Diabetes Mellitus 1, 2 Epidemic -- New Weapons

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New Weapons Take on Deadly Diabetes Epidemic

Fort Worth Star-Telegram, Texas

05-11-07 -- FORT WORTH, Texas - Millions have it but don't know it.  Some lose limbs, incur blindness or develop heart disease because of it.  And, millions die from it.

Diabetes is a disease in which the body either does not produce or cannot properly use insulin -- the hormone that regulates glucose, which circulates in the blood and provides energy for the human body.

An estimated 20.8 million people in the United States -- 7 percent of the total population - now have diabetes, up from 18 million when the Centers for Disease Control and Prevention measured the prevalence in 2003.  If the current rate continues, one in every three people born in 2000 will develop diabetes.

In the short-term, unregulated blood sugar starves cells of energy and usually causes excessive thirst and urination.  Long-term, it damages nerves and blood vessels and can cause complications including heart disease, stroke, blindness, loss of limbs and kidney failure.

Ron Springs, 50, best known as a running back for the Dallas Cowboys in the early `80s, developed type II diabetes in 1990.  Springs had several toes on his left foot and his entire right foot amputated because of staph infections.  He went into kidney failure in 2004.  After three years of dialysis, Springs received a kidney transplant from his best friend and former Cowboys team mate Everson Walls on Feb. 28.  "Type II is a very silent and very deadly disease," Spring says.  "You can't ignore it."

The good news is that there are new drugs, insulin-delivery systems and medical procedures to help combat this deadly disease.  From "smart pumps" with constant glucose-monitoring to a new drug that helps diabetics lose weight as well as control their blood sugar, some folks are fighting back -- and winning.  Here are their stories.


Rebecca Wilson, 15 years of age, Grand Prairie, Texas

Type I diabetes; uses insulin pump and continuous glucose monitor.  Rebecca Wilson says she was clueless in July 2004 when her doctor checked her blood sugar to find out why she had no energy, was always hungry and had lost 30 pounds for no apparent reason.  Rebecca always had been healthy, never been hospitalized, never been to an emergency room and knew nothing about diabetes.

Her doctor immediately sent her to Cook Children's Medical Center in Fort Worth.  There was no stopping, not even to grab breakfast at a fast-food restaurant on the way, the Grand Prairie High School freshman says.  "It really scared me.  I didn't know what was going on, but when we got to the hospital, they were waiting for me and put me on IV insulin as soon as I got to the emergency room," she recalls.

Before breakfast the next morning, Dr. Paul Thornton, director of endocrinology and diabetes at Cook Children's, had Rebecca giving herself insulin injections.  By the time she began using the new insulin pump with a continuous glucose monitoring system in October, Rebecca knew all about type I diabetes.

The system approved for adults about a year ago and for children in March includes a pump carried in a pocket or on a belt and a tiny electrode sensor that takes readings every five minutes to determine how much more insulin a person needs around the clock.  It includes an alarm that sounds, just in case the patient isn't awake or paying attention when insulin levels get too high or too low.  It helps patients take immediate and precise action to maintain healthy glucose levels and avoid any complications.

Thornton says the new continuous monitors and pumps mark a fundamental improvement in children's ability to manage their diabetes.  "It allows patients to really fine-tune their insulin needs," he says.  "Normally, patients are happy to know their blood sugar is 80, but with continuous real-time monitoring, you know if it's 80 and rising, or 80 and falling, and that can be important."

Tom Wilson, Rebecca's father, says the device is invaluable.  "It has helped her a great deal. The difference between this and monitoring with finger sticks and test strips three or four times a day is like night and day," he says.

Rebecca says she loves the pump.  "The pump just clips on my belt, or I can carry it in my purse.  It's the size of a cellphone," she says.  "It makes it a lot easier to control my blood sugar."  And makes it a lot easier to act like any other teenage girl.


Woody Runner, 49 years of age, Fort Worth, Texas.  Type I diabetes; uses insulin pump.

Woody Runner, 49, of Fort Worth was born with an unusually narrow pancreatic duct.  He was diagnosed with type I diabetes about a year ago when his pancreas finally shut down and quit producing insulin.

"I was losing weight without trying and always fatigued, and thirsty all the time.  I had classic symptoms," he says.  "I started on both slow-release and quick-acting insulin immediately ... then started tracking my blood-sugar levels and calorie and fat intake and entering the data on spread sheets in my computer because it is too much information to manage manually," Runner says.

About eight months ago, Runner began using a new insulin pump that can interface with blood glucose monitors for both his long-acting and short-acting insulin.  The new pumps became available just a year ago and are considered a major step in the development of a closed-loop system, sometimes referred to as an artificial pancreas.  The systems combine continuous glucose monitoring with an automatic pump to inject the proper amount of insulin needed throughout the day and night.  Pumps deliver both a continuous "basal," or background, dose throughout the day and night and a "bolus," or booster, dose to cover mealtimes or to correct a high blood glucose (sugar) anytime it is needed.

"The pump I use is extraordinary, and liberating in a sense.  I don't have to give myself injections with every meal ... I can be a lot more precise in my dosage with this, and have lot more flexibility to change my mind about what I eat and how much," Runner says.


Musarrat Alavi, 57, Richardson, Texas.  Type II diabetes; uses new drugs.

What Musarrat Alavi, 57, noticed first was a little numbness in her feet.  Then, she stubbed her toe and realized it was taking a long time to heal.  "I had been gaining some weight.  I weighed almost 175 when type II diabetes was diagnosed, almost 10 years ago," Alavi says.  "I started taking Glucophage and different things my doctor prescribed and exercising and watching my diet, but nothing was helping, and I was gaining more weight."

That's when she tried Byetta, a once-a-month injectable drug that was approved in April 2005 for the treatment of type II diabetes.  The first in a new class of drugs based on Gila monster saliva, which incapacitates prey by destroying its blood sugar, Byetta not only increases the life span and number of beta cells produced but also causes many patients to lose weight, according to several published studies.

"I had gained up to 190 when I started taking it almost three years ago, and I started losing weight on Byetta right away.  Today, I weigh 134 and have good blood sugar control," says Alavi.

She also does a lot of cardio exercise - "whatever it takes to burn about 1,000 calories a day," she says - but is not on a diet.

"The Byetta makes you a little nauseous when you first inject it, but you get used to it, and it makes you feel full quickly," Alavi says.

It is unclear why Byetta causes weight loss, according to the Mayo Clinic, but one effect of the drug is that it delays the movement of food from the stomach into the small intestine.  As a result, people feel full faster and longer, so they eat less.


Steve Moore, 48, McKinney, Texas.  Type I diabetes; uses inhaled insulin.

It's not about the needle sticks.  Insulin injections are no big deal when you have lived with type I diabetes for more than 25 years.  But good control of your blood sugar is a very big deal, says Steve Moore, 48, who is participating in a long-term clinical trial on Exubera, the first and only inhaled insulin approved by the Food and Drug Administration.

"I love inhaled insulin because it is so fast-acting," Moore says.  "It makes me feel better in 15 minutes, and it requires no refrigeration, so I can pack it and take it with me anywhere, even in the summer when I'm riding my motorcycle."

Fast-acting Exubera replaces mealtime injections for a quick boost of insulin needed when carbohydrates - found in sugar, starch, fruits and vegetables - cause blood sugar to increase.  It does not, however, do away with the need for syringes or pumps to inject the long-acting, slow-release forms of insulin, which all type I diabetics, and many with type II, depend on as a kind of maintenance dose.

Moore has used Exubera for more than three years.  He also participated in clinical trials on Lantus, one of the newer, slow-release human insulins that are injected once a day.  He says Lantus made an even bigger difference in his quality of life because it gave him "a better, more consistent energy level," but Exubera makes it possible to fine-tune his insulin needs.

When Exubera finally reached the retail market last fall, it was celebrated as the biggest advance in diabetic care since insulin was discovered, in 1921.  But so far, it has been slow to catch on with patients.  It seems the extra cost and effort to use a bulky inhaler (the size of a standard flashlight) may be a factor.

"In the last 10 years or so, injectables have become so much easier to use and acceptable to patients, with smaller, better needles, better pumps, better faster-acting insulins," says Dr. Vivian Fonseca, professor of medicine and chief of the endocrinology section at Tulane Medical School.

More than 5 million people take insulin in the United States, according to the FDA.  Exubera was approved for type I and II adult diabetics, but market analysts say that only about 1 in 500 prescriptions written for insulin are for the inhaled version.

"I think people just don't know about it.  There haven't been any big advertising campaigns, and a lot of doctors never even discuss it.  I think as soon as they start advertising it, everyone will want it," Moore says.


Shan Wolff, 48 years of age, Fort Worth, Texas.  Type I diabetes; had islet cell transplants.

For years, Shan Wolff says, he could feel his blood sugar dropping dangerously low and knew intuitively that he needed some extra glucose or other fast-acting sugar, immediately.  But, about five years ago, he developed hypoglycemic unawareness - sudden and extreme low blood sugar levels that strike without warning, sometimes causing loss of consciousness.  "I was no longer able to recognize when I had low blood sugars," Wolff says. "It was terrifying."

Wolff, 48, was on an insulin pump, taking 55 to 60 units of the life-sustaining hormone every day and his blood sugar was out of control.  His only effective treatment option was an islet cell transplant.  Wolff received one of the first such transplants in northern Texas 18 months ago.

Islet cell transplants were first used successfully to treat diabetes about five years ago at the University of Alberta in Edmonton, Canada.  Islet cells harvested from a donor pancreas are dripped by IV line into a patient's liver, where they begin producing insulin and releasing it into the blood stream, where it regulates how much glucose gets into the various cells of the body that use it for energy.  The main drawbacks are getting enough donor tissue and taking immune suppressant drugs to prevent rejection of the transplanted cells, says Dr. Marlon Levy, surgical director of transplantation at Baylor All Saints Medical Center in Fort Worth and medical director of the only islet cell program in North Texas.

"We have done six patients at Baylor for a total of 11 or 12 transplants - on average, it takes two transplants to get enough insulin-producing cells to do the job normally done by the pancreas," Levy says.

In the beginning, islet cells were sent to the University of Miami for processing, but since August, they have been collected, processed and implanted at Baylor University Medical Center in Dallas.

Levy says physicians do not consider islet transplants to be a cure for diabetes, but patients use the term because it eliminates most of their insulin injections and gives them better blood sugar control.

Wolff, a clinical specialist with LifeGift Organ Donation Center in Fort Worth, had a second islet transplant Dec. 5.  "Now, I take one and sometimes two units of insulin a day, maybe six a week, and I have more energy and my blood sugar is better than it's been in years," Wolff says.


ISLET CELL TRANSPLANTATION

What it is:  Islet cells harvested from a donor pancreas are dripped by IV line into a patient's liver, where they begin producing insulin and releasing it into the blood stream.

How it works:  The patient begins producing his own supply of natural human insulin to fuel the various cells of his body.

Who should use it:  An option only for adults who have had diabetes at least five years and experienced either hypoglycemic unawareness or metabolic instability (uncontrolled diabetes that produces life-threatening excess acid).

Drawbacks:  Patients must take immune suppressant drugs to prevent rejection of transplanted cells.

What's next?  Plans include living-donor transplants so that closer matches can be made and fewer anti-rejection drugs needed.  There is also hope for embryonic stem cell transplants to finally cure diabetes and there is optimism fueled by a new study in which patients were treated with stem cells taken from their own bone marrow (before they completely quit producing insulin).


TYPE I DIABETES

What it is:  An autoimmune disease in which the immune system mistakenly destroys the beta cells that normally produce insulin in the pancreas.  Without insulin, glucose builds up in the blood rather than entering different cells of the body where it is needed for fuel.  Type I is most often diagnosed in children and young adults, and is sometimes called insulin-dependent or juvenile-onset diabetes.

What causes it:  No one knows what causes type I, but some type of virus or other environmental toxin and/or genetic factors are likely involved.

Treatment:  Daily insulin replacement is crucial to survival.

Good to know:  Obesity, lack of exercise and aging have nothing to do with type I.


TYPE II DIABETES

What it is:  Either the body does not produce enough insulin to properly regulate blood sugar or does not respond well to the insulin that is produced, a condition called insulin resistance.

What causes it:  Obesity, inactivity and aging are major risk factors for the development of type II, because they both inhibit insulin production and cause insulin resistance.

Treatment:  Can usually be managed with a combination of prescription drugs, weight loss and exercise, although people with type II often need insulin replacement as the disease progresses.

Good to know:  Accounts for 90 percent to 95 percent of all diagnosed cases of diabetes.  Directly related to the worldwide obesity epidemic.


GESTATIONAL DIABETES

What it is:  Abnormal glucose tolerance that develops in about 3 percent to 5 percent of all pregnancies, mostly among older women.

What causes it:  Hormones produced to help sustain the pregnancy can inhibit the production of insulin.

Treatment:  It usually goes away on its own shortly after childbirth, but about 50 percent of women who have had gestational diabetes end up developing type II diabetes within 10 years.

Good to know:  Does not mean that either the mother or the baby will have diabetes, but the baby may be larger than average because the fetus converts into fat the extra glucose that crosses the placenta.  Can be a warning to watch your diet and exercise regimen closely after delivery and to discuss preventive measures with your doctor.

SOURCES: "Johns Hopkins Family Health Book," American Diabetes Association, Juvenile Diabetes Research Foundation, U.S. Food and Drug Administration, "Diabetes Survival Guide."


TIPS TO PREVENT DIABETES

Coffee, black pepper and even a little alcohol can help control blood sugar and stave off the development of diabetes, according to the Diabetes Survival Guide, by Dr. Stanley Mirsky, associate clinical director of metabolic diseases at the Mount Sinai School of Medicine in New York and a former president of the American Diabetes Association.

He recommends:  Drop a few pounds, especially if you carry your extra fat around your waistline and abdomen.  A 5 percent to 7 percent weight loss can cut your risk of diabetes by 58 percent.  Get moving -- exercise improves your body's ability to metabolize sugar.  Do some type of moderate aerobic exercise for a minimum of 30 minutes a day, three to five times a week.

Improve your diet, especially if you have a genetic susceptibility and above-normal blood sugar levels.  Avoid sugar and simple carbohydrates such as sweet baked goods, white bread, regular soft drinks, large servings of pasta and some fruits, including bananas, melons and berries.

Cut back on red meat and hot dogs, all kinds of high-fat and processed meats.

Add coffee (four to six cups a day, according to several studies); a drink or two of beer, wine or liquor a day; spices, including pepper, cloves, bay leaves and cinnamon, magnesium (especially spinach and other leafy green vegetables, seafood and nuts); and high-fiber food, including whole-grain cereals.

Eat fish, preferably tuna, salmon, mackerel or other cold-water varieties, or take a fish-oil supplement approved by your doctor.


INSULIN PUMP

What it is:  A small pager-size device to deliver insulin through a single injection for two to three days.  Pumps have been used for 20 years, but the first insulin pump integrated with real-time continuous glucose monitoring was approved just a year ago.

How it works:  Patients program the pumps to deliver insulin at various rates to meet their needs throughout the day and night, as well as on demand.  The new "smart pumps" continuously monitor glucose levels and determine how much insulin is still active in the body then automatically pump the amount needed into the blood.  The "smart" system uses nearly 100 times more information than supplied by three finger sticks and, at the touch of a couple of buttons, can deliver extra insulin to meet unexpected needs.

Who should use it:  Anyone who requires precise and adjustable insulin delivery and wants to rid themselves of multiple daily injections and finger sticks, strict meal schedules and rigid sleep patterns (There's no need to get up at the same early hour every day to take your insulin).

For more information on insulin pump therapy, go to www.medtronic.com

INHALED INSULIN

What it is:  Inhaler is about 10 inches long, the size of a regular flashlight and much bigger than an asthma inhaler.

How it works:  Patients inhale a powdered form of insulin that very quickly lowers blood sugar concentrations by allowing the blood sugar to be taken up by cells as a source of fuel.

Who should use it:  Approved in 2006 for the treatment of adult patients with type I or type II diabetes.  Only for people who have good lung function and don't smoke.

Cost:  About $5 a day compared with insulin injections (as little as $1 a day for original basic human insulin or about $3 a day for the better, short-acting analogs).

Will insurance cover it?  Most insurance covers whatever kind of insulin is prescribed.

What's next?  Several other inhaled insulin products are near approval, no long-acting insulins.  Patches, mouth sprays and coated pills and capsules that can survive stomach acid are also in the pipeline.

For more information, go to www.diabetes.org 


ISLET CELL TRANSPLANTATION

What it is:  Islet cells harvested from a donor pancreas are dripped by IV line into a patient's liver, where they begin producing insulin and releasing it into the blood stream.

How it works:  The patient begins producing his own supply of natural human insulin to fuel the various cells of his body.

Who should use it:  An option only for adults who have had diabetes at least five years and experienced either hypoglycemic unawareness or metabolic instability (uncontrolled diabetes that produces life-threatening excess acid).

Drawbacks:  Patients must take immune suppressant drugs to prevent rejection of transplanted cells.

What's next?  Plans include living-donor transplants so that closer matches can be made and fewer anti-rejection drugs needed.  There is also hope for embryonic stem cell transplants to finally cure diabetes and there is optimism fueled by a new study in which patients were treated with stem cells taken from their own bone marrow (before they completely quit producing insulin).

For more information, contact the Juvenile Diabetes Research Foundation International at www.jdrf.org


WHAT'S NEW IN DIABETES CARE?

Byetta -- How it works:  Increases insulin secretion

Who should use it:  Type II diabetics who need to lose weight to help control their blood sugar.  For more information:  www.byetta.com 

Januvia -- How it works:  Once-a-day tablet enhances the body's ability to lower blood sugar by helping the pancreas produce more insulin and the liver make less glucose (sugar), particularly right after you eat.

Who should use it?  People who have type II diabetes and are struggling to control their blood sugar with diet, exercise and certain other commonly prescribed oral medications.  For more information:  www.januvia.com 

Lantus -- How it works:  Hailed as a breakthrough in diabetes care, Lantus, the most prescribed form of insulin, provides a slow release of insulin, with no pronounced peaks, over a 24-hour period.  SoloStar, a disposable insulin pen prefilled with Lantus, was approved by the FDA last week.

Who should use it?  Anyone who is insulin-dependent (types I and II), especially if you have blood sugar dips as well as peaks.  For more information: www.lantus.com 

Kineret -- How it works:  Already approved to block inflammation in patients with arthritis, Kineret may increase the secretion of insulin in patients with elevated blood sugar as well as protect against the further loss of beta cells to delay or prevent type II diabetes, according to a new study published in the April 12 New England Journal of Medicine.

Who should use it:  Arthritis patients who are borderline diabetic may benefit from this arthritis drug.  For more information:  www.topix.net/drug/kineret 

I-Port -- How it works:  An insulin-delivery device, which became available in July, that uses a tiny catheter attached to a very fine needle, which remains attached under the skin, allowing patients to inject insulin through the same "infusion site" for three days with one needle stick.

Who should use it:  Anyone with type I or II diabetes who has a hard time with insulin injections.  For more information:  www.pattonmd.com 

Injection Pen -- How it works:  Allows you to carry a whole month's worth of certain drugs, including Byetta and insulin in one fat cigar-looking pen and to dial up the doses needed each day.

Who should use it:  Active people seeking convenience and needing insulin that does not require refrigeration.  For more information:  www.lantus.com.  Source:  Dr. Darin Lackan, Fort Worth specialist in diabetes and thyroid disease.


For more information:  American Diabetes Association at www.diabetes.org.  Juvenile Diabetes Research Foundation International at www.jdrf.org.  National Diabetes Education Foundation at www.ndep.nih.gov.


If you have been diagnosed or told by a medical professional that you are at risk or borderline diabetic, you may want to consider reading the following articles.  They expound upon the above newspaper article giving sound advice to anyone interested in possibly avoiding/supporting any of the above treatments.

Natural/Alternative/Preventive measures to consider:  Diabetes Mellitus - Page 1 | Page 2 | Page 3 | Page 4

More Information:  Diabetes Mellitus Type 2, Exercise, Blood Sugar | Dietary Troubles - Obesity, Diabetes, Heart Disease |
Retinopathy Occurs in Pre-Diabetes | Diabetes, Obesity Seen as Accelerated Aging |
Adult Lifestyles - Late Onset Diabetes | Early Detection - Insulin Resistance

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