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by cpwright 696 days ago
One thing that I would object to is this characterization from the article:

>There are people who take insulin pumps (which provide insulin in very small very frequent doses and are ~permanently injected into your body, but are otherwise dumb as a brick) and combine them with continuous glucose monitors, and make the glucose measurements inform and control the pump. This is called “closed loop” or “artificial pancreas”, and getting one officially is very hard or impossible: not FDA approved yet / you need to be part of an university study to get one / … It’s one of those things that “will be here in 5 years”, they say every year for the past 30 years.

I've had a Medtronic CGM and pump for 6 years now (680G, now 780G). It is an FDA approved system with feedback from the CGM to the pump. The only thing I needed to get insurance approval was a blood test showing that I was T1 and not T2.

The auto mode has been greatly improved in the 780G pump vs. the 680G pump. I only need to stick my finger a couple times a week, and my control has improved. Without the pump and MDI it was quite a bit higher. It's nowhere near as good as an actual pancreas, but it is definitely not vaporware by any stretch of the imagination.

The Medtronic support is (mostly good), and I have a pretty high degree of confidence that it will keep me alive. I do have Kwikpens as backup in case of malfunctions - which do happen. The biggest things for me are as simple as ripping your infusion set out while away from home, or the thing has an intractable Bluetooth communications problem or other kind of hardware error.

The author is pretty much 100% right about "vibes" though, even with a pump.

2 comments

My wife is T1D and she is really scared about the idea of moving to a closed loop system with a pump, but her endo is constantly pushing her towards it even though she is keeping her A1C at like ~6% with her Dexcom CGM.

The concern is the the G7 CGM seems to have times where it is so wildly off with readings that a closed loop system could kill her. This weekend the CGM was saying she was all the sudden at 40, but she was at about 115. I am scared to think what would happen in the night if the closed loop system thought it needed to raise her blood sugar... Logically I know it wouldnt raise it to a point that would cause medical harm, it would still put it higher than would be ideal for her health.

Maybe there are differences between the different brands, but the G7 from Dexcom's big selling point was "no more calibrations" and the FDA approval for that tagline, and we've been seeing a need to calibrate more than the G6, which is disappointing. Granted... sample size of n=1 so...

I don't find the Medtronic solution to be that off. But the closed loop solution can't raise your blood sugar, it can only lower it. It only has insulin which it can dial back or increase. The real danger would be if it detected you very high and then tried to rapidly decrease it.

The FDA approved systems do have safeties in there that alarm persistent highs or on any lows. They also won't provide more basal than a multiple of the pre-configured setting you have.

The biggest thing for me was the 780G alarms less than 680G when there is nothing that I actually want to do to change it. Waking up all the damn time is no fun.

Ahh you are right, I had the situation reversed in my head. It would be the false high reading that would be the issue.

That is good to know there are some safeguards in place to prevent an over-correction.

And I agree about the constant wake-ups. The Dexcom system will sometimes not stop alerting when it detects a low, even if she has taken glucose tabs and knows it will be taken care of. If she doesnt interact with the notification it continues to alarm every 15 minutes or so. There is a recompiled APK for the dexcom apps that changes some of the notification behaviors but she hasnt needed to use that recently.

Hey, thank you for the correction! I am not keeping up to date with how are the closed loops progressing, and from quite a few of comments here it seems like the future is already here :) Maybe just not evenly distributed - I just need to wait for it to get from US to CZ. I'm glad closed loops are already helping people around the world!
I recently worked for a company called Tandem Diabetes which has multiple closed loop, FDA-regulated systems going back 9 years:

"In July 2014, Tandem announced that it had submitted a PMA for the t:slim G4 insulin pump, which integrated t:slim Pump technology with the Dexcom G4 Platinum CGM System. This device was approved by the FDA in September 2015."

https://en.wikipedia.org/wiki/Tandem_Diabetes_Care

We were still working on international support when I left last year. As you can imagine, there are quite a few regulatory hurdles esp. regarding patient data portability and access.