The article on the Insulink design concept caught my interest. I have a neighbor (young adult) who has been a diabetic for some time and has a sugar level that is extremely variable and hard to control. While I am sure the development of the insulin delivery part of the Insulink concept will be a while in coming, are you aware of any testing or trials being done on glucose level monitors along these same lines? My neighbor's problem seems not to be with absolute levels so much as rapid changes in level. A non-invasive device that could sound an alarm on detecting a rapid change would, I think, be the answer.
Although Insulink, at the moment, is a long way from the prototype even, it is not fanciful in the light of modern technology. The non-invasive measurement of blood sugar is something of a philosophers stone for bioengineers in the diabetes field using mostly the techniques of infrared spectrometry and electroosmosis. The delivery of insulin by iontophoresis has not been much tried. The basic mechanism is many years old and has been used with pilocarpine in the diagnosis of cystic fibrosis for a long time. A difficulty, that might not in the end, be important relates to the movement of crystalline and protamine bound insulins. The computer aspects of the scheme are currently getting a lot of attention from teams in both the U.S. and the United Kingdom. A system based on sliding scale algorithms is already approved and others involving the more complex mathematics of glucose metabolism in relation to glucose levels, exercise, stress and carbohydrate intake are being tried out.
It is important to emphasize however that any composite instrument is still many years away. The problem that your neighbour is having is a common one in his age group. Often they became diabetic before the importance of early education and subsequent good control was realised and they often are only recently established in the workforce and have inadequate insurance. Nevertheless if they can be looked after, even for a limited period, by a team that involves not only a physician, but also a nurse educator, a medical social worker and a nutritionist, they usually do very well, especially if they can accept a pump or the discipline of intensive insulin therapy.
From an immediate practical point of view it seems to me that what the young neighbour needs is to get involved with a diabetic team and to see if they cant help him to better control. After that non-invasive blood sugar measurement would be the star on top of the Christmas tree.
[Editor's comment: There was a device previously available, that could monitor changes in the skin relating to low blood sugar, and sound an alarm; it's called the the Sleep Sentry. Unfortunately, normal sweating also could set off the alarm, and the device isn't used much anymore. WWQ]
Original posting 30 Dec 96
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