The future of diabetes

What is the future for diabetes? Is there a cure? Will there be a cure soon?

There is no cure for diabetes at this time but with continual research and technology, things are only getting better and more hopeful for diabetes.

A device that has been out for some time is called a continuous glucose monitor(CGM).

The CGM is on the left and the insulin pump and insertion site is on the right. 

CGM measures glucose levels 24/7 via a tiny electrode called a glucose sensor. This sensor is inserted under the skin to measure glucose levels in tissue fluid. It is connected to a transmitter that sends the information via wireless radio frequency to a monitoring and display device. The device then lets you know if your glucose is reaching a high or low limit.

This does not replace finger sticks.  The device requires 3-4 finger sticks per day to calibrate the sensor.  This is an especially great tool for small children who have labile glucose readings or for people who don’t feel their highs and lows.

Bionic pancreas

Below is a video that talks a little bit about the bionic pancreas.  The bionic pancreas is a device that continuously measures the blood glucose in a diabetics body and then automatically delivers as much insulin or glucagon needed to keep the blood glucose in a normal range.

Pancreas transplants

Although pancreas transplants or islet cell transplant seem like the best option for curing diabetes, it is not so easy as it seems.

Although islet cell and pancreas transplants are possible, they are not the first line treatment for a few reasons:

·      There are not enough human islets

·      The medications needed to prevent rejection cause side effects

·      The rejection medications are costly and have to be taken for the rest of the person’s life.

·      Increased possibility of infections

·      Low white blood cell count

·      Increase in cancer risk

My cousin who was diagnosed with Type 1 Diabetes at a very young age received a pancreas transplant almost a year ago.  It was the first one performed at Univeristy of Utah.  The link to read about it is here: First ever pancreas transplant at U of U

Sources:

http://www.medtronicdiabetes.com/treatment-and-products/continuous-glucose-monitoring

Understanding Diabetes

Diabetes burnout

Diabetes burnout is something that happens when a diabetic stops managing their diabetes for either a period of time or in worst case, forever. 

Diabetes is a disease that requires constant monitoring and treatment so it is no wonder why burnout can happen.  Imagine pricking your finger 5-6 times a day and not putting anything in your mouth without  counting how many carbs it has and giving yourself a shot of insulin if necessary.  If there is one thing I learned when I went and worked at the diabetes camp, it was that young kids with diabetes grow up quickly.

Diabetes burnout is not the same thing as depression, it is something that takes place when a person is either unwilling to change or just tired of endless attention to diabetes care.

This can obviously be very dangerous as it increases risk for diabetes complications.

Joslin Diabetes gives two approaches to help prevent diabetes burnout.  These are things you can share with your diabetic patient:

1) Stay motivated, not “perfect”

            Often, diabetics feel that their blood glucose readings must be perfect and become frustrated if their readings are off.  Helping the patient understand that although, good blood glucose control is important, they do not have to be perfect.  This can relieve some stress that comes with a diabetic feeling they have to be perfect and eventually becoming burned out with caring for themselves.            

2) Identify barriers to good diabetes care:

            What is preventing the patient from taking good care of themselves? Are there obstacles that are causing them to stop caring for their diabetes? If so, have the patient make a list of these obstacles and being creating new options to face the obstacles.  For example, if the patient is finding difficulty making it to the gym, another option could be a workout on dvd in the home or buying a treadmill. 

What can also be a huge help is having a good support system.  Educating family and friends and letting them help motivate the patient is a good way to avoid burnout.  When the patient is educating their family and friends, they can be specific in how they would like the family or friend to support or help them manage their diabetes better.   

Diabetes complications

We are always teaching patient’s that having high blood glucose readings often is bad for them…but are we educating them on why? The long term effects of hyperglycemia can be detrimental to a diabetic. Below are some of the longterm effects:

Some facts about long term effects:

Long term complications do not occur in young children. In fact, the greatest risk for complications seem to start after puberty. *In young diabetics (under 5 years of age) the recommended BG is 80-200 and for ages 5-11, the recommended range for BG is 70-180*  This is because the young diabetic’s brain is still developing and a high BG is less detrimental at this age than hypoglycemia.

After puberty, the blood vessels usually stay normal in diabetics with good BG control.  In those that do not have good BG control, blood vessels may change.

Around the time of puberty, growth hormone, sex hormones and other hormones increase and cause BG levels to increase making it more difficult to manage BG levels.

Complications:

Eyes- Cataracts, retinal changes or retinopathy

Kidneys – kidney disease or diabetic nephropathy

Neuropathy(nerve damage)

Coronary and other blood vessel narrowing

Joint contractures

Birth defects(to babies born with diabetic mother)

Foot problems

This information was found in Understanding Diabetes

Diabetes medications

There are many diabetes pills on the market.  Below is a list of the different diabetes pills you might see your patients taking and what you need to know about them:

This information is provided by  Joslin Diabetes

Diabetes Pills	How to Take	How They Work	Side Effects	Of Note
Biguanides Metformin (Glucophage) Metformin liquid ( Riomet) Metformin extended release  (Glucophage XR, Fortamet, Glumetza)	Metformin:usually taken twice a day with breakfast and evening meal. Metformin extended release:usually taken once a day in the morning.	Decreases amount of glucose released from liver.	Bloating, gas, diarrhea, upset stomach, loss of appetite (usually within the first few weeks of starting). Take with food to minimize symptoms. Metformin is not likely to cause low blood glucose. In rare cases, lactic acidosis may occur in people with abnormal kidney or liver function.	Always tell healthcare providers that it may need to be stopped when you are having a dye study or surgical procedure.
Sulfonylureas Glimepiride (Amaryl) Glyburide  (Diabeta, Micronase) Glipizide (Glucotrol, Glucotrol XL) Micronized glyburide (Glynase)	Take with a meal once or twice a day.	Stimulates the pancreas to release more insulin, both right after a meal and then over several hours	Low blood glucose, occasional skin rash, irritability, upset stomach	Because these medicines can cause low blood glucose, always carry a source of carbohydrate with you. Follow your meal plan and activity program. Call your healthcare provider if your blood glucose levels are consistently low. If there is an increase in your activity level or reduction in your weight or calorie intake, the dose may need to be lowered.
Meglitinides Repaglinide (Prandin) D-Phenylalanine Derivatives Nateglinide (Starlix)	Both of these medications should be taken with meals. If you skip a meal, skip the dose.	Stimulate the pancreas to release more insulin right after a meal.	Effects diminish quickly and they must be taken with each meal; may cause low blood glucose.	These work quickly when taken with meals to reduce high blood glucose levels. However, they are less likely than sulfonylureas to cause low blood glucose.
Thiazolidinediones Pioglitazone (TZDs) Pioglitazone (Actos)	Usually taken once a day; take at the same time each day.	Makes the body more sensitive to the effects of insulin.	May cause side effects such as swelling (edema) or fluid retention. Do not cause low blood sugar when used alone. Increased risk of congestive heart failure in those at risk.	Increases the amount of glucose taken up by muscle cells and keeps the liver from overproducing glucose; may improve blood fat levels. Talk with your healthcare provider if you have the following symptoms: nausea, vomiting, fatigue, loss of appetite, shortness of breath, severe edema or dark urine.
DPP-4 Inhibitors Sitagliptin (Januvia) Saxagliptin (Onglyza) Linagliptin ( Tradjenta)	Take once a day at the same time each day.	Improves insulin level after a meal and lowers the amount of glucose made by your body.	Stomach discomfort, diarrhea, sore throat, stuffy nose, upper respiratory infection. Do not cause low blood glucose.	Can be taken alone or with metformin, a sulfonylurea or Actos. Tell your healthcare provider if you have any side effects that bother you or that don’t go away.
Alpha-glucosidase Inhibitors Acarbose (Precose) Miglitol (Glyset)	Take with first bite of the meal; if not eating, do not take.	Slows the absorption of carbohydrate into your bloodstream after eating.	Gas, diarrhea, upset stomach, abdominal pain	Take with meals, to limit the rise of blood glucose that can occur after meals; these do not cause low blood glucose. Side effects should go away after a few weeks. If not, call your healthcare provider.
Bile Acid Sequestrants Colesevelam (Welchol)	Take once or twice a day with a meal and liquid.	Works with other diabetes medications to lower blood glucose.	Constipation, nausea, diarrhea, gas, heartburn, headache (may interact with glyburide, levothyroxine and contraceptives)	Primary effect, when used either alone or with a statin, is to lower LDL cholesterol; has blood glucose-lowering effect when taken in combination with certain diabetes medications. Before taking this medication, tell your healthcare provider if you have high triglycerides (blood fats) or stomach problems. If you take thyroid medication or glyburide, take them 4 hours before taking Welchol. Tell your healthcare provider if you have side effects that bother you or that don’t go away.
Combination Pills Pioglitazone & metformin) (Actoplus Met)  Glyburide & metformin (Glucovance) Glipizide & metformin (Metaglip) Sitagliptin & metformin (Janumet) Saxagliptin & metformin (kombiglyze ) Repaglinide & metformin (Prandimet) Pioglitazone & glimepiride (Duetact)	Check with your provider; usually taken once a day.	Combines the actions of each pill used in the combination.	Side effects are the same as those of each pill used in the combination. Some combination pills may lead to low blood glucose levels if one of the medications contained in the combination has this effect.	May decrease the number of pills you need to take.