Use of Hybrid Closed Loop therapy in hypoglycaemia awareness

Not feeling a low blood glucose level can be dangerous for people with type 1 diabetes, as they have a high risk of having a hypoglycaemic seizure or going into a coma. Usually people with type 1 diabetes make some hormones like adrenaline that gives them the pale and shaky feeling when they have a hypo – and provides a warning that they need to treat the hypo. But we know that people who get lots of hypos end up not making as much of these hormones, and develop impaired awareness of hypoglycaemia (IAH). We also know that by avoiding hypos for several weeks, we can improve this hypoglycaemic awareness. However, this often means running the blood glucose levels quite high for a while. So, we want to test the use of a hybrid closed loop insulin delivery system (HCL), which has been shown to cause less hypos, but without running blood glucose levels high, in patients with IAH and see if the awareness improves. A hybrid closed loop system consists of an insulin pump, a sensor with transmitter attached, and a maths program (an algorithm) in the pump that automatically works out how much “basal” or background insulin is needed, and is adjusted every 5 minutes. This study will tell us if the use of a hybrid closed loop system can improve awareness of hypoglycaemia.