Diabetes is a major public health concern in the United States with a substantial economic burden that continues to worsen. We present a case report of a patient who built his own closed-loop insulin delivery system to better manage his type 1 diabetes.
Our patient is a 39 year-old Caucasian male who was evaluated for management of uncontrolled type 1 diabetes. He was diagnosed at age twenty-three. His diabetes is complicated by bilateral mild non-proliferative retinopathy. The patient was previously using a generic insulin pump but later joined a growing community of patients who build their own Artificial Pancreas System. He used his old Medtronic pump to design a monitor with an algorithm that is programmed to respond to changes in his blood glucose levels. We follow this patient as he manages his diabetes with a DIY closed loop implementation to determine the success of his glucose control.
The patient’s hemoglobin A1c was 8.6% during his initial presentation in March 2018. He was using a freestyle libre continuous glucose monitor. He was in target glucose range between 70 to 180 mg/dL for 35% of the time. He was above the target range for 63% of the time with 2% of his readings below target. He created his own Artificial Pancreas System prior to his follow up. His repeat hemoglobin A1c was 7.8% in August 2018. He was in target glucose range for 61% of the time with 39% of readings above target and with no hypoglycemic events.
The management of type 1 diabetes is quickly evolving as technological advances are made and clinicians should be aware of the available options. There is a growing community of technologically savvy patients who are investing in “do-it-yourself” automated insulin-delivery systems. These systems combine insulin pumps, continuous glucose monitors, and algorithms that interpret glucose readings and adjust insulin doses. DIY pumps may be a more affordable alternative compared to the current hybrid closed-loop pumps. Closed-loop systems are designed to improve outcomes including maintaining target glucose levels, decreasing rates of hypoglycemia, and improving quality of life by decreasing the self-care burden in type 1 diabetes.
Our patient was able to achieve more optimal glucose control as evidenced by his lower hemoglobin A1c with no episodes of hypoglycemia using a DIY closed-loop Artificial Pancreas System. He has been able to reduce his burden of living with type 1 diabetes. Physicians need to work with their patients to develop an optimal strategy for diabetes management to improve quality of life and decrease long-term complications.
Internal Medicine Resident
I am currently a third year Internal Medicine resident at The University of Texas at Houston, McGovern Medical School. I will be serving as a Chief Medical Resident for the 2019-2020 academic year and will be pursuing a fellowship in Endocrinology with a special interest in Women's Health.
Associate Professor of Medicine
Dr. Shah joined the Internal Medicine Division at The University of Texas at Houston in 2011. He received his undergraduate education from Northwestern University in Evanston, Illinois and his medical degree from the Northwestern University Feinberg School of Medicine in Chicago, Illinois. He completed his residency in Internal Medicine and Chief Residency at the University of Texas Medical Branch in Galveston, Texas. He completed his fellowship in Endocrinology, Diabetes and Metabolism at The University of Texas Medical School at Houston. Dr. Shah is board certified in both Internal Medicine, and in Endocrinology, Diabetes and Metabolism.
Dr. Shah has a strong interest in medical education, both at the undergraduate and postgraduate level. He currently serves as the Associate Program Director for the endocrine fellowship program. He has won multiple Dean’s Excellence in Teaching Awards. His clinical interests include diabetes management, insulin pumps, thyroid disorders, fine needle aspiration, bone metabolism, and pituitary/adrenal abnormalities.