Scott Scolnick is a sales territory manger for Tandem Diabetes Care, Inc. the insulin pump company which makes the tslim insulin pump. He is also a person who has had type 1 diabetes for about 35 years. He received the news that he had type 1 as a 15 year old vacationing in Israel. The doctor who diagnosed him at the time didn’t give him much hope of living past his forties.
Despite the M.D.’s grim prognosis, he has survived that hurdle and now uses an insulin pump and continuous glucose monitor (CGM) to control his blood glucose levels. I talked with Scott about his experience as a participant in the Massachusetts General Hospital trial of the “bionic” pancreas.
Massachusetts General is conducting clinical trials of the artificial pancreas created by Edward R. Damiano, Ph.D., Associate Professor at Boston University, in an ambulatory setting. The device (nicknamed a bionic pancreas) has been previously tested in a tightly controlled inpatient environment on adults and teens. This is the first time it has been put to the test in anything resembling the real world.
How did you find out about participating in the study?
Through a colleague of mine. She was looking into it and thought I might also be interested.
Tell me a little about your experience?
I was connected to two pumps and a continuous glucose monitor which communicated with an iPhone application. One pump delivered insulin and the other glucagon. The pumps were tslims and they used the Dexcom cgm. We stayed at the Wyndham hotel in Boston for six days and five nights. At night we had to stay in the hotel room hooked up to an IV which checked our blood glucose in 30 minute intervals, but during the day we were free to do whatever we wanted as long as we stayed within 3 miles of the hotel.
What was the best thing about wearing the bionic pancreas?
I never had to know my blood sugars. We were offered the information if we wanted it but most of the time I didn’t want it. It was great to feel like everyone else.
So how did things work out?
The experience was amazing. My blood sugars were never above 252mg/dl and I only had one minor low while I was exercising. My maximum blood glucose for a 24-hour period was 252mg/dl and my average was between 106 and 128mg/dl. And I tested the bejesus out of that machine. I ate things I haven’t eaten in years in quantities I never touch. I had 5 slices of pizza for dinner one night, a hot fudge sundae, fried clams, French fries, and Chinese food at 10:30 at night (I rarely touch it—it isn’t worth the effort figuring out how to dose for it with the pump), and sushi–. I usually only get sashimi, but not this time. And it didn’t matter. I exercised like crazy without having to think about going low. The low I had happened when my blood sugar was 84mg/dl and the cgm showed that it (my blood sugar) was heading down. An idea that I had was perhaps they could add priming does of glucagon for exercise the way they have the priming dose of insulin set up for meals.
So you never had to test your blood glucose yourself—it was all done through the CGM?
No we checked before mealtimes and exercise for the study protocol as well as the DexCom calibration—but you didn’t have to know the result. You could give yourself a priming bolus if you wanted; otherwise the machine took care of all the adjustments.
Tell me about the priming bolus. What was that for?
Since the bionic pancreas is reacting to blood glucose levels, rather than anticipating them, the priming bolus for food let you get ahead of the curve if you wanted to. You had several options to choose from when giving the priming bolus: a smaller than usual, usual or larger than usual meal or just a bite.
Was there any downside to wearing the pancreas?
At night you had to be attached to an IV; your BG was measured through the IV. That was annoying. And you had two infusion sets which you had to change every 24 hours. But those were minor frustrations and this is only the testing phase. They are going to be making many modifications as they conduct more trials.
What was the best thing about your experience?
Not having to think about it (having diabetes) (how much food I am eating, what my blood sugar is and what direction it is going in)-not having my brain be full of this stuff. When I was exercising I could concentrate on what I was doing and just listen to the music, instead of always having to keep focusing on what my blood sugar was doing. Even my interactions with my family were better. No tension about whether I was going too low or too high. It is unbelievable how much stress diabetes puts on your family
It sounds like you found the experience life-changing. How did you react when the trial was over?
I was a bit down, having to go back to checking, counting carbs, always being aware of my blood sugars was depressing. I guess it was similar to the experience of having a great, relaxing vacation, there is always a little bit of sadness when a good thing ends.
Do you think the artificial pancreas will really come to fruition?
Yes, you know when I was diagnosed in the 70s, they said there would be a cure within 10 years and people have been saying the same thing year after year. This is the first time I believe it might be so. I think its close enough that they could work out the bugs in the next few years
*The artificial pancreas would replace the functions of the human pancreas but it doesn’t cure the disease.