Insulin+Pump

= Insulin Pump  = The insulin pump is a small mechanical, computerized device that Type I Diabetic patients use to improve the control their diabetes. This technological advancement was a major breakthrough in the medical treatment of Diabetes. As of 2007 in The United States there are 23.6 million people with diabetes. Of that amount only 17.9 million people have been diagnosed; the remaining 5.7 million people have yet to be diagnosed. On top of these statistics the total amount of people with Type I Diabetes is about 5 to 10%. [|[1]] This percentage roughly breaks down to about 15 new cases of Type I Diabetes per 100,000 of the population per year. [|[2]] The Animas Corporation, a division of the Johnson and Johnson Company, is one company that has developed several insulin pumps that are widely used today. They are located in West Chester, PA. For this report its purpose is to concentrate on a technology that was developed close to Philadelphia, PA and for that reason the Animas Pump Corporation’s One Touch Ping is discussed later on in the document. = The History Behind Diabetes  = Diabetes has been around for many years although doctors could not explain it or understand it clearly. The first mention of Diabetes came in 1550 B.C.E. from an Egyptian medical document called //Ebers Papyrus [|**[3**]] //. The author of this document depicts a circumstance of “passing too much urine”. 2 Following the Egyptians and several years later the beliefs of a few Greek physicians emerged. In about 2 A.D.E. the first name for diabetes appears. Aretaeus used a Greek word that meant siphon, meaning to pass through. This was later translated into diabetes. Aretaeus described diabetes as follows: “Diabetes is a wonderful affection, not very frequent among men, being a melting down of the flesh and limbs into urine...” [|[4]]. Early Hindus used the term “honey urine” 3 that described the sweetness of the urine in diabetic patients. Many people began to observe this notion. One way diabetes was being diagnosed was to pour urine of a suspected patient near an anthill. The physicians at that time believed if the ants were drawn toward the urine then in fact there was a presence of too much sugar. By 1776 scientists added the Latin word mellitus to diabetes to describe the sweetness of the urine. They also learned that sugar glucose was found in the blood of both patients with diabetes and those without. This discovery led them to conclude that the sugar was passed from the blood to the urine when an excess of too much sugar was present. At this point though the scientists were still not sure of how this occurred. About 100 years later in 1889 two German physiologists discovered that the pancreas was somehow involved in the diabetes occurrences. Their names were Oskar Minkowski and Joseph von Mering. They came to this conclusion by experimenting with dogs. They were conducting tests on how fat metabolized in the body and removed the pancreas of one dog. After the removal of the dog’s pancreas they noticed that he began to urinate frequently. This led them to test the dog’s urine for glucose. The test came back positive for diabetes. The conclusion was obvious to the two physiologists. They concluded that there must be something inside one’s pancreas that stops diabetes from developing. In the next several years many scientists tried to find a cure based on a “magic” substance that was in the pancreas. Three possible cures they came up with were opium, diets, and bloodletting. 3 For some these cures seemed to work but it was mostly for those that the diabetes was not in its extreme case. Many young Type I Diabetics did not have any affects from the ailments and in most situations died a few years after being diagnosed. During the same time people were searching for cures Paul Langerhan discovered the pancreatic islets in his doctoral presentation in 1869 at the University of Berlin. The pancreatic islet cells were later called the islets of Langerhans. Finally, in about 1921 Professor J.J.R. Macleod and Dr. Frederick Banting began working with a lab dog and the idea of the pancreas and the islet cells. Dr. Banting cured a dog that had diabetes by injecting an extract from the islet cells. After a successful result the team attempted to cure a 14 year old boy who was dying from diabetes. The extract had to be purified although it worked and he lived for 15 more years. Dr. Banting and Professor Macleod won the Noble Prize in 1923 for this discovery. Although they had been noted for the discovery it was also both of their assistants who had collaborated on the discovery of the first insulin. They are Charles Herbert Best and James Bertram Collip. With the discovery of this cure people with diabetes began to live longer. The next issue arose with people living longer was the various complications. Elliot P. Joslin, the first doctor to specialize in Diabetes in the United States, noted that "The era of coma as the central problem of diabetes has given way to the era of complications. People with diabetes are at increased risk for the development of serious complications, including blindness, kidney failure, heart disease, stroke, and amputations." 4 It has been proven with the proper management of one’s diabetes along with instruction from a specialized doctor, Type I Diabetes can be controlled. = Causes of Type I Diabetes  = The main basic development of Type I Diabetes is the immune system attacking the beta cells in the pancreas. The beta cells the immune system attacks are those that produce insulin. One’s own body is the sole cause and reason for Type I. This is termed an autoimmune disease. The body mistakenly targets the beta cells as a foreign cell that does not belong. When the beta cells are destroyed the pancreas can no longer produce the body’s natural insulin. Insulin is vital to all human beings. It is what turns the food they eat into fuel for their body. Fabricating human insulin was the first biotechnology and engineering success. [|[5]] With this in mind there are several studies that have found different links to those diagnosed with Type I Diabetes such as genetics, auto antibodies, and viruses. Genetics are believed to help explain why a person may get Type I Diabetes. It is believed that Type I Diabetes runs in families. Thus, a child may inherit diabetes from previous family members having it; this would usually be a mother or father. Another possibility some researchers have been looking into is analyzing the genes in one’s DNA. They have made several correlations between diagnosed patients with genes that may actually make someone develop Type I later on in life. These genes are called diabetes susceptibility genes because researchers have not yet found one single gene that causes Type I; rather there are several gene possibilities. Auto antibodies are present in people who have autoimmune disorders. In this case it would be Type I Diabetes. There are three auto antibodies that are common for someone to have that has been diagnosed with Type I diabetes. These auto antibodies recognize islet cells (beta cells), insulin, and glutamic acid decarboxylase (protein made by the beta cells). These antibodies may even be present for many years before or if the body ever acts on them. The T cells are what primarily go after and kill the insulin producing cells of the pancreas. At the time of diagnosis 70 to 80 percent of the people have antibodies to islet, there are 30 to 50 percent with insulin antibodies, and 80 to 95 percent with glutamic acid decarboxylase antibodies. 3      Some scientists believe that viruses may also play a role in causing Type I Diabetes to occur. The main reason for this assumption is because a lot of the time those that develop Type I have often had a recent viral infection. The theory behind this idea is that when the T cells in one’s body recognizes the foreign cells of a virus, they begin to fight it off. The cells of the virus are so similar to that of the beta producing cells in the pancreas that the T cells, in turn, assume the beta cells to be foreign as well. This creates the T cells to kill off the beta cells; thus causing Type I. Another possible idea related to viruses is that when the virus is in the body it may alter the structure of the antigens on the outside of the islet cells. This alteration may be the reason for the T cells presuming the beta cells are foreign. = Diabetes Type I Management   = The main concern for Type I Diabetics is controlling their blood glucose level. Since their body no longer makes insulin in order to lower the higher blood glucose levels, insulin injections are crucial. There are three main factors that play a role in Type I management. They are food, exercise, and level of blood glucose. The amount of insulin that one’s body needs depends on mostly the above three factors. When it comes to a range of a normal blood glucose reading, the range tends to vary between different companies and institutions. On average before eating anything a typical person will have a blood glucose reading between 80 – 120 mg/dl. Most Type I patients will have two types of insulin that are used to control their sugar levels. They are long acting insulin, such as Lantus, and fast acting insulin, such as Novalog or Humalog. The long acting is used to cover a patient’s background insulin or basal rate. This is to cover the sugar that one’s body naturally makes from their liver. Typically, if a patient does not eat anything or do any vigorous exercising with an accurate dose of long acting insulin, their sugar should stay stable. The next factor is eating. Diabetics need to be concerned with the amount of carbohydrates that are in what they eat because the carbohydrates turn into sugar. With a nutrionist and an Endocrinologist, a ratio between carbohydrate intake and insulin will be determined. This ratio will then be applied to the fast acting insulin. Fast acting insulin is used for two reasons. The first is for food intake. A patient will take fast acting insulin prior to eating, and the amount of insulin they take is based on their carbohydrate to insulin ratio. Fast acting insulin will generally peak within about two hours after injection and be out of one’s system within four hours after injection. The next use for fast acting insulin is when one’s blood sugar is high. Like the carbohydrate to insulin ratio, there is also a ratio for lowering blood sugar. There are currently three ways to receive insulin injections. They are the traditional syringe and needle, insulin pens, and an insulin pump. The insulin pump will be later discussed as well as future research. Another potential source of managing diabetes is transplantation of the pancreas and the islet cells. When considering a pancreas transplant, the patient needs to look at all the possible outcomes and side effects. Transplants can be a whole new pancreas or a portion of a pancreas someone has donated while leaving the old one still in the body. For successful transplants the patient may have normal sugar levels and no longer need insulin. The major downside of pancreas transplants is the patient’s body will treat the pancreas as a foreign object. In order for this not to happen, strong immunosuppressant drugs are required in order to avoid rejection. When taking these drugs it lowers the immune system’s ability to fight off viruses, bacteria, and diseases. This opens up new areas of concern when considering a pancreas transplant. Islet cell transplants are still being researched. They still would require strong immunosuppressant drugs that cause other health issues to arise. One major issue with transplants in general is the amount of organ donors in comparison to the amount of patients with Type I diabetes. = The Insulin Pump  =

Historical Progression
The first insulin pump was produced by a Los Angeles doctor named Arnold Kadish. He presented it in the early 1960’s, although he did not get any real recognition until the 1980’s. It had to go through several clinical and beneficial tests before it was considered an alternative to insulin injections. It was very large and had to be worn as a backpack on a patient. The first insulin pump manufactured was in the late 1970’s from Whitehall Laboratories. [|[6]] This insulin pump was just as large as the one Arnold Kadish developed with the idea that it too had to be worn like a backpack. While the technology was promising, the first commercial pump lacked the controls and interface to make it a safe alternative to manual injections. [|[7]] The inaccuracy of the dosing of the device made the pump more harmful than advantageous to the traditional injections. A few companies began investigating new features and ways to produce a marketable and accurate insulin pump. The most prominent advancements began in the 1990’s. Nowadays there are several pump manufactures with a wide range of features, and the accuracy is better than the traditional injections. Today several patients are choosing the insulin pump over injections for its ease of use and ability to mimic their bodies’ pancreas closer than traditional injections.

How Does it Work
An insulin pump attempts to take on the role of the beta cells in the pancreas. It is generally about the size of a pager. The pump is a computerized, mechanical device that delivers fast acting insulin continuously throughout the day. The insulin is stored in a reservoir inside the pump. It is connected to thin tubing that is also connected to an infusion set. From the tip of the infusion set is a cannula that is inserted into the body. It is removed and changed every 48 to 72 hours. The insulin pump is programmed to suit the needs of the Type I patient’s individual requirement of insulin throughout the day. It also regulates the insulin for food intake and acts as a sugar lowering factor. It is powered generally by a double A battery. The patient is still required to test their blood sugar during the day to accurately input the readings in the insulin pump. This aids in determining the required amount of insulin needed. There are about 250,000 people around the world that are using insulin pumps and have had better results in maintaining their blood sugar levels than when they were on regular injections. [|[8]]

Various Companies and Features
There are currently quite a few insulin pump providers. To name a few, there are Meditronic (Minimed), Animas Corporation, Omnipod, and CoZmo. Many factors come into play when choosing an insulin pump. Some considerations are size, user friendly abilities, warranties, basal increments, reservoir capacity, flexibility, and weight. The ideal pump to choose really depends on the user. All the pumps have their pros and cons depending on the specific features someone is looking for. For example the Omnipod does not use the traditional setup with tubing running from the pump’s reservoir to the infusion site on the body. Instead the Omnipod has a disposable pump that communicates wirelessly to a PDA that is provided with the pump. One issue with some users may be trying to be discreet with the location of the pump. Another feature is the reservoir size. Omnipod and Animas Ping can hold a maximum amount of insulin of 200 units of insulin, where as CoZmo and Minimed can hold up to 300 units. As previously stated, the main consideration when choosing a pump should be based on the research behind each pump and company interface. The user should choose the one that best suits all of his or her unique needs and requirements. = The Animas Pump Corporation  = The Animas Pump Corporation is located in West Chester, PA and is used throughout the nation. This report will concentrate specifically on the One Touch Ping Insulin Pump that is produced by the Animas Corporation. The One Touch Ping holds up to 200 units of insulin and weighs approximately 3.9 oz. It uses the traditional setup between the user and the pump. Two significant advantages to this pump, in particular, are that it is waterproof up to 12 feet for 24 hours [|[9]], and it comes with a PDA that can communicate wirelessly with the pump as well as manually. With its ability to communicate between the pump and the PDA, it shares information between the two. For example the PDA is also a blood glucose tester. When a patient tests his or her sugar, that information can be transferred to the pump, and an insulin dosage can be determined that is based on the information already programmed into the pump. This may be an important feature for some because it allows the user to keep the pump out of sight while delivering insulin. Another feature is that it has a more precise basal dosage than others. This is important for young children that have Type I Diabetes. The pump also offers a friendly interface for the user. Furthermore, without the technological advancements behind designing an insulin pump many Type I Diabetics would not have the advantage to a more flexible lifestyle and control of their glucose levels. = Future Advancements  = There are currently numerous research studies being conducted to try to find a cure, to prevent the disease or monitor any complications, and for advancements in treatments. A large majority of the work is focusing on trying to discover a method to reverse the loss of beta cells. In 2002 there were a series of trials conducted using oral insulin to prevent Type I occurrences. This research started back in 2007 and will continue for almost 10 years. Another advancement that is slowly being implemented today, is the continuous glucose monitoring system. Meditronic has another device that can be worn that will send a RF signal to the insulin pump reading the patient’s blood glucose around the clock. This is just starting to be used and still very new. Some people are hesitant to use it. Many insurance companies are not ready to approve such a new device. Another idea for continuous blood glucose monitoring is having a device in a contact lens. The lenses would work with the tear ducts and the amount of sugar that is transferred to them. A con to this idea would be the time delay between the sugars in the blood to the tear ducts. A study in new ways for treatment is having inhaled insulin as opposed to injections. This would be similar to that of what an asthma patient uses as an inhaler. It is still being researched to see if it is as safe as injections. Finally, the most controversial issue in today’s society has just been approved by President Obama and that is stem cell research. Some scientists believe stem cells can regenerate the beta cells. With all these ideas in mind there is a certainty that the management of Type I Diabetes can only improve. =    = =  Works Cited  = (n.d.). Retrieved March 2009, from Diabetes Journals: http://spectrum.diabetesjournals.org/cgi/content/full/15/1/56 (n.d.). Retrieved March 2009, from http://www.facts-about-diabetes.com/the-history-of-the-insulin-pump.html (2007). Retrieved March 2009, from National Diabetes Fact Sheet: http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2007.pdf Alan L. Rubin, M. (2008). //Type I Diabetes for Dummies.// Hoboken: Wiley Publishing, INC. Allman, T. (2008). //Genes and Disease Diabetes.// New York: Infobase Publishing. American Diabetes Association. (1996). //American Diabetes Association Complete Guide to Diabetes.// United States of America: Susan H. Lau. Corperation, A. P. (n.d.). Retrieved March 2009, from Animas Pump Corperation: http://www.animascorp.com/animas-onetouch-ping-insulin-pump.aspx Guide, D. T. (2004). //Katherine J. Moran MSN, RN, CDE.// Lanham, Maryland Toronto Oxford: The Scarecrow Press, INC. Katrina Parker, M. (2008). //Teen's Guide Living with Diabetes.// New York: Infobase Publishing.

[|[1]] National Diabetes Fact Sheet, 2007 http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2007.pdf [|[2]] Type I Diabetes for Dummies [|[3]] American Diabetes Association Complete Guide to Diabetes [|[4]] http://spectrum.diabetesjournals.org/cgi/content/full/15/1/56 [|[5]] Genes & Disease Diabetes [|[6]] Diabetes The Ultimate Teen Guide [|[7]] http://www.facts-about-diabetes.com/the-history-of-the-insulin-pump.html [|[8]] Teen’s Guides Living with Diabetes [|[9]] http://www.animascorp.com/animas-onetouch-ping-insulin-pump.aspx