Outsmarting Smart Insulin?

I tuned into yesterday's JDRF Advocacy webcast with Dr. Aaron Kowalski to find out some more about what's going on with the Artificial Pancreas Project. (If you didn't have a chance to tune in, the recorded version can be found here.)

Not drawn to scale.
Also, not drawn by me.

I'm a fan of Dr. Kowalski. He's a smart and engaging presenter with the perfect storm of expertise and experience - because he is a scientist AND a person living with type 1. (He also appears to be an avid Diet Coke drinker - bonus points.) Who better to have on our side?

Listening to, as well as participating in, these webcasts helps me as someone without an extensive science background understand my own disease a bit better (and reassures me that I'm pronouncing words like "interstitial" correctly). It also gives me (what feels like) an insider's look at what JDRF is working on, and what they need volunteers (like myself) to do to help. These webcasts help put a face and voice to a huge organization. It endears them to me, frankly. Seeing that kind of transparency and accessibility is refreshing.

Though much of what was discussed were topics I'm already fairly familiar with - clinical trials for the AP, smart insulin, etc. - it did get me thinking about a few things. And so, as I'm want to do, here's my (short) feedback about what was discussed.

• The idea of an AP that incorporates a CGM, insulin pump, and glucagon pump seems to make the most sense to me. However, that brings up some real-world concerns in my mind, like "Aren't I going to run out of skin real estate with that many sites to rotate around?" And if I'm worried about that problem as a fully-grown adult, it is sure to be even more of an issue for small children.
• As someone who tends to see their BG plummet during certain types of exercise, the idea of "smart insulin" concerns me. If you're not familiar with the concept of what "smart insulin" is, take a look here. Essentially, it's an insulin that could both detect and respond to elevated glucose levels. So here's my concern: there are times when I want my blood sugar to be elevated. Like before I walk that marathon in May. Exercise + Insulin On Board usually = Big Trouble. Which would mean that Exercise + Insulin That Dispenses Itself Without Knowledge That I Don't Need It = Yikers. I'd need a way to outsmart the "smart" insulin.
• Dr. Kowalski touched on that concern that many of us have - that CGMs can sometimes be inconsistent and inaccurate, and it's hard to trust that having one hooked up to an insulin pump would be a good thing. He made a great point that I hadn't really thought of before: because these monitors do not test blood, they can't be expected to exactly match blood testing results. Just think - what if, instead of blood glucose monitors, we had been using interstitial fluid glucose monitors this whole time, and then they came up with Continuous BLOOD Glucose monitors? Then we'd think that blood testing was "way off". It's not realistic to think of the two technologies in apple-to-apple terms. When I see the Dexcom being accurate most of the time, I start to think that it should be that way all of the time - when, really, it's supposed to be there just for trending information. I keep forgetting that.

***Disclosure: As in the past, JDRF has not asked me to blog about their webcasts. They did ask for any follow-up questions and thoughts viewers might have had via Twitter, but I didn't think I could fit all of this into 140 characters.  :)