Diabetic Live

Diabetic Gene Therapy Proves Promising in Mice: Research can be a protracted effort with baby steps resulting in new findings that simply ask new questions. One recent discovery indicates the potential to control diabetes independent of weight. As with most research this is preliminary with more research needed.

According to ScienceDaily.com, “Researchers have found that even a very little bit of the fat hormone leptin goes a long way when it comes to correcting diabetes. The hormone controls the activity of a gene known as IGFBP2 in the liver, which has antidiabetic effects in animals and could have similar therapeutic effect in humans, according to a report published by Cell Press in the January issue of Cell Metabolism.”

Jeffrey Friedman of Rockefeller University is quoted by the online resource as saying, “It was surprising to me how potent leptin was in treating diabetes. It had a highly significant impact at plasma levels that were undetectable.”

Leptin provides an interesting yet helpful side effect, “Leptin also causes marked weight loss, which by itself can improve diabetes. To get around that issue in the new study, Friedman and his colleagues first identified the lowest dose of leptin that could correct insulin resistance and diabetes without leading animals to eat less or lose weight,” according to ScienceDaily.com.

In essence researchers were already aware of the fact that this hormone causes weight loss, but by significantly reducing the dose in research subjects (animals) they further found that even the small doses had a profoundly positive effect on diabetes. The report further declared, “Earlier studies had shown that leptin treatment effectively corrects high blood sugar and insulin levels in leptin-deficient mice and humans. Leptin’s usefulness as a therapy has also been shown in some clinical settings, in people with rare metabolic disorders. But it wasn’t clear exactly how the hormone produced in fat tissue acts to improve diabetes.”

In a practical application researcher were led to the IGFBP2 gene. The ScienceDaily.com report states, “Treatments designed to increase IGFBP2 expression in obese and diabetic mice reversed their diabetes. Further study showed that animals treated with the protein responded to insulin three times better than untreated ones.

“They also found that leptin-deficient patients do indeed have lower blood levels of IGFBP2 at baseline and that those levels can be raised with low-dose leptin treatment.”

As mentioned earlier this discovery may sound amazing on the surface, but in order for it to eventually lead to a medical therapy further clinical research will be needed to answer the new questions raised from this initial research.

To immediately begin marketing this as a cure-all for diabetes may be irresponsible because while all indicators point to effective control, the research has yet to extend to humans and side effects have not been noted in long-term use. In fact, “Friedman said that future experiments in mice lacking IGFBP2 altogether are needed to confirm that the protein is required for leptin’s antidiabetic influence. Now that they know that very high levels of IGFBP2 can act to improve diabetes, they’ll also need to explore the effects of normal physiologic levels,” said ScienceDaily.com.

In other words there will still be rodent research before it ever gets to human clinical trials. The most important ‘next’ finding will simply be to replicate the findings of this initial, and compelling research and answer as many new questions as possible in the process.

Back on the World Stage 10 Years After Diabetes Diagnosis: He is thought of as one of the most elite cross country skiers in America and, “Kris Freeman is back in the hunt for an Olympic medal in Vancouver after being named… to the U.S. ski team following a disappointing finish at the 2006 Games in Torino, Italy,” according to PRNewsWire. Freeman lives with Type 1 diabetes.

It is anticipated that Freeman will participate in as many as five events in the 2010 Olympics including “the 15 km freestyle, the individual sprint, the 30 km pursuit, the team sprint, and the 50 km mass start classic,” said PRNewsWire.

Freeman was diagnosed ten years ago as a teenager and health care providers told him he would never be able to compete in the Olympics. This isn’t the first Olympics in which Freeman has been able to participate. According to the press release, “A key marker on Freeman’s comeback trail is how he is now treated for type 1 diabetes.  To compete in the 2010 Games, Freeman will wear a small device, called an insulin pump, which provides an adjustable supply of insulin to help manage his diabetes even while racing.”

Freeman was quick to point out, “I’m motivated to win for my country and myself, but to also prove to detractors that it’s possible to compete against the world’s best cross-country skiers, even with type 1 diabetes.”

It is this ‘can do’ attitude that has allowed Freeman to not only achieve much, but also to excel in his chosen sport. It should be noted that only one other American Olympian has ever medalled in cross-country skiing. To add a greater sense of drama to the prospect PRNewsWire reported that Freeman “underwent surgery in both legs last spring to alleviate debilitating pain caused by a rare muscle disorder called compartment syndrome.”

While Freeman is looking for a win he is also concerned about the health of other young people who also must wage a daily battle with Type 1 diabetes. When he’s not skiing Freeman “travels for sponsor Eli Lilly and Company to children’s diabetes camps across the U.S. to speak to campers about their disease. To date, he has met with more than 3,000 youngsters nationwide.”

Freeman talks about that experience, “I have a blast meeting the campers, but more importantly, I want them to see that a person with diabetes can do almost anything he or she puts his mind to, including competing in the Olympics.”

Press release information states, “In competition, Freeman is a 13-time U.S. National cross-country champion and recently had his best finish at the 2009 World Championships and the best U.S. finish in any cross-country event in more than two decades. He came in fourth in November’s World Cup 15 km classic in Kuusamo, Finland.

“At the 2002 Olympics in Salt Lake City, Freeman placed 22nd in the 15 km classic and 14th in the 30 km pursuit. He also logged the sixth fastest time overall in the 4 x 10 km team relay, helping the U.S. team secure fifth place — the best Olympic finish for the U.S. cross-country team in history. In 2003, Freeman finished sixth and fifth in two consecutive World Cups, and finished 22nd in the 15 km classic at the 2006 Winter Games in Torino, Italy.”

While managing his disease can take time and patience Freeman continues to prove that diabetes does not have to prevent you from achieving your dreams.

Seeking Quality Insulin Delivery For Type 1 Diabetics: As research continues into the possibility of an artificial pancreas there is new evidence to suggest that the current method of insulin delivery for Type 1 diabetics may have some flaws.

According to Marketwatch, “Researchers at Sansum Diabetes Research Institute and University of California, Santa Barbara have concluded that changing the height of a conventional insulin pump in relation to its tubing and infusion set can significantly impact expected insulin delivery rates. Such changes can occur during routine daily activities like dressing, sleeping or showering. The study, ‘Siphon Effects of Continuous Subcutaneous Insulin Infusion Pump Delivery Performance,’ evaluated the siphon or hydrostatic pressure action effects on continuous subcutaneous insulin infusion and was published in the January issue of Journal of Diabetes Science and Technology.”

The core findings of this report suggests that some of the most common insulin pumps will supply less insulin when the unit is lower than the tubing site and more insulin when the unit is above the tubing.

Marketwatch continues by quoting lead investigator Howard Zisser, MD, Director of Clinical Research and Diabetes Technology at the Sansum Diabetes Research Institute in Santa Barbara, CA, “In this study we found a pronounced siphon effect in conventional insulin pumps, which caused significant fluctuations in the accuracy of insulin delivery rates when the pump position was moved higher or lower relative to its tubing and infusion site. Insulin pump therapy allows for precise control of insulin delivery for patients with type 1 diabetes. The unintended fluctuation in insulin delivery, which may arise from pump movement during normal daily use, can increase blood glucose variability, a risk factor for the progression of complications of diabetes. The effect of hydrostatic pressure was most significant at low basal rates and therefore these findings may be particularly important for pediatric diabetes patients, who often use insulin pumps at low basal rates.”

The primary reason for the research was to identify which pump could supply the best delivery of insulin according to the actual need. While no pump was perfect the research did indicate, “The OmniPod, which has no external tubing, was the least affected by pumping orientation and direction. With the OmniPod System, the 1U/hr rate differences only ranged from 98.3% when its delivery cannula was in a level pumping position to 101.3% when the cannula was in an upward pumping position. For the 1.5U/hr rate, its differences only ranged from 96.0% in a level pumping position to 102.5% in an upward pumping position.”

The research was funded by a grant from the Insulet Corporation and was conducted by the Sansum Diabetes Research Institute, “A non-profit research center devoted to the prevention, treatment and cure of diabetes through research and education. In particular, it is known for its work on methods to detect and chart the progress of diabetes, its success in developing protocols to increase the incidence of healthy babies born to women with diabetes, and its expertise in new diabetes technology.”

The goal of this type of research is to work to hold manufacturers accountable to produce pumps with the highest degree of accuracy. By pinpointing the best it may encourage other manufacturers to work to provide pumps with a greater level of accuracy as well. It is presumed that when the artificial pancreas is available the delivery of insulin will be more accurate because no outer tubing will be required.

Diabetes and Black History Month: February is Black History month and one Congressional leader is urging African Americans to get their eyes checked – especially if they also have diabetes.

According to a press release from the American Academy of Ophthalmology (AAO), “The incidence of diabetes continues to increase, particularly among African Americans. 3.7 million African Americans aged 20 years or older have diabetes. Studies show that African Americans with diabetes are more likely to develop diabetic complications and experience greater disability from the complications than white Americans with diabetes. The only way to prevent this is through strict glucose control and by having an annual dilated eye exam.”

Congressman and House Majority Whip James E. Clyburn (SC-6) is quoted in the release as saying “Diabetes is an epidemic in the African American community. People with diabetes are 25 times more likely to go blind and African Americans with diabetes are at an even higher risk — almost 50 percent more likely to develop diabetic retinopathy. If you have diabetes, it’s critically important for you to receive an annual diabetic eye exam, because it will help detect and prevent eye disease.”

Retinopathy is a common optical issue among those who have diabetes. This can be even truer among African Americans. The release states, “For every white American who gets diabetes, 1.6 African Americans get diabetes and one in four black women, 55 years of age or older, has diabetes. Diabetes is associated with an increased risk for a number of serious and sometimes life-threatening complications, including blindness, heart disease, kidney disease, and stroke. Managing your diabetes can help reduce your risk.”

On a related Note the National Health Service (NHS) in the UK is celebrating a nurse practitioner of African Caribbean descent. Because diabetes is so prevalent among people of Asian and African descent it was easy for Grace Vanterpool to pursue a career as a “nurse consultant in diabetes”.

A video provided by the NHS shows Vanterpool visiting patients and discussing ways to improve their condition. Vanterpool is also the only African Caribbean nurse consultant in diabetes in the U.K.

The NHS report states, “Grace works closely with patients, GPs and practice nurses, as well as training students and clinicians to provide high-quality care. She also works to ensure that all local services for people with diabetes provide the same standards of care.”

Grace and her team work with around 5,000 patients in treating and educating. Grace remembers some of her early work, “We had a double decker bus that went around town, testing people for diabetes and giving out information. During evenings and weekends we’d go wherever people gathered, such as train stations or the university. We also went to local factories, mosques and churches. We discovered that a lot of people had diabetes but didn’t know it.”

The report suggests that there are some 75,000 people in the U.K. that had undiagnosed diabetes. Grace continues, “Raising awareness among black and minority ethnic (BME) communities under an award-winning project called Action Diabetes. As a result, in 2006, she won Community Nurse of the Year and overall Nurse of the Year at the Nursing Standard awards.”

Grace concluded her NHS interview by saying, “The important message is not to ignore diabetes, as it’s a progressive condition. It’s the biggest cause of blindness in the UK working population, but this and other complications are preventable if diabetes is managed well and monitored.”

That includes regular eye exams.

A new study suggests that more than 50% of all diabetics who must use insulin injections to manage their disease miss injections on a regular basis. Why would someone intentionally bypass the use of medication that can help them in their personal health care?

The role of insulin is especially important to those who have Type 1 diabetes because the pancreas either stops producing insulin or it is created at a less than ideal rate. There are some Type 2 diabetics that use insulin. However, in both cases there seems to be a significant number who risk long-term health complications by skipping insulin dosing.

According to WebMD, “The study showed that people with type 1 diabetes who didn’t follow their recommended diet were most likely to skip their insulin injections. Among those with type 2 diabetes, younger people, those with a lower income, and those who perceived their insulin injections as painful or embarrassing were more likely to skip them.”

According to MedicalNewsToday, “Using an Internet survey of more than 500 U.S. adults, the study found that 57% of survey respondents with either type 1 or type 2 diabetes purposefully failed to take their insulin shots at least occasionally. It also found that older patients, those who were disabled, those who followed a healthy diet and those with higher household incomes were more likely to take their shots at the frequency prescribed.”

A couple of underlying themes that seem to present themselves in noncompliance include low income and an other health issues that would cause the patient to at least consider that it may be less important to manage their diabetes.

However, according to MedicalNewsToday, “Risk factors for failing to comply with insulin regimens differed between those who had type 1 and those who had type 2 diabetes. The researchers found diet non-adherence to be a more prominent risk factor for missing injections in type 1 patients, whereas younger age, lower income, and perceived pain and embarrassment were more prominent as risk factors for people with type 2.”

WebMD reported, “Other factors that increased the likelihood of skipping insulin injections were:

• Not following a healthy diet
• Thinking that the injections interfered with their daily activities
• Feeling that the insulin injections were painful or embarrassing (Source: WebMD)

Roughly one-fourth of all diabetics must rely on insulin injections, but the truth is there is a large number who are not getting the shots they need to manage their health.

What may compound the issue is the number of physicians who may be resistant to prescribing insulin for their patents. While no medical professional wishes to over-prescribe a medication there seems to be evidence to support the claim that many physicians do not view insulin injections as a course of first response. Their lack of willingness to use insulin may cause some diabetics to believe that their primary care physician does not believe this form of medical care is important. If it’s not important then it may be believed that taking the medication may not be especially important either. A patient may even believe that medical advances may cure their condition soon so it may not be as important to work toward daily care.

Physicians working to educate their patients coupled with patients willing to engage in medical warfare against their disease will be needed in order to manage this disease both now and in the future.

Remaining Connected With Diabetes: Why is it that some diabetics seem to shrink into themselves and appear to have given up on life while others reach out and embrace whatever is to come next? One Type 1 diabetic has a thought – and it doesn’t take a dummy to figure out what she’s up to.

Annie Lario lives near Fort Saskatchewan, Canada. Lario is an entertainer specializing in the art of ventriloquism. She also lives with Type 1 diabetes.

Diagnosed with the disease at the age of 16 Lario could have taken her private pain and left the world stage in favor of a struggle less visible. However, Lario always seemed to thrive on entertaining those around her.

She participated in a recent fundraiser for the Juvenile Diabetes Research Foundation (JRDF) in Canada by providing a show featuring four of her ventriloquist puppets including Kittie, Kitango and Henry Kissingher.

Fort Saskatchewan The Record attributed Lario as saying, “Although there can be complications with diabetes, keeping healthy and being 100 percent honest with the doctors is the best way to avoid problems.”

This response indicates a need for action. It also indicates that doctors are there to help, but only if you allow them to.

Success in diabetes is to do the hard work of staying connected with others. This is important because depression is often a companion of diabetes. The reason face-to-face interaction is essential is that the self-talk we speak to ourselves can have us believing we are the only ones experiencing the difficulties associated with diabetes. We can cycle in a downward spiral to a place where others feel unwelcome and we are considered less than desirable to be around.

This condition also seems to follow many who move into retirement. They may have enjoyed interaction with others, but it becomes very easy to simply take the easy road and stay home rather than finding ways to connect with others.

Engaging life with a support group can go a long way in helping you overcome your depression or lethargy that may be related to diabetes. Finding ways to help others can allow you to dim the lights that are fixed on your own problems. This doesn’t mean you fail to treat your disease. What it does mean is that you embrace the role of one willing to see the needs of others in a light of equal value with your own.

Finding ways to help others can provide a sense of purpose and joy to your life that can be quickly diminished when your primary consideration is how poorly life has treated you.

This is true whether you struggle with Type 1 or Type 2 diabetes. And as hard as it may be to view yourself as a helper when you may believe you are the one needing help it is a powerful change in thinking that can alter your perspective on living.

Lario has lived with Type 1 diabetes for nearly 30 years. She continues to entertain audience as well as raise awareness and financial support for the JDRF. In recent years this has meant taking her brand of entertainment and walking a JDRF Walk to Cure backwards.

It may not always be easy to stay positive in dealing with your disease, but it is personally beneficial as well as a perceived positive development for those who love you and want the best for your life both now and in the future.

Casey Johnson’s Death Related To Untreated Diabetes: The Los Angeles County coroner came out on Thursday and said the socialite had died due to untreated diabetes. DKA or ketoacidosis was a direct result in her death.

Click here to learn more about ketoacidosis.

Children and Obesity: The Diabetic Connection: What has been suspected for many years is proven true in new research delivered by the New England Journal of Medicine – obese children are more likely to die at a young age.

According to the New England Journal of Medicine (NEJM), “The lifetime risk of type 2 diabetes is now more than one in three in the general U.S. population, and one in six adolescents is now obese, suggesting that prevention should start in childhood. Many consider diabetes and obesity to be ‘common-source’ epidemics that are rooted in our culture, as evidenced by national trends toward larger portion sizes and more meals built around calorically dense fast food, sugar-sweetened drinks, and sedentary behavior. Fighting such a powerful wave with purely clinical and adult-based approaches to prevention may seem like pasting a small bandage on a gaping wound. Rather than focusing on adults who may be set in their ways, we should perhaps target our youth, who may represent a better hope for changing the norms, habits, attitudes, and preferences that define our culture’s collective energy balance.”

The primary struggle with targeting young people is the lack of perceived reward for the effort. Because the risk of Type 2 diabetes among young people is relatively low there would need to be improved lifestyle changes in adulthood in order to justify the expense associated with youth intervention. The NEJM report states, “Impaired glucose tolerance, impaired fasting glucose, and elevated glycated hemoglobin levels are practical targets among adults not only because they indicate a high risk of diabetes but also because structured lifestyle interventions can be highly effective. Segregated interventions may not work as well among youths because the long incubation period from risk factor to disease and unclear positive-predictive value for the development of diabetes and its complications make for inefficient risk stratification and allocation of intervention resources.”

There are other studies being conducted to help determine the actual benefit of childhood intervention with respect to Type 2 diabetes. A secondary study will follow 6,000 children through, “a unique, rigorous test of a model intervention to reduce glucose levels and other risk factors that incorporates thoroughly integrated nutritional, physical-activity, behavioral, and social-marketing components. Other experts suggest that we must reach far outside the schoolhouse to find out whether focusing policies on culturally embedded risk factors — sugar-sweetened beverages, calorically dense foods, excessive television and video watching, the high price and limited availability of healthy foods, and community designs that discourage physical activity — can be as fruitful as targeting tobacco, saturated fat, and trans fats has been for the prevention of cardiovascular disease, “ according to the NEJM.

WebMD suggests, “The American Academy of Pediatrics has a tool parents can use called 5210…It stands for:

• 5 servings of fruits and vegetables daily
• 2 hours or less of television viewing daily
• 1 hour of exercise daily
• 0 or nearly zero sugar-sweetened beverages daily (Source: WebMD)

What this new research seems to tell us is that obesity in childhood is a problem that can lead to diabetes and premature death. However, because these ‘problems’ can be decades away there may be a problem in developing support to address the issue in childhood since the risk of imminent death is not typically an issue. There are those who believe these findings may be used as a foundation for a long-range plan to enable better choices among the world’s youth.

Tackling Diabetes in Rural America: Health care can be a struggle for many Americans, but it can be even more so in rural locations where care can be more difficult to find. What can be done to provide quality care for diabetic patients in rural locations?

According to a new report from the American Diabetic Association (ADA), “Because of its widespread prevalence and potentially debilitating impact, diabetes has become an international and national priority area of health concern. Although the importance of addressing diabetes is well recognized, translating clinical, evidence-based management interventions for practical implementation has proven difficult, particularly for rural communities. Individuals living in rural communities often encounter difficulties obtaining appropriate health care because of distance from health clinics, financial limitations, cultural barriers, mistrust, communication issues, and high rates of health illiteracy.”

Rates in diabetes cases are 17% higher in rural areas, yet access to health care may be limited by many factors. The ADA report suggests, “Significant challenges such as small sample size, technology and staffing limitations, and data collection issues have made quality of care comparisons between rural and urban centers difficult at best. There is ample evidence, however, that rural communities grapple with system-level barriers such as high rates of poverty; limited access to insurance, specialty medical care, and emergency services; and minimal exposure to diabetes education, all of which exacerbate the associated complications of detecting and managing diabetes. For example, it is not uncommon for rural diabetes patients to have difficulty affording glucose meter strips for routine glucose self-monitoring or to have foregone screenings, such as eye examinations, that are crucial to the detection of diabetes-associated comorbidities. These system-level barriers may exert a more profound effect on rural racial and ethnic minorities, whose household incomes are 40-50% less than that of rural white households and 50-60% less than suburban white households.”

Technology is considered a front-runner in providing the support many rural diabetics may need. This includes online tracking as well as access to live support from qualified medical providers who can answer questions via the Internet or phone. For those who prefer a face-to-face visit with someone the ADA report suggests, “One increasingly popular approach to addressing diabetes care in remote or underserved communities is to involve trained lay individuals who understand their communities and who themselves have diabetes or are intimately familiar with its day-to-day management. Community Health Advisors (CHAs), “natural helpers” from the community who are trained to deliver health information and facilitate health care access, are increasingly involved in health-promotion strategies to reach underserved communities.”

To a greater or lesser degree these strategies are being used in various ways in multiple rural locations. The ADA report concludes, “Significant strides have been made toward addressing the diabetes epidemic in rural areas. However, there remains much work to be done to optimize self-management and improve outcomes for those living with diabetes in rural communities. Several strategies have been identified, including telemedicine, telephone help lines, Web-based interventions, and CHAs, each with its own set of strengths and limitations. Future research is needed to delineate which strategy or combination of strategies will be best suited for broad-based implementation.”

The development of a synergistic approach to health care in rural locations is going to be important as a means of maintaining a lifestyle consistent with rural living within the context of healthy outcomes using multiple resources to alter end results.

An Oceanic Light Switch for Type 2 Diabetes: What if medical science could find a way to allow humans to turn diabetes on and off again? Would there be benefits? If so, where did the idea come from?

You may have watched the television show Flipper when you were young or perhaps you’ve seen reruns. What you may not have realized was that this dolphin (and others like him) could become diabetic and then return to a non-diabetic state as needed.

The way this works is that in times when food is scarce the dolphin will develop a condition that mimics diabetes. When there is plenty of food the situation reverses and the diabetic condition goes away.

This ability allows for significant blood sugar levels to maintain energy for mental function.

Right now diabetes is responsible for five in every one hundred human deaths. In fact, the prominence of diabetes is expected to double in the next ten years, as is the overall rate of obesity.

Dr, Stephanie Venn-Watson made the discovery off the coast of San Diego, California according the Telegraph.co.uk. This article reported, “By taking regular blood samples of the dolphins, she discovered that they could induce type II diabetes at times of fasting and then almost immediately turn it off again when food became available.”

The report suggests a ‘fasting gene’ exists in humans, but isn’t currently called upon to provide a similar function as observed in dolphins. The hope is that if this gene can be accessed it is possible to essentially shut off diabetes. In fact Dr. Venn-Watson suggests this ability may be the “smoking gun” in stopping diabetes in its tracks.

Dr. Venn-Watson believes that, “researching the dolphin’s DNA to work out how they do it could result in therapies in humans to switch on the ability again.”

The Telegraph article quotes Dr. Venn-Watson as saying, “Dolphins in the ocean go in to feast or famine situations. They will eat a bunch of fish at once and then they may go a while and fast and not eat.

“During that fasting state they need a mechanism to keep sugar pumping around their blood.

“Dolphins can switch off diabetes but people cannot. Could there be gene therapies that control that switch if it exists in humans. If we could control that switch like dolphins it could be a cure.

“Then identifying and controlling such a switch could lead to possibly a cure for type II diabetes in humans.”

As with many types of research one hurdle will be the care and treatment of the dolphins. Many animal rights groups have already expressed outrage that blood samples will need to be taken from dolphins to conduct the research. These animal rights groups are opposed to research on the dolphin for any purpose.

Dr. Venn-Watson told the Telegraph that, “many [dolphins] ‘volunteered’ for research, approaching the beach and putting their tails in the air to have their blood taken.”

One other complication is the fact that others within the medical community are not at all certain that dolphins use blood sugar in the same way humans do. In this regard there are questions as to the validity of the premise from which the study is derived. As with all research there will be disagreements as to the meaning and importance of the findings. For Venn-Watson this is considered a monumental finding that may alter the face of diabetes.