Dr Ananda Basu elaborates on the changing role of technology in Diabetes care.
What is pancreas?
The pancreas is an important organ located in the abdomen behind the stomach and is surrounded by liver, kidneys and spleen. It is necessary not only for the digestion of food but also for complex carbohydrates, protein and fat. It secretes important hormones such as insulin and glucagon which are very important for metabolism. Insufficient secretion of insulin or excess glucagon causes blood sugar levels to rise and results in Diabetes.
The pancreas is divided into two – exocrine and endocrine parts. The exocrine part of the pancreas secretes important enzymes such as amylase and trypsin that help in digestion by breaking down the proteins, carbohydrates and fat in the food. The endocrine part of the pancreas is responsible for maintaining blood glucose levels in the body. The endocrine part of the pancreas consists of the islets of Langerhans. These islets contain beta cells which produce hormones like insulin and glucagon and release directly into the blood.
In order to maintain blood sugar levels, our body requires insulin and glucagon. When food enters in the system, the digestive enzymes process the food. This leads to an increase in blood sugar levels. Insulin processes this blood sugar for the functioning of the body and thus blood sugar levels are maintained. When there are low blood sugar levels in our body, the pancreas temporarily stops secreting insulin and secretes glucagon to maintain the blood sugar levels.
Blood sugar levels fluctuate throughout the day and are managed by pancreas through the secretion of insulin and glucagon. During the night hours, our body tends to experience mild hypoglycaemia (low blood sugar levels). In such cases, a small amount of glucose is released from the liver and thus the blood sugar levels are kept normal.
Pancreas and Diabetes
Pancreas naturally secretes insulin and glucagon hormones that help manage blood sugar levels in a healthy body. Irregular functioning of the pancreas over time affects the body and can cause Diabetes. Diabetes is a group of metabolic diseases that lead to high blood sugar levels in the body. Regardless of its type, Diabetes means there is a presence of high blood sugar in the body.
Type 1 Diabetes is an autoimmune disease in which the beta cells that produce insulin are destroyed by the immune system. This impairs insulin production leads to high blood sugar levels. In order to manage blood sugar levels, people with Type 1 Diabetes are prescribed insulin injections. Type 1Diabetes is also sometimes called juvenile onset Diabetes as it is commonly seen in children.
Type 2 Diabetes occurs as a result of insulin resistance developed by the body. In Type 2 Diabetes there is either very low secretion of insulin or the produced insulin is inefficient to manage the blood sugar levels in the body. Some of the causes of Type 2 Diabetes are obesity, reduced physical activity, high cholesterol levels, high blood pressure and poor management of prediabetes. People with Type 2 Diabetes are sometimes prescribed insulin along with medication to manage their blood sugar levels.
Understanding the artificial pancreas system
Artificial pancreas system or closed loop system is an electronic, man-made pancreas system that works by mimicking the functioning of a normal pancreas. It consists of a glucose monitoring sensor, a Bluetooth enabled smartphone and insulin pump and an insulin delivering patch. In this system, the continuous glucose monitoring sensor, a device that sits under the skin, is used to measure blood sugar levels in the body.
The sensor constantly measures the blood sugar levels through and transmits the data to the insulin pump through Bluetooth service. An insulin pump is attached to the skin through a patch under the skin of the belly. The algorithm in the pump calculates the dosage of insulin required based on the data provided and infuses insulin accordingly. In this way, the loop gets completed.
Research studies are being carried on to design a pancreas system with an algorithm in the insulin pump which directly receives the blood sugar level data from the sensor. Studies are still undergoing regarding the intervention of the artificial pancreas system along with other devices such as a pacemaker for the heart. Also, cybersecurity of glucose measurement and insulin management is being looked at.
Benefits of artificial pancreas system
The artificial pancreas has been tested in both children and adults. The research studies have shown improvement in glucose variability and reduced cases of hypoglycaemia in children and reduced cases of hypoglycaemia and hyperglycaemia in adults on the artificial pancreas system. Research studies in the U.K have also shown positive outcomes in women with Gestational Diabetes.
The artificial pancreas system can be easily carried while travelling on land. The device can also be used while doing adventurous activities such as skiing. Also, any kind of exercise can be easily done while wearing an artificial pancreas system. Water activities such as swimming are restricted as some of the devices are not water-proof. The performance of the artificial pancreas system is yet to be seen in lower altitudes and during air travel. Any diet that is recommended by a dietician can be taken with the device system.
The artificial pancreas system also helps reduce the requirement of medication in people with Diabetes. Currently, the artificial pancreas system is not available for purchase, as it is a research tool.
The future with artificial pancreas system
Insulin pumps and glucose monitoring sensors without the algorithm are more commonly used by people with Diabetes. The artificial pancreas system includes an algorithm in the smartphone and the insulin pump which measures blood glucose levels continuously and delivers insulin accordingly.
In future, the sensors will directly communicate with the insulin pump, informing the necessary insulin dose. The algorithm in the insulin pump is being devised to learn for itself and recalibrate like artificial intelligence for better blood glucose management.
Another generation of artificial pancreas system is being devised to not only mimic the functioning of insulin but it also includes other important hormones secreted by natural pancreas such as glucagon.
Artificial intelligence can certainly pave a long way in better healthcare. Artificial intelligence in devices such as the artificial pancreas system learns, adapts and adjusts insulin functioning according to the diet, sleep patterns, exercise regime, blood sugar and lifestyle patterns. Modifying technology according to the changing healthcare requirement can help provide better patient care for a physician and have ensured better health in people with Diabetes.