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.

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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.