A healthy dose of cynicism

By | 14 January, 2010

Here at ShootUp we believe a healthy dose of cynicism is as important a part of living well with diabetes as insulin, carb counting and a balanced helping of optimism. 

I’ve already admitted the cardinal sin of not being excited about a cure and questioned whether the sexiness of finding a cure distracts us from providing decent care today.  Now it seems that there are more super cynical Brits around.

Fellow Brit Caroline is a little underwhelmed by the hype around the artificial pancreas. I’ve been meaning to write an article about the issues facing the artificial pancreas for a while, but this one is a really well thought out look at the reality of the situation that I certainly couldn’t improve on. Enjoy!

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About Alison

Diagnosed with Type One in 1983 at the age of four, Alison's been at this for a while now. She uses Humalog in a combined insulin pump and continuous glucose monitoring system and any blood glucose meter as long as it takes five seconds or less.

16 thoughts on “A healthy dose of cynicism

  1. Tim

    Also the problem is that if a wonderful new, working artificial pancreas did appear on the market tomorrow it would be years before NICE and the PCTs / health insurers (delete according to continent you’re currently reading this from) actually allowed any of the pancreatically challenged hoards to have one of the damned things.

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  2. Alison

    @Tim Yep. That’s why I’m so passionate about people fighting for funding for pumps/CGMS/whatever else they need – at the moment we don’t have a good system for getting new developments into use quickly. Unless we fix that issue the money we put into developing new treatments is wasted because they just sit on the shelf unavailable to the majority.

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  3. Samantha

    hmmm, i suppose the idea of it is ‘good’, but what tim says is right. NICE and PCT’s just wouldn’t fund them quickly enough. It may be a step in the right direction for a ‘cure’, but i don’t think it could come into effect quickly enough.

    That, and that idea that a high blood sugar thingy where it gives you more insulin (technical term there jumped out of my head…), that could be disasterous…what if the CGM is buggered? Could turn nasty.

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  4. Caroline

    I realised as I was reading Caroline’s piece (I only got halfway then had this brainwave) that having been a diabetic for so long, I’ve got tons and tons of ‘control’ issues. I have had to get used to managing my health and the balancing act that is diabetes and it’s now so much a part of my life and my self that I’m not sure that I could cope with handing that control over to a machine. Even with practice. Maybe for newly diagnosed folk it could work, but I absolutely think that better tools to manage what we are used to (and very practised at) managing are going to be worlds better than handing that management over to a wee bit of man-made, breakable, potentially malfunctioning and rejectable kit. Ooh! A rant…

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  6. Tim

    @Samantha I don’t think the technology itself is actually much a of a problem. Here we’re looking at the first possible commercial iteration of an artificial pancreas. If we compare the first cranky blood glucose meters to the swanky ones we have now there is a world of difference and I suspect it will be the same with artificial pancreases (what *is* the plural of pancreas?) So problems will be ironed out as they become commercially available.

    The problem with this will be that they may get a bad reputation with the medical profession as being unreliable and not very effective – a hangover that pumps still seem to suffer from from their early days.

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  7. Tim

    @Alison I couldn’t agree more as that it what is happening at the moment (as we all know). Good solutions for managing diabetes, such as pumps and CGMS just aren’t available.

    This is exemplified by a letter I received from the Chief Exec. of my PCT recently which proudly noted that 3.4% of the population of my region were using pumps (proudly noted, as the next best region has only 2.2%!)

    So 96.6% don’t have a pump. Taking into account the undeniable fact that pumps aren’t for everyone, this isn’t anywhere near acceptable, especially as pumps are hardly cutting-edge technology.

    /rant

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  8. Tim

    Caroline :

    it’s now so much a part of my life and my self that I’m not sure that I could cope with handing that control over to a machine.

    You’re right – it would certainly take a hell of a lot of adjusting to, effectively, not having diabetes.

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  9. Samantha

    @Tim
    pancreai?

    looking at the press release i read yesterday http://www.prnewswire.com/news-releases/jdrf-forms-partnership-with-animas-to-develop-first-generation-automated-system-for-managing-type-1-diabetes-81323767.html, it seems as thogh the first generation pancreai (lol) will be nothing more than slightly swankier pumps.

    I like the idea of it, but again like you say, the liklihood is that early ones would get a bad reputation. Technology *could* be ironed out, but something like this i doubt would ever be perfect technology wise.

    I’m talking myself out of liking the idea of the artificial pancreas now……

    It might be that animas, dexcom and the JDRF are taking steps in the right direction and moving towards a ‘cure’, but like alison, i can’t get excited. I was told at diagnosis there would never be a cure in my lifetime, only to be told a few months later i would get one in ‘the next ten years’. That ten years has gone now and I’m still waiting. Steps in the right direction (ala this) are obviously a good thing, but i just can’t really get that excited about it…

    pancreai. New word of the day

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  10. Tim

    @Samantha I dimly remember having a discussion at the last Shoot Up night out about building our own artificial pancreai out of MDF, bits of plastic, elastic bands and bubble wrap. This, my friends, is surely the way forward.

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  11. Ckoei

    I think pancreAI hits the artificial&intelligent bull in its eye. With pancreases you’re going to end up with undulating eggs. And “MDF, bits of plastic, elastic bands and bubble wrap” will be better spent on building a time machine in which to cruise towards a future containing pancreAI.

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  12. Caro

    Thank you Alison!

    I’ve been quite surprised to find that I’m not in a minority with the way I feel, but I also agree with the other Caroline here that my control freak side may also have something to do with my scepticism! I can’t imagine ever handing over all that control to a computerised device.

    The other thing that seems to have been missed amongst all the brouhaha, is that JDRF have been funding artificial pancreas research for a number of years. There have been studies here in the UK where academics have been given money carry out research in to possible algorithms for closing the loop. A couple of these studies at least have used Medtronic devices. The press release yesterday simply confirms that in this case JDRF will be giving money directly to specific companies. Here I go with the cynicism again, but these companies will need to bring in, or continue to pay, appropriate academics and clinicians at high cost whilst looking for a healthy bottom line. Doesn’t seem the most efficient way to fund “research” to me. What is being funded is Animas and Dexcom developing a pump that is a step on from the Veo (i.e has Low Glucose Suspend AND a high glucose increase feature). I’m not entirely happy about commercial companies receiving charitable funding to develop a new product which they ultimately aim will make them money.

    As I said yesterday I do want improved pump and CGM technology, I just don’t want it dressed up as more than that.

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  13. Tim

    Interestingly enough, I was reading Robert Tattersall’s Diabetes: The Biography (review coming soon, book review fans!) this morning on the bus and I read that artificial pancreai were attempted in the 1970’s – chief amongst them was the Biostator; see here for details:

    http://www.picturetrail.com/sfx/album/main/201986/3026801

    It was great but had one tiny flaw – it didn’t really work. Ho hum.

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  14. Alex

    Good points made.
    Ultimately diabetics are the same as people buying Inkjet printers. I certainly got offered my fair share of pens and glucose meters in the last 17 months for free. Of course, because Big Pharma nows that I will provide a predictable regular income stream from my repeat test strips and insulins.
    A cure would mean a radical change to them that would disrupt.
    Besides any kind of surgery or even the risks of new algorithms are a too high barrier for me, when one can manage with MDIs.

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