
On Building My Own Artificial Pancreas - liamzebedee
https://liamz.co/blog/im-a-cyborg-now-on-building-my-own-artificial-pancreas/
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jacquesm
So, for those of you that feel that this is worthy of hacking: Diabetes is one
of those diseases that seems right where your average hacker would like it to
be. A single value (Blood Glucose Level) which you can read using some sensor
and an automated delivery method. Connect A to B using some 30 lines of Python
and call it a day. But it is not that simple. The manufacturers of these
devices have to go through some pretty strict testing regimes in order to
ensure the devices work well _when produced in quantity_. And that is where
the trick lies. Doing this once, for yourself with nobody at risk but you if
you fuck up and getting away with it is easy. Doing it repeatably for 10's of
millions of people with all your risks analyzed and regulators happy is very,
very hard.

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devoply
meh still it seems extremely trivial for pretty much any well funded startup
to do... and extremely surprising that it does not exist. i mean if theranos
can exist, why the hell is this problem not solved?

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jacquesm
Well funded start-ups (and established players) are all working on this. Given
that the market is huge and Diabetes is yours for life you can bet that a lot
of clever people have spent a lot of time on this. Not all of the companies
that work on this problem have made it, on top of that it is a patent
minefield. It will take you a few 10's of millions of $ or Euros to get to
market and you would need to do everything right the first time. Then you
still don't know much about how your device will function in the field until
enough time has passed that you can judge by the returns where you got it
wrong. Doing a respin is expensive.

So, Theranos can exist, and if the money that had gone to Holmes and then this
indeed would be a solved problem. But it didn't. Note that there are pumps
with a closed loop option on the market _today_ , but they are neither
convenient nor simple to use. It is work in progress. I fully expect a simple
to use closed loop system to be available in quantity somewhere in the next
year or two based on recent market research. The time is indeed ripe. The
basic tech is there and the pumps have achieved a level of miniaturization and
reliability that it is feasible, there are still problems to overcome but
those are all within the realm of the possible, do not require unobtanium and
enough parties are working on it (competition is fierce) that at least one of
them will solve it within that time frame.

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noir_lord
It's a damn shame that years after this became a thing we are still waiting
for a proper commercial product to hit the market _at a reasonable price_ , I
had a male relative with T1 diabetes and it was a complete burden on his life,
We have the technology to improve peoples lives markedly (because we already
did) but because of what the author mentioned in the article and the lack of
"skin in the game" manufacturers are still dicking about and a lot of this
only works because those manufacturers couldn't secure a blowjob in a brothel.

$8000 is just insane (yes I know FDA approval, testing all that jazz) but
there ~1.3m Americans with Type 1 diabetes alone, there is a massive demand
for a cost effective product at scale.

~~~
dekhn
Making a hardware product that is validated in a regulated market is non
trivial. At least part of the cost goes to reducing overall risk to a large
market, which open source projects aren't really resourced to address.

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amelius
Isn't it possible to design the product such that its risks are greatly
reduced? E.g. by limiting the amount of insulin it can deliver in a given
timeframe?

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dekhn
This comment falls under the "why don't you just..." cluster. Even
implementing a feature like that (assuming it made sense) carries risk
(imagine if your limiter's sensor broke and it failed open).

Designing reliable systems is incredibly hard. It requires a ton of resources
(money, lawyers, engineers) And experience and long time frames with
relentless effort to document everything so that when somebody does die, you
can root cause it and fix the problem without regressions.

I've been continuously impressed with what open source hackers have done with
open biology projects, but that doesn't mean any of these products are
reasonable replacements for the products that are used by tens to hundreds of
millions of people.

~~~
jacquesm
> This comment falls under the "why don't you just..." cluster.

It does, but just this once it is _spot on_ , the best pumps on the market do
just that.

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dekhn
yes, it's spot on, but only a tiny part of a much larger system. And even
implementing that feature is devishly complicated. Hence my statement "why
don't you _just_ ".

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chrispeel
I'm curious what the build-your-own-pancreas people have to say about
Tidepool's plan to build an iOS app to do the control logic, and at the same
time developing standard interfaces to insulin pumps and glucose monitors. Any
comments?

[https://www.tidepool.org/blog/tidepool-loop-medtronic-
collab...](https://www.tidepool.org/blog/tidepool-loop-medtronic-
collaboration)

~~~
jacquesm
> Any comments?

I hope they don't mess up the encryption on the pump commands. Especially with
pumps that can deliver high doses that can be really problematic.

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AdamJacobMuller
Is it possible to have interlocks whereby a pump will refuse to dose more than
X ml over Y hours or is a fatal dose for some people in some scenarios less
than a therapeutic does for others in other scenarios?

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friedegg
Yes, dosages vary by your size, weight, gender, stress, and other factors.
Part of type 2 diabetes is often insulin resistance, but people with type 1
can also suffer from it as well (although it's not the cause of type 1). Some
people even need to use highly concentrated forms of insulin, ie U-500 instead
of the standard U-100.

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mirimir
This is absolutely amazing!

One thing that's unclear, and perhaps I didn't read carefully enough, is how
you're connected to this system.

Do you wear it? Or are you only connected while sitting, sleeping, etc?

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cypherpunks01
Read the man page! ;)

[https://openaps.readthedocs.io/en/latest/docs/Gear%20Up/pump...](https://openaps.readthedocs.io/en/latest/docs/Gear%20Up/pump.html)

~~~
mirimir
OK, I guess. But I was looking for something in TFA.

~~~
liamzebedee
Hey Vlad - I added some pictures of what I actually wear day-to-day at the
bottom of the post. Hope this helps!

~~~
mirimir
Thank you!

So really that's not much at all. Impressive. So I'm guessing that there's a
strap/pouch for the pump, right? Are the CGM and injection port adhesive?

And for sure, you're a cyborg now ;) With a body area network (BAN). And with
much more stable insulin and glucose levels than you could achieve manually.
Very cool.

~~~
liamzebedee
Body Area Network! Hahahaha love it, going to use this :)

The pump is actually just in your pocket usually, with a big cord hanging out
ready to catch on things hehe. The CGM/pump sets are adhesive but not as much
as you'd want sometimes.

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bobowzki
I'm a bit annoyed people keep calling this an artificial pancreas. The
pancreas does a lot more than producing insulin.

