(Almost) An Hour With JDRF's Dr. Aaron Kowalski.

Tonight, JDRF's Dr. Aaron Kowalski (who is the head scientist overseeing the Artificial Pancreas project, among other responsibilities with JDRF) did an hour-long webcast to answer live questions about the AP.  I say "almost" an hour, because I forgot it was tonight and didn't get to tune in until about the 15-minute mark.

In true nerd form, I took three pages of very scribbly notes.  I tried to submit questions, but the log-in wasn't working for me.  I learned so much in this 45 minutes, and I wanted to share some of it with you all, in case you missed it.  Dr. K, as I will now refer to him, mentioned that the webcast should be up for viewing on the JDRF website soon, so I'll include a link to that when it becomes available.  (***EDIT - Here's the link! ***)  He came across as a totally nice, down-to-earth, and wicked smart dude.  I'm glad we have people like him on our "team".

Things I Learned:

• Dr. K has type 1, just like we do, and has had it probably about as long as I have.  (He also mentioned that his brother has type 1 as well, and has had it for about 30 years.)  So, this cause is very near to his heart.  And pancreas.
• Dr. K might be Clark Kent.  He kept doing that push-your-glasses-up-with-one-finger thing, and it cracked me up.  Okay, fine, down to the serious stuff.
• Someone asked what the blood glucose range might be for the AP.  He suggested that it would probably be between 70 and 180 or 200.  (Hey, that's what my CGM range is!  I guess I'm 'practicing'.)
• This part - I had no idea this happened, and I found it kind of fascinating.  Remember the story of Pavlov's dog and classical conditioning?  Ring the bell, and it would start salivating?  Turns out a non-diabetic's pancreas does that, too.  When people get hungry and even LOOK at food, he said the pancreas starts to secrete insulin into the blood stream.  I never knew this!  It helps explain why timing your bolus 15 or so minutes before eating makes sense - your body is used to insulin being introduced to the blood stream ahead of food being eaten.  This also is a reason why we need faster-acting insulins, which Dr. K said will be needed for the AP.
• Someone asked what a realistic timeframe is for the AP being introduced to the general public.  The AP project is a four-year project, and right now we're only 8 months in.  All of the puzzle pieces exist (pump, CGM, algorithm); the challenge of course is getting those parts to work together in a safe way.  The process of FDA approval in the U.S. is a long one - safety is a HUGE concern - so a lot of the timing rides on that.  His best guess was 3 - 4 years.
• Will the AP be appropriate for use by type 2's as well?  Absolutely - but he said the challenge will be getting those people to accept wearing it.  The "acceptance rate", or however he put it, for insulin-dependent type 2's compared to type 1's is very small.  I can't blame them - I don't particularly enjoy being half-robot either.  Dr. K mentioned that it maybe would even be "easier" for their bodies to accept the technology, as type 2's have better glucagon response than their type 1 counterparts.  The Kool-Aid Man would be proud. 
• I'm not the only one who has to bolus right when they wake up, to combat the dawn phenomenon.  Dr. K mentioned that he typically, when seeing even a "normal" blood sugar at his first blood test of the morning, will take roughly 1/3 of his breakfast bolus then.  I take about 2 units when I wake up, providing I am not low, or needing a correction.  High five, Dr. K!
• One of the dangers of the AP that they're working on figuring out is balancing risk vs. benefit, and making sure to avoid overdosing insulin.  (He mentioned an interesting statistic from research they'd done:  Of people who have an A1C over 7.0, most typically spend about one hour a day below 70 mg/dL.  Of people who have an A1C of under 7.0, most typically spend about 90 minutes a day below 70 mg/dL.  Again - turns out I'm not alone.)  The problem here is risk vs. benefit.  Yes, reduced average blood sugars lead to significantly fewer incidences of complications - but those lows have a short-term risk of death, while the risk associated with highs is generally long-term.  This plays into why it will take a while for FDA approval - mitigating the risk of hypoglycemia while wearing the AP is crucial.   
• I already knew some of this, but it has been shown that diabetics still produce beta cells - the problem is that the immune system keeps killing them off.  That first part is great news, and helps explain why some of us find our diabetes easier to manage than others, and why some periods of time seem easier to manage than others.  Apparently, there are times where your pancreas produces those beta cells faster than the immune system can kill them off.  So, those days where I've joked that I'm "not diabetic anymore" because I had stellar numbers?  Turns out I wasn't kidding!
• The question came up, "What are the expectations of success with the AP for long-term diabetics, vs. the newly-diagnosed?"  I made sure to listen very closely to this one, as parts of me wonder that since I've had this for so long, it might be that I'm just unfixable.  Dr. K said that the research is showing that the AP works "extremely well" for the newly-diagnosed, and the outlook is "good" for us veterans.  He mentioned the Joslin 50-year Medalist Study group and how well some of those people have responded to it.  This gives me hope, and that's one of the best motivators out there.
• Combining pump and CGM sites into one, instead of having to wear two seperate sites/sensors?  "Everyone's driving this."

To wrap up the webcast, he called for those of us watching to advocate for research funding.  If you haven't done so already, visit the JDRF Advocacy website and please, please sign up as an Advocate.  The Special Diabetes Program is up for renewal in Congress, which currently funds $150 million a year in type 1 diabetes research (35% of the federal investment in type 1 diabetes research).  This is huge.  You can read more about it here.  As people living with and around diabetes, we have the loudest voices.  Make yours heard.