Why is it a Techy Disease? In normal physiology, glucose metabolism - PDF document

4/18/2013 Why is it a Techy Disease? In normal physiology, glucose metabolism is exquisitely controlled; Type 1 Diabetes: A Techy Disease – Blood Glucose (BG) has a tight range – BG levels are sensed continuously Saleh Adi, MD – Instantaneous response in the β‐ cells Director, Madison Clinic for Pediatric Diabetes UCSF – Almost immediate and quick effect of insulin – Short lived effect We’re not even close What makes insulin rapid vs long? • We check BG every few hours Time to circulation • We deliver insulin every few hours • Insulin action is still too slow • Deliver insulin in subcutaneous space (it takes a while to reach circulation) Custom Designed Insulins Custom insulins • Rapid – Lispro Regular Lispro – Aspart – Glulisine A ‐ chain B ‐ chain Reversed to create Lispro • Long acting (slow) – Glargine – Detemir 1

4/18/2013 Rapid insulins are not fast enough Long insulin is too long! Long acting insulins provide one steady state • We secrete insulin as we begin to think about food • Some foods are faster than others • Some foods last longer than others MN 6am Noon 6pm MN Basal insulin Insulin pumps Body’s requirements are not same all day • Use only rapid insulin • Variable rate of infusion to meet basal needs • Different dosing schemes at different time of day • Sophisticated calculators for insulin dosing • Reliable and easy to use MN 6am Noon 6pm MN Insulin Pumps Insulin pump • Exact basal rates • Temporary basal rates • Precise dosing • Extended dosing for fatty meals MN 6am Noon 6pm MN 2

4/18/2013 More Insulin Pumps Insulin pump Insulin pump Pod Pump Old Diabetes Logs Insulin pump 3

4/18/2013 Pump and sensor (CGM) Continuous Glucose Monitor (CGM) A: pump B: infusion set C: sensor D: transmitter Pump and CGM download Old Diabetes Logs Pump and CGM download Implantable Pump 4

4/18/2013 Artificial Pancreas Artificial Pancreas Command Center Connected Meters The App Era The App Era – Logging blood sugar – Guessing carb content in foods – Tracking blood sugar trend after eating at certain places – Social networking – Motivational apps – Tracking activity – Etc… 5