Outlook For Diabetes

By Jude Roberts

 

Although there is still no cure for diabetes, treatment options are now better than ever, whether a person has type 1 or type 2 diabetes, all thanks to the marriage of modern medicine to modern technology. Areas such as self-monitoring blood glucose levels and administering insulin have seen the most significant improvements. Self-monitoring is a key component of successful diabetes management, and refers to the blood glucose/sugar test that a person does themself. The test has always been done by pricking a finger and applying a drop of blood to a strip, with the strip then inserted into a portable machine for interpretation of the levels of blood sugars and/or ketones. The newest blood glucose meters allow for testing from alternative sites other than the fingertips, such as from the upper arm, forearm, base of the thumb, and from the thigh. These sites tend to be less sensitive than the fingertips, and are a desirable alternative especially when testing children. However, as promising as these new monitors seem to be, they may have some drawbacks. There’s a possibility of the blood test not being as accurate when samples are gathered from alternative sites as opposed to samples taken from the fingertips. The reason for the difference is because the concentration levels of glucose may be quite different in other areas of the body than from the fingertips. Concentrations of glucose levels tend to change rapidly after meals, insulin or exercise, and alternative sites for glucose monitoring may show any changes more slowly than when blood is drawn from the fingertips. If you are using an alternative glucose monitoring device, be sure to still check glucose levels from the fingertips if you think your blood sugar is low, if you are still unsure of what your symptoms are when you become hypoglycemic (low blood sugar level), or if the results do not agree with the way you feel.

Although it’s been around for over 25 years, continual advancements and improvements have made the insulin pump a great option for children and adults who must give themselves daily insulin injections. The pump is usually worn discreetly on a belt/waistband, in a pocket, or under clothing, and there are a variety of clips, cases and fashion accessories to help make the pump easy to wear. No larger than a pager, the insulin pump contains a cartridge filled with fast-acting insulin, and can be programmed by the pump’s internal computer by the person wearing it, accessible by a screen and several buttons. Once programmed, a precise motor pushes insulin from the cartridge through a tube and into the body. The tubing that connects the pump to the body comes in various lengths (from 24” to 42”) and is quite durable. To get the insulin under the skin, an infusion set is worn, which uses a metal insertion needle (about the size of an insulin syringe needle) to insert a tiny, flexible plastic tube into the fat just beneath the skin. The infusion set is usually placed into the abdomen, buttocks or hip area. After insertion, the metal needle is removed and the infusion set is then taped securely in place. A new infusion set is inserted every 2 to 3 days, depending on individual usage. When the infusion set is inserted properly, it usually won’t be felt or noticed the entire time it’s worn. Most infusion sets have a quick disconnect mechanism, allowing the user to temporarily unhook the pump and tubing for bathing, swimming, contact sports or intimacy, and afterward, the pump can be reconnected with a simple click.

New, improved pumps also have multiple safety features that ensure against accidental insulin delivery. All insulin pumps run multiple safety checks every second and have sensitive alarms that detect problems such as blocked insulin flow and programming errors. Because the pumps set off an alarm and “lock up” in the event of any internal problem, there is virtually no chance of accidental insulin delivery. They allow for people with diabetes to effectively deal with changes in their activity levels, busy schedules, changes in diet, and changes in blood glucose level because of hormonal changes. This is one reason why they are being prescribed with greater frequency for young children and young adults, since their activity levels and diet levels change frequently. Although these new pumps work great, it is still important to continue to take blood samples in order to monitor your glucose levels. Insulin pumps tend to be a bit pricey - between $4,000 and $6,000 - but many insurance plans will cover the cost of the pump and the supplies that go along with it, greatly reducing the out-of-pocket expense of a person or family. Remember that insulin pumps are usually considered to be “durable medical equipment” to most insurance companies. The pump companies have people who will work with your doctor as well as with your insurance company to try and get everything approved. Should you not be approved for a pump the first time around, don’t give up; many insurance companies know less about these pumps than you do, so stay informed and educate them if you must, in order to receive what you need.

New Treatment Options

Insulin Pump Implants - researchers are currently working to develop an insulin pump which can be permanently implanted to measure blood sugar levels and deliver the exact amount of insulin needed. A device such as this would make  it possible to mimic the action of natural insulin delivery.

Insulin Capsule Implant - scientists are making progress with an insulin capsule which can be implanted to continuously produce insulin and releases it into the bloodstream. It contains insulin-secreting cells that borrow nutrients from the body, allowing it to keep producing insulin indefinitely. One of the challenges in creating such an implant was to overcome the natural reaction of the body’s immune system to reject and destroy a foreign object. Luckily, with the use of microchip technology, a capsule has been created that will not come under the attack of the body’s immune system. Before an implant such as this can be placed on the market, tests must still be done in order to determine the long-term usage and ideal dosage level needed to perfect it for general use, which is still several years away.

Insulin Inhalers - although daily injections of insulin would still be needed, inhaled insulin is currently in clinical trials and may be headed for quick approval from the Food and Drug Administration (FDA). These inhalers are about the size of a flashlight and use a rapid-acting insulin which is sprayed and inhaled into the mouth. Coating the mouth, throat and tongue, the insulin is able to pass quickly into the bloodstream.

Insulin Pill - believe it or not, the discovery of a new polymer substance may allow for the development of an effective insulin pill. When the polymer is used to coat a pill, it allows insulin to get into the bloodstream without being destroyed by the digestive system. So far, it has only been tested in animals, and some experts are questioning whether insulin in a pill form would prove to be safe or useful, since dosing requirements are is so critical and vary so often.

Continuous Monitoring Device - The FDA has approved a wristwatch-like device that provides more information for managing diabetes. It is intended to be used along with, but not as a replacement for, the fingertip blood test to monitor glucose, in order to ensure accurate results. Called the GlucoWatch Biographer, it works by extracting fluid through the skin by sending out tiny electric currents. The watch can be worn up to 12 consecutive hours, producing 3 monitor readings every hour, even while you’re asleep. An alarm will sound if blood glucose levels are detected to be dangerously low, or if a measurement was skipped. The watch can detect the presence of both by excessive sweat. The device is available only by prescription to detect trends and track patterns in glucose levels in adults age 18 and older.

Islet Cell Transplant - this new treatment comes from a technique known as an islet cell transplant which has shown promise in people with type 1 diabetes. Islet cells are found in the pancreas, and the procedure, called the Edmonton technique, has resulted in seven patients becoming insulin free for up to 14 months after treatment. Clinical trials have now begun at 10 national diabetes centers to see if the insulin reversal can be successful with more patients. The Edmonton technique uses islet cells from two or more donor pancreases. The cells are transplanted into a person with diabetes and then special medications are given to prevent rejection of the new islet cells. One difficulty with the transplant is that even though a person may become free of the need to take insulin, the medications to prevent rejection of new tissue must be taken for a lifetime, and these medications can have side effects.

Gene Therapy - recent reports show that research into gene therapy for different aspects of diabetes is beginning to show some promise. Scientists have identified a gene called SHIP2 that appears to regulate insulin, which would make SHIP2 a potential gene therapy target for the treatment of type 2 diabetes aimed at improving the individual’s insulin regulation. There’s also a protein that blocks the overgrowth of blood vessels in the eyes which  is being studied as a possible form of gene therapy for diabetic retinopathy, and it may also be used to treat macular degeneration.

A Possible Vaccine Against Diabetes? - scientists have developed the world’s first drug that stops the destruction of pancreatic beta cells in humans. It offers the possibility of preventing type 1 diabetes in people at high risk and of halting its progress in people newly diagnosed with it. The vaccine contains a drug which is a peptide (a type of protein). By modifying a small portion of the protein, a drug has been created which can selectively block the activity of immune cells which tend to attack the pancreas. In other words, the drug or “vaccine” deactivates the cells which attack the pancreas without interfering with the rest of the body’s immune system.

 

 

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