Partha Kar predicts closed loops will become standard care in the next 5 years

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trophywench said:
The annoying thing for me personally is that when the time came for me to replace my pump a couple of years ago I could have Omnipod (no thanks, far too big in all directions esp outwards as I frequently collide with anything I happen to be walking past, so 'sticky outy' don't seem a good plan) The tandem rep told me a Tslim is a waste of time without Dexcom CGM, a Medtronic 640 (even though by then the 780 had replaced it) or another Roche Combo. What I really wanted was another Roche Insight as I've always hated filling cannulas from the minute I had my first pump, a Roche Combo which I gladly swapped for an Insight. Not without its challenges, first one just killed it's batteries pdq and eventually they replaced it and the new one didn't. Had to charge the handset/meter battery every single night when I went to bed but so what, don't test during the night. Plus I was instructed to turn the handset off after each time I used it for anything,, hence never had any problem when I needed the meter/handset to work any time from getting up in a morning to going to bed. However my lot didn't offer any replacements because of 'all the problems people have had with the meter/h batteries never lasting.' So - can I get a Dexcom CGM then, since the Rep says the Tslim is useless without it? No. We don't offer them unless we make a special case for someone. You aren't a special case. You could self fund Decom, but we don't know anything about how to do that. (and clearly, you are not interested enough to bother finding out, are you, thought I, or even that bothered whether I might be able to afford to?)

So I had another ruddy Combo, although I had to learn again how to work it myself since the DSN's there now don't have a clue. The one who set it up with me, told me to do something I queried there and then - having had my very first pump fail and have to be replaced, specifically caused by what she was telling me to do with the new one. After my failure for this reason they issued a warning that went out to all users and D clinics. I read the handbook that night - I'm right - she was wrong. Of course I told her. (Oh look - she isn't there now.)

I know very well closed loop isn't 'plug and play' - no D tech ever is, they're all hard work to begin with at least. BUT I'd really so love to be allowed to do that work setting one up to suit ME - and then for whatever short periods thereafter just be able to give my flippin brain a slight rest. Why the hell can't a D Clinic recognise that when a woman has spent over 50 years juggling her own D care, she might need a bit of a rest! (I don't believe you actually need any specific training to recognise this - ain't it a fact that when folk get older and also doing the same old same old (with a number of bells and whistles along the way, yeah, but at basic level just more of the same) every damn day of their life, it's bloody boring frankly and the only thing keeping me doing it is simply ME caring about whether I live or die, cos I'm no longer as convinced the NHS want to, that much. My previous Consultant did seem to care - but I'm no longer on his List and I've never felt as if I could unburden myself to him, just not that 'warm and friendly'. What used to be called a 'good bedside manner' - don't think so mate.
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You definitely deserve a rest @trophywench . Keep pushing and see what you can get.
I know the positive impact looping has had on me.
 
BadaBing said:
I'm sure the insulin manufacturers R&D departments try to improve their insulin therapies continually.

The chemistry and pharmacology involved in developing a new, safe, "instantaneous-acting" insulin that will obtain a licence from the US FDA, UK MHRA (or other regulator) is far from straightforward. Gathering sufficient data from animal, then human, trials that a new insulin works precisely as intended - and won't cause unwanted hypos or a. n. other short/medium/long term issues (e.g. cardio-vascular) to put in front of a regulator to get an authorisation is not a quick process. And rightly so.

Perhaps something artificial intelligence might in future be able to speed up?

Does anyone use Novo Nordisks fiasp insulin? I understand it is supposed to start working very quickly, but I've never been prescribed it. I hear many integrated care systems won't prescribe it (cost reasons???)
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I personally think there’s a limit on how fast an insulin should be - for two reasons. Firstly, of course, the risk of hypos, not just from everyday ‘perfect’ injections but from accidental muscle nicks, etc. Secondly, remember all the fuss with the original analogues? Sometimes speeding things up can have unintended results, eg the withdrawal of the very first analogue insulin.

I’d prefer an insulin that had reduced effects on the skin, maintaining cannula sites for longer, reducing the risk of fatty deposits and the accompanying absorption problems. I don’t understand why the insulin manufacturers seem obsessed with speed. There’s plenty of other things to look at.
 
Inka said:
I personally think there’s a limit on how fast an insulin should be - for two reasons. Firstly, of course, the risk of hypos, not just from everyday ‘perfect’ injections but from accidental muscle nicks, etc. Secondly, remember all the fuss with the original analogues? Sometimes speeding things up can have unintended results, eg the withdrawal of the very first analogue insulin.

I’d prefer an insulin that had reduced effects on the skin, maintaining cannula sites for longer, reducing the risk of fatty deposits and the accompanying absorption problems. I don’t understand why the insulin manufacturers seem obsessed with speed. There’s plenty of other things to look at.
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You make an excellent point @Inka

I'm sure everyone who has been taking insulin for some time will be aware that some years ago the drugs regulators licenced an insulin which lowered blood sugars. Unfortunately it was also discovered to be having adverse effects on the cardiovascular syatems of those who took it. In a significant number of cases fatally so.

That insulin had to be withdrawn eventually from the market because its risks far outweighed its benefits.
 
I didn’t know any insulin had been withdrawn for that reason @BadaBing Which one was it? I remember some additional thing being withdrawn because it could cause heart problems, but I can’t remember its name. Ended in -ine and had gs and zs in possibly.

I was thinking of the withdrawal of the first analogue due to worries about cancer - B10Asp, I think it was, but not sure.
 
Inka said:
I didn’t know any insulin had been withdrawn for that reason @BadaBing Which one was it? I remember some additional thing being withdrawn because it could cause heart problems, but I can’t remember its name. Ended in -ine and had gs and zs in possibly.

I was thinking of the withdrawal of the first analogue due to worries about cancer - B10Asp, I think it was, but not sure.
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Mea culpa @Inka! Quite right, it wasn't insulin as such. I should have said the drug Rosiglitazone, better known under the name Avandia, prescribed to diabetics to improve the body's sensitivity to insulin, but whose use was curtailed or restricted severely following studies indicating adverse cardiovascular events.
 
Oooh ah - now you mention it, aka Avandia, I do remember the debacle, cos it certainly must have been in DSF days, but there again, that was a hell of a time ago!

ISTR @Pattidevans opted for Apidra - and that doesn't get mentioned 'nowadays'. I've never wanted to try anything else made by Sanofi, bearing in mind I'd not had an easy time either on Humulin I and S, or with Lantus. I've just Googled it ( 😱 ) and it does look bloomin quick, but the technical bits are comparing it to "Regular" insulin which I really haven't the slightest idea about.
 
Bruce Stephens said:
I think that's right: subcutaneous injection is probably not ideal. We're also missing amylin which would likely make just using a faster insulin not as good as real beta cells. I presume it wouldn't work just to mix in some amylin with the insulin, or maybe it's harder to manufacture (or doesn't last as long as insulin, or something).
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Symlin is a synthetic form of amylin. I don’t think it’s available here but is/was in the US because I used to know someone who used it. Again, the risk of severe hypoglycaemia puts me off.

This is all part of why my favourite cure idea is to actual regenerate our own beta cells so they can perform the delicate act of balancing our hormones.
 
trophywench said:
Oooh ah - now you mention it, aka Avandia, I do remember the debacle, cos it certainly must have been in DSF days, but there again, that was a hell of a time ago!

ISTR @Pattidevans opted for Apidra - and that doesn't get mentioned 'nowadays'. I've never wanted to try anything else made by Sanofi, bearing in mind I'd not had an easy time either on Humulin I and S, or with Lantus. I've just Googled it ( 😱 ) and it does look bloomin quick, but the technical bits are comparing it to "Regular" insulin which I really haven't the slightest idea about.
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I have been extremely lucky to have been surrounded by loved ones and close friends who are "serious" natural scientists, and to work in the field that enables new drugs and medical devices to receive monopoly protection (for a limited period) in so far as such drugs and medical devices are genuinely innovative. It is truly inspiring to be surrounded by extremely intelligent, inquisitive, ethical scientists pushing the envelope to improve healthcare.

Healthcare, like life, is about risk appetite. Unfortunately, sometimes the risks do genuinely outweigh the benefits.

I'm also very aware that the global system for regulating drugs and medical devices relies on the "good chap principle." That those seeking authorisation will hand over promptly all relevant data demonstrating whether the risks outweigh the benefits of this or that new drug or new medical device, so a full and rigourous evaluation can be made before the new drug or medical device is licensed for use and sale to patients.

Unfortunately sometimes the "good chap principle" (notwithstanding that there are severe financial and/or criminal/civil penalties for failing to do so and the duty to provide all relevant documents is an ongoing one, even after a drug or medical device has been placed on the market for use) isn't always adhered to as strictly as it ought to be.

So I prefer always to be a late adopter of new drugs and medical devices, unless the risks are infinitesimal.
 
Yeah - always seemed to me best to let someone else have the teething probs and discover the work arounds for em, before I adopt them!

Perhaps hardly surprising then that I had a fulfilling and enjoyable career in the insurance industry - I highly approve of anyone who mitigates their own risks, before seeking insurance to mop up the things they can't mitigate any further. Life Assurance absolutely does NOT fall into THAT category!
 
trophywench said:
ISTR @Pattidevans opted for Apidra - and that doesn't get mentioned 'nowadays'.
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I’ve only ever used apidra (other than a brief humalog stint when the apidra factory had to be closed for a few months). I quite like it and so never changed to anything else, much prefer it to humalog, but yes almost never hear of anyone else using it!
 
trophywench said:
I highly approve of anyone who mitigates their own risks
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I am a climber and whenever I read about avoiding risk, I remember an interview between an (ignorant) non-climber and a very experienced professional climber.
The interviewer asked the climber how he felt putting his life at risk every time he went climbing. The very calm response was about reducing risk all the time: climbing with someone he trusts, checking his kit, knowing the weather forecast (and not climbing if rain or wind were forecast), testing the rock as he put his foot down or took another hand hold, ...
I believe a good climber (or sky diver or racing driver or motorcyclist) is much more risk adverse than someone who just carries on their life unaware of what is around them.

Likewise as the first in my clinic to trial the Medtrum pump or the first to trial Fiasp. I did it with my eyes open, a very close eye on my blood sugar levels and a back up if things didn't work out including a good knowledge of how to use the backup. The risk was low because I mitigated the situation better than someone who just takes what they are given by their DSN without understanding it and what could go wrong.

I appreciate being a guinea pig is not for everyone but to suggest we are risk takers is not understanding the thought and care we go through in order to achieve the potential benefits.
 
helli said:
I appreciate being a guinea pig is not for everyone but to suggest we are risk takers is not understanding the thought and care we go through in order to achieve the potential benefits.
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I agree, but only up to a point.

Unless one is a hardcore natural scientist, or medical professional, ordinary consumers pay and trust that medical regulators have made the appropriate evaluation/judgement call following sight and vigorous evaluation of the data provided by the pharma company before a drug is authorised for use.

The regulators' evaluation/judgement relies entirely on the "good chap" or "full disclosure" principle of the data submitted. If the product gets authorisation, ordinary patients are then relying on their clinician to assess with the patient whether the drug is suitable for that patient based on the available data and the patient's unique medical history, and if it is suitable to prescribe the drug.

Unfortunately, the history of pharmaceutical creation is paved with drugs, some of which - with hindsight - should not have been made available to people, which ordinary patients (and to be fair also clinicians dealing with patients at the "coalface" day-to-day) couldn't have had an inkling about their adverse effects or the correct level of risk because of poor/inadeqaute data. Thalidomide being the most well known example.
 
@BadaBing I understand your concern. Thalidomide was about 60 years ago and more rules have been put in place to avoid something like that again. I appreciate nothing can be 100% fail proof.

I have participated in a couple of clinical trials. On both occasions I thoroughly read the details and asked questions of myself as well as the guys running the trial. I was given more care in both trials than I get under the current care. Coincidentally, I ended up using both of the drugs I trials - one was an extra fast acting insulin from NovoNordisk (Fiasp) and the other was a covid vaccination that targeted a specific spike (Moderna SpikeVax). Both were based on existing drugs that I had or was currently taking.

However, as I mentioned above, when I was the clinic guinea pig for my pump (and Fiasp), I already knew about insulin pumps (it was not my first) and I was incredibly familiar and comfortable reverting to a different management approach for my diabetes. It scares me when I read about people who switch to a pump without understanding how to configure it for themselves (they just leave it as their DSN set it up for them 4 years ago) and in complete panic if it fails because they have forgotten their MDI doses.

I may not be a hardcore scientist but I am an engineer so I am probably more comfortable than many with a pump and calculating doses, etc.
 
helli said:
However, as I mentioned above,I may not be a hardcore scientist but I am an engineer so I am probably more comfortable than many with a pump and calculating doses, etc.
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@helli, I did my degree many moons ago at a university very well known (then and now) for its engineering degrees. Spent many fond times, living with, eating, drinking and debating into the early hours with engineering fellow students.

As far as I'm concerned engineers are scientists. Engineering is applied science (as my former engineering alumni drummed into me).

My comments above relate to "ordinary" consumers of healthcare who didn't study science in any serious or practical sense beyond the age of 16.
 
BadaBing said:
@helli, I did my degree many moons ago at a university very well known (then and now) for its engineering degrees. Spent many fond times, living with, eating, drinking and debating into the early hours with engineering fellow students.

As far as I'm concerned engineers are scientists. Engineering is applied science (as my former engineering alumni drummed into me).

My comments above relate to "ordinary" consumers of healthcare who didn't study science in any serious or practical sense beyond the age of 16.
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How were your BGs during these “fond times?” (Sorry, I can’t ascertain the era.. But it does sound idyllic.)
 
Satan’s little helper said:
How were your BGs during these “fond times?” (Sorry, I can’t ascertain the era.. But it does sound idyllic.)
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......and I have no intention of divulging the era.

What can I say? I studied hard and tried to get as much out of the university life experience as any student should.

The BGs took care of themselves. I'm still alive to reminisce and tell the tale.
 
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I do not believe we are actually disagreeing - seems like we're all thinking much along the same lines ie whatever it happens to be, we all weigh up the pros and cons that we know about. Then we discuss with whatever people we happen to know who we regard as being sensible like us and we think might have the slightest idea about the particular subject (ie. no point asking the chap next door who runs a security firm of blokes patrolling premises with dogs about health matters) to see what they think about it. Whether it's what colour to paint the bathroom, how to stop the neighbours' buddleias self seeding themselves this year where we want to have the patio laid, or how to find the patience to wait for NHS test results.
 
trophywench said:
how to find the patience to wait for NHS test results
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I’m having the antibody test tomorrow. The follow up appointment to discuss the results and what they mean for what type of diabetes i have came through today. Mid March 2024 :rofl:
 
And I thought Cpeptide test in February/March to discussing results in June was a long wait!
 
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