Innovations in Preventing and Treating Hypoglycemia

Renowned experts discussed the latest in technology and medical innovations for the prevention and treatment of severe low blood sugar events during a panel at the 2025 American Diabetes Association (ADA) scientific conference in Chicago. 

Dr. Alan Moses, board chair of the diaTribe Foundation, moderated the panel, which focused on raising awareness about hypoglycemia – an ever-present concern for people with type 1 diabetes. He was joined by:

• Dean Kamen, inventor of the first wearable insulin pump, founder of DEKA Research & Development, ARMI, and co-founder of Sequel Med Tech
• Stefany Shaheen, diabetes advocate, entrepreneur, author, and candidate for the U.S. House of Representatives
• Dr. Anh Nguyen, chief medical officer of Xeris Biopharmaceutical
• Dr. Joanna Mitri, chief medical officer at Sequel Med Tech
• Dr. Bryce Nelson, chief of the Division of Pediatric Endocrinology at Children's Hospital of Richmond at Virginia Commonwealth University

Advances in insulin pump therapy

Inventor Dean Kamen set the stage for the discussion, describing the first wearable insulin pump, which he created. Kamen holds more than 1,000 patents for inventions that revolutionize mobility and healthcare – including the HomeChoice portable dialysis machine, the iBOT Mobility System, the Segway Human Transporter, a DARPA-funded robotic arm, and a new and improved Stirling engine.

Kamen said the idea for the insulin pump came from a need to deliver very small doses of medicine to infants who his brother, an MD-Ph.D. with a specialty in pediatric oncology, was treating during his early residencies before becoming a faculty member at Yale University Medical.

"I used my mom's oven to create circuit boards that I could adapt," he recalled. "And these little timers would turn on every couple of minutes."

A small screw would turn just slightly, delivering precise doses of medicine, which is essentially how insulin pumps still work today. Decades later, Kamen realized dosing could be made more precise by using sound waves to measure insulin volume in the pump. The result is Sequel’s recently launched twiist automated insulin delivery (AID) system, which uses the new approach to deliver precise insulin doses, as well as identify blockages (called occlusions). 

"All sorts of things have gotten way better in the last few years," said Kamen, whose other organization, Advanced Regenerative Manufacturing Institute (ARMI), is working to manufacture engineered tissues. "I'm hoping the next big leap will lead to people in clinical trials with systems that will cure diabetes, as opposed to chronic treatment." 

Hypoglycemia in the real world

Diabetes advocate Stefany Shaheen, whose daughter Elle was diagnosed with type 1 when she was eight years old, provided some real-world experiences to the discussion. Shaheen, who is currently running for a U.S. congressional seat, wrote a book about their family's experience with type 1 diabetes, “Elle & Coach” (the title refers to her daughter's medic-alert dog). Shaheen also founded Good Measures, a non-profit that supports people with chronic illnesses. 

Shaheen explained some of the concerns people with diabetes face with low blood sugar. Elle has experienced severe hypoglycemia events, including a seizure on the first anniversary of her diagnosis. Elle later faced challenges with hypoglycemia during her transition to college, where she would sometimes sleep through low blood sugar alarms.  

"I was explicitly told the resident services advisors were not permitted to do well checks," Shaheen said. "My only recourse was to call campus security and basically have them bang down the door. That's how her 18th birthday started."

Luckily, she said, EMTs were only seven minutes away – and they were able to help Elle in time. 

"When she's by herself and still half-asleep during a low, it's an anxiety-provoking experience – one that people with type 1 and their families deal with all the time," Shaheen said.  

Glucagon and challenges in use

The panel then turned to the need for better education and tools to manage hypoglycemia, including the use of glucagon and diabetes technology, such as continuous glucose monitoring (CGM) and AID systems. 

"Hypoglycemia itself is a public health concern," said Dr. Anh Nguyen, chief medical officer at Xeris Biopharmaceuticals, which produces the ready-to-use glucagon product Gvoke. "It's an understated health concern that we don't talk about."

Nguyen said only 1 in 15 people who take insulin keep glucagon on hand.

"How do we fix the problem?" Nguyen asked. "It takes innovators, health systems, public health, and experts in schools and communities. Clinical inertia is something we have to tackle together. We need to say: ‘If you're on medication for your blood sugar, you should have tools to help raise your blood sugar.’ Because that's an everyday risk."

Shaheen raised the idea of using small corrections of glucagon for people with type 1 diabetes who are often dealing with lows, for example, when they don't want to consume more food. (This use of ready-to-use glucagon in this way is currently an area of investigational use and not FDA approved.)

Nguyen said that Xeris has partnered with Beta Bionics to provide the glucagon component to develop the first dual-hormone insulin pump. The addition of glucagon into an AID system, instead of insulin alone, could act like the brakes in a car to treat low blood sugar. 

Better living through automation

Dr. Joanna Mitri, chief medical officer at Sequel, explained the functionality of the twiist AID system, which incorporates novel insulin pump technology called iisure developed by Dean Kamen.

The system uses sound waves to directly measure insulin delivery in real time down to the nanoliter. She offered an analogy: "It's like blowing air into a soda bottle; the sound changes depending on how much liquid is inside." Dr. Mitri emphasized the clinical importance of this feature, explaining that measuring insulin inside the pump chamber allows detection of occlusions much faster.

"If insulin delivery fails, it can lead to hyperglycemia, a common and serious issue. By alerting the user promptly, the system enables timely intervention before glucose levels begin to spiral," she said.

The twiist AID system uses the twiist Loop algorithm – based on the popular open-source Tidepool Loop – integrated into a circular, tubed pump. It officially became available to the public on July 7, 2025.

Preventing and delaying type 1 diabetes

Looking toward innovative treatments, Dr. Bryce Nelson with Richmond at Virginia Commonwealth University, introduced the idea of focusing on the early stages of type 1 diabetes, where symptoms may not have yet appeared. 

"We're at an amazing, exciting time where we can reconceptualize how we think about type 1 diabetes," said Nelson.

 Nelson described the three stages of type 1 diabetes:

• Stage 1: Diabetes antibodies are present, but blood sugar is normal.
• Stage 2: Antibodies are present, and higher average blood sugar levels are seen.
• Stage 3: Hyperglycemia (high blood sugar) raises health risks, including diabetic ketoacidosis (DKA), which is when insulin levels are too low.

He stressed the importance of early antibody screening, so that treatment can begin to delay the onset of type 1. About 60% of newly diagnosed people with type 1 are first seen in the emergency room with DKA, he said.

Identifying when people with type 1 diabetes are in the early, asymptomatic stages is key, he said. Then, treatment with an immune-modulating medicine like Tzield (teplizumab) can begin. Tzield can delay stage 3 by two years or more. 

"Screening needs to be a full-court press," Nelson urged. "We need a coordinated effort between specialists and primary care physicians. But we also need advocacy from our government and community."

Challenges remain in spreading awareness, he said, but in the last year, he's witnessed progress in early screening and more robust screening programs. 

"It's moving forward," he said. "Something I tell my patients: A little bit better is still better. As long as we're taking that first step, then we can keep innovating and keep moving things forward."

Learn more about managing blood sugar here:

• A Guide to Navigating Nighttime Hypoglycemia
• What Is a 'Low Hangover'? Plus How To Get Through It
• Join a Clinical Trial Investigating a New Medication to Prevent Nighttime Lows
• When You Don’t Know You’re Low – Hypoglycemia Unawareness 101