Ema and the artificial pancreas (part II)
How to make life easier with diabetes with the help of technology
Type 1 diabetes is an autoimmune disease in which the human body attacks and destroys beta cells located in the pancreas, which are used to produce insulin. Then, you no longer produce insulin, the hormone you need for glucose to enter your cells, but you have to take insulin into the body yourself, using injections or an insulin pump.
This is a story about how an insulin pump, a sensor that constantly measures blood sugar values, an Intel Edison minicomputer with a Linux operating system and free programs written by patients themselves try to imitate that organ without the help of pharmaceutical companies that are still developing the product. And how much this project helps those who use it. Something about this is also available in the second text. The first home-made artificial pancreas – in Croatia!
When our child got diabetes in 2015, I already knew something about it because her mother had diabetes for about 10 years at the time, but it is much harder to regulate diabetes in a three-year-old child than in an adult. Our day looked like this: measuring blood glucose from your fingers every hour or two, waking up at night and checking every two to three hours, limiting what and when she can eat, and giving insulin by injection after every meal – not at all cheerful and fun. The two biggest problems with type 1 diabetes are hypoglycemia – low sugar from which you can fall into a coma and ketoacidosis, a condition of long-term high blood sugar that produces ketones in the blood that can be dangerous to the whole body and also lead to coma. Fortunately, at the beginning of our diabetes story, a new glucose control device appeared on the market, FreeStyle Libre, which allows painless (no more finger poking) monitoring of glucose trends and values 24 hours a day just by pressing the reader to the sensor you wear glued to the upper arm.
Soon after we started using that sensor, we also got an insulin pump, a device that holds an insulin reservoir that is connected to the body through a catheter and delivers insulin whenever needed, without injections. It was a great psychological relief to her because we didn’t have to poke her finger sxđconstantly and to us parents because we had a constant insight into sugar movements that were never stable for long. However, waking at night too often and frequent glucose checks still remained. At night, we usually woke up every 2 to 3 hours for control, and if she ate some food that breaks down more slowly, there was often more control and correction with insulin. Sometime around that time, the #WeAreNotWaiting movement also emerged, which is actually made up of a group of programmers who have type 1 diabetes or have family members with the disease. They decided not to wait for the products of pharmaceutical companies and made their own artificial pancreas that would do the same as the real ones. The resulting project was called OpenAPS (The Open Artificial Pancreas System). In short, a sensor that reads glucose values sends this data to a computer that controls the insulin pump. If the glucose value rises, the computer gives more insulin, if it falls, the pump stops the flow of insulin. E.g. the sensor reads a glucose value of 4 mmol / L, the glucose trend is declining, there are no carbohydrates in the body, the pump stops and thus prevents a further drop in blood glucose. The same is valid vice versa, the value of glucose is 9 mmol / L, the trend is growing, the computer gives the command to the pump to deliver a certain amount of insulin. Sure, it’s not exactly such a simple algorithm, but some basic logic is.
How it works and looks like:
On the upper arm, you see a FreeStyle Libre sensor that measures the value of glucose and sends it via a MiaoMiao device, and a smartwatch that is on your hand and is connected to the Internet. The clock sends the data to the cloud via nanoSIM, from where the minicomputer (Intel Edison) downloads it and manages the pump based on this data and manually entered values of individual carbohydrates.
At the beginning of using this system, security was the item I devoted the most time to, i.e. it was necessary to anticipate what could go wrong and how to prevent it. After 10 months of using OpenAPS, the system not only proved to be safe but gave us extra security and speed in preventing
low and high sugars.
An example of how everything works
At night, Ema’s basal (basal is insulin that the pump constantly releases slowly and which covers the body’s basal needs such as breathing and digestion) is set at about 0.5 units per hour. Our goal is to maintain glucose levels at 5.5 mmol / L. If the value is higher, the temporary basal on the pump is raised to a value that the OpenAPS algorithm calculates will return glucose to the target value of 5.5 mmol / L. If the measured value is lower and the trend is downward, the temporary basal is reduced or completely extinguished to avoid hypoglycemia.
Within OpenAPS, there is also the option “meal soon” which, if we start it twenty minutes before the planned meal, sets the target value of blood glucose at 4 mmol / L, temporary basals rise, so during the meal the curve of glucose movement is “strengthened”. That way we have a much smaller postprandial jump.
OpenAPS is one of the first systems of its kind, created by patients themselves, and with the existing technology they came up with a solution to their health problems. Although this is not a cure for diabetes, it almost completely eliminates a large number of symptoms and problems that existed, and with the application of this solution, they disappear.