Got questions about navigating life with diabetes? Ask D'Mine! Our weekly advice column, that is, hosted by veteran type 1 and diabetes author Wil Dubois. This week, Wil is tackling a query about fluctuating glucose levels you said it closed-loop system systems (you roll in the hay, so-known as "Counterfeit Pancreas" technology) power be a way to get a handle on blood lucre woes. Read on…

{Got your own questions? E-mail US at AskDMine@diabetesmine.com}

Nancy, D-mom from Wisconsin, writes: Constant glucose monitoring devices use opening fluid to measuring rod glucose. It is glorious that interstitial glucose has a delay relation to blood glucose of adequate to 15 transactions. To boot, at that place is an truth problem with all measurements, blood glucose or interstitial glucose. If a diabetic is relatively stable, maybe I can see that a closed loop organisation exploitation them would work. However, my baby and others that I screw are non stabilised. Would you delight comment happening this?

Wil@Ask D'Mine answers: You stakes! Actually, I can make individual comments, and my first is: Don't kid yourself. There's no such thing as a "relatively stable" person with diabetes, at any rate not when information technology comes to blood glucose, and maybe not when information technology comes to anything other, either. But this want of blood sugar stability was a big offend to the research community in the early years of continuous glucose monitoring (CGM). They now could see that we PWDs (people with diabetes) were complete the place — much many so than anyone had ever complete before, as no PWD in chronicle had ever been precondition enough test strips to reveal the inherent topsy-turvydom under our skins! So, on the bright side, your baby is non an outlier.

But the good news here is that the closed-loop system development crowd knows this fact, and the algorithms in development are capable the task of riding this bucking bronco of real-life unstable blood shekels much better than you'd defendant. More on that in a bit.

Of course, your point on accuracy is accurate. No affair what consumer grade engineering you use to exam blood glucose, the results are questionable. That same, the improvement in CGM accuracy over the last decade is zip short of mind-boggling, and that accuracy has evolved at a rate that puts our long-revered fingerstick tests to disgrace. Information technology's non for no reason that the FDA has cleared some CGMs for use to replace fingersticks. They are that skillful, surgery, depending connected how you look at it, fingersticks are that bad. Either room, I think it's safe to say that modernistic CGMs are nearly as good atomic number 3 fingersticks in any single-point measurement.

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But it doesn't final stage there. Because a fingerstick, even if it were past some miracle or stroke of luck 100% research laboratory-grade accurate, still doesn't tell you much, does information technology? A perfect—but isolated—measurement of sugar in a universe of people who have inherently unstable sugar isn't very all that laboursaving. The power of CGM is being able to view non what your blood sugar is, just what IT's doing. Is it going up? Or kill? Down fast? Down really, really fast?

Fingersticks are a photograph. Predestined, maybe a beautiful, framed fine art black-and-flannel print, but  just a tranquillize shoot nonetheless. CGM, then again, is many along the lines of "Diabetes: The Flic." Even the early CGMs, which had rather piss-bust accuracy, still provided superior situational awareness for CGM pioneers comparable me, and that awareness of the tides and surges of our ancestry lettuce is the best tool we have to attempt to stabilize our unstable diabetes.

As to the delay between interstitial glucose (Immune serum globulin) and capillary glucose, information technology doesn't actually matter that much. Trustworthy, the IG has, as you same, a more surgery less 15-minute of arc wait when compared to glucose measurements from a fingertip (which is however postponed compared to glucose in the brain, where it matters). But to realize why IT doesn't matter we need to babble out almost trains. Yep. Like choo-choo trains.

The engine of a choo-choo train gets to whatsoever given level on the track before the caboose does, but they both travel the same way. Too, even though capillary glucose will be ahead of IG when the saccharide is dynamic rapidly, the Immune serum globulin behindhand is on a more-or-less predictable itinerary along the same track. Actually, concern have in mind it, for us PWDs, maybe a roller coaster would have been a better visual than a choo-choo train, but you get the mind. Anyway, the folks working along closed-loop system systems also know this, and have studied their software package to account for the "lag" in IG.

And actually, our current partly-closed loop systems work surprisingly well, especially given that they use only one hormone—insulin—either restricting or increasing its flow to attempt to keep blood glucose variations in cheque. Previous on, earlier the current systems, my money was on dual-endocrine pumps: Systems that could deliver insulin to lower glucose PR, and glucagon to wage hike it, also as needed.

That made analytic sense to me: a hormone and a heel counter-regulatory internal secretion for perfect homeostasis. That's what the body does in not-polygenic disorder common people. But the stable glucagon needed for such systems has been slow in coming, giving the insulin-only systems a chance to prove themselves—which they are doing marvelously. And like the quietus of this D-tech, they'll only get amend and improved over time. Will they reach perfection? I very much doubt it. Simply the day when the closed loop far outstrips the efforts of the virtually diligent and consecrate PWD using conventional tools is shortly off the least bit. I think that your child, and all the other "not-stable" children (and adults) unfashionable there will do much better than you can conceive of as this tech matures.

And ironically, the Thomas More impermanent a person's blood sugar is, the more I think they will benefit from a closed loop. After all, if you somehow managed to be comparatively stable, you wouldn't necessarily need a unopen loop, now would you?

This is non a medical exam advice newspaper column. We are PWDs freely and openly sharing the wiseness of our collected experiences — our been-there-through-that knowledge from the trenches. Bottom Line: You still need the guidance and worry of a licensed checkup professional.