Diabetic Live

While the idea of an artificial pancreas has been discussed before, the idea has now moved past a strong potential to actual development. The new treatment is being called “revolutionary”.

According to ArtificialPancreaseProject.com, “The Juvenile Diabetes Research Foundation announced an innovative partnership with Animas Corporation to develop an automated system to help people with type 1 diabetes better control their disease – the first step on the path to what would be among the most revolutionary advancements in treating type 1 diabetes: the development of an artificial pancreas, a fully automated system to dispense insulin to patients based on real-time changes in blood sugar levels.”

As stated in an earlier report this device can allow Type 1 diabetics profound freedom because data is being sent wirelessly to compensate for blood sugar changes in the diabetic.

The Juvenile Diabetes Research Foundation said, “The objectives of the partnership, a major industry initiative within the JDRF Artificial Pancreas Project, are to develop an automated system to manage diabetes, conduct extensive clinical trials for safety and efficacy, and submit the product to the U.S. Food and Drug Administration for approval.”

The Animas Corporation is owned by Johnson & Johnson. The company has been promised $8 million over 3 years for the development of this product. Alan Lewis, PhD, President and Chief Executive Officer of JDRF said, “Ultimately, an artificial pancreas will deliver insulin as needed, minute-by-minute, throughout the day to maintain blood sugars within a target range. But even this early system could bring dramatic changes in the quality of life for the 3 million people in the U.S. with type 1 diabetes, beginning to free kids and adults from testing, calculating and treating themselves throughout the day.”

ArtificialPancreaseProject.com reports, “The first-generation system would be partially automated, utilizing an insulin pump connected wirelessly with a continuous glucose monitor (CGM). The CGM continuously reads glucose levels through a sensor with a hair-thin sensor wire inserted just below the skin, typically on the abdomen. The sensor would transmit those readings to the insulin pump, which delivers insulin through a small tube or patch on the body. The pump would house a sophisticated computer program that will address safety concerns during the day and night, by helping prevent hypoglycemia and extreme hyperglycemia. It would slow or stop insulin delivery if it detected blood sugar was going too low and would increase insulin delivery if blood sugar was too high. For example, the system would automatically discontinue insulin delivery to help prevent hypoglycemia, and then automatically resume insulin delivery based on a specific time interval (i.e., 2 hours) and/or glucose concentration. It will also automatically increase insulin delivery to reduce the amount of time spent in the hyperglycemic range and return to a pre-set basal rate once glucose concentrations have returned to acceptable levels.”

It is anticipated that first generation devices would still require input from diabetes patients to administer needed doses. Presumably this is intended to provide a human element to the insulin distribution. It is also presumed that at some point the device will be approved to make the changes on its own to allow the greatest amount of freedom to the more than 3 million Type 1 diabetics in the United States. ArtificialPancreaseProject.com adds, “The JDRF-Animas partnership will build upon the progress made since 2006 in the JDRF-funded Artificial Pancreas Consortium, a group of university-based mathematicians, engineers, and diabetes experts that has developed the computer programs needed for an artificial pancreas, and established their scientific feasibility.”

What if getting your body to recognize insulin was something simple – like turning on a light switch? A recent multinational study indicates it might just be that simple.

According to ScienceDaily.com, “A breakthrough by an international team of researchers in Canada, France, the UK and Denmark has uncovered a new gene that could lead to better treatment of type 2 diabetes, as well as a better understanding of how this widespread disease develops.”

This newly discovered gene doesn’t tell your body to develop more or less insulin, but rather, “how the body responds to insulin already in the bloodstream.”

The gene in question is referred to as Insulin Receptor Substrate 1 (IRS1). Dr. Robert Sladek of McGill University and the Génome Québec Innovation Centre in Montreal says, “IRS1 is the first inside the cell that gets activated by insulin. It basically tells the rest of the cell, ‘hey, insulin is here, start taking in glucose from the blood!’ If IRS1 doesn’t work, the whole process is disrupted.”

Sladek explains it another way, “Most of the genes that we’ve identified as diabetes risk genes to date reduce the function of the pancreas, specifically of beta cells in the pancreas that make insulin. IRS1 has to do with the function of the other tissues in the body. Rather than reduce production of insulin, this gene reduces the effect of insulin in muscles, liver and fat, a process called insulin resistance.”

Insulin generally takes glucose from the blood and converts it to energy. If the proverbial light switch hasn’t been turned on then tissue within the body may not know to take in the glucose. This condition allows for the development of diabetes.

What if medical science could find a way to kick-start the process? ScienceDaily.com suggests, “This study, which used genetic material drawn from more than 6,000 French participants divided into two separate groups, represents the final step in a series of collaborations between these researchers that has redrawn our understanding of diabetes genetics. In this instance, not only did the researchers pinpoint a new diabetes-linked gene, they found the genetic trigger, which leads to malfunction, in a totally unexpected place.”

Why is it unexpected? Scientists always look to closely connected issues to address problems they encounter. In this case the answer wasn’t even close to where they should have been looking. Sladek explains, “It’s a single-nucleotide polymorphism (SNP, pronounced ‘snip’), a single letter change in your DNA. What’s interesting about this particular SNP is that it’s not linked genetically to the IRS1 gene in any way; it’s about half-a-million base-pairs away, in the middle of a genetic desert with no known genes nearby. In genetic terms, it’s halfway from Montreal to Halifax. And yet we can see that it causes a 40-per-cent reduction in the IRS1 gene, and even more important, a 40-per-cent reduction in its activity. Which means that even if insulin is present, it won’t work.”

Is it possible that adding extra insulin may be less helpful in Type 2 diabetics than it should be? If the IRS1 gene switch isn’t working correctly than this could be the case. Returning to the light switch analogy Sladek concludes, “It’s possible that in diabetic patients, the signal to turn this gene on and off might be impaired. But we might be able to use one of the other pathways to turn it on.”

This could be a very positive step in disease management or at the very least better personalized diabetic care.

The first in a two-part look at the complications associated with diabetes in the United States by way of information from the Centers for Disease Control (CDC). This report takes a look at the most applicable diseases and conditions that mirror a diagnosis of diabetes.

Heart disease and stroke

• In 2004, heart disease was noted on 68% of diabetes-related death certificates among people aged 65 years or older.
• In 2004, stroke was noted on 16% of diabetes-related death certificates among people aged 65 years or older.
• Adults with diabetes have heart disease death rates about 2 to 4 times higher than adults without diabetes.
• The risk for stroke is 2 to 4 times higher among people with diabetes.

High blood pressure

• In 2003–2004, 75% of adults with self-reported diabetes had blood pressure greater than or equal to 130/80 millimeters of mercury (mm Hg), or used prescription medications for hypertension.

Blindness

• Diabetes is the leading cause of new cases of blindness among adults aged 20–74 years.
• Diabetic retinopathy causes 12,000 to 24,000 new cases of blindness each year.

Kidney disease

• Diabetes is the leading cause of kidney failure, accounting for 44% of new cases in 2005.
• In 2005, 46,739 people with diabetes began treatment for end-stage kidney disease in the United States and Puerto Rico.
• In 2005, a total of 178,689 people with end-stage kidney disease due to diabetes were living on chronic dialysis or with a kidney transplant in the United States and Puerto Rico.

Nervous system disease

• About 60% to 70% of people with diabetes have mild to severe forms of nervous system damage. The results of such damage include impaired sensation or pain in the feet or hands, slowed digestion of food in the stomach, carpal tunnel syndrome, erectile dysfunction, or other nerve problems.
• Almost 30% of people with diabetes aged 40 years or older have impaired sensation in the feet (i.e., at least one area that lacks feeling).
• Severe forms of diabetic nerve disease are a major contributing cause of lower-extremity amputations.

Amputations

• More than 60% of nontraumatic lower-limb amputations occur in people with diabetes.
• In 2004, about 71,000 nontraumatic lower-limb amputations were performed in people with diabetes.

Dental disease

• Periodontal (gum) disease is more common in people with diabetes. Among young adults, those with diabetes have about twice the risk of those without diabetes.
• Persons with poorly controlled diabetes (A1c > 9%) were nearly 3 times more likely to have severe periodontitis than those without diabetes.
• Almost one-third of people with diabetes have severe periodontal disease with loss of attachment of the gums to the teeth measuring 5 millimeters or more.

Complications of pregnancy

• Poorly controlled diabetes before conception and during the first trimester of pregnancy among women with type 1 diabetes can cause major birth defects in 5% to 10% of pregnancies and spontaneous abortions in 15% to 20% of pregnancies.
• Poorly controlled diabetes during the second and third trimesters of pregnancy can result in excessively large babies, posing a risk to both mother and child.

In part two of this series we will look at additional complications along with prevention and control efforts that can be put to effective use in diabetes management.