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Advancement in Insulcagon Pump Simulating as

an Artifcial Pancreas for the Treatment of


Diabetes
Engr.S.Ghufan Khalid
1
, ProfDr.M.Iqbal Bhati
2
, Engr.Kamran Hameed
3
I
BMD, NED Universit of Engineering and Technology, Karachi, Pakistan
2
BMD, Ziauddin Universit, Karachi, Paistan
3
BMD, Sir Syed Universit of Engineering and Technology, Karachi, Pakistan
Email: syed_ghufrank@hotmail.com
l
.i_m_iqbal@yahoo.com
2
.engr.kamranhameed@gmail.com
3
b$lruO~ Diabetes Mellitus prevalence is escalating in
epidemic proportions on the global basis. This disease afects
various body organs. Due to that reason, it should be treated
effectively. Hyperglycemia, a condition of diabetes is treated
via insulin pump, pens and injections while hypoglycemia is
treated by only glucagon injections. Signifcantly, there are not
any such pumps available in the market aimed for the
treatment of both condition simultaneously. Whereas our
designed prototype pump named as insulcagon pump have
ability to control both situations. This prototype has invitro
continuous glucose sensor that senses blood glucose level whose
output goes to micro controller that decides which pump to be
activated either insulin or glucagon pump in order to maintain
blood glucose level. That's why Insulcagon pump acts as an
artifcial pancreas for diabetic patients. The adequate results
of this prototype shown in graphical form in this paper. We
added advance features in Insulcagon pump that will
considered as an era towards device modernization. Thus we
incremented some peculiar functions in this medical
instrument. These functions include: trends, modes and power
compatibility. Trend provides the past record of activities
according to the time selected. Modes have options for the user
to select calibration, auto-mode and manual selection mode.
These modes assist in providing required amount of bolus
directly injected into the body. Power compatibility option
prevents disruption in the continuity of the device. We expect
that our designed prototype will be benefcial for the efective
treatment of Diabetic patients and biomedical companies will
play important role in the enhancement and the accuracy of
device according to the guidelines of American diabetic
association.
I. INTRODUCTION
The basic concept of fabricating the insulcagon pump is to
design a prototype that automatically regulates glucose levels
in the blood of diabetic patients identical to the pancreas
this acts as feedback for both stimuli in the body. Glucose is
the main physiological controller of insulin as well as
glucagon Secretions in human body [2].The device detects
hypo and hyper condition of blood glucose level and aid in
the recovery of regular glucose level through the pumps of
glucagon and insulin. This device can allow for more
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confdent and efective treatment of diabetic patient than
insulin pump that only capable of controlling hyperglycemia.
In case the pump malfnctions or out of calibration, it injects
slightly high quantit of insulin consequently patient
abruptly goes into hyoglycemia condition and due to lack of
continuous monitoring of glucose level, patient may go into
coma or any other severe situation. Our designed prototype
overcomes this artifact by continuous monitoring of glucose
level in blood. If the glucose level suddenly drops, insulcagon
pump will control this situation through injecting glucagon
automatically in time and keep monitor the patient till
glucose level reaches the normal. Further, this combined
glucose sensing and hormone deliver approach may also
pave the way to eventually developing an artifcial pancreas.
The algorithm of our protote is based on the diference
between the current blood glucose and the target glucose
level. This protote is well suited for the control of blood
glucose in tpel diabetic patients. The addition of glucagon
pump is helpfl in better hyoglycemic control [3], [1]. With
addition of some extra fnctions like modes, trends and
power capabilit in this prototpe we can say that this
prototpe is moving towards standardization.
II. MATERIALS AD METHODS
A. Glucose Sensing
With the help of an insertion device, the sensor is inserted
into the subcutaneous space in to the skin of albino rat with a
little discomfort being an animal patient, which is
conventionally pre checked by the strip base glucometer.
Invitro glucose sensor senses the glucose blood level for two
to three days. The transmitter attached with the sensor sends
data via wireless to the receiver. Aer few hours, sensor
equilibrates with its surrounding simultaneously send data
that displayed on monitor which is pre-calibrated with the
conventional strip meter. The receiver receives the glucose
data level from the transmitter then Micro-controller
processes the data and takes decision according to the
Figure-I : Controlling Circuitry [1]
requirement. The sensor used in this process is
manufactured by dexcom which is use in the Dexcom STS
product. Continuous monitoring of glucose increases the
frequency of presentation of glucose values to the hundreds
per day with consequent exposure of even greater previously
undetected variability [4], [1].
B. Controlling
Micro controller which is shown in fgure-I takes serial
data from the receiver of continuous glucose sensor that is
proportional to the concentration of blood glucose and then
controller according to the algorithm takes diference
between measured glucose level and the reference level.
Specifcally, it receives real time voltage input from
transmitter and takes the diference between voltage value
corresponding to set point glucose level and input voltage
(set point - input), and check if error is negative or positive.
When the error is negative, it means the measured blood
glucose is higher than the set point, so the controller will
send signal voltage to the pump. When the error is positive, it
means the measured blood glucose is lower than the set point.
Assuming that normal glucose level is within 5 % percent of
set point, controller should send signal to the pump when
error is bigger than 5% [I].
From the qualitative analysis, 89C51[6] controller seems
to be the best controller because it can reach set point
relatively faster, have low overshoot, and have better
response to noise. Stability is an important fnction since
unstable system can have unpredictable and uncontrollable
behavior. Proper perormance in the presence of constraint is
also necessary for controlling glucose level [I].
C Injection System
Now days, a variety of insulin delivery systems exist that
use disposable, wire-thin needles that have been laser
sharpened and silicon-coated so that injections are usually
painless. The disposable syringes come in diferent sizes but
we use 100 units syringe, needle thickness 28 gauges [5]. The
injection system needs to deliver concentrated glucose
solution into the object at a variable and controllable rate,
with appropriate sensitivity and over the appropriate volume
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Figure- 2 : Injection System [I]
range. The pump indicated in fgure 2 able to fnction
against a pressure head equivalent to the blood pressure of
the object. In the fnal version, the pump should be small and
eventually implantable; mnning from a batter power source
[7]. The fnal choice was made to use a syringe pump for
preliminar experiments. Syringe pumps are designed to
rotate the one end of the screw connected with the steeper
motor and the other end is connected with the support of a
syringe at a specifed rate, injecting the solution into a
catheter. The rate of injection has a larger range because
various syringe sizes can be accommodated. Some of the risk
associated with the insulin administration include incorrect
rate but we take over this problem by the use of fow meter in
our system [12].
III. PROCEDURA STEPS
A. Glucose Detection
The initial step in determining the concentration of
glucose in blood based on the sensing. The sensor used in this
project known as glucose sensor, belongs to a type of
chemical sensor. In this project we use invitro sensing
technology. Sensor converts glucose concentration in to
voltages.
B. Decision Making
The output voltages from the sensor will transform in to
binar by AD converter go in to the microcontroller that will
display the reading in the decimal form on the LCD screen.
In the mean time Microcontroller suggest according to the
condition which solution (insulin or Glucagon) to be
injecting through infsion pump.
C Infusion
A multisyringe infsion pump will control by
Microcontroller containing insulin and glucagon. Which
syringe will be infsed? This will be decided by
Microcontroller according to value of glucose level in the
hypo or hyper glycemic condition. In normal values of
glucose level insion pump remain in stationary phase.
Figure- 3: Air Bubble and Blood Leak Detector [1]
D. Air Bubble Detector
The main purose of the air bubble detector is to detect
air bubbles and stops the infsion. For this purose we use
INTERFACER-AIL'S technology normally use in dialysis
to detect and change output voltage as a result of air trapped
inside a clear tube as depicted in fgure 3[8].We use
optocoupler, when the light falls on the bubble. Light's
refractive index change that varying the output voltages of
the detector.
1 Blood Leak Detector
The main purose of the blood lea depicted in fgure 3
detection is to detect the back fow of the blood through the
catheter in to the valves and cease the whole system. If the
blood pressure greater than the infsion pressure sensitivit
suciently decreased [11]. The blood lea detector's
sensitivity is flly programmable to accommodate many
applications [9].
IV.
F
UNCTIONS
A. Trend
We have introduced trends calculations in insulcagon
pump while setting trends. However, there is an option to set
trend for continuous glucose monitoring as shown in fgure 4
GLUCOBE MOMlTORlMG [1hrTrend]
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Figure- 4: Glucose Monitoring I h Trend
4
978-1-4244-8003-6/10/$26.00 201O IEEE

so as to record diagnostic glucose level as well boluses that
can be given in a certain time period. We also set trend for
both cases that depicted in fgure-5.0ne can also select
monitoring along with transfsed dose trend at the rate: 1, 12
& 24 hours [14]. We also set trend for monitoring 'error
ratio' at the time of calibration of the device which will
provide the fnctional accuracy of the device [13].
B. Mode Selection
1) Calibration Mode
In this mode the protote takes sample just like
conventional glucometer and inserts the sample strip in to the
particular area of the device. The device then compares the
current observed glucose level and then provides sample
glucose concentration using small size glucometer built in
the device. This way it calibrates the noted reading according
to the sample reading and divisional reading is called error
ratio which is equally important in the diagnosis of the
device.
2) AutoMode
In this mode, insulcagon pump automatically detects the
glucose level with invitro glucose sensor and acts according
to the desired glucose level. At that level the mode acts as an
artifcial pancreas being an auto- activated according to the
situation.
3) Manual Bolus Selection
In this mode, user entered the required dose for
infsion. The mode has all tpes of insulin to be delivered
includes: rapid acting, short acting, and intermediate acting,
as well long acting insulin. Added, in the injection chamber
there exists option to insert these injections but due to the
complexit and patient requirement, we currently use rapid
acting injection and on the other hand glucagon injection
also congurable for manual dose infsion.
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Figure- 6: Insulin and Glucagon Pumps Activities over Blood Glucose Level
[1]
C Power Capabilit
Previous version of insulcagon pump posses only a
single batery source where-as in current version dual battery
system exists i.e. at frst, single battery provides power for
operations and the second one will act as a backup power
being benefciary that If the frst battery is depleted then
backup batery will take its position with warning indication
appearing on display of insulcagon pump.
V
.
R
SULTS
The graphical analysis of previous version shows excess
inadequate results as aer few days we observed serious
variations in the glucose level of the rat's blood and
treatment by our designed prototpe device. The graph,
shown in fg-6, is giving information about patient glucose
level as a fnction of time. The red line shows the glucose
level, the circle indicating the rapid insulin humalog inject
and the square depicted the glucagon inject.
T ALE- 1: KEFERENCESCALEFORNSUPNJECTlONSr 11
Blood Glucose Insulin Dose Insulin type
Level
6-125mgldL 0units Rapid acting
126-150 mgldL 4 units //
151- 175mgldL 8 units //
176 -200mgldL 12 units //
201- 225mgldL 16 units //
226 -250mgldL 20 units //
>250 mg/dL 24 units //
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T ALE- 2: REFERENCE SCAE FOR GLUCAGON INJCTIONS [1]
Dose Time of Onset of Action
0.25 -0.5 units (IV) 1 min
1 units (!M) 8-lOmin
2 units (IV) 1 min
2 units (!M) 4-7 min
At Sam rat glucose level is ver high 300mg/dl at that
time insulin pimp activated and inject insulin in this way if
the blood glucose level increase from the normal glucose
level above 150mgdl that means the reading lie in the
Hyerglycemic region and it clearly indicate that patient
have hyerglycemia and according to the treatment insulin is
inject in to the body to lower down the glucose concentration
till the normal blood glucose level is maintained. At 12pm,
the patient glucose level is ver low 60mg/dl and at that time
glucagon pump is activated and inject glucagon in the same
way If the glucose level decrease from the normal glucose
level below 70mgdl that means the reading lie in the
hypoglycemic region and
according to the treatment glucagon inject in to the body to
remain the body in homeostasis [1). This concept provides
limited results but in a new version of insulcagon pump. We
provided trend fnction depicted in fgure - 4, 5. These trends
provide valuable information about the rate of change of
glucose concentration and required dose infsion at a
particular time.
V
.
D
ISCUSSION
The body does not produce or properly use insulin if a
disease occurs named as "diabetes". Insulin is a type of
hormone that is required to convert sugar, starches and other
Food into energy required for daily life. Usually in children
and young adult tpe- 1 diabetes is diagnosed. Frequently
insulin pumps use to deliver rapid- or short-acting insulin 24
hours a day through a catheter placed under the skin [S).We
have delivered the required amount of doses of insulin to the
patient as shown in table 1 and the glucagon doses also
shown in table 2. Insulin is only capable of controlling
hyperglycemic condition not hypoglycemic and market have
not any pump use to treat both condition that's why we make
a prototpe device named as insulcagon pump. In previous
version of this prototpe device we talk about how insulcagon
started. Initially you enter the date time and patient name
through 4 *4 keypad. Then give the normal range. The device
will not work in this range. The subcutaneous continuous
glucose sensor takes reading of blood glucose level. Aer that
sensor serially transfer the data to the microcontroller. It
takes decision which pump is activated either insulin or
glucagon.
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Figure- 7: Project Flow Diagam [1]
The whole system is shown in fow diagram of the project
fgure 7. It depends on the sensor reading. Whenever the
sensor reading cross the upper limit of range insulin pump is
activated. If reading cross the lower limit of range glucagon
pump is activated. The system includes the patient securit
system just like dialysis. Blood leak detector detects the
leaking which is usually due to the blood pressure and air
bubble detector detects the air bubble and stops the whole
system for patient safety [1]. In this version we have
introduced some key features that should essentially required
in an improved medical instrument, therefore, introduction
of trend feature compares with previous activities related
with the patient and the device. We have also added mode
feature consist of three modes, initially- a user select
calibration mode, if the device calibration is required. This
mode is an essentially feature of any standard device. In this
mode we added conventional glucometer for the device
calibration. Auto mode is just act as an artifcial pancreas
which automatically detects the glucose level just like a
conventional insulcagon pump. In manual Bolus selection
mode is new for this device like calibration mode. In this
mode user select the required dose of insulin or glucagon
according to the requirement and directly inject the dose.
This mode is also usefl in the insion syringe perormance.
VII.
C
ONCLUSION
In the light of mentioned advancement in insulcagon
pump, the device gets the track of standardization for
diabetic patient like insulin pump. This pump is benefcial
because it aims at continuously monitoring patient's blood
glucose level and prevents severe cases of hypoglycemia as
well as hyperglycemia. In addition, biomedical principal
companies ofen require testing of new drugs to determine
diferent efects on hepatic glucose production and as such
insulcagon pump will be in place to measure the changes in
hepatic glucose production [1].
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REFERENCES
[1] M. Iqbal Bhatti, Kamran Hameed and Syed Ghufran Khalid,
"Sigifcance of "The Insulcagon Pump"in the treatment of diabetes" .
World Congess on Medical Physics and Biomedical Engineering,
IFMBE Proceedings, Volume2517, January 04 2010, Springer.
[2] F. Belfore, C. E. Mogensen, "New Concepts in Diabetes and Its
Treatment, Basel, Karger", 2000, p-20.
[3] William K. Ward, "Sensor-Augented insulin delivery: insulin Plus
Glucagon Vs insulin alone", Legacy health system, November 28,2008
[4] Serge Jabbour, Elizabeth, A STEPHENS, "Type-I Diabetes In
Adults", Informa, Health Care, Newyork, NY 10017, p37-38.
[5] Booth, Kathryn Et A, "Math and Dosage Calculations for Medical
Careers", Ed.2007
[6] Jack L. Leahy, William T. Cefalu, Insulin Therapy,
Marcel Dekker, New York. Bessel.
[7] <http://be-web.uscd.edu/seniordesigPast_ Desigsl studentpages
12006/project7/solution.HTML>, Access Date 02/03/2008, Link has
been change to: <http://seniordesig.be.ucsd.edu/projects/
student pages/2006/project7/index.html>.,student
project, hypoglycemic glucostat project home page.
[8] < www.diabetes.orglabout-diabetes.jsp> AccessDate 05/06/2008,
Diabetes Basics, Type-I Diabetes.
[9] <www.introtek.comlassets/pdf/Optical_B1ood_Leak_Detector.
Pdt. Access Date 07/02/2008, Optical Blood Leak Detecor/Blood
Vs Saline Detector.
[10] RS Khandpur, Biomedical Instrmentation, 2.ed, p-874.
[11] Allen R.Nissenson, Richard N. Fine, Dialysis Therapy, P-81
[12] Joint Commission Resources, High Alert
Medication: Strategies for Improving Safety, p-55
[13] M.V.Landow, "Trends in Dietary Carbohydrates Research",
2006, pg.78.
[14] Sheri Colberg,"Diabetes Ahlete's Handbook", 2008, p-85.