Guest Post by Dr. Mariela Glandt

When Dr. Mariela Glandt, an endocrinologist, volunteered to treat African refugees in Tel Aviv, she had no idea she would meet a type 1 diabetic like Samuel Agant, 28, from South Sudan. Below, Dr. Glandt shares Samuel’s story of living on the streets of Tel Aviv with type 1 diabetes, without a work permit, without food, and without a constant supply of insulin.

Samuel Agant, 28, was born in a small town called Rumbek in South Sudan. For his entire life, he has struggled to survive. He has faced devastation, destruction, and displacement caused by the Second Sudanese Civil War.

Samuel’s father was killed when Samuel was only five years old. His mother, three brothers, and sister had to flee to another side of the country. At that time, Samuel was left in the care of his maternal uncle, who was later killed himself. At 15, after a childhood spent in hiding, Samuel was totally alone. He headed to Khartoum, and then, with the help of a relative, sought refugee status in Egypt. Waiting in vain for resettlement in Egypt, he spent more than five years in Cairo, taking whatever cleaning jobs he could find.

“I got sick in Egypt in 2005,” Samuel said. “One day I felt immensely thirsty and I began drinking 7-Up. I couldn’t stop drinking. I then drank seven bottles of water throughout the night, and urinated constantly. My lips and my heart felt dry. I was weak. I went to the Catholic Church. They had a doctor there and he immediately told me he thinks I have diabetes. They gave me medicine at the church. I had no idea what diabetes was, so I went to a cyber-cafe and looked it up in Google. I felt down. This was really bad. When you get diabetes at a young age it is bad. Until then I was so young and strong. I played sports. I didn’t know why this happened to me. I don’t know of anyone in my family who had diabetes. I thought that maybe it happened because I left my country.”

In Egypt, Samuel struggled to take care of his diabetes. In the aftermath of what is known as the “Mustafa Mahmoud Massacre” – the violent Egyptian police raid of a refugee protest camp – Samuel and a group of Sudanese friends fled violence once again. Samuel had heard that diabetes could be cured in Israel. He and his friends paid of Bedouin smugglers to take them across the Sinai desert to Israel. Hidden in a vehicle under piles of blankets, they reached the Israeli border in 2007.

Samuel and his friends were arrested at the Israeli border and imprisoned for nine months. Upon his arrival in Israel, Samuel had been without insulin for several days. He went into DKA and was hospitalized. Prison was tough, but ironically, also good for Samuel. In prison he received ongoing medical care, ate three meals a day, and felt strong enough to exercise. It was the first time he had felt well in years. “They didn’t put handcuffs on me like they did on my friends because they knew I was diabetic. They knew I had no interest to run or escape,” he said with a laugh.

According to Samuel, he and his friends were released from prison following UN intervention. He received insulin from the clinic of Physicians for Human Rights when it was available. He lived with friends in various places in Israel and worked when work was available and whenever he felt strong enough to do so. He has been hospitalized at least five times in Israel due to severe cases of DKA. “If I don’t find insulin for two days, I get really sick,” Samuel said.

In the past weeks, the Israeli government has deported hundreds of South Sudanese refugees back to the now independent South Sudan. Samuel, however, could not be deported due to UN intervention: Having no chance of finding an ongoing supply of insulin in South Sudan, going back means a death sentence. Thus protected by the UN, Samuel stayed in Tel Aviv while most of his friends were deported.

Paradoxically, however, while in Tel Aviv Samuel does indeed have a chance for getting insulin, he has no money, and he has no ongoing supply of food or shelter. In the past, he had his South Sudanese friends to rely on for help. As refugees, these friends stuck together. They were a family. “We collected our hands together to defend our lives,” he said. Left behind in Tel-Aviv with nothing, and having had his work permit revoked by the Israeli government, Samuel is at his lowest point yet. For the most part he manages to find about a dollar’s worth of food a day – usually an apple and a container of yogurt (two or three hundred calories feeding his 6-foot plus frame). Even if he could legally work, he is far too weak to do so. He has no permanent housing, and is currently sleeping in a room with several other men.

Samuel is a tall and impressive man. He is also extremely thin and visibly suffers from malnutrition. Fluent in English, he talks of his life with acceptance and serenity, as well as with hopefulness. “I want to study and find work,” he says. “I want to stay here and receive medicine and be treated.”

At the end of my meeting with him in Levinsky Park – the center of the refugee quarter in Tel Aviv – it was Samuel who reassuringly said: “Everything is going to be okay.” I was visibly worried. I had brought some food with me, and made sure he had enough insulin for the upcoming days. I gave him instructions about dosages and food types. Samuel said, “No one can ever know what will happen tomorrow. The poor, the rich – we are all the same. We all live our lives without knowing what can happen tomorrow. We all die in the end. It’s the same for everyone.”

“True,” I told him. “But I promise to do everything I can to try to help you. No one is going to die here any time soon.”

Dr. Glandt has volunteered to follow Samuel’s medical care. With our donations, she will see that he has access to enough food to regain his strength, and hopefully much more than that. One of the things our community does best is making sure no one feels alone. Let’s help Samuel learn that diabetes is not a death sentence, and that he is not alone.

Even tiny amounts of money are significant to Samuel. Please help! You can donate here.

Dr. Galit Ailon contributed to this article.

Dr. Mariela Glandt is a practicing endocrinologist. She is the head of the Diabetes Medical Center in Tel Aviv and also works at Bronx Lebanon Hospital in New York. She is the medical director of ASweetLife.

The post Diabetic Refugee from South Sudan Finds His Way to Israel appeared first on The Faster Times.

My mother was diagnosed with Multiple Sclerosis (MS) when I was five-years-old. At the time, there were no effective treatments for the disease. My mother tried every medication doctors prescribed, an experimental surgery, and even non-conventional therapies. Everything failed. I tried to help her too, using the tools I had as a child – hope, prayers, and my imagination. I imagined ways to make her better. And I hoped and prayed with all of my might that she would stop seeing two of everything, that she would stop shaking, and that she would be able to walk and talk again. MS is an autoimmune disease, and the concept of autoimmunity was incomprehensible to me. Why would a body do that to itself? Why can’t we make it stop?

My mother’s case, unlike a lot of cases of MS, had almost no remissions. Her condition worsened until her death in 1989. Less than two years after she died, I met Mike, the man who would become my husband. With Mike I began to build a new life, a good life. My obsessive thinking about autoimmunity moved to the background of my mind until Mike started to lose weight and was always thirsty.

Six months later, twenty pounds lighter, with blurred vision and numb feet, Mike was diagnosed with type 1 diabetes, an autoimmune disease which destroys the body’s insulin producing beta cells. We hardly knew what that meant, but we did know a diabetes cure was nowhere in sight. Thankfully, unlike my mother’s MS, diabetes was treatable. In fact, Mike’s doctor told him that there was a drug in clinical trials that might be able to stop the progression of diabetes. Stop the progression. Though not in the same context, I’d been waiting to hear those words for most of my life. They sounded too good to be true and they filled me with hope. We asked no questions. Mike underwent a number of tests after which he was accepted into the clinical trial for a drug known as Diapep277.

Diapep277 was discovered in 1990 by Professor Irun Cohen and his team at the Weizmann Institute’s Department of Immunology. They were studying the mechanism by which the immune system attacks and destroys the insulin producing beta cells in the pancreas. In mouse studies they discovered that heat shock protein 60 (HSP60) was involved in the attack. HSP60 is a ubiquitous protein, part of a highly conserved family of intracellular chaperones, but with a special location in insulin-secretory granules of beta cells. HSP60, Cohen found, works like an antigen, that is, it triggers the T-cells in the immune system to attack. Cohen’s team also found that a small peptide fragment of HSP60, p277, works as a signal to the immune system to stop the immune attack on the beta cells, thereby preventing the progression of diabetes. Cohen and his team were led to p277, he told me, by studying the responses of T-cells and antibodies to HSP60 in mice that spontaneously develop a form of type 1 diabetes.

When Mike enrolled in the Phase II trail of Diapep277, he was told it was a potential diabetes vaccine. This notion of vaccine was somewhat confusing. Mike, after all, had type 1 diabetes. Diapep277 wasn’t going to prevent it like the chicken pox vaccine prevents chicken pox. But the notion of a vaccine is more complex than that. “The immune system, like the brain, learns from experience,” said Cohen. “A vaccine is a signal or set of signals that teaches the immune system how to respond to a particular situation. We could call Diapep a ‘therapeutic vaccine’ – probably it would be clearer to call it a specific modulator of the immune system – a signal that helps the immune system to make desirable decisions in how it should relate to the body.”

Mike’s Diapep277 trial took place in 2002-2003. The study coordinator told him the participants were divided into three groups – high dose recipients, low dose recipients, and a placebo group. Then, Mike did not know which group he was in. He now knows he did receive Diapep277. Throughout the study, doctors monitored Mike closely. They were checking for residual beta cell function by a measurement of C-peptide (C-peptide is a protein produced along with insulin, and its presence in the body is a sign of insulin secretion, or beta cell function.) In order to measure beta cell function, Mike was given glucagon injections and then blood was drawn to learn his body’s response to the glucagon. The study also measured his HbA1c. “What was most surprising was the lack of side effects,” says Dr. Mariela Glandt who led a follow-up trial to Mike’s under Prof. Itamar Raz at Hadassah Hosptial in Jerusalem. “Patients had no complaints.”

Phase II results were promising and a combined analysis of all the adult phase II studies revealed that DiaPep277 significantly inhibits the decline in stimulated C-peptide secretion, thus preserving endogenous insulin secretion, or in simple terms, it slows the progression of type 1 diabetes.

In 2007, Andromeda Biotech Ltd., a then newly formed wholly owned subsidiary of Clal Biotechnology Industries, purchased the Diapep277 program. Two years later, Teva Pharmaceutical took an equity position in Andromeda. Teva licensed worldwide rights to DiaPep277 from Andromeda Biotech and invested $170 million in the company last year to fund a clinical trial to confirm earlier results for DiaPep277. (Coincidentally, for me, Teva’s longtime blockbuster drug has been Copaxone, for the treamtment of MS.)

In November 2011, Andromeda Biotech announced Phase III study results equally, if not more promising, than the Phase II results. The new results from patients who were treated with DiaPep277 showed that the study has met its primary endpoint- significant preservation of C-peptide levels demonstrated in patients treated with DiaPep277 compared to the placebo arm.

The study also achieved a key secondary endpoint, showing that a greater proportion of DiaPep277 treated patients maintained good metabolic control compared to the placebo, measured by HbA1c levels equal or less than 7% at the end of the study. “The results I have seen thus far are better than I expected,” said Cohen. “Large clinical trials have so many confounding variables that even treatments that are effective can fail to reach statistical significance. In this case, all the declared endpoints seem to have been achieved.”

For scientists and researchers involved in a clinical trial, achieving declared endpoints is indeed a success. The patient, however, doesn’t necessarily measure success in the same way. Mike wears an insulin pump, checks his blood sugar ten times a day, and battles both episodes of hyper and hypoglycemia. “I ate rice last night and woke up with a blood sugar of 200, despite taking insulin,” Mike said. “This morning I went out for a one-hour run and my blood sugar stayed at 190 the entire time.”

If Diapep277 did anything to slow down the progression of Mike’s diabetes, it was never noticeable. If it will help in the long-term, we don’t know. Over the years, Mike’s study hasn’t followed him. And we wonder how long the effects of the Diapep277 injections lasted. I asked Cohen about this. “The effect seems to need boosting every three months or so,” he said.

Also interesting to note is that a 2007 study showed that in children, treatment with Diapep277 “appears to have no beneficial effect in preserving beta-cell function or improving metabolic control.” Cohen said a more thorough analysis of the data indicates that there is a positive response in the children who do not carry the most decisive susceptibility genes. “Apparently, the disease progresses too quickly for Diapep to help in the children who have a more intense, accelerated course of beta cell destruction. I would like to believe that the solution will be to detect and treat persons early in the course of the autoimmune reaction, before the loss of beta cells become irreversible.”

The key, then, if Diapep277′s continuing trials prove successful, will be to identify the right people and treat them at the right time- as early in the disease process as possible. But the development of screening tests is a complicated and expensive process. “I’d been sick for more than six months when I was diagnosed with diabetes,” Mike says. My fasting blood sugar was over 400. My HbA1c was 15.7%. Maybe I was too far gone to be helped by Diapep. Maybe if I’d received the injections as soon as I started to feel thirsty, there would have been a noticeable difference.”

The post Diapep277: A Landmark Discovery in Diabetes Treatment appeared first on The Faster Times.

I’m mildly agoraphobic and it’s not easy for me to plan long trips. And while I like looking at travel guides for places like Ecuador or Tanzania and imagining what it would be like to go there, I know that I’m not brave enough to go through with the trip. So what inevitably happens when I read these sort of guides is that I end up with a feeling of slight longing for adventure, and a strong feeling of regret. But now – finally- Catherine Price has written the perfect travel book for me- 101 Places Not To See Before You Die. It’s a book where i can read all about traveling adventures I don’t want to have – a travel guide that is highly enjoyable, but doesn’t make me feel like I’m missing out.

Catherine came up with the idea for 101 Places in response to all the other list-based books currently on the market. As someone unable to turn down an assignment, she felt inundated by the thousand albums she was supposed to listen to, the thousand gardens she was supposed to visit and the thousand beers she was supposed to try. So she created 101 Places Not To See Before You Die as a reprieve — a “get-off-the hook” guide to places you don’t need to feel bad about missing. Though Catherine is highlighting some of the worst places on earth, she is at the same time emphasizing that sometimes the best experiences when you’re traveling are not the ones on the beaten path. And she believes people shouldn’t be afraid to go out and have their own adventures – whether they’re good or bad, they’ll likely be more memorable. An avid traveler, Catherine, who is a type 1 diabetic, is currently on the road with her husband Peter, about to head off for a biking trip through Eastern Europe. I caught up with her while she was in a place that’s tough to visit if you have diabetes: Paris.

You’re traveling now. Will you be heading to any of the places in your book?

Yes, there are definitely places in the book that friends suggested but that I haven’t gotten a chance to check out firsthand. I’m a sucker for unusual and weird attractions – I just dragged my husband on the Paris sewer tour. So I’m looking forward to checking out the Beijing Museum of Tap Water.

How did you compile the book? What was the process like?

I compiled the book by combing through my own travel memories, picking out stories that were unpleasant in the moment but funny afterwards (like getting my period for the first time on a 23-hour train ride in China, where the bathrooms were so gross my mother told me to pee in a zip-loc bag). I also got lots of suggestions from friends and family members, and reached out to authors I admired, like Michael Pollan and Nick Kristof, to see if they might add their own contributions to the list.

Were there any challenges? How did you chose the places that you featured? Are there any of the 101 places you really wouldn’t visit under any circumstances?

The main challenge was finding places that struck the line between so-awful-I-don’t-even-want-to-write-about-them and awful-but-also-kind-of-funny. As for places I wouldn’t visit under any circumstances? Well, there are a lot of places in the book that you actually couldn’t go to, even if you wanted to – like Io, Jupiter’s Worst Moon, or the bottom of the Kola Superdeep Borehole. But personally, I’d probably skip most superfund sites, and things that involve any sort of violence or cruelty, like Pamplona from the perspective of a bull. I’d rather go to the tap water muesum.In 101 Places you write about your travels, but you don’t mention that you have type 1 diabetes, a disease which requires constant care and monitoring.

How do you manage to stay on top of diabetes on the road?

Staying on top of diabetes while traveling is a constant challenge. As everyone with type 1 knows, it’s very helpful to have a relatively consistent diet and schedule – both of which go out the window when you’re traveling. Also, I find that living with diabetes requires a lot of logistics in my head – and when I’m having to deal with other logistics, like finding a place to stay for the night, it’s difficult to do everything well.Right now I’m in an apartment for a few weeks, so I’m trying to cope by boiling a lot of eggs. But frankly, my blood sugars have not been as good as they are at home, and it’s been very frustrating to experience a food-loving place like Paris as someone who has to watch carbs. (I was diagnosed with type 1 when I was 22, so I have plenty of travel memories from before I was diabetic.) There are just so many croissants and baguettes. I also haven’t had a regular exercise schedule, which means that some days I’ve coped with extreme highs, and some days, I’ve had scary lows. But I’m making this sound too depressing. Despite the challenges of traveling with type 1, this experience is completely worth it. And maybe the fact that I have to watch my croissant consumption means that I’ll avoid another pitfall of traveling in Paris: gaining weight.

How do you carry all of your supplies?

I have two bags with me: an Osprey Meridian pack, which is a fantastic roller-backpack with a detachable daypack (which has a lot of pockets, making it great for daily supplies). And I also have a regular backpack with me that’s stuffed with six months’ worth of supplies – pump infusion sets, backup syringes, insulin, alcohol swabs, test strips, CGM supplies, batteries – viewed from the side, it’s a little absurd.It takes a lot of courage to travel with diabetes – you have to be ready for unknowns all of the time.

Do you worry about being in places where you don’t know what to expect at your next meal, or if you needed urgent care it might not be available?

I think that the key to traveling with diabetes is to think ahead. You have to know where you’re going, and have a sense of what supplies and services will be available. But at the same time, you need to be self-sufficient enough to survive if those supplies and services are *not* available. I have several backup glucometers, a ton of extra batteries, a travel loaner insulin pump, syringes and long-acting insulin in case both pumps fail . . . I mean, I tried to cover my ass and then some. I thought that it might be overkill (and I suppose it still might be!) but the other day I went into a Parisian pharmacy looking for some extra glucose tablets (you know, like basic four-grams-a-tablet orange coins that are available in any drugstore in the US) and the pharmacist had no idea what I was talking about – even when I showed her the empty package and explained what it was. You just never know what you will or won’t find – so be sure to be prepared. (And also, I find that being prepared makes the idea of traveling less scary – you can still be in control. It just takes extra work.)

Does traveling have an influence on your blood sugar levels?

Definitely. Both good and bad. I’m still working on figuring out a good strategy for eating while on the road (part of the difficulty is that eating is pretty much my favorite part of traveling – and I’m not willing to give up that part of the experience.) But on the good side, spending much of the day walking – as opposed to sitting at my desk – really helps with insulin absorption.

Do you expect your Hemoglobin A1c to be better or worse after your trip?

I’m going to say worse. But hey, maybe I’ll be pleasantly surprised – I am, after all, about to spend three or four weeks biking, which tends to do great things for my blood sugar. But I’m trying to keep in mind the advice of a fellow traveling diabetic, Bridget McNulty. She wrote a comment to one of my recent blog posts that said “Be careful enough to not do yourself any damage, but not so careful that you miss out on the adventure.” I think that’s really sage advice.

101 Places Not To See Before You Die is available on Amazon.

Twitter handle: 101worstplaces Facebook Fan Page: http://www.facebook.com/pages/101-Places-Not-To-See-Before-You-Die/102647109497 Book website: 101worstplaces.com

Cross-posted on ASweetLife

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More than 50,000 Greeks with diabetes use Novo Nordisk’s insulin pen products.

Cross-posted on ASweetLife.

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I do make an effort to keep my sons away from processed foods, soda, and junk food in general. I’m far from a tyrant about it, though.  And whenever they (or I) eat junk, I wish we weren’t eating it. But it’s everywhere, and sometimes -no matter how strong your will – it’s unavoidable.  So the question is, what will deter us from eating garbage food?  What can I do to keep my sons from wanting the food products that increase their risk for obesity and/or type 2 diabetes?

I touched on this subject in a post about whether Ronald McDonald should be forced into retirement.  And I’ve written before about why I’m not a fan of soda tax.  I think that America’s obesity (and diabetes) problem runs so deep that pointing a finger here or there isn’t going to solve anything. Soda is junk, but so is sugary cereal.  So are a thousand other products.  I don’t see small tax increases in these products, like 12 cents on a can of soda, as a real solution.  When it comes to a cigarette tax, however, I find myself feeling differently.

Recently I’ve been reading about Australia’s 25% tax increase on cigarettes.  This tax hike raised the price of cigarettes by $2 a box, which is enough, I believe to curb some cigarette purchases.  And moreover, as of July 1, 2012, cigarette packs in Australia will have no logos, color or font variation.  Each pack will bear the brand name and a graphic photo depicting the gruesome consequences of smoking like images of fat oozing out of blocked aortas, or rotting gums, or cancerous lungs.

Reading about this made me think that plain packaging laws might be a real solution for the obesity and type 2 diabetes epidemic in America.  Think of those DHARMA Initiative food containers on Lost.  If you weren’t stranded on an island, would you eat what’s in them?  No!  You’d never pay attention to them on a supermarket shelf.   If you had a choice, you’d choose the colorful, cheerful food boxes – the ones with pictures of attractive people, attractive food, or words like healthy and delicious written on them (even if they aren’t).  I’d do the same.

Of course, there are a million drawbacks to the idea of plain packaging laws.  I’m not about to raise a case for it here.  But I do think that it’s something that really could make an impact.  Imagine a plain white box with words Nabisco Chocolate Chip Cookies written on it in black print, and nothing more.  Not so exciting, right?  But wait… happens if you see a box labeled Swedish Fish.  Is there chewy candy or herring inside?

If we think about the Australian model of using gruesome photos on cigarette boxes, I say -in the case of junk food – that’s going way too far.  I think the shock effect wears off pretty quickly and we’d all stop noticing the ugly photo.  Or worse, it could have a Pavlovian effect.  Every time our kids saw a picture of diseased tissue, they might start to drool for candy.

Cross-posted on ASweetLife

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What I quickly learned was that no matter how much information you have and no matter how close you’ve been to a diabetic, you don’t really know diabetes until it’s in your blood. And so while I still maintain to know an inordinate amount of information about my pancreas, I don’t claim to know it all. Not even close. In fact, new research on the defunct organ poking from beneath my stomach like a hitchhiker’s thumb indicates pancreatic cells are capable of something I’d never imagined – regeneration. A study , conducted at the University of Geneva and co-funded by the Juvenile Diabetes Research Foundation , has found that alpha cells in the pancreas, the cells which secrete the hormone glucagon, can regenerate themselves into insulin-producing beta cells after normal beta cells have been destroyed. The study is the first to show that this change of alpha cell into beta cell can happen naturally and spontaneously.

The researchers, led by Dr. Pedro L. Herrera, discovered that when they destroyed beta cells in mice to induce an artificial form of type 1 diabetes, the alpha cells in the pancreas then changed into insulin-producers. They found that when nearly all of the beta cells had been destroyed, if mice were given insulin therapy to keep them alive, the alpha cells spontaneously changed into functioning beta cells. After enough alpha cells converted into beta cells, insulin therapy was no longer needed. The Geneva researchers pointed out that the critical factor in sparking the alpha-to- beta-cell reprogramming was removing (or ablating) nearly all the original insulin-producing cells in the mice. In mice where the loss of beta cells was more modest, the researchers either found no evidence of beta cell regeneration (when only half the cells were destroyed) or less alpha cell reprogramming (when less than 95% of cells were destroyed).

While I’m aware that this is research in its infancy and far from a cure, reading about a study which includes the words “insulin therapy no longer needed” brings to mind Moses seeing the Promised Land. The catch, however, is that type 1 diabetes is an autoimmune disease in which the body kills off its own beta cells, and chances are that the immune system would destroy any newly regenerated beta cells, just as it destroyed the original cells. Nonetheless, the research is promising and this study is another step forward for JDRF’s research focus on Regeneration as a potential pathway to restore insulin production – and normal blood sugar in people with type 1 diabetes. I had the opportunity to send some questions to Dr. Andrew Rakeman, JDRF Program Manager in Beta Cell Therapies, to learn more about the study.

Is this the first time alpha cells are being considered as a potential source of cells for beta cell treatment in diabetics?

It has been previously shown that alpha cells can be converted into beta cells, but this work relied on genetic manipulations – forcing expression of a key beta cell transcription factor, Pax4, in alpha cells. What is new in Dr. Herrera’s work is the demonstration that the ability of alpha cells to convert to beta cells appears to be intrinsic and can occur without genetic manipulation of the cells. We know a bit about some of the transcriptional changes that accompany the conversion of alpha cells to beta cells, but we still do not know the signals that trigger those changes. One of the current challenges is to identify the signals and pathways that are triggering the reprogramming of alpha cells to beta cells and ways to manipulate those pathways.

Are efforts being made to convert alpha cells to beta cells in vitro to see if we can increase the supply of beta cells for transplantation?

The first likely application for any beta cell reprogramming effort would be in vitro reprogramming for transplantation. However, when considering alpha cells as a starting cell it is important to remember that beta cells outnumber alpha cells in human islets. Therefore even a perfect conversion of all alpha cells would only give a modest increase in the number of beta cells available for transplant.

Many different studies have shown that we can make insulin producing cells. Do you believe that this is different and if so, how?

Being a beta cell is more than just producing insulin. Beta cells must be able to continuously sense the level of glucose and secrete insulin appropriately in response to the body’s needs. What is exciting about these results is the demonstration that the body can spontaneously make new beta cells from pre-existing alpha cells and that these new beta cells are functional and able to control glucose levels. The demonstration that the conversion of alpha cells to beta cells is a spontaneous and normal process raises hope that we can identify therapeutic interventions that will mimic this process to safely and efficiently reprogram alpha cells to beta cells for the treatment of diabetes.

There is research that shows the cells that line the ducts of the pancreas can convert to beta cells. Do you think these findings contradict or support the idea that beta cells might come from ducts?

These findings don’t rule out a ductal or duct-associated beta cell progenitor. One of the emerging themes coming from this work and other work is that the pancreas is more plastic than we previously appreciated – there appear to be multiple mechanisms and sources for beta cell regeneration.

Do you think these findings will significantly change the focus of research on the search for the beta cell stem cell?

JDRF maintains an active interest in identifying and characterizing an adult beta cell stem cell and will continue to support research in this regard. These and other recent results have increased our interest and support of research aimed at reprogramming of non-beta cells to beta cells. Reprogramming is emerging as a new priority area and growing part of our portfolio.

Do you dream about a clinical application for this?

At JDRF we are hopeful that reprogramming will one day become a clinical reality. However, it is important to remember that we are at very early stages – we still need to gain better insights into the pathways and triggers that tell alpha cells to convert to beta cells and develop strategies and approaches to manipulate those pathways.

Cross posted on ASweetLife

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But instead, I’m terrified.

I spent the morning before the bill’s passage as a guest speaker at a pediatric diabetes symposium put on by the Diabetes Center at the University of California San Francisco, one of the country’s top centers for diabetes research and care. I heard firsthand reports from doctors and researchers about some of the advances – both medical and technological – coming down the pipe for people with Type 1 diabetes, and felt myself becoming excited about new advances that might help reduce the burden of living with this disease. As I listened, I periodically checked the numbers on my continuous glucometer, a small, cutting-edge device that allows me to see my blood glucose levels in near-real time. I was particularly concerned because I had taken a shot of a medication called Symlin, a synthetic version of a hormone called amylin that helps reduce spikes in your blood sugar levels after meals. It, too, has only recently become available – and is not yet widely used.

Now, I am no fan of insurance companies. I had already spent three hours that week on the phone with Blue Shield. But despite the endless hassles, I am grateful for the end result: I have the most cutting-edge diabetes gear available in the world.

So here’s my fear with the healthcare package that just passed. Supposedly, this will require all Americans to hold health insurance – and millions of healthy people, like my husband, will subsidize the millions of expensive people, like me, whom insurance companies will no longer be allowed to exclude. On the surface, that is great. Far too many Americans with Type 1 and Type 2 diabetes don’t have adequate access to care. As a self-employed person myself, I know how difficult access to insurance can be.

The problem, though, is that people like me – the “sick” ones — are going to be flocking to insurance companies’ doors. People who are young and healthy are not. I don’t trust the idea of the universal mandate – partially because there are already lawsuits that challenge its constitutionality, and partially because actually enforcing it will require keeping an up-to-date record of the insurance policies of every person in America. That seems like a bureaucratic nightmare – and one that would be very easy to cheat. What’s more, with penalties that start at only $695 per year (and top out at $2,250 per family in 2016), the price of not holding health insurance is far less than the cost of many policies. For healthy workers, choosing to pay the penalty might actually save them money.

The result will be, one way or another, that insurance companies are going to end up with a hell of a lot more expensive people like me to cover. They’re going to have to say yes to us. That is going to cost money. To prevent damage to their bottom lines, they are going to have two major options: raise premiums (likely, if politically unpopular) and/or reduce the number of products and medications that are covered. And that’s going to have a negative effect on access to – and development of – new medications and technologies.

Think about it: is the continuous glucometer lobby large enough to prevent Blue Shield from deciding not to cover them? And what about Symlin, which has an enormously positive effect on smoothing out my blood sugar after meals – but isn’t necessary to keep me alive? Wouldn’t that be easy fat to trim? And once that starts happening, why would researchers and pharmaceutical companies put resources into developing products that have a limited audience and are unlikely to be paid for by insurance?

You see where I’m going with this.

For the moment, it’s easy to argue that there are a lot more people whose diabetes care is going to improve as a result of this bill than there are people like me, the fortunate elite who already have access to top-of-the line products. But it wasn’t that long ago when insulin pumps themselves were a rarity – as were electronic glucometers before them. New technologies start with “early adopters,” and eventually, thanks in part to the positive reaction (and insistence) from the first people who use them, they become widely available. With no profit motive – or guarantee of insurance coverage for their products — there is less of an incentive for companies to develop or offer new technologies. That’s part of the reason why insulin pumps, common in America since the 1990s, are often unavailable in Great Britain.

I want to be excited about this weekend’s bill, but instead, I am worried. No one likes to think of themselves as part of an insurance company’s bottom line, or as a potential profit for “big pharma.” But unless there’s revenue to be gained from new developments – and insurance companies are willing to cover their cost – the “cutting edge” of diabetes care is going to become increasingly dull.

Cross posted at A Sweet Life. Read about insulin pumps, glucometers, and more at asweetlife.org.

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Now, a new study published online in the Proceedings of the National Academy of Sciences suggests leptin may be making a comeback. Researchers at the University of Texas Southwestern Medical Center conducted a Phase 1 study in mice which showed that leptin can take the place of insulin in treating the symptoms of Type 1 diabetes. The scientists administered leptin instead of insulin to diabetic mice and found the therapy was successful at managing blood-sugar levels. While it is far too early to know whether leptin therapy will work in humans, the results of this study imply that leptin administration may have multiple short- and long-term advantages over insulin monotherapy for type 1 diabetes.

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Indeed it might, but taxing soda alone will not promote good health. Like so many others, Bloomberg is using health as the easiest disguise for raising revenue. A soda tax is a deceptive, easy fix – the last thing we should be seeking now. Instead of an easy fix, Bloomberg and other policy makers should seek a long-term sustainable program that educates people about nutrition. If giving up soda is going to save lives, then let’s do it for real. How about making it illegal for anyone under 21 to buy soda? Instead of having teenagers loiter around store fronts trying to get someone to buy them a few beers, let’s have them out there trying to score a can of Coke. And what would happen if McDonald’s couldn’t serve soda to children?

Pepsi and Coca-Cola recently announced they would improve nutritional labeling on their products. If soda is killing us, then let’s not kid ourselves and think that a more visible nutritional label is going to make a difference. We need to go for the skull and crossbones. No one is going to pay attention to anything less than that. You know why? Because no one knows anything about nutritional labels. No one knows that carbohydrates and sugar are the same thing. The people who drink six cans of soda a day have no idea what 28 grams of sugar per can means. They don’t know this because lawmakers are looking for a quick fixes instead of going through the long and difficult process of educating people.

I’m not a Coke or Pepsi advocate. I think they’re selling crap, and I think they know they’re selling crap. But why are we picking on them? Why not tax all food that is crap, including breakfast cereals like this one?

(Apparently regular Froot Loops weren’t sweet enough for Americans, so Kellogg’s kindly created a marshmallow version.) Or how about this – instead of singling out only one of the causes of obesity, why not make it difficult and expensive to sell all sugared products? Why not treat all sugars equally, as we treat all cigarette brands equally? Perhaps we can institute laws that require supermarkets to make a junk food section, with a tollbooth at its entrance and charge $5 per person to enter. Such a draconian and expensive measure might really lead to real reduction in the consumption of all junk food.

America’s obesity (and diabetes) problem runs so deep that pointing a finger here or there isn’t going to solve anything. Soda is junk, but it’s merely the junk at the top of the pile.

Cross-posted on ASweetLife.

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Apparently, the second annual Krispy Kreme Challenge has just taken place. What is the Krispy Kreme Challenge? It’s a diabetes event centered around doughnuts. No, that doesn’t mean a bunch of people got together ate doughnuts and tried to bring on type 2 diabetes. Surprisingly, it was an event which took place in order to raise money for JDRF. Krispy Kreme Challenge participants ran a mile or so, ate up to a dozen doughnuts, and then ran back. I asked my husband, a serious runner who knows as much as anyone about balancing blood sugar levels, insulin, and exercise, what he thought would happen to him if he ran a mile ate a dozen doughnuts and then ran another mile. “I think I would die,” he said.

On that note, let’s stop for a moment and look at this chart which includes nutritional data for Krispy Kreme glazed doughnuts.

Nutritional Facts

*Percent Daily Values (DV) are based on a 2,000 calorie diet. Your daily values may be higher or lower depending on your calorie needs.

**source: Krispy Kreme

Yes, you did read that correctly – 12 glazed doughnuts contain 2,400 calories, 264 grams of carb, and 144 grams of fat.

Now factor in this:

According to FitSugar, “Syracuse University did a study that involved 12 men and 12 women. Their caloric burn was measured when both walking (19:00 minute miles) and running (9:30 minute miles), for a distance of 1,600 meters (about a mile). The men burned an average of 105 calories while running, and just 52 while walking; the women burned 91 calories while running and 43 walking.”

In summary: A man who completed the Krispy Kreme Challenge consumed 2,400 calories. If he ran the course, he burned 210 of them. If he walked, he burned 104 calories. (And eek – 264 grams of carb in 12 doughnuts! How much do you bolus to cover that?)

Annette Peery, organizer of the Krispy Kreme Challenge knows that some of us might be raising our eyebrows at her event. Her comment to Eye Witness News 9, “A lot of people are saying, ’why would you be running and eating donuts for diabetes.’ She explains that type 1 diabetes is not related to obesity and physical inactivity, but rather, it’s an autoimmune disorder. Dear Ms. Perry, type 1 diabetes might not be caused by obesity, but eating foods like doughnuts which are high in sugar, fat, and carbohydrates, are poison for all people, and especially for type 1 diabetics who are trying to avoid complications of diabetes by controlling their blood sugar and cholesterol.

It’s true, type 1 diabetics *can* eat sugar, so long as they can cover themselves with the proper amount of insulin. But that’s not an easy thing to do. And while almost all type 1 diabetics do sometimes eat sweets, I believe it is important to acknowledge that these foods are not good for us. We have to avoid falling into the “equality” argument which goes something like… I might have diabetes, but that doesn’t mean I can’t eat just like everyone else. As diabetics, we aren’t equal. This isn’t a matter of gender or race. This is about survival with a very serious, chronic illness. No diabetic of any type should be encouraged to eat doughnuts, no matter how good the cause.

Finding a cure for diabetes is no simple thing. But keeping diabetic complications to a minimum is possible for those of us who manage –overall- to keep our blood sugar levels in the target range. My husband and I work hard to do this. And the way we succeed is by avoiding foods high in sugar and carbohydrates. The formula is pretty simple: the less sugar you eat, the less insulin you need to process it.

Meanwhile, I’m inspired. The Krispy Kreme challenge has led me to think of other fund raising ideas. Tomorrow morning I think I’ll approach Phillip Morris and suggest they sponsor the Marlboro Challenge to raise funds for cancer research. Participants will run a mile, smoke a dozen cigarettes, and then run back. Double the money for anyone who completes the course without coughing.

Cross-posted on ASweetLife

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