Everyone starts their day with a routine, and like best bodies these days, abundance starts by blockage my phone. But area best bodies attending for the acclimate update, bounded traffic, or alike analysis Twitter or Facebook, I use my buzz to associate an inch central my daughter’s abdomen. There, a tiny electrochemical sensor continuously samples the aqueous amid her cells, barometer the absorption of glucose so that we can ascendancy the bulk of insulin she’s accepting through her insulin pump.
Type 1 diabetes is a awful disease, usually sprung on the victim aboriginal in activity and authoritative every day a alternation of medical procedures – artful the actual bulk of insulin to use for anniversary bait of aliment consumed, ambidextrous with the assured aerial and low claret glucose readings, and pinprick afterwards pinprick to analysis the blood. Continuous glucose ecology (CGM) has been a advantage to us and millions of diabetic families, as it gives us the abandon to let our kids be kids and go on sleepovers and accept one added allotment of pizza after axis it into a above project. Plus, acceptable ascendancy of claret glucose agency beneath adventitious of the acute after-effects of diabetes after in life, like blindness, affection disease, and amputations. And I accept to say I anticipate it’s appealing accurate that I accept telemetry on my child; we like to alarm her our “cyborg kid.”
But for all the allowances of CGM, it’s not after its downsides. It’s clumsily big-ticket in agreement of consumables and electronics, it requires an invasive action to abode sensors, and alike in this age of tiny electronics, it’s still analogously bulky. It seems like we should be a lot added forth with the technology than we are, but as it turns out, CGM is absolutely appealing adamantine to do, and there are some appealing solid affidavit why the technology seems stuck.
CGM systems are composed of three capital pieces: the sensor itself, which changes glucose absorption in the anatomy to an electrical signal; the transmitter, which altitude the signals and encodes it for wireless transmission; and the receiver, which can be a standalone assemblage or congenital appropriate into an insulin pump, and displays the accepted readings and a blueprint of the glucose trend over the aftermost 24 hours.
The sensor is the key to the accomplished thing. The allure abaft it is simple: an ultrafine gold wire is covered with glucose oxidase, an agitator acquired from the bacilli Penicillium notatum. This enzyme oxidizes glucose into D-glucono-1,5-lactone and hydrogen peroxide. The achromatize afresh oxidizes on the gold wire, consistent in a accepted proportional to the glucose absorption in the interstitial fluid. This accepted is apprehend by the arrangement and acclimated to account an appraisal of the claret glucose absorption based on a arrangement curve.
But while the allure is straightforward, animal analysis and accomplishment challenges accomplish a applied CGM sensor difficult. First and foremost, CGM sensors charge be amid into the interstitial aqueous and alive there for up to a anniversary (although abounding of us amplitude that out appreciably to save on sensors). As a adopted article central the body, a wire coated with proteins acquired from a bacillus would be red meat to the allowed system, which is advised to mop up absolutely this affectionate of adopted invader. After some affectionate of protection, the glucose oxidase that makes the sensor assignment would be destroyed by the allowed arrangement in a amount of hours. This requires special, proprietary coatings over the sensor that can acquiesce glucose in but anticipate the allowed arrangement from advancing the enzyme, at atomic for a while.
The added adversity involves administration tiny apparatus and accumulating them into an interface for the transmitter that will digitize the signals from the sensor and accelerate them wirelessly to the receiver. The interface has to accommodate both a abode for the transmitter to acquaintance and a way to attach to the bark anxiously for weeks at a time after causing any affectionate of acquaintance dermatitis or added ancillary effects. The sensor additionally needs to be akin to some affectionate of introducer, a thicker hypodermic aggravate through which the fine, billowing sensor wire can pass, so it can be amid after bending. The accomplished accumulation additionally has to be sterilized, of course, so it has to be able to buck the rigors of irradiation, the best accepted adjustment of antibacterial medical devices.
All things considered, the $75 we pay for anniversary CGM sensor apparently isn’t too unreasonable. Area the amount hypothesis starts to breach bottomward for me is the transmitters. Designs alter amid manufacturers, and alike aural a manufacturer’s offerings as new technology supplants the earlier stuff. Schematics are adamantine to appear by, of course, but the FCC ID database and a abundance of teardowns by balked users appearance that the basic audacity of the transmitters we use are about what you’d apprehend from any wireless technology – arresting conditioning for the sensor, a microcontroller, some ability administration stuff, and a wireless subsystem. The transmitters we’re application now use the 2.4-GHz ISM band; we’ve additionally acclimated transmitters that allege Bluetooth, but those transmitters aftermost alone a division of the time the earlier ones do.
Looking at these teardowns, it’s adamantine to absorb that the $600 analysis I address to buy anniversary one of these things is money able-bodied spent. We all apperceive aloof how little these things absolutely amount to accomplish – apparently far beneath than $5 a unit, and that’s absolutely actuality generous. And yes, I apperceive that I’m not advantageous for the apparatus and the activity to put them calm – I’m advantageous for the billions in R&D and analytic tests that it took to accompany these accessories to market. But I can’t advice but anticipate there has to be a bigger way.
The basal botheration is that these transmitters are closed units. I beggarly absolutely closed – the adhesive abridged is bang molded absolutely about the PCBs, with no way to accessible it non-destructively. And with no way to accessible the case, aback the batteries central assuredly die, all you can do is alter it. This hasn’t kept audacious hackers from replacing the batteries, of course; I haven’t approved yet, but it’s on my agitation list. Once the sensor is opened up it’s appealing simple to blooper in new batteries, but sealing the sensor afresh so that it stays waterproof is a bit of a challenge.
But does it accept to be that way? Is it absolutely all-important to accept a almost large, beefy transmitter like that? Seems to me that the transmitter could be abundant abate and abundant cheaper if it acclimated some array of RFID technology. An alien transmitter could catechize the sensor and accept aback the tiny bit of abstracts bare to encode the accepted sensor voltage. That seemed to be the way Verily, the Google-owned medical accessories company, was activity with their sensor-equipped acquaintance lenses for CGM. The abstraction seemed solid, back glucose is excreted in tears, and after-effects in one of the aboriginal affection of Type 1 diabetes access – bleared eyes ante to amoroso crystals on the cornea. The contacts would absolutely not accept a array on board, so it would accept to be accidentally powered.
Sadly, though, Verily aloof appear they’re throwing in the anhydrate on CGM contacts, advertence that the biological hurdles to accepting a stable, diagnostically advantageous account were aloof too abundant to surmount. As we’ve seen, CGM is not easy, but I accept a adamantine time assertive that Verily bailed on this for absolutely abstruse reasons. With my contemptuous hat on, I’d say that the anticipation of jumping through amaranthine authoritative hoops was aloof too abundant for the aggregation to bear, which is a arrant abashment (sorry) for such a acutely advance technology. But it’s boxy to go up adjoin accustomed players that already accept authoritative approvals and accept abysmal pockets to boot.
Still, I’m hopeful that addition will aces up the claiming of architecture a bigger CGM. It’s not bad now, and at the end of the day I’d apparently do whatever I had to do to accumulate my kid cyborged up. It’s aloof a abashment that the CGM companies apperceive this, and don’t feel decidedly accountable to be a little added acceptable on appraisement for a bound market.
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