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Diabetes looks like a pretty simple condition to manage to those of us who don't have it.
About one and a half million people with the type one variety and about four and a half million with type two who also require insulin deal with basically A lifetime of daily math tests, what are you eating?
When?
And compose of how many carbs?
What activities are you doing?
For how long?
At what time?
And how many hours would you sleep?
And when that would happen?
And what other medications and how much of them are you taking?
And make sure you get the answer right.
If you don't you'll at least end up feeling like hell.
You could end up in the hospital, you could even die from it.
So let's find out what's happening to make diabetes management, and insulin dosing significantly less taxing, with better outcomes.
Bigfoot Biomedical in Silicone Valley is one company developing what is known as closed loop insulin delivery.
CEO Jeffrey Brewer showed me how it works.
This is called a tether pump.
It has a tubing which will connect to this canula.
This is actually something that's worn on the body.
Usually you can see a little trickle flow of insulin coming out of there.
It trickle flows insulin all day long to cover what's called the basal metabolic needs of the body.
And then During meal time, it will allow you to deliver an extra dose of insulin that would cover the carbohydrates been consumed,
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This will live for the duration of the insulin in that cartridge there>> And then it's gone>> And then it's gone, this is the durable component, which has the brains>> The pump part is actually 2 part.
The smart piece of the pump body with the electronics, and the actual pump mechanism, which also contains a battery.
It's where you load up the insulin.
There's nothing to charge, nothing to refill, you discard it when it's used up.
In fact, Bigfoot's business model revolves around a subscription plan.
It regularly sends you everything you need, except the specific insulin you use, which drops right into their pump.
To give this all the data it needs to work you need a small wireless sensor.
Now in Bigfoot's case they use the Freestyle Libre from Abbott.
Like insulin pumps themselves, these wearable glucose monitors have been around for a while.
You stick it on your arm and wear it for 10 to 14 days.
These non intrusive wireless sensors currently report their data into a specialized handheld reader or an app on a phone.
And then leave it to you to do something with the information.
But the so called close loop model that emerging now, let's the sensor pump in it's little computer.
Automatically ticker insulin as you need it throughout the day.
And with more insight, because the sensor check blood glucose far more frequently than you want to stick your finger.
As with all big ideas in tech, more than one company's chasing this one from Medtronic, which is something of the grandparent of the medical device industry to tandem diabetes care whose closed loop system will use Dexcom's G6 monitor.
And non-profit Tidepool, which plans to commercialize the DIY loop closed loop insulin system.
2019 is shaping up to be a big bang year in closed loop tech
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For the person who's managing diabetes, this idea of automatic insulin delivery changes their life in two ways.
First of all, it really starts to get rid of the highs and the lows of blood glucose levels throughout the day.
That's key because those wide swings are the ones that often put someone with diabetes into a hospital.
Making their life very unpleasant for a while and causing their insurer a lot of money.
Secondly, you've got this idea of reducing cognitive load.
Even if you manage diabetes perfectly, there's nothing fun about that.
To take that away Lightens their day and lets them focus on more important things.
And those benefits will accrue to a rapidly growing number of people.
According to the World Health Organization, the number of people with diabetes has gone from 108 million in 1980 to 422 million in 2014, and will be a full 10% of the entire globe's population by 2045.
And in the US alone 40,000 people are diagnosed with type 1 insulin requiring diabetes every year.
They are the primary target of this closed loop insulin tech.
This closed loop tech isn't just about advancing the state of the art.
It's largely about improving the lowest common denominator.
Most people managing diabetes are not seeing an endocrinologist.
They're just working with their primary care physician, and may not be listening to what they tell them anyway.
Any scalable way to address this public health crisis of people whose lives are dependent upon insulin has the primary care provider at the center.
And that requires a drastic simplification of these tools, and making them more robust and hardy for real world use.
Where people are not reading instructions, where they're not listening to the doctor.
Close glute diabetes tech doesn't replace analysis by a doctor, but like most emerging connected heatlh, it moves the physician up funnel to focus more on the big picture.
It takes all the data analysis off the table of the clinician, they don't have time to do it today It actually will allow clinicians to spend more time with patients around behavioral issues or coma, morbidities, other things that a doctor is required to do.
In terms of actually tuning this insulin pump, this is a math problem and it has an answer.
Closed loop insulin systems could be a boon for children who require insulin but are not yet skilled at managing their condition.
Or for overnight insulin management during sleep.
Both are scenarios that currently are nerve-wracking and sometimes managed with a diabetic alert dog.
Unlike some technologies that come from startups who hope they'll be adopted.
closed loop insulin technology actually started years ago with the users.
When people began hacking their own close loop systems from existing sensors, pumps and open source software.
The hashtag that forms their rally in cry suggests this is a technology that has been waited on long enough.
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