7 ms·

Insulin lowers blood glucose, which of course is a vital tool. However, there appears to now be shelf-stable glucagon [1], a hormone which can be injected simil

by nahsra 3y ago

Insulin lowers blood glucose, which of course is a vital tool. However, there appears to now be shelf-stable glucagon [1], a hormone which can be injected similarly to insulin and raises blood glucose levels. AFAIK there is only one company, Beta Bionics [2], that is working on commercialization of such technology with dual pumps. In this case, you could be more aggressive in either direction of pushing BG, because you have a safety net. Because this feels like a holy grail / functional cure, I'm surprised the incredible DIY teams out there haven't trained their guns on doing this. Having both "turn it up" and "turn it down" knobs seems so much more valuable than squeezing the last 5% of efficacy of AID systems. I feel like glucagon is obviously "the answer", but I don't see much talk about it. Is the problem that there is no hardware for dual hormone pumps? I would have thought by now they'd have hacked 2 patch-pump AIDs to work simultaneously. [1] https://www.medscape.com/viewarticle/947962 https://www.medscape.com/viewarticle/947962 [2] https://www.thejdca.org/article/2023/06/05/fda-approves-beta-bionics-insulin-only-device-what-about-dual-hormone- https://www.thejdca.org/article/2023/06/05/fda-approves-beta...

jeroenvlek 3y ago
My wife has diabetes and her endocrinologist told me 5 years ago that the absence of shel-stable glucagon was the reason her insulin pump and glucose sensor weren't connected yet. Now she is actually using AndroidAPS, after I compiled it for her. Really happy to see that there are people now working on both gradients!
gustavus 3y ago
So my wife is a type 1er. The way glucagon fits into her life is that we have an emergency glucagon shot that she carries in her purse to use in the case of an emergency. The glucagon is more of an immediate emergency recovery. On the flip side glucagon doesn't lower the blood sugar which is dangerous when she is going high.
- uberduper 3y ago
  I may be misunderstanding something here. I'm assuming the emergency you're referring to is low glucose. Why would you use a shot of glucagon rather than a dextrose tablet for that sort of emergency?
  - db3pt0 3y ago
    A glucose tablet and a glucagon shot can both be used in emergencies, but they are best used to treat different levels of emergencies. You can take a glucose tablet if you're coherent and conscious, but when you're incoherent or passed out from a severe hypoglycemia, someone else administering a glucagon shot is a lot easier and safer.
    - uberduper 3y ago
      Okay that makes sense. Thanks. How quickly does a glucagon shot trigger GNG and how quickly can GNG raise glucose levels?
      - groundcontr01 3y ago
        In my experience it takes just a minute or two
awaywethrow 3y ago
My worry with this approach has been that infusion sites (both for insulin and glucagon) can become occluded, pulled out, etc. to suddenly render them completely ineffective, and that automated detection of these scenarios is not great. You need to move forward, and therefore must occasionally have a foot on the gas (insulin). The gas pedal failing, causing you to stop moving forward, is not urgently dangerous (hyperglycemia). However, if your brakes (glucagon) can sometimes fail completely, that could cause you to die almost immediately if you're moving too fast toward danger (extreme hypoglycemia). Given this situation where brakes are unreliable, do you want your automated control system to rely on them and push you to dangerous speeds?
- nahsra 3y ago
  The detectability of failure is an excellent point. Anybody who uses the hardware can confirm it's not 100%. I think your point helps me re-frame the glucagon as more of an insurance backstop for when we accidentally hit the gas a little hard, rather than a permission slip to constantly be going too fast and constantly be slamming on the brakes. Even in this framing, it still feels like an extraordinarily valuable addition, and relatively low risk. It's also, of course, more to add to the patient's maintenance, but might help them or their caregivers sleep at night.
  - awaywethrow 3y ago
    > It's also, of course, more to add to the patient's maintenance I agree with all that you've said, and this point in particular is extremely important. It's also the reason I moved from a DIY system like the one mentioned here, to a commercial system, once the latter was available. There is simply less hardware and software to juggle with the commercial system. There are fewer knobs, bells, and whistles, meaning I might not be able to tweak things to be in as tight control as might be possible with a DIY system (though with risks!), but overall it's been "good enough" for me, and greatly reduces the cognitive burden of having T1D. My experience clearly doesn't match everyone's, but considering I'm typically someone who loves to tinker, and has plenty of T1D experience (engineer, 34 years with T1D), I'm sure I'm far from the only one that feels this way. My glycemic control isn't significantly better than it was when I did it via constant monitoring and mental math, but the cognitive and emotional burden is much lower.
iaresee 3y ago
> Is the problem that there is no hardware for dual hormone pumps? All the well-tested pumps (Tandem, Omnipod, Medtronic) are insulin-delivery only.
- nahsra 3y ago
  Yes, but the "patch pumps" like the Omnipod are small enough you think patients might tolerate 2 of them? Maybe they've already asked, and people wouldn't tolerate it.
  - iaresee 3y ago
    Possibly. But it's more than that. You have site issues, even with one pump, that you need to navigate. There are only so many viable places on a body to attach a cannula for good absorptoin and, while small, these things aren't _tiny_ (especially the Omnipods where the site holds the cannula, pump and reservoir). It'll be a while before we see highly reliable and well-tested dual-reservoir systems is my bet. The complexities of balancing insulin and glucagon in a two-pump system are also high. And the feedback loop from sensors that detect BGL aren't super fast. My kid's Dexcom works on a 5 minute sample loop now. So you can't make decisions fast and when you do, you can't course correct a bad decision quickly. I love that people are working on this stuff. The folks at https://wearenotwaiting.net/ https://wearenotwaiting.net/ are amazing and we even use NightScout here, but the fragility of the systems are stark and it'll be a ways to go before it's not just the brave pioneers pushing these frontiers for T1Ds.
- haldujai 3y ago
  It's not because of pump issues but more glucagon stability and secondarily whether bihormonal is clinically advantageous. Tandem is working on a dual chambered pump. https://diatribe.org/jdrf-and-tandem-diabetes-care-announce-partnership-develop-dual-chambered-pump-artificial-pancreas https://diatribe.org/jdrf-and-tandem-diabetes-care-announce-...
  - iaresee 3y ago
    Yea, but "working on" is a bit different than "readily available and trusted to function well". Everything is harder with two delivery pumps.
jablongo 3y ago
For some background - I'm a T1D working on a search engine and conversational interface for integrating a bunch of new data sources and models into metabolic decision making: https://replica.health https://replica.health. I've also been a user of and worked on various open source artificial pancreas systems through the years, and am currently on Loop. >I would have thought by now they'd have hacked 2 patch-pump AIDs to work simultaneously. As you pointed out, the problem is not really hardware. It could technically be done in a straightforward way using two independently controlled insulin pumps, but the complexity and risk of the whole operation goes way up if you are taking way more insulin. Taking a bunch of insulin and glucagon at the same time is not necessarily a great idea either - they don't just annihilate each other without consequence and you could end up with secondary effects like gaining a bunch of weight. >Because this feels like a holy grail / functional cure Unfortunately it is not; even dual hormone systems have problems keeping up w/ the kinetics of glucose absorption and to address this there is also research into tri-hormonal systems, w/ amylin as the third hormone. In any case you will still need some a-priori info about meals and planned activities, though less so than with a single hormone system. Integration of exogenous data sources to provide this info to the APS is what we are working on at Replica. Also, hate to be the bearer of bad news but beta bionics has shelved their dual hormone ambitions for now; their prototype device soon to be released is insulin-only. On the bright side there is a small Dutch company whose tech predates beta-bionics. They sell a dual hormone device and will give it to you for a ton of $ (and probably have you sign a bunch of waivers): https://www.inredadiabetic.nl/en/discover-the-ap/ https://www.inredadiabetic.nl/en/discover-the-ap/
- haldujai 3y ago
  > In any case you will still need some a-priori info about meals and planned activities Not necessarily, at least not via patient input. In the albeit small Inreda studies manual announcement of exercise and meals wasn't required (or an option). Medtronic also has a meal prediction algorithm on their newest offering that's a step towards a fully automated process and currently more or less obviates carb counting but isn't at the point where you don't have to announce a meal (yet). Rather than integrating external data sources the algorithms are predicting based on historical glucose levels and/or insulin administration and it seems to be working. https://jamanetwork.com/journals/jamasurgery/article-abstract/2795853 https://jamanetwork.com/journals/jamasurgery/article-abstrac...
haldujai 3y ago
No, there isn't a hardware problem and such systems exist. Several trials[1-3] dating back several years have looked at "bionic pancreas" or a closed loop bihormonal system. Inreda (a Dutch company) has a CE-marked device[4] that can be clinically used but one limitation has been glucagon stability (has to be replenished daily). Tandem in the US was working on this as well but I haven't heard anything about them in a while, not sure how far along they are. The Inreda product is still in the early stages of testing but fully functional. Small crossover trials seem promising (defined by more time in euglycemic state). There is a competing approach with "intelligent insulin" or a self-regulating glucose sensitive insulin formulation that has different bioavailability depending on circulating glucose levels rather than relying on a monitor, this is farther out from clinical use. One of the reasons bihormonal pumps haven't entered mainstream use yet is that it's more expensive/complicated and the current techniques of algorithmic predictions of hypoglycemic episodes and insulin delivery suspension are already very good that hypo isn't much of a problem with modern devices like Tandem's offering. Medtronic has added a meal detection algorithm[5] that's really good too (the best on the market I'm told by my endo colleagues) and they say we're getting close to not needing meal announcement anymore, this practically eliminates carb counting. It's the first such algorithm to be in clinical use so we're not there yet but the expectation is that this approach will get us there. The question (for glucagon) then becomes how clinically useful more time in euglycemia is as the hypo episode problem is essentially solved, we'll need more data to draw any conclusions and it will take a while for this particular question as many of the outcome measures are long-term (i.e. what are the long-term sequela of mild intermittent hyperglycemia, it's somewhere between nothing and uncontrolled diabetes but how far along on that line is the billion dollar question). [1] https://pubmed.ncbi.nlm.nih.gov/28007348/ https://pubmed.ncbi.nlm.nih.gov/28007348/ [2] https://jamanetwork.com/journals/jamasurgery/article-abstract/2795853 https://jamanetwork.com/journals/jamasurgery/article-abstrac... [3] https://pubmed.ncbi.nlm.nih.gov/24931572/ https://pubmed.ncbi.nlm.nih.gov/24931572/ [4] https://www.inredadiabetic.nl/en/discover-the-ap/ https://www.inredadiabetic.nl/en/discover-the-ap/ [5] https://www.medtronicdiabetes.com/products/minimed-780g-insulin-pump-system https://www.medtronicdiabetes.com/products/minimed-780g-insu...
- nahsra 3y ago
  It's not clear from their site whether the Inreda product also has CGM built into it, or if it must be paired with one? Glucose-responsive insulin also seems like science fiction as this point, but would be extremely powerful tool. I'm very familiar with one of the most popular, closed-loop system combinations in the USA and I definitely don't feel the hypoglycemia problem is anywhere near "solved". There is too much volatility dictating a person's insulin sensitivity that even today's smartest systems will regularly give too much insulin, requiring treatment, or too little, resulting in prolonged hyperglycemia. I agree that time-in-range is incredible today with the technology, comparatively, but there's still lots and lots of room for improvement.
brudgers 3y ago
My assumption is that the DIY Pancreas community is well-informed, technically capable, and highly motivated. My guess is it hasn't done what you suggest for practical reasons related to supply chain, intended user base, and practical engineering considerations appropriate for high reliability mechanical design for medical use. For example, the insulin delivery system has many points of failure. Any fault or failure is likely to have severe health impacts on the user. To a first approximation, doubling the number of pumps doubles the points of failure. But I could be wrong.
cperciva 3y ago
Glucagon should probably be a safety net, not something you use regularly. Taking too much insulin and compensating with glucagon leads to long term weight gain among other things. Dual pumps are being worked on, but it's not yet clear that the improved glucose control justifies potential long term consequences.
samstave 3y ago
You know what cyberpunk future I am looking forward to ; Bionic Arms/Limbs whi are chosen to be replaced, but in the place of the bicep is a blood filtering, monitoring mechanism that keeps your blood hyper oxygenated and tracked... Although, to go along with the cyberpunk theme ; If you want to kill a Cyborg, you just rip off his arm...
- smoldesu 3y ago
  It's fun to imagine a future where we can design human body parts better than our body but can't figure out how to unplug them without a mess. Damn Magsafe patent still holding up in 2077...
TaupeRanger 3y ago
The only way to "cure" diabetes is to replace the pancreas or get the cells to go back to behaving the way they were before insulin resistance. The 1st is incredibly risky and wouldn't be pursued for that reason. The 2nd is most likely to lead to a cure, using a morphoceutical approach that reprograms or replaces the misbehaving cells.
DoreenMichele 3y ago
There's a lot more going on in the body than this. Muscle protein influences insulin resistance. Diabetes is strongly associated with inflammation which may imply that infection or pH balance (or both) plays a role. For functional hypoglycemia, metabolic syndrome and T2D, dietary changes can have substantial positive impact. I'm thrilled to see this is happening, but the chemical inputs and various metabolic factors are far more complex than "sugar in, one hormone to lower blood glucose levels and another to correctively raise it."
jeffybefffy519 3y ago
The thing is - the ideal solution injects 100% the right amount of insulin and no glucagon because insulin is a growth hormone and too much of it makes you gain weight. Body builders have been known to use insulin to gain muscle.
DavideNL 3y ago
> AFAIK there is only one company… Inreda: “A bi-hormonal fully closed loop system”: https://www.inredadiabetic.nl/en/home-english/ https://www.inredadiabetic.nl/en/home-english/
markdown 3y ago
> Beta Bionics [2], that is working on commercialization of such technology LOL, so no end then to the American insulin caravans to Canada?
conceptme 3y ago
There is https://www.inredadiabetic.nl/ontdek-de-AP/ https://www.inredadiabetic.nl/ontdek-de-AP/ which has both glucacon and insuline maybe there are others still in testing phase though.

by nahsra 3y ago

jeroenvlek 3y ago

My wife has diabetes and her endocrinologist told me 5 years ago that the absence of shel-stable glucagon was the reason her insulin pump and glucose sensor weren't connected yet. Now she is actually using AndroidAPS, after I compiled it for her. Really happy to see that there are people now working on both gradients!

gustavus 3y ago

So my wife is a type 1er. The way glucagon fits into her life is that we have an emergency glucagon shot that she carries in her purse to use in the case of an emergency. The glucagon is more of an immediate emergency recovery. On the flip side glucagon doesn't lower the blood sugar which is dangerous when she is going high.

uberduper 3y ago
I may be misunderstanding something here. I'm assuming the emergency you're referring to is low glucose. Why would you use a shot of glucagon rather than a dextrose tablet for that sort of emergency?
- db3pt0 3y ago
  A glucose tablet and a glucagon shot can both be used in emergencies, but they are best used to treat different levels of emergencies. You can take a glucose tablet if you're coherent and conscious, but when you're incoherent or passed out from a severe hypoglycemia, someone else administering a glucagon shot is a lot easier and safer.
  - uberduper 3y ago
    Okay that makes sense. Thanks. How quickly does a glucagon shot trigger GNG and how quickly can GNG raise glucose levels?
    - groundcontr01 3y ago
      In my experience it takes just a minute or two

awaywethrow 3y ago

My worry with this approach has been that infusion sites (both for insulin and glucagon) can become occluded, pulled out, etc. to suddenly render them completely ineffective, and that automated detection of these scenarios is not great. You need to move forward, and therefore must occasionally have a foot on the gas (insulin). The gas pedal failing, causing you to stop moving forward, is not urgently dangerous (hyperglycemia). However, if your brakes (glucagon) can sometimes fail completely, that could cause you to die almost immediately if you're moving too fast toward danger (extreme hypoglycemia). Given this situation where brakes are unreliable, do you want your automated control system to rely on them and push you to dangerous speeds?

nahsra 3y ago
The detectability of failure is an excellent point. Anybody who uses the hardware can confirm it's not 100%. I think your point helps me re-frame the glucagon as more of an insurance backstop for when we accidentally hit the gas a little hard, rather than a permission slip to constantly be going too fast and constantly be slamming on the brakes. Even in this framing, it still feels like an extraordinarily valuable addition, and relatively low risk. It's also, of course, more to add to the patient's maintenance, but might help them or their caregivers sleep at night.
- awaywethrow 3y ago
  > It's also, of course, more to add to the patient's maintenance I agree with all that you've said, and this point in particular is extremely important. It's also the reason I moved from a DIY system like the one mentioned here, to a commercial system, once the latter was available. There is simply less hardware and software to juggle with the commercial system. There are fewer knobs, bells, and whistles, meaning I might not be able to tweak things to be in as tight control as might be possible with a DIY system (though with risks!), but overall it's been "good enough" for me, and greatly reduces the cognitive burden of having T1D. My experience clearly doesn't match everyone's, but considering I'm typically someone who loves to tinker, and has plenty of T1D experience (engineer, 34 years with T1D), I'm sure I'm far from the only one that feels this way. My glycemic control isn't significantly better than it was when I did it via constant monitoring and mental math, but the cognitive and emotional burden is much lower.

iaresee 3y ago

> Is the problem that there is no hardware for dual hormone pumps? All the well-tested pumps (Tandem, Omnipod, Medtronic) are insulin-delivery only.

nahsra 3y ago
Yes, but the "patch pumps" like the Omnipod are small enough you think patients might tolerate 2 of them? Maybe they've already asked, and people wouldn't tolerate it.
- iaresee 3y ago
  Possibly. But it's more than that. You have site issues, even with one pump, that you need to navigate. There are only so many viable places on a body to attach a cannula for good absorptoin and, while small, these things aren't _tiny_ (especially the Omnipods where the site holds the cannula, pump and reservoir). It'll be a while before we see highly reliable and well-tested dual-reservoir systems is my bet. The complexities of balancing insulin and glucagon in a two-pump system are also high. And the feedback loop from sensors that detect BGL aren't super fast. My kid's Dexcom works on a 5 minute sample loop now. So you can't make decisions fast and when you do, you can't course correct a bad decision quickly. I love that people are working on this stuff. The folks at https://wearenotwaiting.net/ https://wearenotwaiting.net/ are amazing and we even use NightScout here, but the fragility of the systems are stark and it'll be a ways to go before it's not just the brave pioneers pushing these frontiers for T1Ds.
haldujai 3y ago
It's not because of pump issues but more glucagon stability and secondarily whether bihormonal is clinically advantageous. Tandem is working on a dual chambered pump. https://diatribe.org/jdrf-and-tandem-diabetes-care-announce-partnership-develop-dual-chambered-pump-artificial-pancreas https://diatribe.org/jdrf-and-tandem-diabetes-care-announce-...
- iaresee 3y ago
  Yea, but "working on" is a bit different than "readily available and trusted to function well". Everything is harder with two delivery pumps.

jablongo 3y ago

For some background - I'm a T1D working on a search engine and conversational interface for integrating a bunch of new data sources and models into metabolic decision making: https://replica.health https://replica.health. I've also been a user of and worked on various open source artificial pancreas systems through the years, and am currently on Loop. >I would have thought by now they'd have hacked 2 patch-pump AIDs to work simultaneously. As you pointed out, the problem is not really hardware. It could technically be done in a straightforward way using two independently controlled insulin pumps, but the complexity and risk of the whole operation goes way up if you are taking way more insulin. Taking a bunch of insulin and glucagon at the same time is not necessarily a great idea either - they don't just annihilate each other without consequence and you could end up with secondary effects like gaining a bunch of weight. >Because this feels like a holy grail / functional cure Unfortunately it is not; even dual hormone systems have problems keeping up w/ the kinetics of glucose absorption and to address this there is also research into tri-hormonal systems, w/ amylin as the third hormone. In any case you will still need some a-priori info about meals and planned activities, though less so than with a single hormone system. Integration of exogenous data sources to provide this info to the APS is what we are working on at Replica. Also, hate to be the bearer of bad news but beta bionics has shelved their dual hormone ambitions for now; their prototype device soon to be released is insulin-only. On the bright side there is a small Dutch company whose tech predates beta-bionics. They sell a dual hormone device and will give it to you for a ton of $ (and probably have you sign a bunch of waivers): https://www.inredadiabetic.nl/en/discover-the-ap/ https://www.inredadiabetic.nl/en/discover-the-ap/

haldujai 3y ago
> In any case you will still need some a-priori info about meals and planned activities Not necessarily, at least not via patient input. In the albeit small Inreda studies manual announcement of exercise and meals wasn't required (or an option). Medtronic also has a meal prediction algorithm on their newest offering that's a step towards a fully automated process and currently more or less obviates carb counting but isn't at the point where you don't have to announce a meal (yet). Rather than integrating external data sources the algorithms are predicting based on historical glucose levels and/or insulin administration and it seems to be working. https://jamanetwork.com/journals/jamasurgery/article-abstract/2795853 https://jamanetwork.com/journals/jamasurgery/article-abstrac...

haldujai 3y ago

No, there isn't a hardware problem and such systems exist. Several trials[1-3] dating back several years have looked at "bionic pancreas" or a closed loop bihormonal system. Inreda (a Dutch company) has a CE-marked device[4] that can be clinically used but one limitation has been glucagon stability (has to be replenished daily). Tandem in the US was working on this as well but I haven't heard anything about them in a while, not sure how far along they are. The Inreda product is still in the early stages of testing but fully functional. Small crossover trials seem promising (defined by more time in euglycemic state). There is a competing approach with "intelligent insulin" or a self-regulating glucose sensitive insulin formulation that has different bioavailability depending on circulating glucose levels rather than relying on a monitor, this is farther out from clinical use. One of the reasons bihormonal pumps haven't entered mainstream use yet is that it's more expensive/complicated and the current techniques of algorithmic predictions of hypoglycemic episodes and insulin delivery suspension are already very good that hypo isn't much of a problem with modern devices like Tandem's offering. Medtronic has added a meal detection algorithm[5] that's really good too (the best on the market I'm told by my endo colleagues) and they say we're getting close to not needing meal announcement anymore, this practically eliminates carb counting. It's the first such algorithm to be in clinical use so we're not there yet but the expectation is that this approach will get us there. The question (for glucagon) then becomes how clinically useful more time in euglycemia is as the hypo episode problem is essentially solved, we'll need more data to draw any conclusions and it will take a while for this particular question as many of the outcome measures are long-term (i.e. what are the long-term sequela of mild intermittent hyperglycemia, it's somewhere between nothing and uncontrolled diabetes but how far along on that line is the billion dollar question). [1] https://pubmed.ncbi.nlm.nih.gov/28007348/ https://pubmed.ncbi.nlm.nih.gov/28007348/ [2] https://jamanetwork.com/journals/jamasurgery/article-abstract/2795853 https://jamanetwork.com/journals/jamasurgery/article-abstrac... [3] https://pubmed.ncbi.nlm.nih.gov/24931572/ https://pubmed.ncbi.nlm.nih.gov/24931572/ [4] https://www.inredadiabetic.nl/en/discover-the-ap/ https://www.inredadiabetic.nl/en/discover-the-ap/ [5] https://www.medtronicdiabetes.com/products/minimed-780g-insulin-pump-system https://www.medtronicdiabetes.com/products/minimed-780g-insu...

nahsra 3y ago
It's not clear from their site whether the Inreda product also has CGM built into it, or if it must be paired with one? Glucose-responsive insulin also seems like science fiction as this point, but would be extremely powerful tool. I'm very familiar with one of the most popular, closed-loop system combinations in the USA and I definitely don't feel the hypoglycemia problem is anywhere near "solved". There is too much volatility dictating a person's insulin sensitivity that even today's smartest systems will regularly give too much insulin, requiring treatment, or too little, resulting in prolonged hyperglycemia. I agree that time-in-range is incredible today with the technology, comparatively, but there's still lots and lots of room for improvement.

brudgers 3y ago

My assumption is that the DIY Pancreas community is well-informed, technically capable, and highly motivated. My guess is it hasn't done what you suggest for practical reasons related to supply chain, intended user base, and practical engineering considerations appropriate for high reliability mechanical design for medical use. For example, the insulin delivery system has many points of failure. Any fault or failure is likely to have severe health impacts on the user. To a first approximation, doubling the number of pumps doubles the points of failure. But I could be wrong.

cperciva 3y ago

Glucagon should probably be a safety net, not something you use regularly. Taking too much insulin and compensating with glucagon leads to long term weight gain among other things. Dual pumps are being worked on, but it's not yet clear that the improved glucose control justifies potential long term consequences.

samstave 3y ago

You know what cyberpunk future I am looking forward to ; Bionic Arms/Limbs whi are chosen to be replaced, but in the place of the bicep is a blood filtering, monitoring mechanism that keeps your blood hyper oxygenated and tracked... Although, to go along with the cyberpunk theme ; If you want to kill a Cyborg, you just rip off his arm...

smoldesu 3y ago
It's fun to imagine a future where we can design human body parts better than our body but can't figure out how to unplug them without a mess. Damn Magsafe patent still holding up in 2077...

TaupeRanger 3y ago

The only way to "cure" diabetes is to replace the pancreas or get the cells to go back to behaving the way they were before insulin resistance. The 1st is incredibly risky and wouldn't be pursued for that reason. The 2nd is most likely to lead to a cure, using a morphoceutical approach that reprograms or replaces the misbehaving cells.

DoreenMichele 3y ago

There's a lot more going on in the body than this. Muscle protein influences insulin resistance. Diabetes is strongly associated with inflammation which may imply that infection or pH balance (or both) plays a role. For functional hypoglycemia, metabolic syndrome and T2D, dietary changes can have substantial positive impact. I'm thrilled to see this is happening, but the chemical inputs and various metabolic factors are far more complex than "sugar in, one hormone to lower blood glucose levels and another to correctively raise it."

jeffybefffy519 3y ago

The thing is - the ideal solution injects 100% the right amount of insulin and no glucagon because insulin is a growth hormone and too much of it makes you gain weight. Body builders have been known to use insulin to gain muscle.

DavideNL 3y ago

> AFAIK there is only one company… Inreda: “A bi-hormonal fully closed loop system”: https://www.inredadiabetic.nl/en/home-english/ https://www.inredadiabetic.nl/en/home-english/

markdown 3y ago

> Beta Bionics [2], that is working on commercialization of such technology LOL, so no end then to the American insulin caravans to Canada?

conceptme 3y ago

There is https://www.inredadiabetic.nl/ontdek-de-AP/ https://www.inredadiabetic.nl/ontdek-de-AP/ which has both glucacon and insuline maybe there are others still in testing phase though.