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Gary Scheiner, MS, CDCES
Owner, Clinical Director of Integrated Diabetes Services discusses
what AID systems can and can’t do

article by gary scheiner

What is your definition of a “cure” for diabetes?

Some people like to call semi-automated insulin delivery (AID) systems such as Tandem Control-IQ, OmniPod 5, Medtronic 780G, iLet and the open-source Loop systems as an “artificial pancreas”. 

HOGWASH!

I refuse to refer to anything as a “cure” or an “artificial pancreas” until I no longer have to invest my own energy and resources into my diabetes care.  Sure these systems help with some of the work, kind of like a vacuum cleaner alleviates the need to pick all the dirt from the floor by hand.  But someone still has to do the vacuuming.

Even with the latest AI-type diabetes technologies, we still have to bear the brunt of the work.

Automated insulin delivery systems

Consider what AID systems can and can’t do.

AID systems can, and do, adjust insulin delivery in subtle ways when glucose levels are trending in the wrong direction.  While this does not immediately fix the problem, it does reduce the magnitude of, and time spent with, high and low glucose levels.  The insulin delivered by the pump still takes a few hours to have a major impact, so adjustments to insulin delivery are like a big, fast-moving ship with a small rudder trying to make a sharp turn.

Just ask the survivors of the Titanic:  All you get is a very slow, gradual turn.  Nevertheless, automated insulin adjustments do lessen the burdens of living with diabetes and help to keep glucose levels within a reasonable range more often, with less micro-management by the user.

But without user engagement, the best one can hope to accomplish with an AID system is an average in the high-100s (8-11 mmol), an A1c in the 8-10 range, and about half the day within one’s target range.

In order to achieve quality glucose management, we still need to:

  • Manage the pump and infusion sites properly
  • Troubleshoot hyperglycemia in a timely manner
  • Make sure the CGM is functioning correctly (including calibrating when necessary)
  • Ensure that the basal settings and bolus dosing formulas are appropriate
  • Quantify our food and match it to the optimal doses of insulin
  • Time our insulin doses properly
  • Make adjustments for increases (and decreases) in physical activity
  • Utilize temporary “override” features for special circumstances
  • Download and analyze data for self-adjustment

And these only account for day-to-day glucose management.  There is a lot more to living with diabetes than just managing blood sugar! 

Here are just a few of the other responsibilities we have:

  • Preparing for, preventing, and properly treating hypoglycemia
  • Applying protocols for “sick days”
  • Employing coping skills for emotional health
  • Addressing mental health concerns
  • Ensuring that we get enough quality sleep
  • Screening for long-term complications
  • Practicing proper foot care, oral health, and heart disease prevention
  • Achieving and maintaining a healthy body weight
  • Preparing for crisis/emergency situations (including backup plans and hospitalizations)
  • Navigating health insurance and distribution channels to ensure we have the meds and supplies we need
  • Screening family members for potential autoimmune conditions
  • Incorporating ancillary medications in diabetes treatment
  • Educating family members and other loved ones on the nuances of diabetes

Automated insulin delivery systems are nice, but guess what? 

NONE of the items listed above are handled by AID.  Not a single one.  Until they are (yea, right), PLEASE remain actively engaged in your diabetes care.  Keep a positive, can-do attitude, and seek out the expertise of diabetes clinicians who can support you in fulfilling your many roles and responsibilities.

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