With frequent needle pricks and the need for meticulously-managed blood sugar levels, most type 1 diabetics lead lives of constant monitoring and planning. Unlike type 2 diabetes, type 1 often develops during childhood and cannot be controlled simply by changes to diet and exercise, although it can be mitigated. Until researchers can discover a permanent solution to the chronic disease, studies continue to look for ways to ameliorate the lifestyle of those living with the condition. Ahmad Haidar, an assistant professor in the Department of Biomedical Engineering at McGill, and his team are leading the way with a new method to deliver insulin, a hormone that allows the body to control blood-sugar levels.
Presently, type 1 diabetics choose one of two ways to administer insulin—by injection or by pump. The former option is the most common, although frequent injections can be difficult. Injections are typically administered twice a day to begin with, and, later in the prognosis, three or four times a day, usually half an hour before meals. Timely insulin administration can prevent or delay the onset of eye, kidney, or nerve damage associated with diabetes. Meanwhile, insulin pumps, which are attached to the body, are pre-programmed to release a certain amount of insulin throughout the day. Diabetics wear pumps under their skin via a catheter. Pump users receive steady levels of insulin throughout the day and press a button to receive a larger dose of insulin prior to mealtimes. Pumps minimize user involvement throughout the day, however, they are more expensive than injections.
While the pumps and injections provide regular insulin delivery, they are not fool-proof treatment methods. The body’s need for insulin may fluctuate based on factors which alter the amount of blood glucose available such as diet, exercise, and one’s emotional state.
“On average, people with the best available therapy spend about 40 to 50 per cent of the time within the target [insulin] range, and the remaining 50 per cent, which is 12 hours a day, either above or below the target range,” Haidar said. “What we’ve found is that it is extremely difficult for people to get insulin at [the] right times.”
The solution that Haidar and his colleagues are working on is a smart insulin pump which acts as an artificial pancreas. In healthy individuals, the pancreas continuously monitors and releases amounts of insulin according to current blood-sugar levels. Likewise, the smart pump system detects insulin levels and adjusts the amount of insulin released. The smart pump combines three elements: The conventional pump, a continuous glucose monitoring system, and an algorithm developed by Haidar’s lab.
“Every 10 minutes, [the algorithm determines] the optimal amount of insulin that aims to bring sugar levels into target range,” Haidar said.
This summer, Haidar’s lab tested their algorithm at Camp Carowanis, a summer camp that aims to empower young insulin-dependent diabetics in Sainte-Agathe-des-Monts.
In the short-term study his team conducted, Haidar described an improvement in the overnight blood-sugar control. Additionally, the study found that users reported better psychosocial outcomes, including improved quality of life and wellness, and less anxiety.
While the product still requires more testing before it can be made available to the public, Haidar’s lab is already working on a more advanced system, which uses multiple hormones including glucagon and pramlintide, to enable better hormone regulation. Pramlintide slows meal absorption, while glucagon raises blood sugar levels by signalling the conversion of stored forms of sugars in cells into blood glucose.
“With [just] insulin, it’s like driving a car with only gasoline, but then [adding] glucagon, you now have brakes. You have more control,” Haidar said.
Although adding these two hormones to the system would certainly be more expensive it would enable better regulation of sugar levels and hence better health outcomes for those living with the chronic condition.