What is the pancreas?
The pancreas is a triangular-shaped organ located behind the stomach. The larger end of the pancreas is called the head. The smaller end of the pancreas is referred to as the tail. The area between the head and tail of the pancreas is simply called the middle.
The pancreas is part of the digestive system and performs two important jobs:
- The primary job of the pancreas is to help with digestion by secreting enzymes that break down food to a usable form so the body can use it. These enzymes include lipase that breaks down fats; protease that breaks down proteins; and amylase that breaks down carbohydrates.
- The pancreas also produces hormones responsible for controlling blood glucose. These hormones include insulin that lowers blood glucose; glucagon that raises blood glucose; and somatostatin that modulates the ebb and flow of hormones.
Problems with the pancreas ultimately impact the entire body, so maintaining a healthy pancreas is vital for quality of life. Unfortunately, things can go wrong with the pancreas including pancreatitis, cancer, cystic fibrosis, trauma / injury and more. For a disorder that affects digestive enzymes there’s Pancreatic Enzyme Replacement Therapy (PERT), the only FDA-regulated enzyme replacement therapy currently. When blood glucose control becomes challenged, therapy can be complicated.
The pancreas and diabetes
While there are other conditions that can affect the pancreas, the most common disorder of the pancreas is diabetes. There are different types of diabetes. Type 1 diabetes begins with the immune system attacking the insulin producing beta cells within the pancreas. The result is an interruption in the availability of insulin. Insulin lowers glucose by opening the cell “doors” or cell receptor sites and allows glucose to leave the blood and go into the cell and provide energy.
There is also type 2 diabetes. In type 2 diabetes the body’s cells “resist” the work of insulin; this is called “insulin resistance”. Initially, the pancreas tries to make more insulin to overcome the insulin resistance. Over time the beta cells “wear out” and eventually can’t make enough insulin for normal blood glucose control.
When insulin is part of the solution
While insulin is clearly part of the solution in diabetes — it must be available and it must be usable — glucose management is complicated by things that cannot be easily managed, e.g., stress, illness, food composition, exercise, and more. It is the continual goal in diabetes research to find ways to improve blood glucose control and improve the quality of life for people living with diabetes.
To meet this goal, there are many new medications and improvements to older medications. With the inclusion of technology in our daily lives, there has been an explosion of ideas on how technology can improve the health and wellbeing of those living with a chronic illness.
The history of the insulin pump includes the transition from delivering small drops of insulin in a programmed fashion to insulin pumps that auto-adjust insulin delivery according to individual need.
Better diabetes management has also been supported by advances in individual glucose monitoring. Glucose monitoring has transitioned from urine testing to “hanging drops of blood” on a test strip, to a continuous glucose monitor (CGM) that checks glucose every 1 – 5 minutes. The improvement of glucose monitoring from an occasional finger-stick to 24-hours a day continuous glucose monitoring allows the user to know what the glucose did in the past, is doing in the present, and the expected trend 30 – 60 minutes into the future. The ability to adjust behavior to improve glucose control becomes easier with a CGM system.
What is an AID system?
When you integrate the insulin pump with the continuous glucose monitor you get what may be referred to as a “smart” insulin pump, “closed-loop” or “hybrid closed-loop” glucose control system, “automated insulin delivery” (AID), or an “artificial pancreas”. While the names vary and may create confusion, there are a few things that are good to know:
- Automated Insulin Delivery (AID) pumps must be used with a compatible CGM.
- AID pumps have different algorithms and may affect individual results. Users sometimes report different outcomes.
- AID pumps are not “plug-and-play”, that is to say there is a learning curve whatever system one may choose.
- AID pumps aim to minimize high blood glucose levels and reduce low blood glucose levels with less effort on the part of the user than non-AID pumps.
- Most AID pump users report an improvement in Time in Range (70 – 180 mg/dL) with less hypoglycemia.
A successful AID experience requires a properly functioning CGM and integrated insulin delivery system. It doesn’t happen often, but it is possible the technology might misbehave and produce undesirable outcomes.
Is an AID system right for you?
The decision is a personal one but should include the following questions:
- Do you use insulin and are you happy with your diabetes management today?
- Are you willing to put in the effort to learn a new diabetes management system?
- As potentially exciting an AID system may be, science has yet to produce an infallible piece of technology. Can you accept that?
- AIDs require giving up some control of glucose management. As the journey continues, can you give up some degree of control and trust the system?
The best diabetes management system is the best diabetes management system for you. Insulin pumps are just another insulin delivery system. For more information and to see if an AID might be right for you, consider the following resources: