less of a conspiracy theorist, but here’s a photo of the ‘pivotal drive engaging member.'”

 A little, Metal Pod Man? Inside of each Omnipod? I emailed Robert immediately and asked if I could share his photos on SUM (a request he thankfully granted, because seriously – this teeny, metal bathroom logo guy cracked me up so much that I couldn’t wait to post about it.)

Metal Pod Man is actually an integral member of the Omnipod mechanics. According to Robert’s notes: “It seems, in fact, that one of the innovative safety mechanisms that prevents a dangerous massive bolus and controls precision insulin delivery is also a very cute design artifact. I’m referring of course to the Pivotal Drive Engaging Member (PDEM), also known as the little man that dances when I get insulin.”

He lives here:

And he’s in every pump, dancing while you bolus. Robert described it to me like this: “There’s actually a very thin wire that runs into one side of his (I’m being a little presumptuous here since it’s shaped like the men’s room icon) head and out the other. He pivots around a pin that goes through his belly. The wire heats (expands) and cools (contracts) and this makes him dance, or rather, waddle. Each of his arms is in contact with a little wheel that spins one ‘click’ each time he pivots. That’s why you hear the clicking when you bolus. This is actually part of a rather elegant safety mechanism that prevents the device from giving you a deadly bolus if the power control freaks out and gets pegged open.”

So there you have it. The little Metal Pod Man. Hey Omnipod – how come this little guy isn’t your official mascot or something? He’s amazing!

Thank you, Robert, for making me want to crack open every mechanical device in my house to see what kind of gnomes might be living inside.  And THANK YOU, Kerri, for posting this … I too couldn’t help smiling!!!

Read more:  Little Men Who Live in Omnipods

UTI Treatment Is in Crisis was reported by Dana G. Smith for Medium/Elemental, 23 April 2019. The way doctors treat urinary tract infections may be wrong, and antibiotic resistance is growing.  This is enough to sit up and pay attention … I even sent this to my urologist for comment.

Urinary tract infections (UTIs) are one of the most common bacterial infections. By some estimates, 50% of all women experience a UTI in their lifetime, and half of those women will get more than one. The infection is thought to be caused by gut bacteria like E. coli entering the bladder, resulting in feelings of pressure, discomfort, and pain, along with a nearly constant need to pee. If left untreated, the infection can move to the kidneys and, on rare occasions, can even turn deadly. Sex can sometimes contribute to the infection, but it’s not always the cause. Anything that results in bacteria coming into contact with the urethra increases risk.

A single course of antibiotics usually clears things up, but drug-resistant strains of bacteria are on the rise, making recalcitrant infections more common. Standard antibiotic treatments fail in 25% to 35% of people who take them, which worries doctors because antibiotics are the best and often the only way to treat UTIs. Some doctors are concerned that they may one day run out of options.

“Antibiotic resistance — not just [for UTIs] but all kinds of antibiotic resistance — is a huge problem, and no one’s really doing anything about it,” says Bradley Frazee, MD, an emergency medicine physician at Highland Hospital in Oakland, California, who recently published a study about the emergence of a particularly scary strain of drug-resistant UTI. “There’s not enough money in it, and if you talk about oral antibiotics for urinary tract infections, it’s even worse, because that’s [considered to be] kind of a ho-hum problem.”

Kalpana Gupta, MD, a professor of medicine at Boston University who helped write the Infectious Diseases Society of America’s guidelines on UTI treatment in 2010, says doctors are now trying to be more selective with the first antibiotic they prescribe. Doctors and scientists used to think urine was sterile, so they assumed the bacteria that grew in a urine sample must be causing infection. Over the past several years, however, research has revealed that, like the gut, the bladder has its own microbiome. This means it’s totally normal for a urine culture to show different bugs, including E. coli, which is typically blamed for UTIs. As a result, it’s virtually impossible to tell which bacteria in a urine culture are supposed to be there and which are causing an infection.

James Malone-Lee, MD, an emeritus professor of nephrology at University College London — who researches and treats women like Wilson with persistent treatment-resistant symptoms — takes an unorthodox approach to UTIs. Instead of treating the bacteria identified in the urine culture and changing antibiotics in an attempt to hit a moving target, Malone-Lee prescribes all of his patients the same first-generation antibiotic, cephalexin (brand name Keflex), which is a type of cephalosporin antibiotic. He never changes the prescription, and he ignores the urine culture. He only stops treatment after the women are completely symptom-free and have no other signs of infection in their urine, like white blood cells or pus. This might mean that some women are on the same antibiotic for years.

Read more: UTI Treatment Is in Crisis

Smoking with Diabetes: A Double Whammy was written by Julie Maurer for MedPageToday.com, 24 April, 2019. Smoking amounts to a perpetual vascular insult that makes diabetic patients extraordinarily vulnerable.

In a January 2019 study, author Barbara H. Braffett and colleagues at the Department of Epidemiology & Biostatistics at Geiorge Washington University in Washington, D.C. decided to examine the impact of smoking on glycemic control. “Using data from the Diabetes Control and Complications Trial, we describe the acute and long-term risks of smoking on glycemic control and microvascular complications in a well-characterized cohort of participants with type 1 diabetes,” the authors wrote. The trial, which included more than 1,400 participants, recorded smoking behaviors, glycemic exposure, and complications status.

“During a mean of 6.5 years of follow-up, current smokers had consistently higher HbA1c values and were at a higher risk of retinopathy and nephropathy compared with former and never smokers,” the authors wrote. The study revealed that current smokers had a 43% increased risk of retinopathy versus nonsmokers and a 36% increased risk of nephropathy.

He added that parents who smoke can create consequences for their kids. “Their bad habit likely worsens the cardiometabolic health and control of their young diabetic children who reside with them,” Uwaifo stated.

Read more: Smoking With Diabetes: A Double Whammy

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