First of all I must remind that there are different types of Diabetes. Only about 5% of all diabetes cases are Type 1- also known as Juvenile Diabetes- the kind that you are born with or develops after autoimmune attack or traumatic pancreas injury. In Type 1 diabetes the mad pancreas just stops making insulin. Without insulin, sugar can't get into cells and hangs out in the blood stream which is just not a good thing. Treating Type 1 Diabetes requires insulin shots and multiple blood sugar tests daily. Most cases of diabetes are Type 2 diabetes, also known as insulin resistance. The body makes insulin- but it doesn't work effectively. This is a result usually of poor diet and lack of exercise. Phil and I refer to Costco as the Type 2 Club- we stand by and watch as multiple hundred pound humans push past children in the queue for snacks. Some nearly run over the kids on the mobility assisted scooters, legs swollen and purple with neuropathy. I am definitely not a picture of health, but it does sting to be surrounded by people who take for granted the ability to change their circumstance through diet and exercise alone. Now, not all cases are the same and not everyone with T2 suffers from it as a result of overeating. But it is a bit of an epidemic, especially here in the States.
This past spring we took a trip to Disneyland as the girls were performing with PACK. In an effort to be fair we tried to do something fun and meaningful for the other kids. You know in the off chance that getting to go to Disney for spring break was not awesome enough. Phil decided touring the Medtronic facility in Burbank(as opposed to going on the Price is Right- whaaaat?) seemed like a good option. Medtronic is one of the major manufacturers of insulin pumps- small pager size devices that deliver insulin instead of having to do shots. I sometimes vastly underestimate my husband's goofy genius. It was a hugely successful trip because we all got to see how Phillip's latest piece of diabetic machinery was manufactured but there was also a mini "museum" featuring the history of diabetes treatment. From ancient diagnosis- if you were going to the bathroom too much, you would be told to leave a bowl of urine out- if the ants overtook it- you had diabetes which means "to pass through". Later the term mellitus was added- meaning honey, or sweet because the reason the ants were drawn to the urine was because of it's sugar content. We saw models of the first insulin pumps which were seriously the size of a ghostbusters back pack. Although I truly appreciate how far this technology has come- there are still some major hurdles to overcome.
While we were there we saw new innovations- using bluetooth and wireless connections throughout the house- so a mom could be alerted if her toddler napping was experiencing a dangerous drop in blood sugar to continuous glucose monitors and pumps that "talked" to each other- essentially closing the loop in what technicians call an "artificial" pancreas. In medtronic's model- there still needs to be human interaction to ok the administration of insulin. If a person is administered too much insulin- resulting low blow sugar could be deadly. The problem with insulin and blood sugar is that it is a continuous loop involving multiple organs and outside factors. For one stress- stress plays a huge role in the use of sugar in the body. Exercise- where as real time exercise alerts the body to use or store sugar- a continuous glucose monitor can only send data regarding blood sugar trends. All these things constantly remind me how amazing the body is as a series of systems that work together. It makes sense that no one small device could handle the demands of the endocrine system feedback loops. Yet when I look at the technology amassed for convenience- I wonder why the hell not.
Right now, Phillip wears two sites- both are about the size of a half dollar and raised about a quarter of an inch. The cannulas(little plastic tubes) are inserted with a special device(inserter) and have a tape holding them in place. Both are wirelessly connected to a small device that records data. The two devices can talk to each other. Phillip tells it when to give insulin. He also can tell it how many carbs he is eating and it will calculate how much insulin he needs for him- based on his current blood sugar and number of carbs being eaten to keep his blood sugar in range. The sites last for about 3 days- then he has to plug another one in. The insulin is stored in the pump and also has to be changed every few days- as heat and whatnot affect it's potency this is attached to the site through a clear tube. He takes his blood sugar with a glucometer( finger pricks) 4-however many times a day he needs to. Some days are a lot more than others and that was one of our struggles- getting him to take his blood sugar. It doesn't hurt too much, although if you look at his fingertips you will see little dots from the dozens of pricks every couple of days. His new pump sends him alarms to calibrate- he needs manual blood sugar checks to compare to the continuous blood glucose monitor values. Not any system is infallible and the CGM monitors changes in blood sugar values more so than actual Blood glucose- this is good because it alerts him if it senses he is getting too high or too low- in order to shut the thing up- he takes his blood sugar and react appropriately.
The new promised "artificial pancreas" is something we heard about right after Phillip was diagnosed. At my cousin's wedding, a friend of hers was doing research on the feasibility of implantable artificial pancreases. Pancreai? Although the idea of out of sight out of mind insulin pumping is appealing- functionally it requires surgical procedures and steps that kinda worry me for a mutant child. As much as I would like him to spend less time worrying about blood sugar and monitoring- repeated surgeries concern me. That is already something that is on the table due to mutant status and propensity to grow tumors. On the other hand- tighter sugar control means less food for tumors. As much as this lot in life sucks for him- he is managing remarkably well. He learned that diet and exercise are tools to managing how much insulin he has to take and how he feels. Although he can not control his pancreas function, he can control how much he puts into the system and other factors. Even though I would have preferred for him to learn this lesson another way, I appreciate the growth I see and the thriving despite circumstances.
|an implanted insulin pump|
Realistically, I think closing the loop outside the body is a good predecessor to implanting devices. The size of the devices still needs to come down. I look at cell phones and what can be achieved - I know the future holds promise for medical devices. I do believe artificial pancreas in a misnomer. As the mother of a child who is lacking a pancreas- I garner a true appreciation for what that organ does. It also gives the general public a false sense of where the technology is at. The collection of multiple devices talking to each other is a huge step forward- but pancreas they are not. Insulin system, yes. They have even added the glucagon element which is huge- glucagon is a chemical that signals the liver to release sugar stores when blood sugar falls dangerously low. One of the huge worries in a diabetic lifestyle. Phillip carries a shot around with him in case of an emergency. The new "artificial pancreas" system adds this element to another pump, poised and ready to wirelessly communicate with the other pump and continuous glucose monitoring system. You still end up with a whole lot of inpector gadgetry and wiring before it is good to go. In a stroke of genius, the system includes use of an iPhone. By promoting an apple product, hopefully ensuring a partnership that could symbiotically improve the lives and business of many. Because what it ultimately comes down to in the world of health care is the business side of it.
I am hopeful that in Phillip's lifetime there will be really good options for him to manage his diabetes. I am grateful to the researchers and teams who are working really hard at improving these lives. When I told Phillip about it and asked him what he thought- in 14 year old fashion he shrugged. He doesn't really want to wear yet another piece of something. I think in the grand experiences we've had with cancer, sometimes diabetes takes a lesser stance due to it's relied treat-ability. Just like each pancreas is unique- each diabetic has a different take on what is a convenience and what is a hassle. Any way you look at it- options are always good. I can't deny as I hear other parents who have kids with other endocrine disorders using the diabetes model to make their kids' lives better- I have hope. I have hope that these systems will be the forerunners for treating many conditions. So here's to the artificial pancreas and the systems it will lead to. For diabetics and other biological conditions.