It includes information about Hybrid closed loop insulin delivery system-Artificial Pancreas.Its details and how insulin pump develops with the time.It also includes the information about companies which manufacturing pumps.Also includes info about diabetes mellitus.

1. HYBRID CLOSED LOOP
INSULIN DELIVERY
SYSTEM.
Prsented BY- Shubham M. Bhujbal
F.M.Pharm (MQA Dept)
Guided By- DR. D.D.Gaikwad Sir
Dr. S.L Jadhav sir

2.  Introduction
 Diabetes Mellitus.
 Insulin
 History Of Insulin Pump.
 Components Of Insulin Pump.
 Using An Insulin Pump.
 How It Works...?
 Advantages
 Disadvantages
 Plan
 The Research Aspect
 References.

3. WHAT IS HYBRID CLOSED LOOP INSULIN
DELIVERY SYSTEM.....?
 The Hybrid closed loop insulin delivery system is a
technology in development to help people
with Diabetis, primarily type 1, automatically and
continuously control their blood glucose level by
providing the substitute endocrine functionality of a
healthy pancreas.
 It also known as ARTIFICIAL PANCREAS.
 The Hybrid Closed-Loop System: When in auto
mode, this is a hybrid closed-loop insulin
delivery system that automatically adjusts basal
insulin delivery every 5 min based on sensor
glucose to maintain blood glucose levels
as close to a specific target as possible.

5. DIABETES MELLITUS
 is a chronic disorder of carbohydrate,
protein, and fat metabolism resulting from
insulin deficiency or abnormality in the use
of insulin.
 is a group of metabolic disorders in which
there are high blood sugar levels over a
prolonged period. Symptoms of high blood
sugar include frequent urination, increased
thirst, and increased hunger.

6. TYPES OF DIABETES MELLITUS
 1.Type I-
 formerly known as Insulin – Dependent
Diabetes Mellitus (IDDM) .
 destruction of beta cells of the pancreas little
or no insulin production
 Autoimmune (Islet cell antibodies)
-Early introduction of cow’s milk and cereals.
-Intake of medicine during pregnancy
-Indoor smoking of family members.
 requires daily insulin administration.
 may occur at any age, usually appears below
age 15.

7.  2. Type II-
 formerly known as Non Insulin– Dependent
Diabetes Mellitus (NIDDM)
 probably caused by-
 disturbance in insulin reception in the cells
 ↓ number of insulin receptors
 loss of beta cell responsiveness to glucose
leading to slow or ↓ insulin release by the
pancreas
 occurs over age 40 but can occur in
children
 common in overweight or obese .

8. PANCREAS HORMONES:
INSULIN BY BETA CELLS
 GLUCAGON BY ALPHA
CELLS

9.  Pancreas secretes 40-50 units of insulin daily in two
steps:
 – Secreted at low levels during fasting ( basal
insulin secretion)
 – Increased levels after eating (prandial)
 An early burst of insulin occurs within 10 minutes of
eating .
 Then proceeds with increasing release as long as
hyperglycemia is present.

10. INSULIN
 Insulin allows glucose to move into cells to make
energy.
 Inhibits glucagon activity.
 Normal blood glucose level-
 A fasting blood sugar level less than 100
mg/dL (5.6 mmol/L) is normal.
 A fasting blood sugar level from 100 to 125
mg/dL (5.6 to 6.9 mmol/L) is considered
prediabetes.
 If it's 126 mg/dL (7 mmol/L) or higher on two
separate tests, you have diabetes.

11. PRE-DIABETES
Impaired fasting glucose (IFG) – FPG-
100-125mg/dL
 Impaired glucose tolerance (IGT) –
OGTT 140-199mg/dL
 HbA1c 5.7-6.4%

12. WHAT IS HBA1C?
 The term HbA1crefers to
glycated haemoglobin. It develops when
haemoglobin, a protein within red blood
cells that carries oxygen throughout your
body, joins with glucose in the blood,
becoming 'glycated'.
 By measuring glycated haemoglobin
(HbA1c), clinicians are able to get an overall
picture of what our average blood sugar
levels have been over a period of
weeks/months.

13. HISTORY OF THE INSULIN
PUMP
• The first insulin pump was developed in 1963 by
Dr. Arnold Kadish
• 1976 Dean Kamen invented the first wearable
insulin pump
• 1980’s insulin pumps start to enter the market
• Minimed and Disetronic
• MiniMed 502 first popular insulin pump
• 2003 MiniMed 512 first insulin pump to monitor
glucose levels

15. USING AN INSULIN PUMP
• Insert needle anywhere
into body typically the
abdomen
• Three programmable
ways to deliver insulin
• Basal rates
• Bolus doses
• Correctional doses
• Then press ok

19. COMPONENTS OF INSULIN PUMP-

20. 20
THREE PARTS TO ALL CGMS:*
A. Sensor
B. Transmitter
C. Receiver/Monitor

21. 21
A)Sensor
(p.103)

22. 22
B)Transmitter
(p.103)

23. 23
C)Receiver or Monitor
(p.103)

24. CUSTOMIZEABLE BASAL RATES

25. INSULIN DELIVERY MODES
INSULIN PUMPS

26. SENSOR CONVERTS GLUCOSE TO
ELECTRONIC SIGNALS-

27. HYBRID CLOSED LOOP IN TYPE 1 DIABETES -
 The clinical trial is testing Medtronic’s 670G
“hybrid-closed loop” system (insulin pump +
Enlite 3 CGM sensor) in people with type 1
diabetes.
 Based on the Enlite 3 CGM reading every
five minutes, the 670G pump’s software
automatically increases/decreases insulin
delivery to target a blood glucose of 120
mg/dl.
 The 670G algorithm is fully integrated within
the pump itself, so a patient only needs to
wear the Enlite 3 CGM sensor and the
MiniMed 670G pump – no need to carry a
separate CGM receiver.
 The 670G is considered a “hybrid-closed
loop” because the user still needs to bolus
for meals and notify the system of exercise.
 Otherwise, it mostly takes care of insulin
dosing in the background, which is very
effective at night (80%+ time-in-range in one
study we’ve seen

29. ADVANTAGES/ WHY THIS SYSTEM....?
 Eliminates individual insulin injections
 Deliver insulin more accurately and regularly
 Allows for exercise without having to eat a lot of
carbohydrates.
 Makes diabetes management easier
 Better control.
 Allows for lifestyle flexibility
 Eating schedule and food choices
 Activity

30.  Increased security from alarms & alerts
 Immediate feedback - look and learn
 BG trend provides more information than
static readings.
 Control + safety.
 Can reduce Hba1c and glycemic variability
 No need to strictly follow the diet.

31.  288 Data points per Day.

33. DISADVANTAGES
o Can cause weight gain
o Needle can fail out leading to deliver
insulin properly.
o Expensive.
o Requires training.
o Constantly need to be attached to
pump.

34. PLAN
 A pilot of 10 patients begins examined in
December 2018.
 About 100 patients will be enrolled during the
first year.
 All electronic data will be collected and analyzed.
 Subjects will fill specific questionnaires to assess
patient reported outcomes, quality of life and
satisfaction.

35. THE RESEARCH ASPECTS-
 Creating a database of all patients joining the
virtual clinic.
 Measuring the effects of virtual care on:
 Metabolic outcomes: HbA1c, ‘time in range’, rate of
hypoglycemia, etc.
 Patient reported outcomes and quality of life
 Patient satisfaction
 Outcome measures will be collected at baseline,
3 and 12 months of the intervention.

36. PATIENT-CENTERED CARE
Ask the patient:
What is important to
you?
What are your
goals? Health and
life goals?
Identify and respect:
Differences
Values
Preferences
Expressed needs
Decision making
must be mutually
attained
Patients MUST be
listened to and not
dictated to
Patient has a say in
care plan
Patient chooses
therapy and device
after being presented
all options

37. REFERENCE-
• Jerreat, Lynne. Diabetes for Nurses. London: Whurr, 1999. Print.
• IOH Diabetes Treatment - Insulin Delivery Devices." Diabetes Assistance -
Assistance Programs for Diabetes, Diabetes Laws, Insurance Laws. 11 Mar.
2006. Web. 24 Feb. 2011.
<http://www.isletsofhope.com/diabetes/treatment/insulin_devices_1.html>.
• Sattley, Melissa. "The History of Diabetes - Diabetes Health." Diabetes
Health - Investigate, Inform, Inspire. 17 Dec. 2008. Web. 24 Feb. 2011.
<http://www.diabeteshealth.com/read/2008/12/17/715/the-history-of-
diabetes/>.
• Richard. "History Of Insulin Pumps." Diabetes | Type 1 Diabetes | Type 2
Diabetes. 17 Apr. 2008. Web. 24 Feb. 2011. <http://www.dlife.com/diabetes-
forum/viewtopic.php?f=22&t=10964&start=0&sid=46065bf7bcb0a2ec5f38f0
a3b95ed542&view=print>.
• MiniMed. "Minimed ® Paradigm Revel ™ Insulin Pump MMDMMT523B."
Medical Supplies - Discount Home Medical Supply & Equipment Store.
Web. 24 Feb. 2011.
<http://www.onlinemedicalsupply.com/DIABETIC/INSULIN_PRODUCTS/M
MDMMT523B/product.aspx>.

38. • Noida. "Global Insulin Pumps Market Set for Stupendous Upsurge by 2015."
Press Release Distribution, Public Relations Services | SBWire. 16 Feb.
2011. Web. 24 Feb. 2011. <http://www.sbwire.com/press-releases/sbwire-
79053.htm>.
• Reuters. "Artificial Pancreas Shows Promise in Pregnancy| Reuters."
Business & Financial News, Breaking US & International News |
Reuters.com. Reuters, 30 Jan. 2011. Web. 24 Feb. 2011.
<http://www.reuters.com/article/2011/01/31/us-pancreas-diabetes-
idUSTRE70U00N20110131>.
• American Diabetes Association. "How Do Insulin Pumps Work?" American
Diabetes Association Home Page - American Diabetes Association. Web.
24 Feb. 2011. <http://www.diabetes.org/living-with-diabetes/treatment-and-
care/medication/insulin/insulin-pumps-how-do-insulin.html>.
• www.slideshar.com
• www.youtube.com
• www.google.com

39. ANY
QUESTIONS.....?

40. Thank You