What Is Automated Insulin Delivery and How Does It Work?
Managing insulin throughout the day can involve constant decisions. Glucose levels change with meals, physical activity, stress, illness, sleep, and countless other factors. For people who use insulin, keeping up with those changes can be challenging.
Advances in diabetes technology have introduced systems designed to help simplify some of that process. Automated insulin delivery, or AID, combines continuous glucose monitoring technology with an insulin pump and an algorithm that uses glucose information to automatically adjust insulin delivery based on the system’s settings.
For many people, automated insulin delivery represents an important step forward in diabetes technology. But how exactly does it work, and what should you know before considering an AID system?
What Is Automated Insulin Delivery?
Automated insulin delivery is a type of diabetes technology that connects an insulin pump with a continuous glucose monitor, or CGM.
The CGM provides ongoing glucose information. The system’s algorithm analyzes that information and, depending on the specific system, can automatically adjust insulin delivery from the pump.
Instead of requiring every adjustment to be made manually, the technology can make certain insulin delivery adjustments according to its programmed settings and the information it receives from the CGM.
AID systems are sometimes referred to as “artificial pancreas” systems because they are designed to automate some aspects of insulin delivery. However, they do not completely replace the pancreas or eliminate the need for people to participate in their diabetes management.
The Three Main Parts of an AID System
Automated insulin delivery relies on multiple pieces of technology working together.
Continuous Glucose Monitor
The CGM measures glucose levels throughout the day and sends information to the AID system.
Rather than providing only occasional readings, a CGM provides ongoing data that can show current glucose levels and trends.
Depending on the CGM, information may be displayed on an insulin pump, smartphone, receiver, or another compatible device.
Insulin Pump
The insulin pump delivers insulin according to the user’s prescribed settings and the instructions generated by the system.
Modern pumps can provide basal insulin throughout the day and allow users to deliver additional insulin when needed, depending on the pump and treatment plan.
In an AID system, the pump can also receive instructions from the system’s algorithm to adjust insulin delivery.
Algorithm
The algorithm acts as the decision-making component connecting the CGM information and insulin pump.
It analyzes glucose data and uses that information to determine whether insulin delivery should be adjusted according to the system’s programmed parameters.
Different AID systems use different algorithms and have different features, so not all systems operate in exactly the same way.
How Does Automated Insulin Delivery Work?
The process begins with the CGM.
The sensor continuously collects glucose information and sends that information to the compatible AID system. The algorithm evaluates the glucose data and trends, then determines whether insulin delivery needs to be adjusted according to the system’s settings.
The insulin pump then responds by adjusting insulin delivery as directed by the system.
This cycle repeats throughout the day as new glucose information becomes available.
The technology is designed to respond to changing glucose information rather than relying on a single reading.
Does AID Mean You Never Have to Think About Diabetes?
No.
Automated insulin delivery can automate certain aspects of insulin management, but it does not completely take over diabetes care.
Depending on the system, users may still need to enter information about meals, carbohydrates, exercise, or other factors. They may also need to respond to alerts, maintain their devices, replace sensors or infusion sets, and follow their healthcare provider’s recommendations.
The exact responsibilities vary depending on the specific AID system and individual treatment plan.
It is best to think of AID as a tool that can help automate portions of insulin delivery rather than a system that manages diabetes entirely on its own.
What Happens When Glucose Levels Change?
One of the key features of automated insulin delivery is its ability to respond to changing glucose information.
If the system detects changes in glucose levels or trends, its algorithm may adjust insulin delivery according to its programmed settings.
For example, certain systems can reduce or pause insulin delivery when glucose is predicted to reach a low threshold. Some systems can also increase insulin delivery in response to rising glucose levels.
The exact features depend on the specific technology, and users should understand how their particular system responds to glucose changes.
What About Meals?
Meals can cause glucose levels to rise, which is why meal management remains an important part of insulin therapy.
Many AID systems still require users to enter carbohydrate information or provide meal-related information so the system can account for the expected glucose impact.
The amount of user interaction required varies between systems.
This is an important distinction: automated insulin delivery can automate some insulin adjustments, but users may still need to actively participate in their diabetes management.
What Are the Potential Benefits of AID?
Automated insulin delivery is designed to provide several potential advantages compared with manually adjusting insulin delivery throughout the day.
One benefit is the ability to continuously respond to glucose information. Instead of relying solely on scheduled insulin adjustments, the system can use current and trend information from the CGM.
AID may also reduce some of the mental effort associated with making frequent insulin adjustments.
Additionally, many systems provide reports and data that can help users and healthcare providers understand glucose patterns and treatment trends.
The potential benefits vary from person to person and depend on the specific system, how it is used, and the individual’s treatment plan.
How Does AID Compare With a Traditional Insulin Pump?
A traditional insulin pump delivers insulin according to programmed settings and user-directed adjustments.
An automated insulin delivery system adds another layer of technology by using CGM information and an algorithm to automatically adjust certain aspects of insulin delivery.
This does not necessarily mean that an AID system is the right choice for everyone. Different pump systems offer different features, and some people may prefer or require other approaches.
A healthcare provider can help determine which insulin delivery options are appropriate based on an individual’s needs.
What Are the Different Types of AID Systems?
Automated insulin delivery technology continues to evolve, and different systems offer different levels of automation.
Some systems may automatically adjust basal insulin delivery. Others may also provide automated correction doses or additional features designed to respond to changing glucose levels.
The terminology used to describe these systems can also vary. You may hear terms such as hybrid closed loop, automated insulin delivery, or advanced hybrid closed loop.
Because features vary between manufacturers and models, it is important to look at the specific capabilities of each system rather than assuming every AID system works the same way.
What Should You Consider Before Choosing an AID System?
If you’re considering automated insulin delivery, there are several factors to discuss with your healthcare provider.
Your diabetes treatment plan, insulin needs, lifestyle, comfort with technology, device preferences, and insurance coverage can all play a role.
You may also want to consider how the CGM and pump communicate, how often sensors and infusion sets need to be changed, whether the system works with your preferred smartphone, and what features are most important to you.
Device availability and insurance coverage can also change, so checking current options is important.
Learning to Use the Technology
Even the most advanced diabetes technology works best when users understand how to operate it.
Before starting an AID system, users typically receive training on the pump, CGM, alerts, settings, infusion sets, sensor placement, and troubleshooting.
It is also important to understand what to do if the system is disconnected, the sensor is not providing readings, the pump has an issue, or another interruption occurs.
Your healthcare team can provide guidance on how to use the system safely and what backup supplies or procedures you should have available.
The Future of Insulin Therapy
Automated insulin delivery is one of the most significant developments in modern diabetes technology.
By connecting continuous glucose monitoring, insulin delivery, and software algorithms, these systems can automate certain aspects of insulin management and provide users with more connected information throughout the day.
As technology continues to advance, AID systems are likely to become increasingly sophisticated, connected, and personalized.
For people who use insulin, understanding these technologies can be an important part of learning about available treatment options.
Is Automated Insulin Delivery Right for You?
There is no single diabetes technology that is right for everyone.
Automated insulin delivery may be an option for some people who use insulin, but choosing a system should be an individual decision made with guidance from a qualified healthcare professional.
If you’re interested in learning more about automated insulin delivery, start by talking with your diabetes care team. They can help you understand the available options and determine whether an AID system fits your treatment plan.
At Southeast Diabetes, we help patients access diabetes supplies and technology from leading manufacturers. From CGMs and insulin pumps to other diabetes management supplies, we’re here to help make getting the products you need easier.
Technology continues to move diabetes care forward. Understanding your options is the first step.