Diabetes Technology: 'Fear Not'. Futture artificial pancreas? I do not think so, June 28, 2017

Today I felt like I was pulled 10 years into the future and given the opportunity to practice medicine then. This happened when I started treating my first patient with the Medtronic MiniMed® 670G hybrid closed-loop insulin delivery system.
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        Is this future for diabetes type 1 treatment? I hope it is not. 10 years from now is long way in medicine development. Today diabetes is already number 7 cause of death. Diabetes leads to heart attacks and strokes, myopathy and disabilities. But regardless of wrong treatment and avoidance in early diabetes diagnose which will lead to diabetes cure, diabetics live longer. New generation of diabetics are smart and have info they need to survive. For new generation it will never work that they will take Invokana or Glipizide, Metformin or any other junk medicine which today occupied our medical market. They simple will not take it. So, 10 years after now the understanding of diabetes will be right opposit as it it today.
      Any treatment start with diagnose. So, the first thing is how diabetes diagnosed now, and how it suppose to be diagnosed? Today diabetes diagnosed according to the level of sugar in blood. It is the same as patient enter to ER and reading of body temperature is high. What is diagnose? If it is not the case with any other medical conditions then why is it with diabetes? Diabetes is pancreas disorder, so diagnose must be made according the condition of pancreas.  I hope it is not far away in future and we will be diagnosed accordingly.
       There are many guidance how to diagnose diabetes and every one do know it. How type of diabetes diagnosed? Really, when author suggest that a new technology will give new opportunity to treat diabetes type 1, then how diabetes type 1 was diagnosed? Simple, say me how it is today was said, one is diabetic type 2 or type 1? If I come to the new medical office and said I need insulin 300 units, I am diabetic type 1, how doctor will find out, I am really diabetic type 2? There are no tests to diagnose type of diabetes. Any diagnose of any type of diabetes based on the level of sugar in blood. If it will be test how pancreas work then it can be very different types of diabetes, the same as with flu, or cold, or pneumonia, or any other types of inflammations.
     This is all to start with. Author has no one idea what is the subject he pretend to introduce as future revolution in medical care.
     OK, now let us see, if a new system worth to try.

For many people with type 1 diabetes, life will never be the same. I am hopeful that people with diabetes will be able to sleep at night without fear of "going low," and that they will be able to fully participate in a meeting at their job without peeking under the desk at their CGM tracing. This impact is evident in the fact that 80% of pivotal trial participants asked to stay on the 670G when the trial was over, and 96 of the original 129 participants were still using the 670G a year later.

Very dramatic! Nothing true.Just poor author imagination. Yes, we all diabetics regardless type 2 or type 1 in the same situation. Low blood sugar can strike at any time. If so then why it is type 1 diabetics live in fear, and there is no fear for us, type 2 diabetics? What is difference if type 1 diabetic take less then 50 units of insulin, and very often less then 10, and me, 300 units every day? Really, who has low sugar more dangerous? So, it is only speculations, how type 1 diabetics suffer with insulin therapy.

 In an instant, I was transformed from physiology expert and disease coach to machine operator. Although Medtronic's report does offer some transparency by telling you the reasons the system goes out of "auto mode" (which it does at various times), it is, at the end of the day, still very much a "black box."
It comprises many components working together in harmony, meaning that when anything goes wrong, there are infinite possible reasons why. Is the sensor bad? Was the blood glucose reading used for calibration off? Was the algorithm wrong in its dosing choice? Is the insulin infusion site no good? Did the patient eat more than she thought she did?

So many components! Would this system work? Never. Why? Because of there is no any understanding what is diabetes? Why our pancreas is insufficient in insulin secretion? What wrong with pancreas? System simple does not take any of this marks into consideration. In contrary it is concentrated on the side values such as meal, and algorithm.  There are infinite possibilities the system can be wrong. There is very limited possibilities system would be right. If any.

 Today, the curtain to the future was peeled back, as I glimpsed an era where algorithms and artificial intelligence will manage our patients, with the doctor serving as the operator—the guide—in this world.

 This is the point. As doctor author will get machine and provide us with guidance. Is this really what we  are, diabetics, will accept? Not new generation of diabetics. The same as doctor they will get own machine if they need, and forget about doctor's guidance and understanding. Together with reimbursement doctor suppose to have. I love this future!!!!!!!!!!!

Some fear that this will reduce our role. And I understand this fear. For a brief moment, I felt a professional impotence, awed at the power of the machine, wondering how I could compete.

This will lead to lower public spending on medical bills, and better public health.The ability of medical care to make a new patients would be cut. Simple and Brilliant.

Professional informaticists will remain the experts and be the ones designing and training the systems, but it will no longer be acceptable for a physician not to understand the basics of an algorithm. With closed- loop insulin delivery, for example, we have to ensure that we and our patients still understand how to manage diabetes manually—the "old- fashioned" way—as well as learn how to optimize and troubleshoot the auto mode.

 Finally. With all that complications of algorithm what is at the end? Diabetic must manage system manually/ If so, then this system needs for what? If I have finally to determine how many units to inject into my belly then why do I need all these calculations? Why do I need something which hung on on my body? I inject insulin even without any readings, simple dose what I need daily, 100 units in the morning, 127 units at 12 pm, and 80 units at the bed time. 307, the one pen a day. I have to keep something handy, such as protein bar, coffee, OJ, or something eatable in case I feel low.
    I love simple life. Simple and natural. No, I will not use this system.

via Ravenvoron