1. NOT A NEW CONCEPT: Really ‘Back to the Future’

2. 1979- BIOSTATOR-Artificial Pancreas: Closed -loop IV Insulin & Glucose Delivery
blood -2ml/hr;
sensor glucose-oxidase;
program set for goal of 5.6mM- non-linear PD algorithm

3. SUCCESSFUL PROOF OF CONCEPT, but
1.Value of glycemic control was not accepted –
2. Relationship of complications to peri-op/ critical care
glycemia not known in 1979
3. Clunky, full time tech support required, blood loss, heparin
= ARRESTED DEVELOPMENT
Insulin,5μU/ Min
Glucose infusion
Plasma Glucose ~ 5.5 mM
1979
Schwartz, S.S.,et.al., Use of a glucose controlled insulin infusion system (artificial beta cell) to control diabetes during surgery. Diabetologia 16: , 1979.

8. Components in the Use of CGM Status, Issues, Problems
Open Loop Closed Loop Sensor
Accuracy
Arterial, Venous, Capillary, Subcutaneous
Dose Calculation
Human Ordering Computerized algorithms
a. MD judgment, Compensate for
b. paper protocols a. site/ sensor inaccuracy
c. order-entry systems b. variable stress/ insulin sensitivity.
d. computerized algorithms c. rate/ direction of change Automatic stop/ restart Delivery
1. Site
2. Therapy - glucose, insulin, glucagon

9. Components in the Use of CGM Status, Issues, Problems
Open Loop Closed Loop Sensor
Accuracy
Arterial, Venous, Capillary, Subcutaneous
Dose Calculation
Human Ordering Computerized algorithms
a. MD judgment, Compensate for
b. paper protocols a. site/ sensor inaccuracy
c. order-entry systems b. variable stress/ insulin sensitivity.
d. computerized algorithms c. rate/ direction of change Automatic stop/ restart Delivery
1. Site
2. Therapy - glucose, insulin, glucagon