Towards a Physiological Prandial Insulin Profile: Enhancement of Subcutaneously Injected Prandial Insulin Using Local Warming Devices

El-Laboudi, Ahmed; Oliver, Nick

doi:10.1007/s13300-015-0125-z

Cited by 5 publications

(3 citation statements)

References 42 publications

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“…Alternative delivery routes to accelerate systemic insulin appearance include inhaled prandial insulin, which has a faster onset and shorter action profile compared with rapid-acting subcutaneous insulin [ 63 ] and preprandial administration by a closed-loop system [ 64 ], resulting in an increased amount of time spent in the target glucose range. Alternatively, a specialised heating pad may be attached to the pump infusion set to warm surrounding tissues following a prandial insulin bolus, accelerating insulin pharmacokinetics and pharmacodynamics [ 65 ].…”

Section: Foundations Of Closed-loop Systemsmentioning

confidence: 99%

Coming of age: the artificial pancreas for type 1 diabetes

2016

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The artificial pancreas (closed-loop system) addresses the unmet clinical need for improved glucose control whilst reducing the burden of diabetes self-care in type 1 diabetes. Glucose-responsive insulin delivery above and below a preset insulin amount informed by sensor glucose readings differentiates closed-loop systems from conventional, threshold-suspend and predictive-suspend insulin pump therapy. Insulin requirements in type 1 diabetes can vary between one-third–threefold on a daily basis. Closed-loop systems accommodate these variations and mitigate the risk of hypoglycaemia associated with tight glucose control. In this review we focus on the progress being made in the development and evaluation of closed-loop systems in outpatient settings. Randomised transitional studies have shown feasibility and efficacy of closed-loop systems under supervision or remote monitoring. Closed-loop application during free-living, unsupervised conditions by children, adolescents and adults compared with sensor-augmented pumps have shown improved glucose outcomes, reduced hypoglycaemia and positive user acceptance. Innovative approaches to enhance closed-loop performance are discussed and we also present the outlook and strategies used to ease clinical adoption of closed-loop systems.

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Section: Foundations Of Closed-loop Systemsmentioning

confidence: 99%

Coming of age: the artificial pancreas for type 1 diabetes

2016

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“…Potential alternative approaches include ultrafast‐acting insulin , adjuvants such as amylin which delays meals absorption , or local warming devices to enhance insulin absorption . Prior to adopting these approaches into wider clinical practice, large‐scale studies are still needed to demonstrate their clinical efficacy and user acceptability.…”

Section: Discussionmentioning

confidence: 99%

Bolusing frequency and amount impacts glucose control during hybrid closed‐loop

et al. 2017

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AimTo compare bolus insulin delivery patterns during closed‐loop home studies in adults with suboptimally [HbA1c 58–86 mmol/mol (7.5%–10%)] and well‐controlled [58 mmol/mol (< 7.5%)] Type 1 diabetes.MethodsRetrospective analysis of daytime and night‐time insulin delivery during home use of closed‐loop over 4 weeks. Daytime and night‐time controller effort, defined as amount of insulin delivered by closed‐loop relative to usual basal insulin delivery, and daytime bolus effort, defined as total bolus insulin delivery relative to total daytime insulin delivery were compared between both cohorts. Correlation analysis was performed between individual bolus behaviour (bolus effort and frequency) and daytime controller efforts, and proportion of time spent within and below sensor glucose target range.ResultsIndividuals with suboptimally controlled Type 1 diabetes had significantly lower bolus effort (P = 0.038) and daily bolus frequency (P < 0.001) compared with those with well‐controlled diabetes. Controller effort during both daytime (P = 0.007) and night‐time (P = 0.005) were significantly higher for those with suboptimally controlled Type 1 diabetes. Time when glucose was within the target range (3.9–10.0 mmol/L) during daytime correlated positively with bolus effort (r = 0.37, P = 0.016) and bolus frequency (r = 0.33, P = 0.037). Time when glucose was below the target range during daytime was comparable in both groups (P = 0.36), and did not correlate significantly with bolus effort (r = 0.28, P = 0.066) or bolus frequency (r = –0.21, P = 0.19).ConclusionMore frequent bolusing and higher proportion of insulin delivered as bolus during hybrid closed‐loop use correlated positively with time glucose was in target range. This emphasises the need for user input and educational support to benefit from this novel therapeutic modality.

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“…When the capillary exchange surface in SC tissue expands with the recruitment of capillaries, vasodilation and increased blood flow, insulin absorption is accelerated. As such, insulin absorption is positively correlated to the blood flow at the injection site ( Binder, 1969 ; Vora et al, 1992 ) and can be promoted through injection into areas with hyperperfusion, for instance, after direct or indirect heating or skin massage ( El-Laboudi and Oliver, 2015 ).…”

Section: Factors Delaying Onset Of Insulin Action In Sc Artificial Pa...mentioning

confidence: 99%

Vasodilatory effects of glucagon: A possible new approach to enhanced subcutaneous insulin absorption in artificial pancreas devices

Teigen

Riaz

Åm

et al. 2022

Front. Bioeng. Biotechnol.

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Patients with diabetes mellitus type 1 depend on exogenous insulin to keep their blood glucose concentrations within the desired range. Subcutaneous bihormonal artificial pancreas devices that can measure glucose concentrations continuously and autonomously calculate and deliver insulin and glucagon infusions is a promising new treatment option for these patients. The slow absorption rate of insulin from subcutaneous tissue is perhaps the most important factor preventing the development of a fully automated artificial pancreas using subcutaneous insulin delivery. Subcutaneous insulin absorption is influenced by several factors, among which local subcutaneous blood flow is one of the most prominent. We have discovered that micro-doses of glucagon may cause a substantial increase in local subcutaneous blood flow. This paper discusses how the local vasodilative effects of micro-doses of glucagon might be utilised to improve the performance of subcutaneous bihormonal artificial pancreas devices. We map out the early stages of our hypothesis as a disruptive novel approach, where we propose to use glucagon as a vasodilator to accelerate the absorption of meal boluses of insulin, besides using it conventionally to treat hypoglycaemia.

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Towards a Physiological Prandial Insulin Profile: Enhancement of Subcutaneously Injected Prandial Insulin Using Local Warming Devices

Cited by 5 publications

References 42 publications

Coming of age: the artificial pancreas for type 1 diabetes

Coming of age: the artificial pancreas for type 1 diabetes

Bolusing frequency and amount impacts glucose control during hybrid closed‐loop

Vasodilatory effects of glucagon: A possible new approach to enhanced subcutaneous insulin absorption in artificial pancreas devices

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