Closing the loop: Practical and theoretical

Using presently available technologies, a closed-loop system can be devised that employs patient-monitored glucose determinations and self-adjusted insulin administration. Improved glucose control has been documented in type I diabetes and in pregnant women with insulin-dependent diabetes mellitus. In pregnancy, self-administered insulin may achieve levels of carbohydrate control that are superior to those achieved using a self-contained glucose-controlled insulin infusion system, programmed by existing algorithms. Improved closed-loop systems are necessary in order to achieve carbohydrate 'control' that will surpass that which can be attained using presently available means. A potential approach might employ a lectin glucose-controlled insulin delivery system.