Life for Juvenile Diabetics is About to Be Improved by the “Artificial Pancreas”(Pedcast by Doc Smo and Sonya Corina Williams)

 

Photo compliments of Pixabay

Today, we’re talking about an interesting development in pediatric medicine that will likely revolutionize the management of  childhood onset diabetes, a disease also known as type I diabetes.  The advance is known as the “artificial pancreas”. It sounds like science fiction, but as you are about to see, it’s not and it’s almost here.

Musical Intro

 Detour Down Science Lane

In order to understand this new “artificial pancreas” technology, we need to take a detour down science drive, and make sure your knowledge of glucose metabolism is up to speed. Glucose is what is known as a simple sugar because it is very easy for your child’s cells to burn for quick energy or to store as fat. Your child’s body has to keep their blood sugar in the “Goldie Locks” range in order to be in good health, with a blood glucose not too high and not too low. A high blood glucose will produce diabetes symptoms like excessive thirst, excessive urination, fatigue, and possibly even coma and death. Low blood glucose can be equally dangerous since your child’s brain almost exclusively uses glucose for energy. Without enough glucose in their blood, your child will first get sweaty and weak and, if low enough, then slump into a coma. As you can see, whether high or low glucose, it’s all bad. Insulin, a hormone made in your child’s pancreas, is the hormone most responsible for regulating the glucose system. In a non-diabetic child, insulin unlocks your child’s cells to get glucose into cells and therefore out of their bloodstream, thus lowering their blood glucose. When glucose is scarce, like during fasting at night, insulin levels are usually low. When glucose is plentiful like after a big meal, your child’s pancreas is busy making insulin to push that excess glucose into fat cells. So, you can see that your child’s pancreas, the place where insulin production is controlled, acts as the master regulator of your child’s very important blood glucose level.  And remember, a pancreas does this all automatically.

 

Now let’s consider what is happening in a child with childhood onset or type 1 diabetes. Unfortunately, in this condition, the pancreas cannot make adequate insulin in response to a meal since the cells that produce that insulin were destroyed by an autoimmune process when the child first became diabetic. A type 1 diabetic child has to control their own blood sugar by a combination of carefully measured food intake balanced with exercise and insulin injections. Balancing all this is very difficult as you might imagine. This is a continuous job, 24/7, year in and year out, for the rest of the diabetic child’s life. No wonder so many teenage diabetics rebel and just refuse to manage their disease, often with horrible consequences as a result.

 

 

 

 

History of the Management of Type 1 Diabetes

To understand just how big a leap the artificial pancreas is in the management of diabetes, it helps to know how it has been managed in the past. The treatment goal when helping a child with type 1 diabetes has always been the same, keep the child’s blood glucose in the narrow range that the child’s pancreas did before they got sick. In the early days of diabetes management, doctors did this by having children taste their urine to see if was sweet or salty. You see, normal urine is salty and diabetic urine has a sweet taste because some of the excess glucose in their blood has spilled over into their urine. When the child’s urine turned sweet, that meant they needed an insulin injection to lower their blood glucose. Next, came what was known as the sliding scale management method, measure the amount of sugar in the urine with as chemical reaction rather than with taste buds. Insulin administration was thus adjusted by the amount of glucose in the child’s urine. This offered a little more refinement than tasting urine but not much. In the past few decades, came the finger stick measurement of blood glucose and adjustments being made based on this data. Still better but really not tolerable for most children. Recently, along came continuous glucose monitors along with insulin pumps. Finger sticks and insulin shots were gone but this type of management still required the child or their parent to make minute to minute decisions about how much insulin to administer via the pump. And of course, this process totally broke down when the child and parent slept since no one was awake to make insulin decisions. Which brings us to the current breakthrough of the “artificial pancreas”.  In reality, the artificial pancreas is simply a computer algorithm that links the data from the continuous glucose monitor to the insulin pump, eliminating the need for guesswork by the child’s parent or the child themselves. The biggest advance of this system is that it works when the child is sleeping. The current manual system can’t do that. Recent evidence has demonstrated a significant improvement in blood glucose levels with the artificial pancreas over the manual approach being used today. That improvement will likely lead to fewer diabetic complications and a better quality of life for those children who have access to it.

 

The Artificial Pancreas is Almost Here

Now you’re all caught up on the science and management of type I diabetes. This brings us to the very exciting technology in development – an ‘artificial pancreas’. The artificial pancreas essentially consists of two parts – a monitoring system for tracking blood sugar levels and a pump that automatically administers insulin to the bloodstream to tightly regulate blood sugar, all controlled by a computer algorithm making the insulin delivery decisions. This algorithm essentially does what the child’s  pancreas used to do. Although the child’s pancreas is not making insulin, the artificial pancreas monitors blood sugar and automatically administers insulin via a pump as needed, effectively keeping blood sugar in the “Goldie Locks” range. If all goes as planned, the artificial pancreas will soon eliminate the need for constant monitoring and self-administered insulin, decreasing the risk of hypoglycemia, reducing patient burnout, and overall acting like a normal pancreas would.

 

The “artificial pancreas”  technology is still being developed, and has not been approved yet by the FDA, but the current data looks very promising. I feel confident that soon, the days of patients and their families living minute to minute around their child’s blood glucose will be gone thank goodness. Becoming a type 1 diabetic will no longer mean a life dominated by managing the disease. Type I diabetes still isn’t curable, but the artificial pancreas technology could and hopefully will, significantly ease the life-long burden diabetes management.

 

Outro

Thank you for joining me today for another edition of Portable Practical Pediatrics. My goal is to make you the best informed parent in the room. I hope today’s installment helps toward that goal. If you haven’t taken a moment to write a review of our podcast on Apple Podcasts or where you get your podcasts, please take a minute to do so. That helps other parents find our content. We would really appreciate your support. This is Doc Smo, broadcasting for the 11th year from studio 1E, hoping to keep your knowledge of pediatrics is first rate, and of course, up to date. Until next time.

This post was written by Dr. Paul Smolen and Sonya Corina Williams. Thank you Sonya.

 

Looking Within (Book Review Pedcast) by Doc Smo and Sonya Corina Williams


If you have a child in your family interested in pursuing a career in medicine and healthcare, do I have a great gift that you can give them!  Stay tuned to learn more.

 

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3 Parenting Missteps That Can Harm Your Children (Archived Pedcast)

Image Provided by Paul Smolen M.D.

Huntington Gardens, California

 

Knowing your own blind spots is an important aspect of being an effective parent.  I have been watching my own family, as well as thousands of others for the past four decades, and I think I have identified some parenting missteps that might be helpful for you to recognize, as you try and give your children the best childhood possible. Take a few minutes and read or listen to this installment of Portable Practical Pediatrics to find out what I have noticed.

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Doc Smo’s Annual Holiday Message 2020 (Pedcast)

Ten years of weekly podcasting, 569 published posts, and I am still going strong connecting to you, my listeners. And, it’s time for one of my favorite posts of the year, my annual holiday message. Today’s message is kind of personal and equally important. I hope you enjoy listening to it as much as I enjoyed writing it.

Image complements of Pixabay

Musical Intro

Why Healthcare for Doc Smo?

As a child, I had no idea that I could or would turn out to be a doctor. I liked math and science in school but mainly I wanted to be outside playing sports. When I got to college, I was forced to confront the question, “What am I going to do with this fancy education I am getting and what am I going to do with the rest of my life?” My strengths were in math,  science, and… hard work. The latter being the most important. I was an overachiever who knew my most powerful weapon was a good work ethic and persistence. Hard work and persistence were my secret weapons that had taught me that if I wanted something enough, I could get it with sheer determination. A career in medicine came up on my radar as a career path, initially, because a full 50% of my undergraduate class were pre-med.Maybe I could do that?  We all tend to want others around us want, right? So, I set out to find out if it was for me. As an undergraduate, I volunteered at a VA pharmacy, I worked summers in a neurosurgeon’s research lab doing dog and cat experiments, I got a part time job in a neurology lab doing some of the earliest research on brain neuro-transmitters, and I helped staff a free community medical clinic for disadvantaged residents in Durham, NC. The more I explored the world of healthcare, the more intrigued I became. Yes, medicine was going to be my path I thought.

I remember coming home during my 4th year of medical school and having a conversation with my father about my future. It’s in your fourth year that you have to choose a residency specialty. Its fish or cut bait time for a major life decision. I had decided on pediatrics for two reasons… I enjoyed taking care of acute illness in patients, children, who had incredible powers to bounce back from adversity and I loved the energy that children gave off. I just liked being around them. When I told my father of my decision I’ll never forget his response, “You have a license that allows you to do brain surgery and you are going to do what with it?” I explained my reasoning and he just listened. I knew what he was thinking though; he thought I was crazy to go into the lowest paying medical specialty that carried little status when I could have so much more. But to his credit, he never said another thing about my choice. He supported me in my decision. When the time came to start my residency, he even helped drive the 16 hours’ drive to my new life as a budding pediatrician.

The Reality of the Job

Pediatrics turned out to be everything I expected-lots of acute life-threatening illness where quick action rescued a lot of little souls. I was literally saving and changing lives on a daily basis. As my skills grew, the job became even more satisfying. When I entered the world of private practice and was making important decisions without supervision, I knew I had arrived. I was even beginning to get enough life experience to help children and families work through psychological stress and grow. Oh sure, there is a lot not to like about primary care pediatrics in those days, 80-hour work weeks, middle of the night trips to delivery rooms and EDs, and the nearly constant intrusion of phone calls. But underneath all that, there was the knowledge that I was doing something important to improve people’s lives. I was helping my patients and they were proving to me that I had made the right career choice.

Would I Do it all Over Again?

People often ask me if I would do it all over again? Was this a good career choice looking in the rear-view mirror. For me, the answer is an unequivocal yes. Why, because as the name says, I was in the “caring” business, the “healthcare” business. I was being well paid to “care” for children and families.  When you think of other professions, think about the verbs that we associate with them; lawyers provide counsel, accountants help you make sound financial decisions, architects and engineers provide blueprints and plans, and university professors provide enlightenment. All important and noble professions but not as important as doctors who provide care, healthcare.  There is an intimacy in practicing medicine that other professions can’t touch. So yes, I would do it all over again.

My Holiday Wish for Your Children

So why have I told you all this about myself? Because my holiday wish for your children is for them to eventually find their own meaningful life work. I think their choice of an occupation is as important for them as choosing the right mate, nurturing their children, or leading a virtuous life. In my mind, we were born to work and to serve. I want your children to start the process of finding work that is fulfilling , now, while they are still under your roof. How do you do this you ask? Here are my suggestions to get you started:

-Let your children try a wide range of activities and skills so they can discover their unique interest’s.

-Teach your children about the importance of work to living a full and rewarding life.

-Discuss with your older children what you find rewarding about your own work whether that be a W-2 job, running a household, or volunteer work for your community.

-Set a good example for your children by having a positive attitude toward your work.

-Help your children think through the different types of occupations that suit their personalities and talents.

-Stress with your children that it is an honor to work and support your family and community.

-Point out to your children that most of their adult lives will be spent working. They need to find work that is both interesting and meaningful.

 

It’s that simple. Don’t underestimate the influence you have on your children’s attitudes and motivations. Ultimately, your children will need to find their own path but your input and guidance is very valuable to them. Don’t hesitate to provide it for them.

 

Outro

Well, as always, thanks for joining me today. I am honored that you chose to spend a little time with me today. We at Portable Practical Pediatrics try very hard to bring you thought provoking information and insights. We hope you will tune in again soon. Feel free to check out our library of 569 posts to date. I am sure you will find content here that will be very relevant to your parenting experience. This is your host, Dr. Paul Smolen, hoping that you found  good reason to keep listening this holiday season. Until next time.

 

 

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