The Artificial Pancreas

How Will This Benefit Patients With Diabetes?

In type 1 diabetes, the pancreas cannot produce insulin, which is why the body cannot
naturally control blood sugar itself. In the absence of adequate treatment, the disease can
lead to extremely serious complications: loss of vision, renal failure, cardiovascular disease.
The artificial pancreas is a technology that has been developing since the 1970s, which is
intended to be a solution against type 1 diabetes. The pancreatic implant is a medical device
that should be placed inside the abdomen. It is also called ‘bio-artificial’ pancreas:
artificially, because it is made of a synthetic polymeric material and bio, because it
complements a biological function, that of the pancreas. Type 1 diabetes is a disease that
triggers when the pancreas decreases insulin secretion until it is almost completely absent,
with increased blood glucose. The incidence of this disease has increased significantly over
the last decades due to (in particular) changes in environmental factors and (less) genetic
factors (which require much more time to change within the human species).

It is a double secretion gland, exocrine and endocrine. Endocrine pancreas is represented by

the Langerhans islands, made up of several types of endocrine cells; each type of endocrine
cell secretes a polypeptide-like hormone: cells glucagon secretion, cells b-insulin, g-gastrin,
d-somatostatin, PP- "pancreatic polypeptide", but also pancreatic juice that reaches the
digestive tract. Although the pancreas has some important digestive and hormonal
functions, only lack of insulin secretion has provided a good reason to develop a
replacement. The pancreatic implant is a medical device that should be placed inside the
abdomen. However, it is It is also called ‘bio-artificial’ pancreas: artificially, because it is
made of a synthetic polymeric material and bio, because it complements a biological
function, that of the pancreas.

Type 1 diabetes mellitus or insulin-dependent diabetes is triggered by environmental factors

such as viruses, diet and chemicals, and genetic factors. Patients with type 1 diabetes should
inject insulin several times a day and monitor closely the disease and blood glucose levels. In
this case, almost all insulin-producing pancreatic cells are destroyed without a chance to
recover. Therefore, pancreatic insulin production is reduced or even absent. Type 1 diabetes
occurs at any age, but predominates in young children and adults, which is why it is called
"juvenile diabetes". In type 1 diabetes, hereditary transmission plays an important role. One
of the most known symptoms of type 1 diabetes, and not only, is polyuria - frequent
urination. Increasing the amount of fluid released leads to intense thirst, a symptom also
known as polydipsia. Urinary losses caused by sudden loss of weight. Other symptoms may
include visual disturbances, sleepiness, nausea, and reduced resistance to exercise. All of
these signs of diabetes begin suddenly and intensely in type 1 diabetes. In the absence of
insulin, cells in the body can no longer use blood glucose, so they start using a secondary
mechanism to replace cells that produce energy. Fat cells begin to metabolize fats, which
leads to the production of chemical compounds called ketones. The problem is that they
cause blood acidification, even if they are a source of cellular energy, and may favor the
installation of diabetic ketoacidosis, which is very dangerous for the patient.

The patient using this medical device, the artificial pancreas, also called closed-loop insulin
delivery system, will have a normal life span without taking care of glycaemic control and
regular insulin administration. He just has to calibrate the device periodically twice a day by
measuring glucose and enter the carbohydrate information he will consume at each meal.
Next, the device will calculate and administer the correct insulin dose on its own to keep the
glucose level within normal limits.

The artificial pancreas system consists of several elements: a computer program, a

continuous glucose monitor that measures glucose from the interstitial fluid associated with
blood glucose levels, and an insulin pump. The data taken by Continuous Glucose Monitor is
run by the algorithm control, and based on its calculations, the controller sends the
information with the exact dose of insulin the body needs. The insulin infusion pump adjusts
the amount of insulin delivered to the body following the instructions sent by the controller,
through a catheter located under the skin. The last element of this ensemble is the patient
himself. The level of blood glucose is constantly changing, depending on certain variables,
such as nutrition, lifestyle.

The artificial pancreas promises a chance for a normal life for type 1 diabetes patients who
are currently forced to inject insulin. Another advantage of the artificial pancreas is that the
blood glucose level is always kept under observation, so the risks to which the patient is
exposed diminishes. The automatic procedure eliminates the risk of forgetting taking the
insulin dose. Also, the patient can take carbohydrates if the device noticed that the glucose
level falls below normal, thus avoiding a possible complication.

The artificial pancreas promises an innovative solution for type 1 diabetes and has many
advantages. however, it is not a perfect system and it also comes with disadvantages. It is
quite uncomfortable, requiring two permanent devices that may have technical problems.
The skin can become irritated from the devices, athletes are prevented from performing at
the performance level. Another disadvantage is that Continuous Glucose Monitor checks
the glucose level in the interstitial fluid that does not change values as fast as the blood
glucose level, and so the result displayed by the Continuous Glucose Monitor may be
erroneous.

Diabetes mellitus is not a new "disease" but has been known for millennia, and its clinical
manifestations have been described since antiquity in Ebers Papyrus - 1500 BC. Nowadays,
questions like: Why did my diabetes develop? Who is to blame? What should I do to prevent
diabetes? remain unanswered, still remain unanswered, great hopes to solve this problem
are the artificial pancreas. The progress made in this area since the 1970s has been
remarkable, the benefits of this automatic insulin delivery system overcoming the
disadvantages presented above.

References:

1. Graham K. & Dean S. (2018) Fundamentals of anatomy & physiology, Pearson press

2. Subrata P. (2014) Design of Artificial Human Joints & Organs, Springer Press

3. The International Diabetes Closed Loop (2016) [online] available at:

https://clinicaltrials.gov/ct2/show/NCT02985866

4. The artificial pancreas in 2017: The year of transition from research to clinical
practice (2017) [online] available at:
https://www.nature.com/search?q=artificial%20pancreas%20&order=relevance

5. Artificial pancreas treatment for outpatients with type 1 diabetes: systematic review
and meta-analysis (2018) [online] available at:
https://www.bmj.com/content/361/bmj.k1310

6. Diabetes (2012) [online] available at:

https://labtestsonline.org.uk/conditions/diabetes

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