Glucose Monitors

The artificial pancreas is a technology in development to help people with diabetes automatically control their blood glucose level by providing the substitute endocrine functionality of a healthy pancreas. more...

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There are several important exocrine (digestive) and endocrine (hormonal) functions of the pancreas, but it is the lack of insulin production which is the motivation to develop a substitute. While the current state of insulin replacement therapy is appreciated for its life-saving capability, the task of manually managing the blood sugar level with insulin alone is arduous and inadequate.

The goal of the artificial pancreas is twofold:

to improve insulin replacement therapy until glycemic control is practically normal as evident by the avoidance of the complications of hyperglycemia, and; to ease the burden of therapy for the insulin-dependent.;

Different approaches under consideration include:

the medical equipment approach -- using an insulin pump under closed loop control using real-time data from a continuous blood glucose sensor. This is emerging technology and will be the larger subject of this article.; the bioengineering approach -- the development of a bio-artificial pancreas consisting of a biocompatible sheet of encapsulated beta cells. When surgically implanted, the islet sheet will behave as the endocrine pancreas and will be viable for years.; the gene therapy approach -- the therapeutic infection of a diabetic person by a genetically engineered virus which causes a DNA change of intestinal cells to become insulin-producing cells.;

Background in endocrine physiology

The pancreas produces three hormones that are important to glycemic control:

insulin, which lowers blood glucose;; amylin, which slows digestion and slows the rate of glucose entering the bloodstream, and temporarily suppresses release of glucagon;; and glucagon, which raises the blood glucose.;

Upon digestion of carbohydrates, glucose levels in the blood will begin to rise. As the blood and glucose flow into the pancreas, insulin and amylin are cosecreted by the pancreatic beta cells directly into the bloodstream in response to elevated blood glucose levels. Insulin causes blood glucose to be removed from the bloodstream and stored in the liver and muscle cells. Notice as the blood sugar goes higher, additional insulin will bring the blood sugar back down in a classic negative feedback loop. As insulin is released from the beta cells, amylin is also released into the bloodstream. Amylin slows gastric emptying, and also inhibits the release of glucagon from the pancreatic alpha cells. The effect of amylin is to spread out the blood glucose peak after eating, reducing the quantity of insulin needed. As the blood sugar level comes back toward normal, the beta cells will stop spurting insulin and amylin. As the glucose level approaches a low mark, the pancreatic alpha cells will release glucagon directly into the bloodstream. Glucagon causes the liver to release stored glucose back into the bloodstream. Notice that increased glucagon will increase blood glucose levels in a positive feedback loop. Together, the three endocrine hormones work as a system to control the blood glucose level between high and low boundaries.

Read more at Wikipedia.org