Could diabetes jabs be replaced by a simple skin patch?
Published 6 Sep 2016
Women with diabetes are at risk of complications during pregnancy due to uncontrolled blood sugar levels.
A new wireless patch delivers insulin automatically and keeps mother and baby safe.
Chelsi Brown, 24, an office worker from Cambridge, is one of the first women to have it fitted, as she tells ROGER DOBSON.
THE PATIENT
When I was about 18, I was diagnosed with type 1 diabetes.
I was working part-time in Tesco at the time and one day, while working on the tills, I suddenly lost my vision. I couldn’t read the numbers on the screen — it was really frightening.
I went to the local walk-in clinic after my shift and the GP there was so concerned he referred me straight to hospital for tests.
That same day they carried out blood tests and physical examinations then diagnosed me with type 1 diabetes.
This meant my body mistakenly attacks healthy cells in the pancreas that produce insulin. As a result, my body can’t control my blood sugar levels.
There is a genetic element to it and I have since found out that a great grandmother of mine had it.
I clearly had it for years because it was now so serious that it was damaging the cells in my eyes, causing temporary vision loss.
Looking back I realise I had symptoms before I was diagnosed — unintended weight loss, severe thirst, exhaustion — but I never took much notice or saw a doctor until that episode of blindness which really scared me.
In hospital, the doctors told me I was lucky as if I’d left it much longer I could have died because the severe lack of insulin meant I had developed diabetic ketoacidosis, meaning my body was starting to break down muscle.
I was told do finger prick tests to measure my blood sugar levels and I would need to inject insulin for the rest of my life. I was worried I’d lose my freedom.
On occasions I could inject insulin up to ten times a day, to cover what I had eaten or correct the previous doses if I didn’t feel right.
It was such a chore but I had to get on with it.
Earlier this year I started attending a pre-pregnancy clinic for women with diabetes at Addenbrooke’s Hospital because my fiance, Lewis, 25, and I wanted to start a family and my diabetes adds risk to pregnancy.
It was during one of these clinics that I found out about a new study called the artificial pancreas project.
I was told it would cut the risk of complications, including stillbirth and high birth weight, and I was asked if I would like to join the trial.
I was a little reluctant at first but then decided to give it a go as it meant no more insulin injections — I joined when I was 12 weeks pregnant.
I was given instructions and the ‘artificial pancreas’ system to fit at home.
It is made up of a patch which I stick to my stomach, an insulin pump in my pocket which feeds insulin into a tube in my stomach, and a glucose meter, a smartphone-like device. I assembled everything myself in about four minutes at home.
The patch continuously monitors blood sugar levels in my skin, and sends signals to the glucose meter — this then works out how much insulin I need and sends signals to the insulin pump to deliver the correct amount to my body via a tube.
I no longer have to do the finger prick tests or inject insulin which is a great relief.
I am now 23 weeks pregnant and my baby is due on December 16. So far my blood sugar levels are within the normal range and my baby is healthy.
I was worried about becoming pregnant but I couldn’t be in safer hands — I am so grateful and lucky to be a part of this trial.
THE SPECIALIST
Dr Zoe Stewart is a clinical research fellow at the Institute of Metabolic Science, University of Cambridge.
Around 350,000 people in the UK are estimated to have type 1 diabetes, an autoimmune disease where the body’s own immune system attacks the pancreas, a small gland behind the stomach, and prevents it from producing insulin, the hormone that regulates the body’s blood sugar (glucose) levels.
There is no cure and treatment includes insulin injections for life to keep glucose levels as normal as possible.
If diabetes isn’t treated, over time excessive levels can damage blood vessels, which can cause damage to nerves and organs such as the eyes and kidneys.
Controlling glucose levels is a daily challenge for all patients with diabetes, but is particularly challenging during pregnancy when there is added demand on the woman’s body to provide nutrients for the foetus and changing hormone levels which can affect glucose levels.
This makes it difficult to predict how much insulin the woman needs.
If not managed properly, it can increase the risk of complications such as premature birth and stillbirth, and patients may need admission to hospital for observation.
The baby is also at risk of developing diabetes.The ‘artificial pancreas’ we have developed has the potential to revolutionise treatment for all type 1 diabetes patients.
We are studying it in pregnancy first because this is a high-risk group who arguably need it most.
It is a three-part system designed to mimic a healthy person’s glucose regulation system. It is simple enough to put together at home.
There is a small patch which can be worn on the arm or stomach, an insulin pump carried in the pocket with a tube connected into the abdomen to deliver the insulin, and a special phone.
The patch has a sensor in it which contains needle-like electrodes about half an inch long.
This is inserted just under the skin of the tummy in a simple painless step and covered with the patch.
It monitors glucose levels because platinum in the electrodes reacts with a chemical called hydrogen peroxide found in the blood.
Although hydrogen peroxide is known for being the main component in bleaching chemicals, there is also a version in our blood which is produced as part of a chemical reaction involving a natural enzyme called glucose oxidase which converts glucose to hydrogen peroxide.
The more glucose there is, the more peroxide and this results in an electrical signal sent to the phone.
Patients also insert information on their meals, physical activity, sleep, stress, and metabolism which all affect the insulin dose.
The phone then signals by Bluetooth to the pump how much insulin it should release to the patient as required.
The insulin pump can be worn on a belt or clipped to a bra and has a small tube which goes into the stomach.
When the pump gets the signal, it releases insulin through the tube and into circulation. You can take it off for cleaning or replacing.
The advantage of the artificial pancreas system is that it operates 24 hours a day and calculates insulin requirements every 12 minutes — that means sugar levels are more tightly controlled than standard injections.
Our recently announced results show that the artificial pancreas was associated with a 25 per cent improvement in control of glucose levels compared with the currently used insulin pumps.
While we don’t yet know whether this system will change outcomes such as stillbirth, we do know that improving glucose control in pregnancy is associated with a lower risk of complications.
Chelsi and the 31 other women on our trial at Cambridge are the first in the world to use the devices through their pregnancy — we have had 20 babies delivered successfully already.
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