scholarly journals Intraperitoneal insulin infusion: on the way to the artificial pancreas

2015 ◽  
Vol 18 (3) ◽  
pp. 32-45 ◽  
Author(s):  
Vladimir Aleksandrovich Karpel'ev ◽  
Elena Anatol'evna Fedorova ◽  
Yury Ivanovich Philippov ◽  
Aleksandr Yur'evich Mayorov ◽  
Marina Vladimirovna Shestakova
Keyword(s):  
Insulin Infusion ◽  
Insulin Pump ◽  
Artificial Pancreas ◽  
Glucose Monitoring ◽  
Promising Alternative ◽  
Insulin Pharmacokinetics ◽  
Intravenous Insulin ◽  
Modern Engineering ◽  
Intraperitoneal Insulin ◽  
Fast Insulin

Creating an "artificial pancreas" (a "closed loop" insulin pump, with self-adjusting insulin abilities, based on real time continuous glucose monitoring data) – is one of the most actual medical challenges of modern engineering and cybernetics.Artificial pancreas (AP) prototypes based on wearable insulin pump with subcutaneous insulin delivery are still problematic, mainly because of slow insulin pharmacokinetics. Intravenous insulin infusion via AP allows effectively maintain euglycaemia for inpatients, due to insulin pharmacokinetics and pharmacodynamics advantages. Unfortunately, it can’t be used for outpatients. Intraperitoneal insulin infusion is still relatively infrequently used in the world, but it is a promising alternative, compared to both previous methods due to a physiological action profile, fast insulin pharmacokinetics, relatively better safety and availability for outpatient usage.The purpose of this review is to describe the intraperitoneal insulin infusion features for diabetes patients at a point of AP creation perspectives. 

scholarly journals Moving Toward a Unified Platform for Insulin Delivery and Sensing of Inputs Relevant to an Artificial Pancreas

2016 ◽  
Vol 11 (2) ◽  
pp. 308-314 ◽  
Author(s):  
Anneke Graf ◽  
Sybil A. McAuley ◽  
Catriona Sims ◽  
Johanna Ulloa ◽  
Alicia J. Jenkins ◽  
...  
Keyword(s):  
Insulin Infusion ◽  
Insulin Pump ◽  
Artificial Pancreas ◽  
Glucose Monitoring ◽  
Insulin Delivery ◽  
Glucose Sensing ◽  
Glucose Sensors ◽  
Physical Burden ◽  
Ongoing Development

Advances in insulin pump and continuous glucose monitoring technology have primarily focused on optimizing glycemic control for people with type 1 diabetes. There remains a need to identify ways to minimize the physical burden of this technology. A unified platform with closely positioned or colocalized interstitial fluid glucose sensing and hormone delivery components is a potential solution. Present challenges to combining these components are interference of glucose sensing from proximate insulin delivery and the large discrepancy between the life span of current insulin infusion sets and glucose sensors. Addressing these concerns is of importance given that the future physical burden of this technology is likely to be even greater with the ongoing development of the artificial pancreas, potentially incorporating multiple hormone delivery, glucose sensing redundancy, and sensing of other clinically relevant nonglucose biochemical inputs.

Comparison of intraperitoneal, intraportal and intravenous insulin infusion

1980 ◽  
Vol 95 (4) ◽  
pp. 500-504 ◽  
Author(s):  
J. S. Dirch Poulsen ◽  
Mogens Smith ◽  
Marja Deckert ◽  
Torsten Deckert
Keyword(s):  
Portal Vein ◽  
Peritoneal Cavity ◽  
Plasma Insulin ◽  
Insulin Infusion ◽  
Peripheral Vein ◽  
Intravenous Insulin ◽  
Intraperitoneal Insulin ◽  
Arterial Plasma ◽  
Mini Pump

Abstract. In order to avoid complications induced by long-term infusions of insulin into the portal vein, we examined the effect of intraperitoneal (ip) insulin infusion on arterial plasma insulin and glucose concentrations in 6 pigs, made diabetic by a constant intravenous (iv) infusion of glucose, epinephrine and propranolol. Insulin was infused by an electromechanical programmable mini-pump (Pharmaject Micro Infusion System®, Pharmacia Electronics) as a booster injection of 46 mU highly purified porcine insulin Leo®/kg body weight, followed by 3 infusion periods of 30 min each with stepwise decreasing infusion rates of 1.6–0.8 and 0.2 mU/kg/min in a total volume of 192 μ1. Insulin was infused in a peripheral vein, a portal vein and into the peritoneal cavity. A steep rise of arterial plasma insulin was demonstrated followed by a slow and identical decline in the peripheral and portal experiments, whereas only a small increase of plasma insulin was seen in the ip experiment, indicating insufficient absorption of insulin from the peritoneal cavity. The decrease of plasma glucose was identical in the peripheral and portal vein experiments, indicating that insulin infused in the portal vein does not seem to have a higher hypoglycaemic effect, than insulin infused in a peripheral vein. Intraperitoneal insulin infusion seems not to be a practical substitute for iv insulin infusion.

scholarly journals Analyzing the Potential of Advanced Insulin Dosing Strategies in Patients With Type 2 Diabetes: Results From a Hybrid In Silico Study

2018 ◽  
Vol 12 (5) ◽  
pp. 1029-1040 ◽  
Author(s):  
Florian Reiterer ◽  
Matthias Reiter ◽  
Luigi del Re ◽  
Merete Bechmann Christensen ◽  
Kirsten Nørgaard
Keyword(s):  
Type 2 Diabetes ◽  
Cell Function ◽  
Insulin Pump ◽  
Artificial Pancreas ◽  
Glucose Monitoring ◽  
Substantial Improvement ◽  
Performance Measure ◽  
Patient Acceptance ◽  
Clinical Criteria

Background: The ongoing improvement of continuous glucose monitoring (CGM) sensors and of insulin pumps are paving the way for a fast implementation of artificial pancreas (AP) for type 1 diabetes (T1D) patients. The case for type 2 diabetes (T2D) patients is less obvious since usually some residual beta cell function allows for simpler therapy approaches, and even multiple daily injections (MDI) therapy is not very widespread. However, the number of insulin dependent T2D patients is vastly increasing and therefore a need for understanding chances and challenges of an automated insulin therapy arises. Based on this background, this article analyzes conditions under which the use of more advanced therapeutic approaches, particularly AP, could bring a substantial improvement and should be considered as a viable therapy option. Method: Data of 14 insulin-treated T2D patients on MDI wearing a CGM device and deviation analysis methods were used to estimate the expected improvements in the clinical outcome by using self-monitoring of blood glucose (SMBG) with advanced carbohydrate counting, a full AP or intermediate approaches, either CGM measurements with MDI therapy or SMBG with insulin pump. HbA1C and time in range (70-140 mg/dl, 70-180 mg/dl, respectively) were used as a performance measure. Outcome measures beyond glycemic control (eg, compliance, patient acceptance) have not been analyzed in this study. Results: AP has the potential to improve the condition of many poorly controlled insulin-treated T2D patients. However, as the interpatient variability is much higher than in T1D, a prescreening is recommended to select suitable patients. Conclusions: Clinical criteria need to be developed for inclusion/exclusion of T2D patients for AP related therapies.

scholarly journals Occlusion Detection Time in Insulin Pumps at Two Different Basal Rates

2017 ◽  
Vol 12 (3) ◽  
pp. 608-613 ◽  
Author(s):  
Guido Freckmann ◽  
Ulrike Kamecke ◽  
Delia Waldenmaier ◽  
Cornelia Haug ◽  
Ralph Ziegler
Keyword(s):  
Patient Safety ◽  
Insulin Infusion ◽  
Insulin Pump ◽  
Glucose Monitoring ◽  
Time Limit ◽  
Occlusion Detection ◽  
Detection Time ◽  
Insulin Pumps ◽  
Basal Rate

Background: The detection of insulin infusion set (IIS) occlusions is an important feature of insulin pumps with regard to patient safety. However, there are no requirements for a time limit until an alarm has to be triggered after an occlusion occurred. The standard IEC 60601-2-24 is applicable for insulin pumps and describes test settings and procedures to determine occlusion detection time (ODT). Methods: In this study, ODT of six different insulin pump models with different IIS (in total 10 different insulin pump systems) was tested for two basal rates (1.0 U/h and 0.1 U/h). Results: Differences were seen between the tested pump systems. At a basal rate of 1.0 U/h all insulin pump systems showed an acceptable ODT of less than 5 hours. However, at a basal rate of 0.1 U/h, as often used in children, the median ODT ranged from approximately 4 hours to more than 40 hours. With the lower basal rate, median ODT was longer than 6-8 hours for 9 of the 10 systems. Conclusions: Insulin pump users should not blindly rely on occlusion alarms but perform regular glucose monitoring and manufacturers should develop mechanisms that allow an earlier detection at low basal rates.

scholarly journals New Design of a Percutaneous Port System for Continuous Intraperitoneal Insulin Infusion

2019 ◽  
Vol 13 (6) ◽  
pp. 1158-1160
Author(s):  
Cosima Rieger ◽  
Klaus Kurz ◽  
Wiebke Mueller-Hoffmann ◽  
Bernhard Gehr ◽  
Andreas Liebl
Keyword(s):  
Insulin Therapy ◽  
Intensive Insulin Therapy ◽  
Insulin Infusion ◽  
Insulin Pump ◽  
Insulin Delivery ◽  
Insulin Dependent Diabetes Mellitus ◽  
Glucose Measurement ◽  
Dependent Diabetes Mellitus ◽  
Port System ◽  
Intraperitoneal Insulin

Insulin-dependent diabetes mellitus is treated with intensive insulin therapy using multiple daily injections or continuous subcutaneous insulin infusion with insulin pumps. For people with diabetes who cannot achieve acceptable glycemic control despite the use of intensive insulin therapy and continuous glucose measurement, there exists the possibility of continuous intraperitoneal insulin delivery via an implantable pump or a percutaneous port system that is connected to an external insulin pump. In this article, the current second generation of the Accu-Chek® DiaPort system for continuous intraperitoneal insulin delivery with its improvements over the former generation is presented and discussed.

An algorithm mimicking pancreas pulsatile behavior improves artificial pancreas performance

2021 ◽  
pp. 039139882110271
Author(s):  
Guillermo Cocha ◽  
Victor Tedesco ◽  
Carlos D’Attellis ◽  
Carlos Amorena
Keyword(s):  
Blood Glucose ◽  
Linear System ◽  
Insulin Infusion ◽  
Insulin Pump ◽  
Artificial Pancreas ◽  
Insulin Concentration ◽  
Postprandial Blood Glucose ◽  
Diabetic Patients ◽  
Control Input ◽  
Blood Insulin

Background: Artificial pancreas design using subcutaneous insulin infusion without pre-meal feed-forward boluses often induces an over-response leading to hypoglycemia due to the increase of blood insulin concentration sustained in time. The objective of this work was to create an algorithm for controlling the function of insulin pumps in closed-loop systems to improve blood glucose management in type 1 diabetic patients by mimicking the pulsatile behaviour of the pancreas. Methods: A controller tuned in a pulsatile way promotes damped oscillations of blood insulin concentration injected through an insulin pump. We tested it in a simulated environment, using nine ‘in silica’ subjects. The control algorithm is founded on feedback linearization where through a change of variables, the nonlinear system turns into an equivalent linear system, suitable for implementing through a PID controller. We compared the results obtained ‘in silica’ with the volume injected by an insulin pump controlled by this algorithm. Results: The use of this algorithm resulted in a pulsatile control of postprandial blood glucose concentration, avoiding hypoglycaemic episodes. The results obtained ‘in silica’ were replicated in a real pump ‘in vitro’. Conclusions: With this proposed linear system, an appropriate control input can be designed. The controller works with a damped pulsatile pattern making the insulin infusion from the pump and blood insulin concentration pulsatile. This operational would improve the performance of an artificial pancreas.

Multicentre Trial of a Programmable Implantable Insulin Pump in Type I Diabetes

1995 ◽  
Vol 18 (6) ◽  
pp. 322-325 ◽  
Author(s):  
◽  
M. Pinget ◽  
N. Jeandidier ◽  
F. Ortega ◽  
D. Wix ◽  
...  
Keyword(s):  
Insulin Therapy ◽  
Insulin Infusion ◽  
Multicentre Trial ◽  
Insulin Pump ◽  
Type I Diabetes ◽  
Diabetic Patients ◽  
Type I ◽  
Catheter Obstruction ◽  
Potential Alternative ◽  
Intraperitoneal Insulin

Programmable implantable pumps permitting variable-rate intraperitoneal insulin infusion are currently investigated as a potential alternative to subcutaneous insulin therapy. An improved version of the Siemens implantable system has been evaluated in 6 European centres on 31 type I diabetic patients treated for 10–30 months. Contrary to other pump models there were no proven pump malfunctions and only one no-flow reduction unrelated to catheter obstruction. The latter resulted in 12 surgical catheter replacements. There were 2.0 incidents of programmer malfunctions per patient-year easily managed by reconfiguration or replacement. Insulin remained clear and active in the pump reservoir and glycaemic control remained in the near-normoglycaemic range. Thus, insulin therapy with the Siemens implantable pump is feasible and effective up to 2.5 years.

Sign in / Sign up

Export Citation Format

Share Document