In May 2023, the FDA approved the Beta Bionics iLet Bionic Pancreas insulin pump for individuals 6 years and older. This is the first automated insulin delivery (AID) system to eliminate the need to enter carbohydrate (carb) counts for meals or snacks.
With over 1 million people worldwide utilizing insulin pump therapy, removing the intricate skill of carb counting has grabbed the attention of the diabetes community.¹
Diabetes is a disease that can be overwhelming, causing a substantial risk of distress and burnout. As a diabetes health care professionals, you help individuals living with diabetes choose technology to enhance their self-management and reduce some of the associated burdens.
Key Features
The iLet Bionic Pancreas is a continuous subcutaneous insulin infusion (CSII) system, also commonly referred to as an insulin pump. Like other tubed insulin pumps on the market, it features a small cartridge that holds insulin, an operating system that delivers the insulin, integration with a continuous glucose monitor (CGM), and is connected to the body via tubing with an insertion set.
CGM compatibility includes:
☑️ Dexcom G6
☑️ Dexcom G7
☑️ Libre 3+
The Bionic Circle app enables iLet users to invite up to 10 friends or family members to view alerts, blood glucose trends, meal announcements, and insulin doses. Healthcare providers utilize the Healthcare Provider Bionic Portal to download iLet data for review during office visits or for remote patient monitoring.
But How Is iLet Different?
The most significant difference with the iLet is that there are NO traditional pump settings. The only initial settings used are the individual’s weight and target range. Because there are no traditional settings, there is no user input for corrections or carb counting.
Three different algorithms drive insulin delivery. Let’s look at each algorithm²:
Basal Algorithm
- The original basal profile is developed based on the individual’s weight; however, over time, the system continually adapts the basal profile using continuous glucose monitor (CGM) data.
Corrections Algorithm
- Based on CGM data, the algorithm adds additional insulin beyond the basal requirements every 5 minutes, aiming to maintain blood glucose within the predetermined target rang.
Meal Announcement Algorithm
- When the individual announces a meal, the system customizes the insulin delivery based on dosing history for similar-sized meals.
- It determines and adapts meal types separately (breakfast, lunch, or dinner). Initially, the meal dose is calculated, just like the basal rate, and then postprandial corrections are applied if necessary. Based on this data, the system will continuously adapt to individualize the insulin needs based on the size of meals.
- The only decisions made at meal announcements are:
- Choosing the meal: breakfast, lunch, or dinner
- Choosing the size of the meal: If the meal is the usual amount of carbs, smaller, or larger
The only adjustable setting is the glucose target range. There are three different glucose targets to choose from. Two different blood glucose targets can be set within a 24-hour period.³
- 🩸Higher (130 mg/dL)
- 🩸Usual (120 mg/dL)
- 🩸Lower (110 mg/dL)
The Educator’s Perspective
When using the iLet there are a few crucial points to consider:
🥖 Carbohydrate education is not gone! Although no carb counting is required, clients must be aware of carbs. They will still need a basic understanding of which foods contain carbs to accurately determine the size of the meal.
📲 There are no traditional pump settings to manage. The only setting that can be changed is the target range. Education is key for clients who would self-adjust pump settings with previous insulin pumps.
🏃♂️ Managing exercise has changed. There is no exercise mode, activity mode, or temp basal setting to adjust insulin delivery for physical activity. Please see tips from Beta Bionics on managing physical activity with the iLet at https://www.betabionics.com/articles/exercise/.
As a diabetes healthcare professional, you support individuals living with diabetes in setting personalized goals and developing tailored treatment plans. After assessing the client’s needs and barriers, you may find that they are overwhelmed or distressed by the constant need for carb counting. You may also find those who prefer to be ‘hands-off’ with their diabetes for many reasons. These individuals may find that an AID system like the iLet can improve glycemic control without increasing treatment burden.
If you’re looking for more information on diabetes technology or identifying barriers to self-management, join our 2-Day Training Seminar in San Diego to help those living with diabetes continue to thrive.
References
Association of Diabetes Care and Education Specialists. (n.d.). The DCES and pump therapy. Danatech Diabetes Technology. https://www.adces.org/education/danatech/insulin-pumps/pumps-in-professional-practice/dces’s-and-pump-therapy
Beta Bionics. (n.d.). HCP webinars. https://www.betabionics.com/hcp/hcp-webinars/
- Beta Bionics (n.d.). Healthcare provider resources. https://www.betabionics.com/hcp/hcp-resources/
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For the past three year, Dr. Isaacs has served as a contributing author for the 2023 ADA Standards of Care.
As the Program Coordinator and clinical pharmacist specialist in the Cleveland Clinic Diabetes Center, Dr. Isaacs brings a wealth of clinical knowledge combined with extensive research and speaking experience to this program.
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Estimated time to complete the activity: 15 hours and 30 minutes
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