So this is less of a statement more of a question I’ve been asking as an aspiring bio-med engineer, I want to help research into an artificial pancreas or something to take away all the struggles of T1D, how far do you all believe we as a community of T1Ds can take this? Possibly even removing the need for insulin shots due to making artificial pancreisis available for most people? Or even finding something completely different? And what does everyone think of pancreas transplants? Too risky, or worth it? If anyone wants to theorize with me about T1 advancement’s please do!
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I like and admire your ambition, Landen @REESEScups07!
Do keep in mind that a true Artificial Pancreas will do much more than
“only” replace the beta-cells that produce insulin, but also provide, among other features, the alpha-cells, and the t-cells that work with the beta-ells to regulate the body’s glucose levels. A company, Beta Bionics, has been working on a project like this that uses a pump with dual cartridges - insulin and glucagon; currently at level four testing for approval
The person who discovered and identified insulin in 1886, and published a paper in 1889, Paul Langerhans, also identified the other cells operating to regulate body glucose levels - the section where these cells reside in the pancreas is called The Islets of Langerhans. Between 1890 and 1922 when Banting and Best hit upon pig insulin that would work in humans, there were many scientists experimenting in this attempt to help us.
there have been attempts at transplant but this has been found difficult - one factor is the difficulty getting to and retrieving a working pancreas from a donor. Whatever you can do in this field will be a BIG step for people like us - as we all know insulin - injected or infused - is just a stop-gap allowing us to live. Your ambition to create a working pancreas would do away from the needles and pump.
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Cool. I’m in engineering and I help create medicines for people and animals, and the machines that make it possible. I also worked for a major US diabetes supply company and in the early days of the 1990’s we played with pumps. Anyway it’s a rewarding vocation but you have to like difficult puzzles and math, a lot.
My distant cousin received a pancreas transplant when her kidneys failed (and needed s kidney transplant) as a result of diabetes. This is a “last ditch” strategy in my opinion. The longevity of transplant organs is not awesome and the anti rejection drugs are very difficult and can lead to additional complications. So the transplant for her was better because her choice was that or death. Granted, she makes her own insulin now but the cost is very high. Good luck @REESEScups07
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Artificial pancreas would be a huge step forward.
But the problem we’ve always had, as Joe mentioned, is rejection. T1D is usually an autoimmune disease. We’re diabetic because our own immune system attacked and killed our islet cells. It’s been over 30 years and I’ve still got antibodies against islet cells. If you gave me a new pancreas, my immune system would just kill it again.
30 years ago, they were talking about transplants and how to make them viable. And the immune system is always the problem. The patient has to be on immune suppressant drugs, which have their own major drawbacks. (Definitely not a situation you want to be in during a global pandemic, for example.) Even with those drugs, the most successful transplants I’ve heard of only lasted 5-10 years.
I remember back in the 90s there was a researcher in Canada who was working on seeing if they could encase the pancreas in a micron filter. Basically a mesh with holes just big enough for things like water, sugar, and insulin to pass through but just a little too small for antibodies to fit. But, while such a mesh exists, I don’t think it became a viable solution.
I know they’re working on “3D printing” new organs using cells cloned from the patient’s own stem cells, grown on a 3D mesh that ensures the organ takes the right shape and structure. If you could do that reliably and cheaply and at scale (we’re a long way from any of that, but it’s a worthy goal) then I suppose it might be possible to just keep growing a new pancreas to transplant once or twice a decade. Not ideal. But it could theoretically work.
For now, I’m grateful for my CGM and pump, which do a much better job of mimicking my pancreas than the tools I started out with when I was first diagnosed.
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More than 50 years ago, when my T1D struck me with a vengeance, the UCLA medical center staff told me not to worry, a cure was just around the corner. A nurse pulled me aside later and gave me a warning… “Diabetics lead short, troubled lives.” They were both wrong.
I’m 74, very healthy, 20-20 vision, no neuropathy, and sexually active. But, hell yes I’d like to throw away the pump, insulin & all of the related gear. I’d like to look at a piece of cherry pie and not just see carbs and calculations. I’d like to sleep the night through with zero fear of low blood sugar.
I don’t think you will find a single person in love with insulin, needles, pumps, transmitters, battery chargers, infusion sets etc. We must live with this stuff.
Your big fight will be big pharma & the medical industry that makes billions from us. But go ahead. Make us well. I will line up to be your first volunteer.
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Hi there landen,
this is something I’ve thought about too- usually when my teachers are going on and on and on… ;p I’d like to be a nurse someday (I’m not that great at engineering and stuff like that but I love people) and I enjoy reading any article I can get my hands on about diabetes related research- it’s fascinating.
I think that we can go pretty far in finding solutions for T1D. Nothing will ever replace our original, fully functioning pancreases but hopefully we can get close.
I think the biggest issue is going to be finding something that will work for everyone- all ages, sexes, health conditions, etc. it would have to be sustainable long term and be able to produce on a large scale because there are millions of people with T1D around the world. My main fear is that what might work for 60% of the population won’t work nearly as well for the rest- sort of like how everyone likes different types of insulin, pumps, cgms, etc.
As others have mentioned, transplants are risky and having to take medications that weaken your body’s immune system and other areas of your body isn’t ideal. Plus if the transplant were to fail, you could end up far worse than before. Unless if there was a very high success rate and they found some way to eliminate a lot of the risk, I would stick with insulin.
another thing- making sure that people in Africa (for example) have the same access to these types of cures as people in the United States or Canada. If people are dying because insulin just isn’t available, or they can’t get an organ transplant, how are they going to be able to afford or get access to a cure that could potentially cost hundreds of thousands of dollars?
Then there’s the cost- large companies are already making billions off of our need of insulin. How much are they going to ask for new technologies?
Those are just my thoughts. Correct me if any of my facts are wrong. I’ll be watching this thread- as a teenager with the prospect of having T1D for the rest of my life, new technology is definitely something intriguing to think about.
I think about that now and then. Having had Type1 for 60 years now though I think I would just keep doing what I’m doing now - using a pump - even if an artificial pancreas became available, as I don’t believe I would really be able to trust one completely.
Pumps and CGMS are great, and they must go through rigorous safety testing before they are put on the market - but even so, now and then “things happen,” and when they do I can take measures to bring things back in line myself. If an AP stopped producing insulin I could go back on a pump or injections (how ironic!) - but if it started over-producing I couldn’t simply pause delivery or disconnect. What if my AP started “gushing out” insulin nonstop for some reason? How long would I have to binge to keep up with the out-of-control production should something like that occur? How much glucagon would it take? And what would I need to do ultimately to get it to stop - have emergency surgery to remove it? I couldn’t just go to an emergency room and request the surgery on demand. As for CGMs - they are wonderful, but do not work equally well for all people.
I’m not ordinarily dramatic, but I like to plan for the absolute worst case scenario, even if it is highly unlikely.
As careful and responsible as they try to be when designing medical devices - engineers, researchers, doctors etc are human and there is always the possibility of human error, or that something will not work well for a particular individual.
Of course if everyone thought as I do we would not have gone to the moon - but I’m going to err on the side of safety myself.
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amen. and hours of monitoring to make sure things don’t tank just b/c you ate a slice.
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I have ZERO interest in a transplant if I have to take anti-rejection drugs. That would be trading one bad thing for another IMHO.
I am also like @wadawabbit in that I don’t want to trust my life to machines. That’s the main reason I have not gotten on a pump. I worry that it could “gush out” insulin in case of a malfunction. I know that will never happen blah blah blah.
I resigned myself a looooooong time ago that life for me will be testing my blood (CGM now) and taking shots and I have accepted it.
But I appreciate what you’re doing and hope for the best.
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The anti rejection drugs make me a non starter for a transplant. I don’t want to live in a bubble to prevent being constantly sick. I would love to have an artificial pancreas, i hate the worry about losing a site due to sweat/exercise. This is a common issue for me that I cope with but sure would like to divest myself of.
Such an interesting discussion. My husband asked me recently. do you think there is actually ever going to be a cure/solution? or did I think big pharma will always block it. I told him, I think big pharma will always try to block things, but I also just have to have some sense of hope. I’ve done this for 37 years, and my 12 yo son has for 3 yrs. It’s manageable - but also a maddening monster. Wanting better for myself is one thing, wanting better for him is even bigger. My heart wants to believe there is better out there - my logic says we are closer to better options, but hard to truly believe in a cure.
As for a transplant - not on the radar for me. too much risk
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Ji Karen @T1Dx2, there is hope for a cure and my “optimism” is higher now than ever before during my seven decades figuring out how to live well with diabetes; you may not be “cured” but your son has greater chances. Read some of the studies, and they do not all involve anti-rejection therapy.
A few years ago, following a process our daughter discovered [in her investigational quest to cure cancer] I volunteered to let her experiment in me with CRISOER-Cas9 in a way I envisioned would cure my diabetes - she told me I was too old to consider that. Since then, some institutions [including JDRF] have sponsored projects following her process and have trials underway. There is hope!
Definitely closer…and I’m not pessimistic, hope is all we can do. I count my blessings that my son was dx in a day of closed loop pumps. Game changer for sure.
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Haha I can relate to the reluctance to trust a machine with my diabetes. I’m always paranoid about what my pump is doing and if my CGM is accurate. I’d have to see someone with an artificial pancreas living “normal” life for several years before I considered any kind of major change in my diabetes care.
The idea of closed loop pancreases, the kind where you don’t have to count carbs, makes me nervous. Highs are the worst feeling in the world and I don’t want the thing accidentally overdosing insulin or glucagon and putting me in the ER.
Like @jdiesel mentioned, I don’t appreciate my pump site and it’s so easy to pull/sweat/soak off in the pool. I don’t think adding another set of tubing and tape would work well for me.
But all of that being said, I’m hopeful that we can find some sort of solution and I’m looking forward to new tech. I’m super excited about the new Dexcom G7 (yay for increased accuracy!!) and I can’t wait to get it!
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I was diagnosed 41 years ago and I too was told there would be a cure in five years! Been waiting a long time! Lol! Melinda
Thank you all for engaging with this, due to this I’ve come up with a few ideas on how to create this thing! Namely, Bluetooth connection to your phone AND a device you would receive after the surgery that can shut off functions of the pancreas. Also, something interesting I found:This new study capitalizes on the unique attributes of modified donor white blood cells, which were infused into transplant recipients one week before and one day after the transplant, thereby recapitulating nature’s formula for maintaining the body’s tolerance of its own tissues and organs. Without the need for long-term antirejection drugs, islet cell transplants could become the treatment option of choice, and possibly a cure, for many people burdened by type 1 diabetes.
If you’re talking about a thing that can be turned off via Bluetooth, how is that functionally different from a closed loop insulin pump?
Also: As mentioned, despite being diabetic for over 30 years, I still have anti-GAD and anti-islet cell antibodies. So I’m not sure modifying donor cells is really going to keep my immune system from targeting a transplant when it’s already primed to kill off my own body’s natural pancreatic cells.
I don’t want to shut you down, but I’m not sure I understand where you’re going.
Landen @REESEScups07, I like the sound of your research effort; personally I am not enough of a medical researcher to give an opinion. Our daughter who is an investigative medical researcher has already shot down some of my ideas.
A place to try for anti rejection information is Moffitt Cancer Center located on the campus of USF in Tampa; I don’t have names of the physicians. I knew a person who had success there by having his own cells drained from his body for about a month which were lab-modified and then the treated cells were put back into him before transplant. Apparently successful.
The complexity and intricacy of our bodies continues to amaze me. Anyone who finds a cure or works toward treatments for autoimmune or genetic diseases is a truly gifted and exceptional person.
One question Landen @REESEScups07 - how does a Bluetooth device “turn off” cells? Or are you thinking about an implantable device that somehow makes insulin and a host of other hormones? Sort of like a metal knee replacement?
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That’s a great question and im glad you’re asking!
My current plan, like with all engineering, is meant to change over time, but the first hypothesis is using something that allows only insulin and glucagon to get through, something that wouldn’t need to read to read your BG, I would need doctors and many medical advisors of course to see how this would work, but anyways, the current model I’m envisioning would be something to perfectly mimic the job of a natural pancreas, but if it starts malfunctioning, a fail safe could be as easy as the thing producing it would completely stop itself, turning back on might be an issue but if so it would only mean I get to do what I love most more! Engineering more solutions! Instead of stopping the transmitting device, it would stop the production device as to not cause malfunctions such as too much insulin or glucagon causing the transmitter to burst and then the insulin gets in places it shouldn’t etc., the idea for this would be like other artificial organs of its kind, I believe that this could eventually be a massive breakthrough! And like I said, the whole idea is that this is before a rough draft, this is just to get the boat sailing and research started, the heart of engineering especially bio med, is that you will never be right the first time around, it takes so many tries before the figurative boat sails!
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