

Diabetes Patients Are Hacking Their Way Toward a Bionic Pancreas - webhat
http://www.wired.com/2014/12/diabetes-patients-hacking-together-diy-bionic-pancreases/

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Houshalter
There was an insightful reddit comment about this:

>As someone who sells insulin pumps for a living, in my opinion this article
is slightly misleading. It makes it sound like the technology isn't there to
do exactly what the father/boyfriend want to accomplish: essentially they want
to obtain tighter control for the son's/girlfriend's diabetes. To be clear, we
do currently have the ability to provide patients with a continuous glucose
monitor (which is relatively accurate), and along with that, a model of pump
which will stop insulin delivery if a patient's interstitial glucose goes too
low. What we don't have (that's described in the story) is a pump which
administers insulin doses automatically. But the reason for this is not
because of lack of technology... It's because of liability, and that's an
important distinction to be made. The boyfriend in the article who developed
the auto-delivery system using algorithms for bolus insulin amounts is not
doing anything new. In fact, most insulin pumps already have the ability to
calculate insulin doses for patients. Instead, he is just doing something that
the FDA will not approve of at this time. Every single diabetic responds
differently to insulin, and formulas can not necessarily take those variables
into account before insulin delivery. As a result, the amount of risk involved
at the patient level is too great for the FDA to say "ok" at this time.
Additionally, the insurance companies have no motivation to press on because
of how costly the approved technology could be. In any case, the article is
informative and does a really good job explaining in simple terms how diabetes
works. I do believe that we will see a manufactured cure within the next few
years (I.e. artificial pancreas) and potentially an organic cure within the
next 10-20. Those people who have diabetes deserve that technology and I am
confident we will provide it soon :)

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lucaspiller
In terms of the liabilities it isn't really any different to a pacemaker - if
it fails, the person most likely dies. The difference here seems to be it's
just solo hackers doing the work. Are any of the big medical companies looking
into developing a device like this?

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maxerickson
There aren't really practical alternatives to a pacemaker though. I guess the
FDA would even push for the automatic control to be safer than patient control
before approving it.

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terminalcommand
As a 19 year old hacker, who has been diagnosed with type 1 diabetes for 8
years, I always had the dream of continuous blood sugar monitoring. But in the
real world, a lot of sick people don't have access to these opportunities. The
sensors that monitor blood sugar are expensive. I don't mind checking my blood
sugar 12 times a day, I hardly feel a thing anymore. The problem is that the
insurance only pays for 4 checks a day. If they really want to solve the
problem, they should implant the sensors with a surgical operation. Moreover
the catheters(infusion sets) we have to wear for our insulin pumps are often
faulty. When the needle hits a muscle tissue, it doesn't work, and you are
subjected to high blood sugar levels and frustration. Finally, I have to add
that, diabetes has been there for years. I was a child when I was diagnosed
and my parents never came to check on me every two hours. After a while your
survival instincts kick in and you start to feel when something is wrong. As a
person who experienced a range from 22 mg/dl to 798 mg/dl consciously, I have
to say continuous blood sugar monitoring could save us the excruciating hassle
of being alert all the time. With all that technology, and all the money they
ripped of from us, I think we deserve to get a secure treatment. Not a cure
maybe, but something that would ensure us that we don't get any serious
complications (like blindness per se).

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eatyourpeas
This is all well and good but there are significant safety issues here.
Insulin will kill you if you get the dose wrong. Or more worryingly, won't
kill you but will kill your child. As a children's diabetes doctor I know this
more than most. This article suggests that the only people interested in
fixing the closed loop are a bunch of amateur parents - there are large
studies going on in several centres across the world looking at exactly this
issue - the algorithms to match insulin to glucose are not straight forward:
insulin absorbs slowly, with peak action at 2 hours, gone by 4 hours. In
children absorption is less predictable - I have a baby on my ward now whose
'insulin-on-board' is 6 hours. The closed loop is the holy grail for T1
diabetes and there is a lot of time, intellect and money being thrown at it.
While open source hacking from intelligent and able programmers is always
welcome, experimenting on your own children is dangerous and ill-advised.

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caycep
Why no mention in the article of the actual "bionic pancreas" that has gone
through at least one preliminary clinical trial and was published in the New
England Journal of Medicine? Seems remiss of the reporter.

[http://www.nejm.org/doi/full/10.1056/NEJMoa1314474](http://www.nejm.org/doi/full/10.1056/NEJMoa1314474)

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orasis
A system that aggregated CGMS data from multiple people and used Gaussian
Processes to predict blood sugar would likely be the most accurate you could
get today.

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duaneb
Kind of weird the dude tried to hide his identity—is he doing anything illegal
by treating himself?

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aptwebapps
Probably doesn't want to be harassed for his solution.

