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Home > Knowledge & support > Managing type 1 diabetes > Guide to type 1 diabetes technology > Hybrid closed loop technology (artificial pancreas)
A hybrid closed loop system takes readings from a continuous glucose monitor and uses an algorithm to tell an insulin pump how much insulin to deliver. It does this 24 hours a day.
If you have type 1 diabetes, you already use a treatment loop – you measure your blood glucose levels, work out how much insulin you need, then take a dose of insulin. For this, you need a blood glucose meter, your brain, and an insulin pen.
If you’re using a hybrid closed loop system, you use a CGM instead of a blood glucose meter, an insulin pump instead of a pen, and an algorithm instead of your brain.
The CGM tells the algorithm what your glucose levels are and the algorithm tells the pump how much insulin to deliver. It will pause the flow of insulin if your levels are low or increase the flow if your levels are high.
However, you will still need to check the system is working. You’ll also need to count carbs and be aware of how quickly carbohydrate will reach your bloodstream, so that you can give the system correct bolusing data before you eat.
By automating the treatment loop, hybrid closed loop systems can dramatically reduce the number of decisions you have to make every day.
With hybrid closed loop systems, you can spend more time with your glucose levels in range, with less effort. For example, if you have a hypo whilst sleeping, hybrid closed loop technology will temporarily turn off the delivery of insulin to minimise the time you spend below target range. Your insulin will also be slowed or turned off if the sensor detects that glucose levels are likely to dip into a hypo.
Similarly, if the sensor detects that your glucose level is likely to rise above target, it will temporarily increase the basal rate or deliver small corrective boluses – or a combination of both.
Using a hybrid closed loop system eases the burden of type 1 but doesn’t mean that type 1 treatment is completely automated. For example, you still need to count carbs and give the system bolusing information when you eat.
You will still need to keep an eye on your glucose levels and take action if the system isn’t keeping your glucose in target range, which might suggest that your insulin infusion site isn’t working well. As you only use rapid acting insulin with a hybrid closed loop system, you can quickly develop ketones if your glucose rises and stays high due to technical issues. Part of the training you will receive when you start on HCL includes how to recognise when high glucose needs more than a correction bolus.
There are several hybrid closed loop systems available that work with a variety of pumps and CGMs. Talk to your Diabetes Healthcare Team about what might be available to you.
Visit the Association of British Clinical Diabetologists for more expert opinions on hybrid closed loop systems.
You may have heard this technology referred to as either artificial pancreas or hybrid closed loop, or both.
It’s called the artificial pancreas because the system tries to replicate what the insulin-producing beta cells in the pancreas do in someone without type 1. Some people aren’t happy with this, because it makes it sound like the person using an artificial pancreas has the equivalent of a fully functioning pancreas, which isn’t true because it still takes effort to make sure the system works properly.
Also, the pancreas does other things besides regulating glucose which aren’t affected by having type 1 diabetes – so the pancreas is still doing part of its job.
Some people prefer to say hybrid closed loop; ‘closed loop’ because it closes the treatment loop as explained above, and ‘hybrid’ because you still need to manage some aspects manually, alongside the automated parts.
Automated insulin delivery is another term for HCL which is being used more often.
The DAFNE Closed Loop Essentials (DAFNE-CLE) is a free online course to help you learn about using HCL. The course includes how HCL works, what to do when you eat and how to make sure it’s working safely. It takes four to six hours to complete online.
Learn more on the DAFNE website and speak to your Diabetes Healthcare Team if you would like to do the training.
“I find it incredible to watch Thalia’s levels going up and down and up and down by themselves. The technology is amazing.”
James shares his type 1 diabetes story, from being diagnosed to using hybrid closed loop technology.
“Tim still checks Leon’s levels through the night – we’re not able to all go to sleep and forget about Leon’s type 1. But Tim can now check by looking at the phone app rather than getting up and doing a blood test.”
“After my first week with the artificial pancreas app my time in range was already better than I had managed to achieve before. Things have continued to improve and I’m now spending much less time worrying about my diabetes and just getting on with my life again.” Les Watson, who uses the downloadable hybrid closed loop app, CamAPS FX.
Information about NHS access for this latest type 1 tech across the four nations of the UK
Learn more about how insulin pumps work and how they can help you manage your type 1
Find out about how continuous glucose monitoring can help you manage your glucose levels in real-time
Nearly 20 years of Breakthrough T1D UK research has pushed forward the development of hybrid closed loop technology, changing the lives of people living with type 1.
“Every single day for that pregnancy and since, I have woken up in target. I have had a huge reduction in hypos. I have had to eat less to maintain my diabetes levels and eat what I want, when I want.”
“Physiologically I’m better than ever. I’m mentally stronger. My HbA1c has dropped from 100 to 53. My time in range is now above 80%, when it was around 30% before.”
A smart insulin pen is a reusable self-injection pen, which records information about how much insulin you inject and the timing of it.
Blood glucose meters measure the amount of glucose in the blood. They are an important part of managing your blood glucose levels.
Continuous glucose monitoring can help you manage your glucose levels in real-time and relieve the burden of having to do multiple finger prick tests throughout the day.
A flash glucose monitor is a small wearable device that you scan with a reader or mobile phone to check your glucose levels.
Hybrid closed loop technology – also known as the artificial pancreas – automates many of the decisions that you have to make on a daily basis when you have type 1 diabetes.
Open source and DIY systems are sometimes used by people with type 1 diabetes or people caring for someone with type 1 to help manage the condition.
Apps can help you manage type 1 diabetes, from logging your insulin doses, glucose levels and the food you eat, to helping you count carbs and order prescriptions.
