September, 2023

For most of my career as an endocrinologist and expert in diabetes, I have been captivated with the idea that someday we will have an effective, reliable and practical artificial pancreas for the treatment of diabetes.  Such a device would measure the blood sugar continuously or at frequent intervals and give just the right amount of insulin every few minutes to maintain normal blood sugar levels at all times.  It would be a wonderful treatment option for patients with type 1 diabetes who have severe insulin deficiency, and some type 2 diabetes patients who develop more severe insulin deficiency over time.

With both of the new insulin pumps described below, used in combination with the newest continuous glucose monitors which were discussed in a previous "What's New" article (March,2023) we are getting closer to the "artificial pancreas" we have dreamed about.  Both of the new insulin pumps described in this update still require, or at least work much better, if patients enter into the pump the estimated amount of carbohydrate or meal size to be consumed before any meal or snack.

The Omnipod Gen 5 is shown in the picture below.  In addition to regulating the basal insulin doses at 3-minute intervals, it is also able to give extra bolus doses of insulin if needed for sharp rises in the blood sugar.  This small pump, called a "patch pump" is worn on the skin and requires no tubing.  It is very discrete, but can still be worn when bathing or showering.  Settings and calorie estimates are entered from a cell phone or a small "controller" carried in your pocket or purse.  The small “pod” must be refilled and replaced with new insulin every three days.  It is paired with the accurate and reliable Dexcom continuous glucose monitor.  Our patients and clinic staff have been very pleased with this new device. An illustration of the new Omnipod Gen 5 is shown below.

Another recently available new insulin pump is the Medtronic 780G.  It also infuses extra bolus doses of insulin for sharp rises in blood sugar, as well as adjusting the basal insulin rate every few minutes depending on blood sugar level.  Both the Medtronic 780G and the Omnipod Gen 5 pumps will decrease and then shut off the insulin infusion completely if hypoglycemia (low blood sugar) occurs.  This is a tremendous safety feature, which has greatly reduced the risk of dangerous hypoglycemia in users of these devices. The Medtronic 780G is paired with their new Guardian 4 sensor, which is more accurate and reliable.  The Guardian 4 sensor, like the Dexcom G6 and G7 no longer requires fingerstick calibration!  The Medtronic 780G also utilizes a new 7-Day infusion site, which can be conveniently changed weekly at the same time as the sensor.  Users of the Medtronic 770 can easily and inexpensively upgraded to the 780G with a software programming update. This new pump is also shown in the illustration below.

These new insulin pumps have features which reduce user workload and improve blood sugar control and safety.  Ask your doctor if you think you may be a candidate for one of these devices.

Donald F. Gardner, MD