Mia’s Freedom: automatic control of blood sugar – UT Health San Antonio

Newly approved system eliminates much of the labor of maintaining insulin levels

Freedom is an individual concept. For 15-year-old Mia Campos of San Antonio, it means sleeping without alarms, visiting a friend’s house overnight, and feeling steady throughout a busy school day.

Mia was 10 when, on a trip to a gymnastics competition in Florida, she was drinking a liter of water every night with predictable increased trips to the restroom.

“My mom Googled it on the car ride back, and diabetes was the first thing that popped up,” Mia said. “When we got home, she took me to the doctor, and I had a blood sugar of 300. My parents freaked out because they knew what it was. I was confused; I didn’t know what it was.”

Insulin lacking

Mia has Type 1 diabetes mellitus, a lifelong condition marked by high blood sugar levels if left uncontrolled. Type 1 is the autoimmune form of diabetes where the insulin-producing beta cells in the pancreas are destroyed. Insulin is the hormone that lowers blood sugar (glucose).

In 2018 Mia began wearing pumps that deliver insulin. This required her to enter the amount of carbohydrates consumed at meals. Her parents, Victor and Rubi Campos, kept a constant vigil of monitoring her sugars and reminding her to do a correction of her insulin manually with the pump when needed.

A clinical trial, and hope

In 2022, freedom came into their lives. Mia was one of 18 San Antonio children ages 6 to 17 selected to participate in a clinical research study of a new insulin pump technology called, by its non-brand name, the bionic pancreas. The University of Texas Health Science Center at San Antonio and clinical partner University Health were one of only five sites nationwide to study the device exclusively in children.

Jane Lynch, MD, professor of pediatrics in the health science center’s Joe R. and Teresa Lozano Long School of Medicine, sees young patients such as Mia in the pediatric endocrinology clinic at University Health’s Texas Diabetes Institute.

‘An unforgiving disease’

“Diabetes is an unforgiving disease,” Lynch said. “Families must calculate the carbohydrates eaten at breakfast. They must make sure the teacher and nurse at school understand when and how to give their child insulin. They must weigh out variables such as changes in schedule. A child may have sports after school or PE classes, which can drop or raise blood sugar. It’s so much extra work for families on top of everything else with daily living that it doesn’t take much to fall off the wagon.”

Until now, some children have worn pumps that required calculation of the amount of insulin needed. Other children have relied on insulin shots.

Levels in tight range

The bionic pancreas, developed in Massachusetts by researchers who Lynch met during medical training, is an automated insulin dosing system. It consists of a pump with a vial of insulin, dosing decision software and a continuous glucose monitor. Three algorithms learn the wearer’s insulin demands. This artificial intelligence (AI) device maintains insulin and blood sugar levels in tight healthy range every five minutes.

“A child will put this on and only has to plug in her weight,” Lynch said. “The system will conservatively give her insulin, figure out her schedule, keep her blood sugars in the 200s, then the 150s and down to the 140s, and pretty soon will be running independently to give her the insulin. And all she is telling it is, at mealtimes, whether it is a smaller or larger meal than she would normally eat at that time of day.”

‘I love it’

Mia, who likes hip-hop dancing, is a freshman at Brandeis High School in San Antonio. She greatly enjoyed the freedom afforded by the bionic pancreas for the duration of the clinical trial — a period of 13 weeks.

“I absolutely love it,” she said. “I think it will help a bunch of people or kids who have busy lives and can’t take the time out of the day to input the carbs manually. This will do it for them, and they will have more freedom.”

Restful nights

Her father was relieved. “She got picked for the study, and they taught us how to use it,” Victor Campos said. “It was great because we didn’t have to worry about her having to do [insulin] corrections. The system would automatically do it for her. We as parents had more time to sleep at night, because we were used to setting alarms to get up and check on her.”

Her mother also sees the benefit. “The new system helps Mia a lot, especially since she’s not counting carbs and can take time to do other things,” Rubi Campos said. “She can have free time to hang out with friends or play with her sister. Yes, I’m happy.”

FDA and insurance OKs

The U.S. Food and Drug Administration cleared the bionic pancreas in May 2023 for people ages 6 to 79 with Type 1 diabetes. The clinical trial, which preceded the federal agency clearance, had long since ended. Families had handed in the pump systems. Mia was back on a traditional pump, counting carbs and doing insulin corrections.

She was not yet free, but freedom certainly was on the horizon.

Then, in exciting news for Mia and children and adults with Type 1 diabetes nationwide, the bionic pancreas system was approved in September 2023 by Medicaid and Medicare in addition to private insurances.

“Our nurses here in the clinic are really excited because we are able to get more children started on this system of automated insulin delivery,” Lynch said.

Night and day improvement

Hopefully for many, insulin shots will become a thing of the past.

“Over insulin injection, this is night and day,” Lynch said of the blood sugar control attainable with the bionic pancreas. “With insulin injections, it is very crude. It has no comparison to what this pump can do. We just can’t get there with the insulin shot.”

Breaking loose

Aside from hip-hop, Mia is also into drawing and fashion design, shopping, makeup, skin care and cooking. Before the insurance approval, while wearing the older insulin pump, she lamented the restrictions on her free time.

“It’s hard now because while I can go to a friend’s house, I can’t spend the night,” she said. “I can’t go anywhere. If my friends go to Austin or something, I can’t go with them. Hopefully now I will be able to go.”

Her eyes lit up.

“Do you like music? Would you like seeing bands?” she was asked.

“I would like to,” she said.

‘There is always hope’

The bionic pancreas is the equalizer, the freedom giver. Mia’s father, Victor, said it will “shut the door” to diabetes complications, such as eye or kidney disease, that could arise if sugars aren’t controlled. That is another kind of freedom.

To other youngsters who are struggling with Type 1 diabetes, Mia said, “I want to encourage them. I want to help them. Because I know what it is like. There is always hope.”

Indeed, a few weeks later, Mia received her new bionic pancreas system and her hope was rewarded.

Be mindful of others

Mia wants people to be more understanding of individuals with Type 1 diabetes. “I want them to understand, because sometimes they don’t understand,” she said. “They don’t know the story. They just know what’s on the surface, but they don’t know what’s below. And I want them to know what is below, and it’s way different.”

“We didn’t invent this system,” Lynch said. “But we were lucky enough to be one of the few sites where we were able to study these in children. And this system is a whole leap forward, which is really amazing to see.”

And really freeing for children like Mia. Joyous freedom!