Did You Know? How to Improve the Use of An Artificial Pancreas
The rapid insulin-alone artificial pancreas improves glycemia in type 1 diabetes but daytime control remains suboptimal. A randomized crossover trial was done with 28 adults with type 1 diabetes, comparing a rapid insulin-alone artificial pancreas with rapid insulin-and-pramlintide and with regular insulin-and-pramlintide artificial pancreas systems in adults with type 1 diabetes.
The results showed that, compared with the rapid insulin-alone artificial pancreas system, the rapid insulin-and-pramlintide system increased the time in range from 74% (SD 18) to 84% (13; P = 0.0014), whereas the regular insulin-and-pramlintide system did not change the time in range (69% [19]; P = 0.22). The increased time in range with the rapid insulin-and-pramlintide system was due to improved daytime control (daytime in range increased from 63% [23] to 78% [16], P = 0.0004). There were 11 (1 per 2.5 days) hypoglycemic events (<3.3 mmol/L with symptoms or <3.0 mmol/L irrespective of symptoms) with the rapid insulin-alone system, compared with 12 (1 per 2.3 days) and 18 (1 per 1.4 days) with the rapid and regular insulin-and-pramlintide systems, respectively. Gastrointestinal symptoms were reported after 0% (0 of 112) of meals with the rapid insulin-alone system, compared with 6% (6 of 108) and 11% (11 of 104) with the rapid and regular insulin-and-pramlintide systems, respectively; none of the symptoms were severe.
Diabetes Care 2020 Jan, 2020 (ClinicalTrials.gov number NCT02814123). | 
I was reviewing basal/bolus dosing with our interns and we got on the subject of on-board insulin. One of the problems of not taking this into consideration is the onset of severe hypoglycemia. I explained that many patients walk around with a 500mg/dl blood glucose and don’t feel bad, but give someone a severe case of hypoglycemia and they will never want to go low again.