System and method for enhancement of glucose production by stimulation of pancreatic beta cells

• US 5,919,216 A
• Filed: 06/16/1997
• Issued: 07/06/1999
• Est. Priority Date: 06/16/1997
• Status: Expired due to Term

• Current Assignee: Michael J. Jaro
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Houben, Richard P. M., Renirie, Alexis C. M.
• Primary Examiner(s): Getzow, Scott M.
• Application Number:
  US08/876,610
• Time in Patent Office: 750 Days
• Field of Search: 607/72, 607/73, 607/74.3, 604/31, 604/50
• US Class Current: 607/72
• CPC Class Codes: A61B 5/14532 for measuring glucose, e.g. by tissue impedance measurement
• CPC Class Codes: A61B 5/425 pancreas
• CPC Class Codes: A61M 5/14276 specially adapted for implantation
• CPC Class Codes: A61M 5/1723 using feedback of body parameters, e.g. blood-sugar, pressure measurement of body parameters A61B5/00
• CPC Class Codes: A61N 1/36007 of urogenital or gastrointestinal organs, e.g. for incontinence control

Abstract

There is provided a system for automatically responding to insulin demand without any need for external monitoring or injecting of insulin into the diabetic patient. The system provides for sensing glucose levels internally, and responding by stimulating either the pancreas or a transplant of pancreatic islets in order to enhance insulin production. The enhancing stimulation is delivered at a rate greater than the burst rate, or is otherwise controlled so that the depolarization burst constitutes a greater portion of each islet electrical cycle, thereby resulting in increased insulin production. The system also provides for continuous glucose monitoring, and reacts to sensed hypoglycemia by delivering stimulus pulses timed to reduce the burst durations, and thus to inhibit insulin production. In another embodiment, the system responds to a good intake signal, either externally or internally generated, by going through a time response algorithm to provide a stimulation-enhanced insulin response which simulates the natural response. In yet another embodiment, the functionality of an islet transplant is continually monitored, and performance data is logged and down loaded on command to an external programmer. The stimulation of patient pancreatic cells may be combined with administration of a hypoglycemic agent.

Claims

1. A system for stimulating pancreatic beta cells located at a predetermined patient location for the purpose of increasing insulin production by such beta cells, comprising:

a controllable stimulus generator for generating stimulus pulses;

delivery means for delivering said stimulus pulses to said cells at said location; and

control means for controlling said generator to generate stimulus pulses timed to increase the rate of insulin production by said beta cells.

2. The system as described in claim 1, wherein said control means comprises sensing means for sensing spontaneous depolarization bursts of said beta cells, timing means for developing timing signals corresponding to said bursts, and control signal means for generating control signals for initiating a stimulus pulse as a function of said timing signals.

3. The system as described in claim 2, wherein said control signal means comprises means for determining the rate of said spontaneous bursts and for generating said control signals at a rate greater than said burst rate.

4. The system as described in claim 2, wherein said control signal means comprises means for determining the end of each burst evoked by a delivered stimulus pulse, and means for generating a next control signal at a predetermined time following each said burst end.

5. The system as described in claim 1, wherein said patient has a transplant of islets of Langerhans at said location, and said delivery means comprises lead means for delivering said stimulus pulses to said transplant.

6. The system as described in claim 1, wherein said delivery means comprises lead means for delivering said stimulus pulses to said patient'"'"'s pancreas.

7. The system as described in claim 1, wherein said delivery means comprises lead means for delivering said stimulus pulses to said patient'"'"'s vagal nerve, thereby evoking pancreatic beta cell depolarization bursts.

8. The system as described in claim 1, wherein said patient has a transplant of islets of Langerhans positioned at a second location close to a patient bloodstream, sensing means for sensing electrical activity of beta cells of said islets at said second location, glucose means for determining an increase in blood glucose as a function of said sensed islet electrical activity, and means for initiating generation of said stimulus pulses in response to a sensed increase in glucose.

9. The system as described in claim 1, comprising means positionable external to said patient'"'"'s body for initiating generation of said stimulus pulses.

10. The system as described in claim 9, further comprising program means for controlling said stimulator to generate stimulus pulses in accord with a predetermined program over at least a given period to time.

11. The system as described in claim 1, comprising implantable measure means for obtaining a measure of patient blood glucose, and response means for controlling generation of said stimulus pulses as a function of said measure.

12. The system as described in claim 11, wherein said means comprises means for controlling said stimulus generator to generate synchronizing pulses timed to evoke depolarization bursts in said beta cells.

13. The system as described in claim 11, wherein said patient has a transplant of islets of Langerhans containing beta cells, and wherein said measure means comprises means for determining said measure from the electrical activity of said transplant beta cells.

14. The system as described in claim 1, comprising glucose means for determining a measure of patient glucose, and adjust means for adjusting the timing of delivery of said stimulus pulses as a function of said glucose measure.

15. The system as described in claim 14, comprising means for determining when said glucose measure is below a predetermined level, thus indicating hypoglycemia, and wherein said adjust means comprises means responsive to indicated hypoglycemia for controlling said stimulus generator to time said stimulus pulses so as to decrease beta cell depolarization burst durations.

16. A system implantable in a patient for detecting and responding to patient hypoglycemia, comprising:

glucose means for monitoring patient blood glucose;

means for determining when said monitored blood glucose indicates hypoglycemia;

stimulus means for generating stimulus pulses and delivering said pulses to a selected patient location containing insulin-producing pancreatic beta cells; and

control means for controlling the timing of said stimulus pulses so as to decrease the insulin secretion of said beta cells.

17. The system as described in claim 16, wherein said control means comprises means for determining parameters of spontaneous depolarization bursts of said beta cells, and timing means for timing delivery of said stimulus pulses to shorten the durations of the cell depolarization bursts.

18. The system as described in claim 17, wherein said patient has encapsulated islets of Langerhans at said location, and said stimulus means comprises lead means for delivering said stimulus pulses to said islets.

19. The system as described in claim 17, wherein said stimulus means comprises lead means for delivering said stimulus pulses to the patient'"'"'s pancreas.

20. An implantable system for sensing electrical activity of pancreatic beta cells and stimulating said beta cells to promote increased insulin production therefrom, comprising:

glucose means for continually obtaining a measure of patient blood glucose level, and determining from said measure when increased insulin production is indicated; and

stimulus means responsive to an indication of increased insulin production for stimulating said beta cells with pulses timed to increase the duty cycle of depolarization bursts of said cells.

21. The system as described in claim 20, wherein said patient has a transplant of islets of said beta cells, and said glucose means comprises first sensing means for sensing activity of said transplant cells, and determining means for determining said measure of blood glucose from said sensed activity.

22. The system as described in claim 20, wherein said glucose means comprises means for sensing patient EKG signals and for obtaining said glucose measure from said signals.

23. The system as described in claim 20, wherein said glucose means comprises means for sensing spontaneous beta cell activity in said patient'"'"'s pancreas and for obtaining said glucose measure from said sensed cell activity.

24. The system as described in claim 20, further comprising means for receiving an external communication carrying glucose data pertaining to start of glucose load or patient blood glucose level.

25. The system as described in claim 24, comprising control means for controlling said stimulus means to respond to a glucose load with a predetermined timed response.

26. The system as described in claim 25, wherein said control means comprises software algorithm means for introducing compensation reflective of patient glucose kinetics.

27. The system as described in claim 20, wherein said patient has a transplant of islets of beta cells, and further comprising:

glucose data means for storing data representative of obtained measures of blood glucose level;

burst means for sensing at least one predetermined parameter of the spontaneous depolarization bursts of said transplant and storing data representative of same; and

functionality means for analyzing said stored glucose and parameter data and determining therefrom a measure of transplant functionality.

28. A system for delivering a timed insulin response to start of food intake by a patient, comprising:

intake means for determining when a patient has commenced and/or completed food intake;

algorithm means initiated by said intake means for determining a timed insulin production response following a said food intake; and

insulin means for increasing insulin in said patient according to said timed insulin response.

29. The system as described in claim 28, comprising an implantable device housing said intake means and said insulin means, said implantable device further comprising receiver means for receiving an externally generated intake signal.

30. The system as described in claim 29, wherein said insulin means comprises a controllable insulin pump.

31. The system as described in claim 29, wherein said insulin means comprises stimulus means for stimulating the patient'"'"'s pancreas with pulses timed to increase pancreatic insulin production.

32. The system as described in claim 29, wherein said patient has a transplant of islets of Langerhans, and said insulin means comprises stimulus means for stimulating said transplant with pulses timed to increase insulin production by said islets.

33. The system as described in claim 29, comprising glucose monitoring means for obtaining a measure of blood glucose, and further comprising adjust means for adjustably controlling said insulin means to produce insulin at a rate which is a function of said glucose measure.

34. The system as described in claim 33, wherein said adjust means comprises means for controlling said insulin means to decrease insulin production in response to an obtained glucose measure which is below a predetermined reference which represents hypoglycemia.

35. The system as described in claim 28, wherein said algorithm means comprises compensation means for introducing a compensated insulin response which is based upon insulin and glucose dynamics.

36. A system for monitoring functionality of an islet transplant in a patient, comprising:

glucose means for determining and storing representations of patient blood glucose level;

sensing means for sensing electrical activity of said transplant and for storing representations of said activity corresponding timewise with said glucose representations; and

diagnostic means for providing diagnostic data based on said stored glucose and activity representations.

37. The system as described in claim 36, wherein said glucose means and said sensing means periodically store said representations, and said diagnostic means comprises means for processing said representations to provide data representative of transplant functionality over at least a predetermined period of time.

38. The system as described in claim 36, further comprising intake means for determining when said patient has intaken food, and control means for controlling said glucose means and said sensing means to obtain said representations following patient intake of food.

39. The system as described in claim 38, wherein said control means further comprises algorithm means for timing the operation of obtaining said representations.

40. A method of increasing insulin production by stimulating insulin-producing islets in a patient, comprising:

sensing spontaneous electrical signals of said islets and determining at least one predetermined parameter relating to the depolarization bursts of said signals; and

delivering stimulus pulses to said islets so as to increase the time duration of said bursts relative to the islet repolarization intervals.

41. The method as described in claim 40, further comprising positioning a first relatively large volume transplant of said islets in the patient at a first location and positioning a second relatively smaller volume transplant of said islets at a second location close to a patient bloodstream, and wherein said sensing comprises sensing signals of said second transplant and said delivering comprises delivering stimulus pulses to said first transplant.

42. The method as described in claim 40, further comprising monitoring patient blood glucose, and stopping said delivering step whenever said blood glucose indicates a hypoglycemic condition.

43. The method as described in claim 42, further comprising delivering stimulus pulses to said islets timed to decrease the time duration of said bursts relative to the islet repolarization intervals, thereby decreasing insulin production.

44. A method of responding to patient food intake by delivering insulin in accord with a predetermined time response, comprising:

determining when a patient has commenced food intake;

processing an algorithm to determine a timed response as a function of patient glucose and insulin dynamics; and

increasing insulin production in said patient in accord with said timed response.

45. The method as described in claim 44, comprising implanting a device in said patient which comprises receive means for receiving an externally generated food intake signal;

algorithm means for storing and processing said algorithm; and

insulin means for increasing insulin production in said patient.

46. The method as described in claim 45, comprising sensing at a predetermined patient location when said patient has had food intake.

47. A method of enhancing insulin production in a patient concurrently with the administration of a hypoglycemic agent to the patient, comprising determining when a said agent has been administered to the patient, and initiating a stimulation program following said determining, and stimulating insulin-producing islets in said patient in accord with said program.

48. A system for enhancing production of insulin by a patient'"'"'s pancreas, comprising:

a stimulus generator for generating stimulus signals;

delivery means for delivering said stimulus signals to the patient'"'"'s pancreas, having at least three electrodes positioned in or on said pancreas;

switching means for switching said signals to respective different pairs of said electrodes; and

control means for controlling said stimulus generator to generate said stimulus pulses at a rate so as to increase pancreatic insulin production.

49. The system as described in claim 48, wherein said switching means comprises means for automatically switching said signals to a different pair of said electrodes in accordance with a predetermined program.

50. A system for delivering a timed insulin response to start of food intake by a patient, comprising:

intake means for determining when a patient has commenced and/or completed food intake;

algorithm means initiated by said intake means for determining a timed insulin production response following a said food intake; and

insulin means for altering insulin production in said patient according to said timed insulin response.

51. The system as described in claim 50, comprising an implantable device housing said intake means and said insulin means, said implantable device further comprising receiver means for receiving an externally generated intake signal.

52. The system as described in claim 50, wherein said insulin means comprises stimulus means for stimulating the patient'"'"'s pancreas with pulses timed to increase pancreatic insulin production.

53. The system as described in claim 50, wherein said patient has a transplant of islets of Langerhans, and said insulin means comprises stimulus means for stimulating said transplant with pulses timed to increase insulin production by said islets.

54. The system as described in claim 50, comprising glucose monitoring means for obtaining a measure of blood glucose, and further comprising adjust means for adjustably controlling said insulin means to produce insulin at a rate which is a function of said glucose measure.

55. The system as described in claim 54, wherein said adjust means comprises means for controlling said insulin means to decrease insulin production in response to an obtained glucose measure which is below a predetermined reference which represents hypoglycemia.

56. The system as described in claim 50, wherein said algorithm means comprises compensation means for introducing a compensated insulin response which is based upon insulin and glucose dynamics.