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Johns Hopkins Health Alert

Closing the Loop on the Insulin Pump

Johns Hopkins Health Alerts | Diabetes | Closing the Loop on the Insulin Pump

The marriage of the insulin pump and the new continuous glucose sensor could result in a true artificial pancreas in the not-too-distant future.

The insulin pump has been available in the U.S. for people with diabetes since the 1980s. The insulin pump delivers a small amount of insulin into the body throughout the day and also allows you to deliver a larger (bolus) dose before meals. Manufacturers of the insulin pump are introducing new features that could enable insulin pump users to get better results.

For example, Medtronic Minimed’s Paradigm insulin pump system has two features that could result in more accurate doses of insulin. The insulin pump has an onboard program that calculates the bolus dose based on how much insulin has remained in your body since your last injection, how high your current glucose levels are, and how many carbohydrates you expect to eat in your meal. You decide whether to dispense the suggested dose.

Insulin pump + continuous glucose sensor

The body monitors glucose 24/7 and diabetes equipment suppliers are trying to develop ways to mimic this function. Medtronic Minimed’s Guardian RT Continuous Glucose Monitoring System consists of a small adhesive sensor patch and miniature transmitter that radios glucose measurements to a compact meter that you carry around with you. The sensor patch holds a slim sensor wire that is inserted just under the skin. (The sensor patch must be changed every 3 days.)

The meter displays an updated glucose measurement every five minutes and can be set to notify you when your levels get too high or low. The meter’s memory can hold 288 daily measurements that you and your doctor can download and use to track trends in your glucose control. Prior to a general release on the market, the manufacturer is testing the system in selected cities. The Medtronic system doesn’t completely free you of lancets and test strips. The system requires two standard blood measurements per day for calibration. But if you are accustomed to frequent blood sugar checks, this system could make life a little easier, provide an additional warning of unexpected highs and lows during the day, and allow you and your healthcare team to better monitor your progress.

The progress in smart insulin pumps and continuous glucose monitoring foreshadow the coming of a true artificial pancreas. Such a system would include an implanted insulin pump controlled by an implanted glucose monitor. The system would automatically dispense insulin as needed. No human intervention would be required except to periodically refill the pump and change the batteries. In the meantime, diabetics can still benefit from incremental advances on the way to the artificial pancreas.

Johns Hopkins Health Alerts | Diabetes | Closing the Loop on the Insulin Pump

Posted in Diabetes on October 26, 2006
Reviewed May 2007

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