Diabetes: Treatment (Present and Future)

My cousin and I use Novo Nordisk; who claim to be the “rapid acting insulin of choice” , and, in my opinion, they are! Over the last 15 years, Novo Nordisk have constantly been improving their insulin, developing new types (long and short acting) of insulin, which indeed make a big difference to the daily running of my diabetes. I am, I suppose, more confident in the insulin, and have a regime specific to me.

I asked a consultant, Julie Richardson, what most new diabetics use for treatment, and she replied, “most patient do the basal-bolus regime (4 injections a day), as it is more physiological to the normal body responses”.  This means that as we have a meal, when the glucose level increases rapidly, diabetics inject insulin into the body so that we may reduce it again. This is what happens in a non-diabetic.

INSULIN PUMPS

Insulin pumps are a relatively new conception. A pump is a small box which is strapped onto the body, and is connected to the bloodstream by a cannula (needle) inserted underneath the skin.

Insulin-Pumpers.org describes their purpose; “the pump is not automatic, but is programmed to deliver insulin constantly, at varying rates which you determine. This means that you no longer have to give yourself injections.”

INSULIN INHALERS

Insulin inhalers, like those used by asthmatics, have been proposed recently as a new method of getting insulin into the body’s bloodstream with as little pain as possible.

"It's sort of a device that opens up to have a clear tube at the top," the FDA's representative explains. "And the bottom, you put in an insulin packet that contains the powder, you cock the device almost the way you would a BB rifle, which forced air forces the insulin into an aerosol in this chamber that the patient then inhales from."

I was interested in this; so I asked my diabetes doctor, Dr. Mallik  for his thoughts. He said, “in theory, this is a great development: pain-free administration of insulin has been sought after for a while, and this may be the answer. However, there is a long way to go. It will be very difficult to inhale the correct dosage of insulin, and when you do there is no way of making sure it all gets to the bloodstream. Also, there is no long-term evidence that this works, and that other diseases, such as lung cancer, will not arise from inhaling insulin.”

HOWEVER! – MY CONCLUSIONS

I, and (possibly) you, are not alone in having diabetes. The number of people who have diabetes has grown rapidly in the last few decades. For example my cousin has just been diagnosed with Type 1 diabetes. She is currently adjusting her initial regime to 4 times a day. At the moment her mother (my Aunt) thinks that “although injections are necessary, it is hard to accept that she will have to do them for the rest of her life”.

I also know a few people who have been diagnosed with Diabetes since I was. Each one of them found it very difficult to get over the fact that this is a disease for life, that for those with Type 1 Diabetes they will have to inject themselves up to five times a day for the rest of their life. It is not like a cold which will eventually go away.

This leads me to make a very clear conclusion: it isn’t the actual treatment which is the real problem with diabetes, but the idea behind it. “The bark is worse than the bite” is an expression which I think diabetes can be related to, and I think that the perfect treatment will combat both the mental and physical elements.

Indeed, once you do get over the initial shock, diabetes becomes much more manageable. Quite often I get asked, “But surely the injections hurt? I could never inject myself so often!”. But that’s the point: you have to, and bit by bit the pain disappears. I don’t even need to make it less painful by inhaling it; why would I need to complicate matters? Future treatment won’t be for those like me already over that barrier, but for those who struggle to get over it.

FUTURE TREATMENTS

There seems to be articles on new, future treatments every day. So many, in fact, that sometimes I can even guess what their conclusion will be: that there is a long way to go to actually making it work in humans.

But, what if they did make some of them work in humans? If I had the chance, when I was first diagnosed, or even now, I might have taken some of these treatments. Not that I would be particularly different now, but it might have made the journey a little easier...

STEM CELL RESEARCH

In the 9th of February 2008 edition of “New Scientist”, there is an article entitled “If Stem cells cure diabetic mice...”, which I found to be very interesting.

Stem cells, more specifically, human Embryonic Stem Cells (hESCs) can develop into any cell of the body.

A team of scientists grew hESCs until they developed“The team differentiated into insulin-producing islet cells. They then injected these cells into mice who had non-functional islet cells (diabetic mice). “The transplanted cells produced insulin in response to a high-sugar meal. “The treatment worked for several months,” says the chief executive.”

The article went onto stating that “the cells need to be modified further before they can be transplanted into humans”, but this could potentially be the perfect cure for diabetes. Sufferers would not have to worry about injections, nor inhaling or any other methods of administrating insulin. Diabetics would become like non-diabetics, they would not have to worry if their islet cells were working.

The only thing holding back Stem Cell Research is the law. Following amendments to the Human Fertilisation and Embryology Act (1990) in 2000, based on the recommendations of the Donaldson Report, research is now taking place.

PANCREAS TRANSPLANTATIONS

Pancreas transplantations are a scale further out. They involve transplanting a complete pancreas from one human to another.

The operation is most often done in combination with kidney transplant in a patient who have diabetes and kidney failure as a result of their diabetes.

The risk is a makes me hesitate, and puts me off having the transplantation.

A CURE

Treatment can only go so far. What would really help is a cure. A cure which would definitely work to get rid of any stigmatism or disadvantages that diabetes comes with.

The Sun, on 28th Feb 2008, reported, “Scientists have cured diabetes in mice by giving them a cocktail of drugs, a medical report [has] revealed”. They do not give much specific information, and, while it is a good thing that The Sun is informing its readers of a potential cure, I think, that if Scientists were anywhere close to a cure, they would give a little more information. On the other hand, The Sun is not known to be a newspaper for medically orientated (or aware!) readers, so it should not be thought of as the standard.

This bridge between what scientists are discovering and how close it is to be commercially available is even more apparent in the New Scientist, more specifically the article on discussed in page 6. It is easy to tell that the New Scientist is supposed to be read by at least medically interested readers, and to that end, gives more specifics. We learn that the “cure” lasted “several months”; meaning that it is not a total fix, and there is a lot more research to be done.

I asked Doctor Mann, another doctor specialising in diabetes, about the cure. She said “there is certainly a long way to go for the cure to be made commercially available, but when it does, it will solve every diabetic’s worries and problems. It is the perfect cure, better than any other treatment in the works”. I am sure I am not alone in saying that I cannot wait for that day!

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OBESITY AND TYPE 2 DIABETES

Obesity has been rising, as Figure 11 shows, for the last decade, at least. Studies have shown that an increase in body fat is linked to glucose intolerance (type 2 diabetes) by suppressing the signals sent by insulin receptors (i.e. it is not telling the body it needs insulin).

Of course, obesity is not the only cause of type 2 diabetes, but it really is a main contributor. There will still be those who develop diabetes because they have a genetic predisposition to it, even if they are healthy and active. The obesity epidemic should not only be tackled because of diabetes, but because it contributes to many other diseases or disadvantages, such as the decrease in ability of the body’s immune system to recover from illness.

This leads me to make another conclusion: that half of the problem of diabetes is caused by society itself. Having medication to help diabetes is great for those who have diabetes, but everyone needs to make a conscious decision to become fitter and healthier. Only then will diabetes be less of a problem, it will become rarer and eventually much less expensive to maintain.

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REFERENCES

Books: -

Dr Ragnar Hanas’ Type 1 Diabetes

Newspapers / Magazines: -

The Sun

New Scientist

Websites: -

http://www.novonordisk.com/

http://preventdisease.com/news/articles/study_suggest_obesity_causes_diabetes.shtml

http://www.thesun.co.uk/sol/homepage/news/article855430.ece

http://www.lifespan.org/adam/surgeryandprocedures/13/100129.html

http://cambridge-transplant.org.uk/program/pancreas/pancreas.htm

http://www.newscientist.com/home.ns

http://www.npr.org/templates/story/story.php?storyId=5176120

http://www.Insulin-Pumpers.org

http://en.wikipedia.org/wiki/Type_1_diabetes_mellitus

http://adam.about.com/od/diabetes/Diabetes.htm

People: -

Dr Mallik

Dr Mann

Julie Richardson

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