Miladys Palau Collazo, MD, Pediatric Endocrinologist at Nicklaus Children’s Hospital talks about a device that delivers the precise amount of insulin.
Interview conducted by Ivanhoe Broadcast News in May 2018
About how many children are living with diabetes in the US, do we know? Does it seem to be growing?
Dr. Palau: Definitely we have seen that the incidence has been growing especially among younger kids. It’s estimated that by twenty fifty there’s going to be an increase of more than three percent of the incidence of Type1 diabetes.
Give me an idea again, like the number of cases perhaps that are growing.
Dr. Palau: We’re definitely seeing a rise in the incidence of Type I diabetes and over two hundred thousand youth are currently living in the US with Type I diabetes. In my experience I have seen that even the incidence has been increasing a lot in the younger group like between two and five year olds we have definitely seen an increase in the incidence of Type I.
We don’t really know why do we?
Dr. Palau: We know type 1 diabetes is an autoimmune condition where the immune system starts attacking the beta cells of the pancreas which are the ones that produce insulin. We don’t know why it happens but there are many theories or hypothesis of why it’s happening. We know that people that have Type I diabetes have a genetic predisposition. We know that it’s not only solely genetics because for example, if you have identical twins; if one has Type I diabetes there’s an increased risk of approximately fifty to sixty percent of the other twin having Type I. But it’s not always the case that they develop Type I diabetes.
What are some of the fears, the concerns you hear from parents?
Dr. Palau: I always tell my parents once they have a child that has been diagnosed with diabetes that I know that I have changed their lives forever with the diagnosis. Initially, it is going to be extremely hard but with time it tends to get a little bit better. Like with anything in life, you have your good days and your bad days with diabetes and as long as we have more good than bad days, then we are winning the battle.
You deal with parents all the time it must be very difficult when you first tell a family that their child is being diagnosed.
Dr. Paleu: It’s definitely something that changes the dynamic of a family forever right once you’ve diagnosed them with Type I diabetes. This is a lifelong condition. Can you imagine having a child that you have to prick multiple times a day to check their blood sugars, multiple times a day to give them insulin how stressful it is for a parent running after a two year old trying to stick their fingers and give them shots, so definitely a life changer in terms of having this diagnosis.
Are we seeing anything new that is helping family’s better cope with diabetes, with a Type I diagnosis?
Dr. Palau: Well a great thing about with Type I diabetes is that we have come a long way from since insulin was discovered in the nineteen twenties to what we have now right in terms of technology and helping us monitor diabetes in a better way. Recently the FDA approved a device called a Medtronic 670g which sometimes we refer to as an artificial pancreas. It is the only product in the market that is able to calculate precise insulin doses based on the patient’s blood sugar and deliver insulin to try to adjust those blood sugars and maintain them within a target range.
Talk to us a little bit about how the device works and is it something that the child or the parent would program and then it kind of does it on its own?
Dr. Palau: So the Medtronic 670g works with a glucose sensor, a continuous glucose sensor. It measures the blood sugars every five minutes. Then the sensor sends the information to the pump and the pump has a computer algorithm that can calculate the rate of rise or drops in blood sugar and then delivers insulin. It does require a patient interaction that’s why it’s a hybrid close loop system. The patient still needs to interact with the pump, check the blood sugar, calibrate that sensor, tell the pump when they’re going to eat, how much they’re going to eat, how much was their blood sugar so then the pump can make adjustments. The good thing about this system is that it also learns from the patient. So those patients that are extremely physically active can use a little bit less insulin during that time of activity because blood sugars tend to drop a little bit. So the pump can adjust to deliver less insulin during those periods of time so that it can avoid having the patient have low blood sugars.
So this if you have a child who is active is this something you would recommend to someone’s child who is involved in sports or activities and again really emphasize why?
Dr. Palau: Absolutely. The thing is that when kids are extremely active as you’re going to meet with Colton, he’s a football player, sometimes having that device on while playing football is a little bit difficult because of all that physical interaction that goes on. So sometimes they get disconnected from the system just while they’re playing but once they stop playing they can put the system back on and the system can help them regulate their blood sugars. Usually exercise can have an effect on blood sugars up to twelve hours later. So usually when kids are extremely physically active in the afternoon you can see that low blood sugars tend to happen at night. This is something that’s able to adjust how much insulin to give to avoid those low blood sugars in the middle of the night. So something I would definitely recommend for any parent that has a kid above the age of fourteen, because this device is FDA approved for children above the age of fourteen, or to the discretion of the physician if they’re above the age of eight. So I have some younger patients, younger than fourteen that have been using the system. But definitely it works very well and I think parents do get a peace of mind at night when the kids are sleeping that they’re going to be safe because they have a system that is responding to those low blood sugar numbers in case that they happen.
Does it set off an alarm if the blood sugar goes too low or what does it do?
Dr. Palau: The system has a low glucose suspend feature, this system, if you’re not on the auto mode also known as the artificial pancreas that it’s constantly calculating how much insulin the patient needs, it can make a projection of how fast and how much the blood sugars are dropping and it’ll stop the insulin infusion before telling the patient. Usually when the blood sugar is below 70 mg/dL then it will send an alert to the parents to let them know that the blood sugar is low and that they should come and fix that problem.
Is this something that someone like Colton who is fifteen, sixteen years old could they use in to adulthood?
Dr. Palau: Absolutely. And that’s the good thing about this system. And I know with time things are going to get better right? It’s like you know every time there’s a new piece of technology like a new cell phone, as time goes by they make changes and make it better for the user right. So I know that with time we’re going to be able to have a system that is going to require even less patient interaction and going to be even more precise than what we have now. But what we have now comparing to what we had before which required either six to eight insulin shots a day, despite the fact that the patient needs to interact with the pump, it is a game changer absolutely.
Because now Colton no longer needs to do insulin shots, is that true or not?
Dr. Palau: He still needs the insulin right but it’s delivered in a different way. So Colton used to use a long acting insulin that would serve as a base so as a background insulin. And then every time he ate or his blood sugars would be high he would have to use another form of insulin which is a rapid acting insulin and that would help control the blood sugars throughout the day. So he would have probably to take anywhere from four to eight shots a day depending on how many times he was going to eat or if his blood sugars were higher or not. With this device you place an infusion set that you can change every two to three days. So definitely if you go from six shots a day on average to only one shot every two to three days it’s a world of difference for any child.
It really does make it not just more manageable but in a sense it keeps the patient more balanced when it comes to that.
Dr. Palau: Yes, absolutely. The blood sugars tend to be more within target. What we have seen is that patients usually spend approximately seventy five percent of their time in target range which is very difficult to do when you are on another form of insulin administration such as the multiple injections a day.
How can this allow children to be more active, play in sports, be involved and also give the parents a little more peace of mind?
Dr. Palau: What I have seen with my patients is that they have to think a little bit less about their diabetes. When you have Type I Diabetes you actually have to think like you were a pancreas and every time you’re going to eat you have to sit back and say, okay I need to test my blood sugar, I need to calculate how much insulin I need to give, give yourself a shot and then eat. And then again there are multiple variables that can affect blood sugars such as activity level when we were talking about kids. So when you have a system that is doing some of that thinking for you definitely the kid can have more freedom to be a child and play and do whatever they want to do in life. But it also gives the parents a peace of mind that their kids are going to be safe because we know that having really high blood sugars or having low blood sugars can affect the daily activities, having a system that is able to respond to both its extremely important for any family.
And this is FDA approved so if a parent wanted to get this device for their child it’s available and it’s covered by insurance.
Dr. Palau: You should talk to your doctor about it definitely and the doctor would decide obviously if the patient is a good candidate for the pump. Like I said its FDA approved for those above the age of fourteen or those above the age of eight by the discretion of their physician. Mostly it’s covered by insurance especially private insurance.
Right, if the doctor—
Dr. Palau: Decides that the patient is the right person for the pump.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
Jennifer Caminas, Nicklaus Children’s Hospital PR
305-668-5514
Jennifer.Caminas@NicklausHealth.org
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