For the second time in a bit over a year I find myself living on an artificial pancreas in a trial at the University of Virginia…

It’s night time, and I’ve spent the whole day with the “team” — Boris (the system’s modeler), Marc (a systems engineer), and Stacey (my endocrinologist).  I haven’t pricked a finger or touched a pump since 2 p.m. — once again that odd feeling of elation permeates the room because I’m not thinking about my blood glucose .  I’m thinking about ways to rib JDRF’s Aaron Kowalski.

I first was introduced to my blood meter and lancet over six years ago.  There have been only two times that I’ve been able to put them aside, to walk away from the constant monitoring and action required by diabetes: the first time was the first trial on an artificial pancreas and now again in this second trial.  I ate dinner, I exercised and I haven’t had to test or pump.  Sigh – it really is a lovely feeling.

And as to how things are going…this trial is testing a similar system to what JDRF’s first industry partnership with Animas/Dexcom is pursuing – it is a hypoglycemia/hyperglycemia “minimizer.” And it has minimized the lows and highs – and when it comes into a target range it defaults to my typical basals.  It starts to put the brakes on if its forward prediction indicates I’ll fall below 112 from 45 minutes out…it almost worked perfectly.  At the very end of exercise I dropped to 69.  A one-point drop below the FDA threshold, so I had to take glucose tabs (ugh).  And after dinner I went over the upper limit of 180 (or it predicted I would) so it ramped up extra insulin.  I peaked at 200 and my blood glucoses have very nicely come back down to below 140.  In short – the minimizer is working fine.  It is more complicated – frankly – than the full control of the earlier trial.  But then putting a human into the mix guarantees more complexity…
I should note that this trial is designed to make a person go low to test the system – light lunch at 11 a.m., exercise at 4 p.m. (with no snack), and then dinner at 7 p.m. – whew.  It works – when I ran the show myself two weeks ago I went low EIGHT times – this time with the control program running things I’ve gone low THREE times and each time it was a “barely” low scenario (a 69 to say 65)…what I call a shallow low in that I was more drifting low than plummeting.  Like last time, the system used a lot less insulin than I did.  Amazing!  The purposeful design – aimed at going low – is meant to test the abilities of both patient and computer program.  There is a lot more complexity to all this than I’m including but I am in awe of the vision and brain power behind all this (thanks Aaron!).  This first system that comes to market will be like having my own personal coach in my pocket doing all it can to keep me safe and making suggestions when it can’t anymore and I need to step in…I don’t know why but the refrains from two songs keep going through my head: the Beach Boys: wouldn’t it be nice, and REM’s song (can’t remember the title…Country Feedback I think) where they sing: I need this…I NEED THIS.

Another thing worth noting is the advancements from the first time I did this.  Last time the engineers and Boris and my doctor had to be in the room with me.  Now it is remote telemetry and they are down the hall running the show and monitoring things.  Last time Stacey had to push the button on the Omnipod controller – now the computer program does it remotely and wirelessly – which means I don’t even know when it’s given me insulin.  The last time they had to have to jury-rigged boxes with the sensor receivers in them – this time the receiver is in a little pouch around my waist along with the wireless controller for the pump.  In short – essentially all the items for the artificial pancreas are now in a pouch on my body and it is ambulatory with me (clunky but truly mobile).  So what does this amount to…

We can tell our families, volunteers, and donors that their dollars have made a huge difference in just the past year in advancing the sophistication of this effort.  From big boxes and locked-in-place to everything in a pouch and mobile.  Step by step I am seeing this first generation system become a reality and it is because of the support of all our families!!!!  JDRF: progress you can trust!!!”

This, for me, was one of the first realizations I had as I concluded living on the artificial pancreas in one of JDRF’s human clinical trials of a closed-loop system at the University of Virginia last year. Of course the goal of an artificial pancreas system is to deliver significantly enhanced blood glucose control, avoiding both highs and lows – so why was this one of my first thoughts?

A bit of background may help – my name is Tom Brobson and I have type 1 diabetes.  I’m also ones of those crazy people who work hard to keep their blood glucose as close to normal as possible.  My A1Cs are consistently below 6 which, as we all know is great, but that number comes with a high price.  As my endocrinologist always reminds me it means I am always on thin ice – always at risk of experiencing a severe low.  And over the years I’ve had my share of them – the big change for me came with the arrival of continuous glucose monitoring (CGM).  With CGM I’ve been able to push my A1Cs down without having a low blood glucose episode creep up and ambush me.    That isn’t to say I don’t head low – I do – far too often – but with the CGM alarm I know its coming and head it off at the pass.  The other tough part of trying to have a good A1C is the amount of time and energy required day in and day out, 365 days a year; the constant testing, the judicious tweaking with .05 or .10 units of insulin (for example), and so on.  The burden of a never ending commitment to monitor what I eat, how I exercise, and how I take insulin…as we all know…its exhausting.

So as I prepared to participate in the artificial pancreas trial at the University of Virginia one of my big fears was: “What if the system doesn’t provide as good a control as I deliver for myself?”  This thought wasn’t far from the minds of some of my friends.  One very good friend who is also a type 1 kidded me that I would be the only person to see their A1C go up a tad while on a closed-loop system.

And then came the trial – you can see my blood traces below.  When I ran the show I went low 6 times with one high…the trace of my control looks like a roller coaster ride.  When the closed-loop system took over the difference was dramatic: a wonderful, calm, “normal” looking blood glucose trace.  The difference between the two was even more apparent in how I felt – I woke up on the closed-loop system feeling like I’d not only slept but that for the first time in years I hadn’t had to maintain hyper-vigilance – I was not only rested…I felt more free than I could remember being in a very long time.  In short – the whole experience was fantastic!!!

So often our work toward finding the cure seems to become an intellectual exercise in patience and future visions – something we are working for that will happen “some day.”  Participating in this trial brought home to me that with the artificial pancreas, the proverbial “some day” is today.  Even in its most primitive form, using off-the-shelf technologies, a first-generation closed loop system will vastly improve my ability to live and thrive with type 1 diabetes, ensuring that one day I will be able to fully benefit from the biological cure that JDRF is working to achieve.  The hours I spent on the artificial pancreas during the study allowed me, however briefly, to glimpse what actually experiencing the cure will be like: for me the cure will mean not having to think about my type 1.  With all of you, I look forward to that day’s arrival.