Artificial Pancreas Treatment® (APT) is a process which promotes the normalization of carbohydrate metabolism in diabetic patients. APT affects multiple organs, especially muscle, retina, liver, kidney, and nerve endings. The process involves the administration of insulin pulses similar to those found in the portal circulation of normal humans using the Bionica Microdose infusion device which is FDA labeled for this treatment. The process is monitored by frequent glucose levels and metabolic measurements. Metabolic measurements are taken by a metabolic cart which determines the ratio of exhaled Carbon Dioxide gas to Oxygen gas. This ratio is used to determine the amount of fuel used by the body at any one time. The blood glucose levels are monitored to keep appropriate levels, and the metabolic measurement determines the need for length between treatments. APT is done over 1-hour periods with a rest period between each session for three courses each day of treatment. Typically, APT is performed on a weekly or bi-weekly basis following the first week of two back-to-back daily sessions.
Initial Clinical Assessment
Patients report to the clinic between 7:00 am and 8:30 am for the initial clinical assessment to perform the following:
Capture vital signs.
Determine initial glucose level.
Assess patient’s overall condition.
Establish an intravenous (IV) line.
APT Treatment Session
U / kg of Insulin, pulsed at 10 pulses/hour over 1 hour is administered by the Bionica Microdose specialty pump programmed for the concentration, frequency and duration of pulses, and rest intervals.
The metabolic measurement is performed at the beginning and end of each one hour treatment to measure success of treatment and adjust the amount of insulin and glucose. Glucose levels are taken every 30 minutes or more frequently as medically indicated in patients with a tendency for hypoglycemia.
Oral carbohydrates are given to keep blood glucose over 100 mg/dl and to increase metabolic measurement. Approximately 100 g of glucose is given, (400 cal.)
There is a rest period of 40 minutes to one hour between treatments in order to stabilize blood glucose levels.
This cycle is repeated twice more in a single treatment day.
Patient is evaluated after the session and discharged when stable.
Frequent monitoring of respiratory quotient is essential in order to verify patient response to APT treatment. When metabolic measurement is low (0.7-0.8), fat is the primary fuel and at metabolic measurement’s of 0.9-1.0, glucose is the primary fuel. Protein and mixed fuel utilization have intermediate metabolic measurement’s of 0.8-0.9.
APT increases the respiratory quotient in diabetic patients from levels around 0.7 to levels greater than 0.9. This reflects the underlying physiologic changes of the treatment, confirming the conversion from fat metabolism, typical in the diabetic patient, to a normal metabolic state utilizing carbohydrate as the primary fuel consumed. Both the total amount of insulin contained within each pulse as well as the total amount of consumed glucose is altered in order to maximize treatment results.