Some healthy reading over at Journal of Diabetes, Science and Technology that opens for discussion one man made barrier to accomplishing not only the artificial pancreas but also many of the step wise advancements that might be discovered along the way. This article begs an answer from JDRF as to how they plan to clear these roadblocks. Hopefully they won’t be spending more millions buying up patent licenses or implementing inferior workarounds. Otherwise their first millions may be a waste of money and could easily require a lot more than what is on the table at present. After all, if JDRF is ready with the cash what incentive is there for the for profit entities (assuming there will be more partnerships like this in the future) to fork over the dough?

From the article, this diagram below shows just how many patents are in play around a closed loop artificial pancreas.

Figure 2. Number of U.S. Patents filed per year related to closed-loop glucose control systems obtained by searching for the terms “closed loop”, “glucose control,” “artificial pancreas,” and “diabetes” combined with the most relevant IPC classes (A61M, A61B, and G01N). Similar terms were considered (e.g., “close” instead of “closed”, or “analyte” instead of “glucose”).

Download the full article from the Journal of Diabetes, Science and Technology website here

Diabetes care has never been more overrun by new therapies and technology than today. What’s certain is that this trend will continue. I’ve lived with diabetes through many different “revolutions” in its management, starting with disposable syringes, smaller sharper needles, U-100 insulin, clinitest tablets, ketostix strips, self blood glucose monitoring, insulin pump therapy, human insulin, analog insulin, glucose sensors and everything else in-between. Many of you may not understand the initial references I just made while others may be able to add many more. Having a historical perspective on type 1 diabetes helps many of us understand how far we have come but also how much of a business that diabetes care has become. We drive an economic engine within the health care industry that is only getting larger as our ranks continue to swell.

My posts this week will be different than last week, even though we have a new group of campers. I refer any parents who want get more on my thoughts of childhood diabetes and camp to previous blog posts archived on this site which are also tagged under the category “TLC 2009″.

Quality diabetes self care is a process, not a device or new drug. This is because of the myriad of choices that go into managing constant shifts in blood sugar that occur to every mammal on this planet. In the case of young people, their team MUST include the family. To do less only harms the child or teen. Ironically, we seem to always be looking for ways to transfer many of the key day to day self care skills at younger and younger ages. As Barbara Anderson is well known to say, children and teens almost always lack the emotional muscle to match the physical muscle they use (or should use) to perform frequent daily self care tasks.

The next week will provide yet another window into how diabetes is (and isn’t) managed well in children from across the state of Texas. This camp has been the single greatest teacher in my lifelong study of diabetes in children. I return here each year to learn as well as to serve.

Today’s Diabetes Challenge question of the day asks “who is on your diabetes team?”. Are you a “Lone Ranger” or backed by the Verizon wireless guy and the “power of the network”? While we often applaud the “go it alone” approach and individual initiative in others, diabetes care is best approached as a team sport. The question is who is on your team? Who are the key players that play a pivotal role in how you live day to day with your diabetes or in the life of your child’s diabetes? Furthermore, how much of your success do you attribute to yourself and how much can you directly attribute to others on your team? How many of you wish you had a larger team? A smaller team? A more relaxed team? A more involved team? Perhaps you think that diabetes self care is just that: SELF CARE; and no one else needs to be involved. Be honest and be specific.

Stay in virtual touch with diabetes camp

I am posting daily blogs here about important diabetes issues that directly relate to the camp and posing controversial questions to you as above. I’m also tweeting very frequently from camp. Check out my twitter site: http://twitter.com/Dr_Steve_Ponder . My tweets are real time observations from camp (plus twitpics) as they happen, sent immediately from my mobile phone. I’m discussing how things are going and any special problems or situations that all parents of children with diabetes would benefit from. I’ll also answer questions posted to this blog site as quickly as I can. You can also check out the camp’s website at http://www.lionscamp.com where you can check out daily photographs from the day before. As always, we will be preparing a complementary DVD photo album for all campers to be provided at check out on Friday evening.

Parent’s Webinar on Wednesday Evening

A Parents Day Webinar will be held at 8-9PM CST on Wednesday July 29th 2009. Go to the TLC webinar site now for the details on how to participate. It’s totally free and can be accessed from the comfort of your home PC, laptop or just call in using your telephone. Even if you don’t have a webcam, you can dial in to the conference bridge. I’ll be discussing camper progress at camp to date, key observations about how campers are stacking up compared to each other, and address some major hot button issues in type 1 diabetes care of children in 2009. There are several hot topics I’ll be addressing. Join in and listen, or submit questions on line in the Q&A section of the Live Meeting toolbar during the webinar. See you in cyberspace! Also feel free to suggest topics via comments to the blog posts below. (New comments are approved so if this is your first time it may take an hour or two before you see your comment online).

If you’re a parent or spouse of a person with type 1 diabetes, are you a member of the “3 AM Club”? I’m not talking about a late night out on the town with your friends, but the “witching hour” when low blood sugars are more likely to happen. Scary movies often portray 3AM as a time when mysterious or supernatural things occur to people. In diabetics taking insulin, 3 AM can become a “perfect storm” of sorts where the sugar lowering effect of the insulin, excessive physical activity or less food intake collide at a time when a blood sugar “low tide” naturally occurs.

Being a 3 AM clubber means you’re someone who sets your alarm clock during the middle of the night to check your child or loved one for a surprise low blood sugar. Your membership ritual occurred on that night your child or spouse had that severe low blood sugar during sleep, maybe even a seizure. After ceremoniously witnessing a severe low sugar or even calling 911 for help, you take the vow to not let this happen again, even at the cost of your own physical and mental well being.

3 AM clubbers are everywhere. In my practice I try to find them and offer a way out. Most are not hard to find: just look for the bags under the eyes and the burned out looks on their faces. That’s what years of 3 AM club membership will do for you. One family I know of had her aunt sleep on the floor every night in her niece’s bedroom for 10 years after a low blood sugar when the girl was a toddler.

But first they must be willing to leave and that takes some effort to change. Being the nighttime BG checker is a noble and selfless act, but it takes a dangerous toll on this family member, beginning with sleep deprivation, chronic stress and anxiety, and even eventually problems with marital relations. Many feel it’s a duty and to do anything less would be wrong. They often see no way out. Now in most cases I’m talking about moms, but dads are often found wandering around in this club too.

But unlike the “Hotel California”, you can check out AND leave the 3 AM club. The first step is to carefully review the insulin doses taken in the evening. They might just be too much. Different insulin types peak (work strongest) in relation to the time when they’re injected. If that peak happens during the middle of the night (like with NPH insulin taken at suppertime, or 75/25 or 70/30 premixes), talk to your doctor about changing the time the shot is taken. Since most children and teens today are on basal bolus insulin regimens, the peaking effect of the basal insulin preparations (glargine and detemir) is less pronounced and can be managed by prudent adjustments in most cases.

Adjust the bedtime snack to provide a source of long-acting carbohydrates into the body to allow a steady source of sugar for getting a good night’s sleep. Excessive physical activity the day before can cause post-exercise hypoglycemia and can be offset by increases in the bedtime snack carbohydrates on that night only. In general, proper meal and snack planning can be as helpful as insulin adjustments for reducing the chances of middle of the night low blood sugars.

High tech exits from the 3 AM club include the insulin pump and/or the continuous glucose sensor. Rates of insulin delivery may be lowered at night to avoid aggravating the natural tendency for middle of the night low sugars. Remember to time the rate change to happen about 2 hours before the time you really need less insulin action.

Continuous glucose monitoring sensors now measure blood sugar levels minute to minute and have alarms that go off at night when sugars start to get too low or too high. Add a baby monitor to your toolkit and you’ve got a high tech solution for remote monitoring. These new CGMs require a level of commitment by the family and patient to wear them consistently, which is not insignificant (for help with reimbursement you might try CGMSCentral). Also, these units are pricey and require a doctor’s prescription, but they can get be an express ticket out of the 3 AM club for many.

So just how much BG checking is too much? That’s debatable. Those of you with CGM devices may glance at them every hour or more. But monitoring hourly blood samples is excessive for all but the most obsessive compulsive folks and not a practice compatible with good mental well being. It’s all about what you do with the data you get. Going to the 3AM Club now and then is fine and a very good idea especially for those days outside of normal or even as a planned test for a few days. But when you find yourself trapped in the 3 AM club, start looking for the exits.