[bayesian_horse]

That's not the point.

There are three things to an "artificial pancreas": glucose sensor,insulin pump, and the control logic. The difference between an artificial pancreas and the "manual" operation is just that the control logic is automated.

You even can't "fuck up" very easily, unless you add other diabetic stupidities on top of a malfunctioning control logic. Two failure conditions: a) Too little (or no) insulin delivered. b) Too much insulin.

The second one is the more dramatic/short term. The insulin pump has a limited supply of insulin. The speed of injection is limited. There are probably additional safeguards in the pump's software around knowing you are not an elephant breaking into a candy shop. And you feel the pump acting. You can pull it out if it behaves strangely.

Too little insulin delivered may be trickier, but you still have to check the glucose levels occasionally, probably multiple times a day.

Patients already use "algorithms" for insulin delivery. But they are comparatively shitty and designed for example to deliver insulin as a bolus after a meal. Continuous administration of insulin over a pump already has a lot of benefits. A continuous monitoring already has benefits.

[liamzebedee]

Although I would highlight - there is additional high risk now if the sensor becomes faulty, in which case, more insulin could be delivered for incorrect levels while you sleeping, etc.

[bayesian_horse]

I don't know if insulin pumps are used while sleeping. After all, there's a needle inserted in your skin.

You wake up from hypoglycemia, long before there is more trouble. And the sensor doesn't post glucose levels for example if it gets detached.

[wbrasky]

Insulin pumps (and their cannula; not a "needle") are installed 24/7. They can be "suspended" and the insulin delivery hose unhooked, but they are generally there, and active, at all times. Likewise, a CGM (continuous glucose monitor) will provide, as the name says, continuous monitoring. Both use adhesives to keep them attached and generally remain so, even while sleeping.

Hypoglycemia also may not lead to "waking". After all, a diabetic coma may result from low blood glucose, depending on how quickly it crashes.

Source: my girlfriend is Type 1.

[bayesian_horse]

Diabetic coma is caused by prolonged hyperglycemia (too much blood sugar) and diabetic ketoacidosis. Many diabetic patients go through months of hyperglycemia and even ketosis before they even know that they have diabetes.

Hypoglycemia in healthy adults mainly results from not eating and develops rather slowly. It's hard to recognize at first, but it will get a lot more obvious before it gets serious.

Hypoglycemia in diabetic patients is more often caused by too much insulin delivered at mealtime and this happens more quickly. Patients can become unconscious before they notice the problem, but usually they recover even without treatment. The goal of diabetes treatment is to avoid this hypoglycemia, also because the body reacts with increased glycogenesis leading to an overshoot of blood sugar.

There are sometimes suicide attempts with insulin. This rarely succeeds, it can result in brain damage, but mostly the patients wake up sometime later.

At night an insulin pump would not need to deliver that much insulin. There are also very long-acting types of insulin, which may be preferable to the short-term insulin in the pump to achieve the "baseline" during the fasting period. Or not. That's a strategy question, I guess. I had type 2 for a short time, and I used long-term and short-term insulin at meal times, with the finger-pricking type of measurement.

I don't think insulin pumps would carry enough insulin or are able to deliver enough.

My point is that there is a relatively large margin of error for any algorithm or software before serious harm occurs, and that the continuous monitoring and delivery is already superior in achieving good glucose curves, regardless if the control loop is manual or automatic.

I've read that continuous sensors help patients to have fewer incidents of hypoglycemia.

[liamzebedee]

Haha, I'm the OP, I use the insulin pump ;)

> You wake up from hypoglycemia, long before there is more trouble

And this is one of the main styles of diabetic death - not waking up (diabetic comatose).

> And the sensor doesn't post glucose levels for example if it gets detached.

I was more referring to the circumstance when you're lying on your sensor in a funny way, and it begins reporting incorrect levels.

[bayesian_horse]

You can loose consciousness from hypoglycemia, but normally the body will do everything it can, even autophaging your heart muscle proteins to bring it back up. Unless you have been fasting for a really long time, it will just release glucose from glycogen reserves and you recover quickly.

The diabetic coma thing is the opposite spectrum when the blood sugar is extremely high but the cell metabolism has to run on ketogenic fuel because it gets no glucose. Which leads to ketoacidosis, which can ultimately lead to a coma.