Biomedical Engineering: The Search for Solutions, Big and Small, for Type 1 Diabetes
November is Diabetes Awareness month. Learn more about Type 1 Diabetes and the kinds of medical devices, solutions, and applications being used and developed to help treat and manage the disease—and put yourself in the middle of ongoing research and development with a cutting-edge student biomedical engineering, human biology, or computer science project.
When you get sick, you want to make sure you have the best possible treatment (or the right medicine) to help you get better quickly. Your needs in that situation are, hopefully, short-term. The right medicine or treatment may make the problem go away. If you have a chronic, lifetime disease, however, your interest in ensuring you have the best treatment plan in place may shift into hyperdrive because a single course of a medication won't solve the medical problem.
For a disease like Type 1 Diabetes (T1D), an autoimmune disease in which the body destroys the insulin-producing cells in the pancreas, both proper ongoing treatment and round-the-clock monitoring are required to ensure a person with Type 1 Diabetes stays healthy and prevents serious medical complications that may be associated with uncontrolled diabetes.
The Need for Insulin
For people with T1D, insulin is a requirement—not an option, and insulin isn't something you take occasionally, once a day, or even for just a few weeks. Every day, throughout the day, people with T1D monitor their blood sugar and take insulin in proportion to what they eat to keep blood glucose levels within a certain range. (In a person without diabetes, the pancreas manages the production and release of insulin.)
Many people with T1D take insulin by injection, which involves taking multiple shots a day, and many people at some point switch to an insulin pump to make insulin delivery more convenient and more precise. Insulin pumps can deliver insulin in much smaller increments than possible with a syringe, for example. A pump can also help deliver insulin over time, rather than all at once as a typical shot of fast-acting insulin does.
The Need to Monitor Blood Glucose
Taking insulin is only part of the day-to-day picture for people with T1D. They also have to always keep a close watch on their blood glucose levels. While blood glucose levels rise and fall in response to carbohydrates and insulin, blood glucose levels also go up and down in response to exercise, strong emotion, periods of intense concentration, illness (like the flu or stomach virus), and many other variables. Complicating things even more is the fact that blood glucose responses are different for different people. There is no one-size-fits-all treatment plan for T1D.
Fluctuations in blood glucose happen all day long, and people with T1D have to work to keep their numbers from going too high or too low, both of which can cause serious medical problems. The primary tool someone with T1D uses to keep tabs on blood glucose is a blood glucose meter. The meter uses a special strip to which the person applies a small sample of blood from the finger. The meter reads that blood sample and returns a blood glucose value. Many people with T1D check blood sugar levels 7-10 times a day or more.
Another tool people with T1D may use, in conjunction with finger-stick testing, is a continuous glucose monitor (CGM). A CGM involves a small sensor that is inserted just under the skin and performs blood glucose readings every few minutes, which it then transfers to a receiving device. The data gathered by a CGM can provide warnings to someone with T1D and help prevent a hypoglycemic (low blood sugar) or hyperglycemic (high blood sugar) problem. A CGM not only reads current levels, but it can offer an indication of the way blood glucose is trending. One popular CGM, for example, uses a system of arrows to alert someone with T1D whether blood glucose is rising or falling—and how fast. CGM data also helps provide a look at the patient's blood glucose over time. Looking at the data over a period of days, for example, can help the patient (and her medical team) spot trends and patterns in the numbers that may result in changes in the patient's insulin plan (or food choices) at certain times of the day.
Both pumps and CGM options give patients greater control over their diabetes, but medical and biomedical research looking into ways to make these devices even smarter is ongoing.
Even with existing tools, there are improvements that could be made. For example, despite the fact that people with T1D rely on blood glucose meters when making decisions regarding their insulin needs, blood glucose readings can vary significantly even when tests are performed one right after another or from the same drop of blood. Blood glucose meter strips are also known to have different levels of accuracy at different thresholds of blood glucose. Improving the accuracy of blood glucose testing could make a real difference in how effectively a person can manage her T1D.
When looking at solutions to improve treatment and monitoring for those with T1D, the search for a smarter, more integrated solution immediately comes up. There is, in fact, a great deal of research time and money being spent trying to bring what is often referred to as an artificial pancreas, or a "closed" system, to the market. Researchers are looking to develop a piece of biomedical equipment which will act autonomously to regulate blood glucose—as a pancreas does. Such a system has to be able to read and monitor blood sugar; make decisions about what to do based on blood glucose levels, carbohydrates being eaten, and other variables; and administer insulin.
While there are many biomedical engineering research projects underway that may hold great promise for the treatment of Type 1 Diabetes in the future, advances take time and a great deal of testing. The process of getting something FDA-approved and into the hands of patients is often years and years away.
Individuals Brainstorming Solutions for Today
People with T1D or who take care of someone with T1D are often looking for answers and solutions that can help them right now with the management and monitoring of T1D. Already the desire to better use CGM data and have more visibility into T1D glucose numbers has led a group of parents to patchwork together a solution that allows data from a CGM to be transmitted to a cloud and thus accessible from a smart phone (or a smart watch). This kind of approach makes smart use of the tools and technologies already available and increases the potential and effectiveness of the tools.
A CGM often works only if the device on the person is within a certain number of feet of the receiver that shows the blood glucose number. Even in a single house, this proximity requirement may not allow a child to sleep in one room and a parent in another room to be able to monitor blood glucose with the receiver. Similarly, for parents with children with T1D in school, blood glucose events during the day are often a large unknown until the child comes home and data from a meter or CGM (or both) can be reviewed.
What parents want seems simple—the CGM data to be accessible from a mobile app, a website, or another device to enable remote monitoring.
Finding a way to change the current proximity requirements and limitations and get the data from the CGM device and into the cloud where it can be accessed and viewed by users via a website or mobile app is a powerful concept, especially for parents, and more than 8,000 families have already jumped on board with the Nightscout project, also referred to as CGM in the Cloud. Nightscout was started by a father of a child with T1D and has rapidly evolved with the support and collaboration of a number of families, both those helping further engineer the solution and those following the directions to implement their own Nightscout at home.
Nightscout requires a dedicated OTG-capable Android phone, a website, a cloud account, specific cables, and some old-fashioned tinkering (and maybe tape) to get the solution up and running, but with a mantra of "We are Not Waiting" (#wearenotwaiting) families are scrounging up parts, hacking the solution for their own families, and making blood glucose monitoring something more easily done anytime, anywhere.
Nightscout is not the only individual or small company solution dedicated to changing T1D management. From mobile apps to new meters to other cloud approaches, the T1D community is thriving with ideas, prototypes, and projects designed to make living with and managing T1D easier. (For a summary look at a few of these projects, see: CGM in the Cloud, Joslin's HypoMap and More at the DiabetesMine D-Data ExChange!.)
Students Making Real Connections
For students interested in diabetes research or in medical biotechnology, the kinds of projects underway related to T1D offer lots of exciting opportunities for student science project connections. The following projects at Science Buddies support students in learning more about T1D and the kinds of biomedical engineering, computer software and application development, and health and human biology that come into play treating and managing T1D today and tomorrow:
- Dealing with Diabetes: The Road to Developing an Artificial Pancreas: This project idea guides students in a biomedical engineering project that lets them tackle and explore some of the issues researchers are addressing with similar real-world projects.
In the Dealing with Diabetes project, students create a simplified model of an artificial pancreas that uses an electrical circuit and acid/base chemistry to enable a beginning investigation into the complexity of a self-regulating system.
- Blood Sugar Balancing Act: How Exercise Tips the Scales: Exercise can have a big impact on blood sugar levels, but the way exercise affects blood glucose varies from person to person. Some people find that their blood sugar drops during exercise or immediately after, some people find that their glucose levels rise during exercise, and some people find that their blood sugar shows dramatic difference as many as twelve hours after exercise (in the middle of the night, for example). The variable response to exercise can make properly predicting insulin and carb needs tricky for someone with T1D. Understanding personal trends in response to exercise can help.
In the Blood Sugar Balancing Act human biology science project, students conduct a series of trials to evaluate how someone's blood glucose responds to exercise.
- Staying Healthy with Personal Medicine Apps: With MIT's App Inventor, students can set up apps that can help people remember important tasks—like taking their medicine. The new Staying Healthy with Personal Medicine Apps science project idea guides students in programming a medication reminder app. The project is not written specifically for diabetes, but students interested in healthcare and app development might explore MIT App Inventor and the idea of a personal medicine application that is geared for T1D treatment and the need for frequent testing and injection of insulin. (To better understand the uses of mobile apps for someone with T1D, a survey of popular glucose tracking tools like mySugr may provide helpful insight.)
- Dexcom, a major CGM maker, just recently introduced a new monitoring solution called Dexcom Share.
- For more information about Nightscout, see: CGM in the Cloud: A Community Unites to Tackle Diabetes and Nightscout: #We are not Waiting.
- For more information about the Artificial Pancreas project, see http://jdrf.org/research/treat/artificial-pancreas-project/.
For more information about the Bionic Pancreas project (Boston University and Massachusetts General Hospital ), see http://sites.bu.edu/bionicpancreas/aboutus/">http://sites.bu.edu/bionicpancreas/aboutus/">http://sites.bu.edu/bionicpancreas/aboutus/.
- For more information about Stanford's artificial pancreas and "closed loop" research, see http://dped.stanford.edu/apc/.
- The Washington Post recently wrote about the Nightscout project in an article titled "Citizen Hackers Tinker With Medical Devices: Diabetes Patients, Family Members Try to Make Glucose Monitors More Useful."
- For more information about variances in blood glucose testings, see Why Meters Can't Tell Us Our Blood Sugar Levels
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