Brendon Tarmey's List: CAP101 Research Project

• The insulin pump is a medical device used for the administration of insulin in the treatment of diabetes mellitus, also known as  continuous subcutaneous insulin infusion therapy.

  • I like how this site not only explains what a insulin pump is, but it shows great pictures of all the parts involved as well as pictures of how to fill the cartridge. Great!
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• An insulin pump is an alternative to multiple daily injections of insulin by insulin syringe or an insulin pen

  • Alternative, but better? Some may say yes, but notice of improved insulin analogs may suggest otherwise. Imroved (or in a way, more intelligent) insulin analogs are working towards doing the work of a pump without the pumo.
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• Advantages of  pumping insulin
• The alternative basal insulins, such as the long lasting insulins injected  once a day, often release their insulin at a very unpredictable rate.

  • Might new insulin analogs improve this unpredictability?

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• Continuous glucose sensing: future technology developments.

  • One of, if not THE, newest, most prevalent tech developments. Not directly involved with insulin delivery, but definitely indirectly. You have to monitor your glucose to know how much insulin to give, this is continuous monitoring.
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• The data from blood glucose meters are discontinuous, providing only an estimate of the "amount" of glucose.
• integration with other technologies.

  • Animas Ping, for example? CGM + Pump
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• closed loop (artificial pancreas), the "Holy Grail" of the diabetes device industry

  • I like this metaphor. Very accurate.
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• Third, the patient should feel unencumbered. Integration with other instruments used by the patient, including insulin pumps and pens, and blood meters is essential.
• And, if the future market for sensors is the same as it is today for meters, it will probably consist mainly of insulin users
• What can this window into the body's biochemistry do in addition to helping insulin using diabetes patients?
• Recent studies of high hemoglobin A1c, insulin-using patients indicated that patients with an A1c above 10% had average overnight blood glucose levels above 300 mg/dL when observed with a sensor during a control period when they could not see the data. (3) Over the following 2 weeks, when the patients could see the data, average overnight glucose levels dropped to around 250 mg/dL.

  • Shows how CGM can improve effectiveness of insulin usage.
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• Would this type of behavior modification extend to other diabetes patients who are not on insulin

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• Definition -  the  constant, continuous infusion of a short-acting insulin  driven by mechanical force and delivered via a needle or  soft cannula under the skin

  • This is just the definition of CSII
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• Benefits
   
  • More  predictable with fewer errors
   
  • Allows for  adjustable boluses to cover ingested  carbohydrates
   
  • Allows for  controlled adjustable basal levels of insulin to  cover (1) disparate levels of exercise (2) dawn  phenomenon and (3) fasting hypoglycemia
   
  • Reduces  hyperinsulinemia and weight-gain

  • These are the benefits... over what? Probably other common types of treatments such as oral medication or other forms of injection or types of special analog insulin.
• Problems

  • Important to understand and respect problems with pumps, even if they are considered better treatment overall.
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• figure out a way to inhale insulin, so diabetics can ditch the dreaded needle.
• And even if inhaled insulin makes it to market, injections won't become obsolete soon.

  That's because many diabetics need both short- and long-acting versions of insulin, and the new technology, for now, delivers only the former.
• Data so far have shown that some patients taking Exubera developed antibodies to insulin;
• Some patients also experienced coughing after inhaling insulin, suggesting irritation
• most problematic issue is the long-term effect of sending insulin to the lungs several times a day
• In trials completed last year, Pfizer and Aventis found small decreases in lung function in patients taking Exubera.
• other insulin delivery systems, including a patch and pill, are being studied
• Portable insulin pumps, which deliver the short-acting variety of the drug, have been on the market for years
• And pancreatic cell transplants are in trials

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• The AERX insulin Diabetes Management System (AERx iDMS) (Aradigm, Hayward, CA) delivers an aerosol of liquid human insulin to the deep lung for systemic absorption.