Bionic Pancreas

Introduction
It is an aid in the treatment of diabetes mellitus type I combining the dosing of insulin and glucagon with the measurement of blood glucose levels. This method of treatment helps maintain glucose levels in the target range for a longer period of time while reducing the incidence of hypoglycemia conditions This is currently a unique project that Edward Damiano Ph.d, Ms, BS is working on. This device is in the clinical trials stage.

Principal of bionic pancreas
The device uses Dexcom G4 platinum (continuous glucose monitor) to measure glucose levels at regular five-minute intervals. The measurement is performed using a glucose sensor inserted into the subcutaneous tissue. A transmitter is connected to the sensor, which transmits the data to the Dexcom receiver, which sends the received values ​​via Bluetooth to the Tandem t pump. The Tandem t pump uses a two-chamber system, one chamber is filled with insulin supply and the other with glucagon supply.

Thus, the device is able to respond to changes in glucose levels by releasing a specific dose of one of these two hormones. This ability to release insulin or glucagon leads to alternative names of technology, which are dual hormone, bi hormone , etc.

Mechanism and benefits of bionic pancreas
Using precise dosing, it is possible to influence the glucose level with insulin or glucagon.


 * Insulin administration lowers blood glucose levels. Insulin is given by calculating the current glucose level associated with the interim glycemia values


 * Due to various factors affecting glucose levels, such as physical activity, stress, etc., it is possible that glucose levels will drop excessively and hypoglycemia will occur (a problem with conventional insulin delivery). Another possible problem is insulin dosing during sleep, when glucose uptake is limited and so-called "Dead-In-Bed-Syndrome" can occur.


 * In the case of a decrease in glucose below a specified level, glucagon is applied by a pump, which acts as an insulin antagonist and at the same time promotes gluconeogenesis and glycogenolysis, and thus increasing the glucose levels.


 * The ability to respond to low blood glucose levels with glucagon, along with automation, is a major difference from conventional therapy.

Clinical tests
A number of tests were performed to compare the effectiveness of dual hormone therapy versus conventional therapy. For example, in a study entitled: "Comparison of dual-hormone artificial pancreas, single-hormone artificial pancreas, and conventional insulin pump therapy for glycemic control in patients with type 1 diabetes: an open-label randomized controlled crossover trial"

The study results
Time for which the glucose level was maintained within the established standards within 24 hours:


 * Dual hormone bionic pancreas: 63 %
 * Classical insulin pump therapy: 51 %

Number of hypoglycemic events within 24 hours:


 * Dual hormone bionic pancreas: 9 out of which 0 were symptomatic
 * Classical insulin pump therapy: 52 of which 12 were symptomatic

Similar results are also presented in the study: doi: 10.1503 / cmaj.121265

Conclusion
Based on the results of the study, it is clear that the method of treatment is a benefit for the patient.

Advantages

 * The length of time the patient's glucose level is maintained in the target range
 * Ability to respond to hypoglycemic episodes
 * Automation
 * Possibility of data collection
 * Personalized medicine

Disadvantages

 * Price
 * Insufficient number of clinical trials
 * Dependence on technology and energy
 * To date, no studies have been performed on the long term use of glucagon and its effects on the body

Related articles

 * diabetes mellitus
 * insulin
 * glucagon
 * insulin pump