Comment by idealmedtech | Hacker News Reader

Comment by idealmedtech | Hacker News Reader

Hi, I'm an artificial pancreas developer! Our device has been approved for human trials which we're going to begin shortly, probably near the end of this quarter.

One thing that the article (which is very well researched, by the way, kudos!) does not quite get right is that the insulin sensitivity _changes_ hour to hour, day to day, month to month. It changes nonlinearly with exercise, stress, sleep, diet, and in a million other subtle ways that we're still trying to characterize. This dynamism is part of what makes management of blood sugar so hard, because the same dose that got you in range a couple days ago now sends you into a hypoglycemic episode, which can be really really dangerous!

The good news is that, while cures for diabetes have been Five Years Out (TM) since the 1980s, artificial pancreas technology (like Loop, OpenAPS, and recently approved Omnipof 5) is here _today_ and already giving people a real solution, not to mention peace of mind, but we still have a long way to go! Access issues, trust relating to years of anxiety induced trauma, cost etc are all barriers to making these solutions widely available, but I feel hopeful that in 20 years, a T1D diagnosis will be as manageable as an eczema one.

If anyone has any questions about APs, I'd be happy to field them!

I just looked at your profile and saw what your company is working on. Very interesting!

My wife and I were recently in a situation where I'd wondered why the hospital didn't have such a thing!

My wife has T1D and we just spent 3 days in the hospital for the birth of our daughter. The most scary and frustrating part of the whole process was my wife's diabetes management. She uses a Tandem T:Slim and a Dexcom G6, and generally has very tight control. But the hospital insisted on taking over during active labor, and we had a very tense conversation with a tactless perinatologist about it.

They wanted to put her on an (IIRC) intermediate acting insulin drip, and rely on finger pricks. We were very worried that they would basically be following a canned script and would end up yo-yoing her blood glucose during labor.

We ended up getting our OB to convince the completely tactless perinatologist that we'd define "active labor" as actually pushing. So we delayed getting her off her pump/CGM and self management for quite a while. And by then we'd also fortunately convinced our nurse who was responsible for the insulin that we knew what we were doing. So she consulted with my wife (literally between contractions and pushing) on any insulin delivery. They adjusted the plan in real time based on what my wife said they should do. Had they just followed the script/protocol the hospital had, we probably would have seen them give my wife way too much insulin.

Then for the rest of our stay, the hospital insisted on checking her blood glucose with finger pricks, though she was self treating with her pump. It really felt like it was for their benefit and not hers.

It was really clear that literally every person we interacted with (except maybe the tactless perinatologist) knew less about T1D than we did. They are much more setup for poorly managed gestational diabetes.

Watching the hospital try to manage her T1D made us feel like we were jumping back in time a decade or two. And this was one of the big, nice, (and expensive) hospitals in San Francisco.

If she would have had a c-section or some other situation where she wasn't able to help direct her diabetes management, I'm kind of afraid of what could have happened.

It really made me wonder why there wasn't an artificial pancreas type system for hospitals.

Now I see that someone is actually working on that!

Sorry to hear about your terrible experience, which is unfortunately all too common when it comes to glucose control.

We're on _exactly_ the same page. When people really get what we're doing, often times the reaction is "wait, that doesn't exist yet?" The reasons are complex, and there's lots of hurdles to overcome (IMT was formed in 2014, in development since 2007, we're only just now starting human trials), but we believe that there are millions of people every year who, like your wife if you hadn't spoken up, slip through the cracks and suffer from poor glucose control in the hospital.

Glucose control has the potential to be the next penicillin, in terms of how broadly applicable it is, and how drastically it reduces mortality across a whole range of conditions. We're pretty excited about it!

Sorry to hear about hat - it must have added a huge amount of stress.

I had a similar experience thirty years ago, after being hospitalized for ketoacidosis. (Fun fact: As a DKA patient, I found myself next to an attempted suicide, and noticed that med staff treated us both with disdain. Seriously bad way of managing health outcomes. But I digress.)

The experience in question was a doctor-prescribed insulin injection that the nurse insisted on injecting. I objected, but was unable to be heard. I calmly demanded that the nurse return at 11PM with orange juice to counteract the reaction that was inevitably coming. She did, and the crisis was averted. The next day the doctor prescribed that I could manage my own dosage.

Diabetes management is remarkably complex, and few medical folks know how to do it.

My girlfriend has T1D, she diagnosed when she was very young. She’s great at managing it and has a pump and a CGM, but there’s still so much bullshit that she goes through when parts break. It’s really made me furious at the medical device industry, so I’m happy to see you’re working on new solutions. As a software engineer, I often wonder if there’s anything I can do to help with T1D management, so if anyone knows of projects/companies that need devs, I’m all ears.

OpenAPS is the big one, though I think they need _documentation_ more than code. Reach out to Dana on Gitter or Twitter, she's always been very helpful in the past!

Hey Jeremy, I was hoping to send you an email based on the email in your profile (jeremy@ideal.com) and received an "address not found". Would there be a better way to reach you?

It's @idealmedtech.com! I did it that way to keep the bots away, but perhaps it was a little _too_ effective

The change you've already made seems pretty likely to work but maybe @ <myusername> .com would be even clearer and still have the desired effect? (or since you have the URL in there some reference to that, YMMV, just the thought sprung to mind so figured I'd share in case it was useful)

Good call! I like that even more than what I did, will make the change

How does one go about getting on the list for trials?

Recruiting is usually handled by study centers, and depends on the study. We're going to take in healthy volunteers for this current one, but I don't think we have any say on who, unfortunately! Would also present a potential conflict of interest to have anyone even tangentially related in the study.

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