The “artificial pancreas” is making headlines in diabetic communities. People are claiming that it will all but eliminate diabetes from our existence. The JDRF campaign says it will be like becoming a “bionic” diabetic and many groups are hoping it will give more freedom to people living with diabetes.
But what is an “artificial pancreas”? And where do you get one?
The short answer is that the artificial pancreas is a combination of devices and technologies designed to automatically deliver insulin as needed using an insulin pump and a continuous glucose monitor. No surgeries. No extra drugs. As for availability, the US is running far behind other countries and you are most likely to see this system develop in Europe well before the United States at our current rate.
Thursday, November 10, 2011
Tuesday, October 11, 2011
Define Normal
 |
| Italian book of monsters from 1618. |
I can’t say how other people felt when they were diagnosed with Type I Diabetes, but for a long time I felt like I would never be normal again. All of a sudden, I needed to check my blood for sugar and I needed to take shots and carry an emergency kit around if I happened to crash really bad. The school nurse had to send notes to all my teachers and coaches warning them that I wasn't like the other kids. It wasn't as bad as the guy in the picture above, but I certainly wasn't normal anymore.
I remember one time early on in my disease, a doctor tried to scare me into monitoring my sugars more closely. He told me point blank, “Everything is different now. You have diabetes and you need to accept it for what it is. Stop thinking you're normal”...
Wednesday, September 14, 2011
That's Just Plane Crazy
Luggage? Check.
Boarding pass? Check.
Passport and credit cards? Check.
All your fluids sequestered into 3oz. containers and in a Ziploc baggy? Check and check.
While most people go through the more common airport checklists, diabetics have a few atypical tic-boxes to consider. Such as a note from your current doctor explaining that you are a diabetic and that you need to carry your liquid medication. And that the medicine needs to be kept cool in a container that will most likely have some kind of jelly or liquid inside. Insulin pump wearers especially need to be weary when going through security because you must NEVER put the pump through the X-ray machine. Every insulin pump wearer knows
Boarding pass? Check.
Passport and credit cards? Check.
All your fluids sequestered into 3oz. containers and in a Ziploc baggy? Check and check.
Thursday, August 25, 2011
Heart Helping News
I just read an interesting news announcement from the grocery store chain Publix, most common in southern states of America. From the Publix press release-
Very briefly, lisinopril is an ACE inhibitor that is primarily used to lower blood pressure and treat hypertension. However, ACE inhibitors are also routinely used to help with kidney and heart disease, both of which are common in diabetics. In fact, many diabetes specialists recommend ACE or ARB inhibitors as a preventative drug to keep blood pressure at a very healthy and low level. By incorporating ACE or ARB inhibitors before any problems arise, doctors hope to prevent the very common onset of kidney and heart disease seen in diabetics.
A lot of health care changes that have been accepted in the Affordable Health Care Act include provisions for preventative health care in what feels like a paradigm shift in the medical field to prevent the health problems before they even occur in patients. Diabetes is a special group of interest because of the rise in the number of diabetics and cost to treat illnesses like kidney failure, which could require the incredibly expensive process of dialysis treatment.
Publix announcement is possibly the first that I have seen of a business chain making a commonly used drug available for free. Many big box stores like Walmart and Target have flaunted reduced prices, but none have offered medication at no cost.
Lisinopril isn’t exactly an expensive drug. It usually costs $2-4/month with most prescription plans and has generic versions readily available. It is also worth mentioning that the Publix promotion doesn’t cover another commonly used combination version that includes hydrochlorothiazide (HCTZ). But the step forward with Publix trying to help the public is still impressive to me.
LAKELAND, Fla., Aug. 23, 2011 — Beginning today, Publix will offer free 30-day supplies (up to 30 tablets) of lisinopril to customers with a prescription for the medication.
Very briefly, lisinopril is an ACE inhibitor that is primarily used to lower blood pressure and treat hypertension. However, ACE inhibitors are also routinely used to help with kidney and heart disease, both of which are common in diabetics. In fact, many diabetes specialists recommend ACE or ARB inhibitors as a preventative drug to keep blood pressure at a very healthy and low level. By incorporating ACE or ARB inhibitors before any problems arise, doctors hope to prevent the very common onset of kidney and heart disease seen in diabetics.
A lot of health care changes that have been accepted in the Affordable Health Care Act include provisions for preventative health care in what feels like a paradigm shift in the medical field to prevent the health problems before they even occur in patients. Diabetes is a special group of interest because of the rise in the number of diabetics and cost to treat illnesses like kidney failure, which could require the incredibly expensive process of dialysis treatment.
Publix announcement is possibly the first that I have seen of a business chain making a commonly used drug available for free. Many big box stores like Walmart and Target have flaunted reduced prices, but none have offered medication at no cost.
Lisinopril isn’t exactly an expensive drug. It usually costs $2-4/month with most prescription plans and has generic versions readily available. It is also worth mentioning that the Publix promotion doesn’t cover another commonly used combination version that includes hydrochlorothiazide (HCTZ). But the step forward with Publix trying to help the public is still impressive to me.
Friday, August 5, 2011
Rising Sickness
The problem for diabetics is that being sick makes their blood sugar rise higher than normal. In fact, diabetics can tend to have higher blood sugar when their bodies are stressed from many things, not just the common cold. Simply put, all kinds of stress can cause blood sugar to rise. Such a short statement carries so many implications for the health of millions of people.
The complexity of stress is buried in the its definition.
Sunday, July 31, 2011
What's the big deal about insulin?
Diabetics are the most common group of people who need and take insulin. I’m a diabetic myself, which means I have a chronic illness that causes high blood sugar. High blood sugar is usually caused by resistance to insulin or depreciated production (typically Type 2 diabetes) or flat out no insulin production at all (Type 1 diabetes). I’m a Type 1 diabetic, so my body doesn’t produce insulin at all, which means I need to give myself insulin manually. All Type 1 diabetics and even some Type 2 diabetics need insulin to control their blood sugar.
Insulin is a clear liquid that comes in a vial or sometimes a device that looks a lot like a pen. It even has a cap and button at the top! Starting from this point, I’ll try to answer some questions that people frequently ask me when they see my insulin vial or learn that I’m a diabetic.
HOW DO YOU 'TAKE' YOUR INSULIN? CAN YOU USE PILLS?
Insulin is actually a sensitive hormone made up of amino acids, just like proteins, so we cannot take it in a pill. Just like proteins, insulin has a three-dimensional shape that is important to its activity and ability to work properly in the body. Stomach acid has an incredibly low pH, which destroys the 3D shape of insulin and makes it completely useless to the body. So diabetics can’t take insulin orally without destroying
Friday, July 15, 2011
Diabetic Dining in Korea
My wife and in-laws are Korean and that means we eat a lot of Korean food at home. I love when our home is filled with the smells of hot soups, spicy meats, and steaming dumplings.
We try to visit Korea every other year. When we travel, food is always a major part of our trip and it’s even more important when we travel to Korea. Of course we have a lot of the same food and ingredients at home, but the flavor, quality, and variety in Korea is incomparable. This year, our trip landed right in the middle of the rainy season (June until the end of July). And so I’ve been looking forward to a lot of hot soups and noodles.
As a diabetic, I may seem like a killjoy when it comes to eating out. I’m mentally measuring and questioning each dish, trying to find the integral for the area under the curve of my pasta. In the states, I’ve become pretty adept in figuring out my food when we’re away from home, but cuisine in Korea is particularly challenging. I wanted to share a couple major challenges and offer a few solutions so that people can understand the thoughts of a diabetic eating out in Korea.
We try to visit Korea every other year. When we travel, food is always a major part of our trip and it’s even more important when we travel to Korea. Of course we have a lot of the same food and ingredients at home, but the flavor, quality, and variety in Korea is incomparable. This year, our trip landed right in the middle of the rainy season (June until the end of July). And so I’ve been looking forward to a lot of hot soups and noodles.
Monday, July 4, 2011
Who should be allowed to buy your doctor's data?
Pharmaceutical companies hold a special niche. With their research, they provide the drugs our nation now rely on for treatment and recovery. On the other hand, corporation’s insatiable desire for profit bottlenecks drug delivery and advancement by creating a system of profit over people. Big Pharma thrives because of their money enables the research and development of new drugs. So how do we balance the power between Big Pharma companies and the people that their drugs are meant to serve?
An interesting story about this struggle has been growing out of Vermont. In 2007, Vermont enacted a law to restrict how Big Pharma uses information bought from pharmacies. These restrictions only applied to Big Pharma marketing. According to §4631 (see Vt. Stat. Ann., Tit. 18, §4631), pharmaceutical companies are forbade from buying prescriber identifiable data for the purpose of marketing. Statute 4631 is meant to prevent a tactic called detailing and the manipulation of drug costs and prescriptions. Data mining companies, as well as pharmaceutical industries and many other agencies, claimed the law infringed on the Freedom of Speech in the First Amendment. The Supreme Court of the United States (SCOTUS) heard the case in April 2011 and a decision was handed down on June 23rd 2011. (Outline of case here) (Decision outlined here)
In the end, Vermont lost the case of Sorrell, Attorney General of Vermont, et al. vs IMS Health Inc., et al.
Justice Kennedy of SCOTUS wrote,
“Vermont argues that its prohibitions safeguard medical privacy and diminish the likelihood that
marketing will lead to prescription decisions not in the best interests of patients or the State. It
can be assumed that these interests are significant. Speech in aid of pharmaceutical marketing,
however, is a form of expression protected by the Free Speech Clause of the First Amendment.
As a consequence, Vermont’s statute must be subjected to heightened judicial scrutiny.
The law cannot satisfy that standard. “
I will define a few key vocabularies so that we can fully appreciate the case and the verdict. First, when doctors write a prescription, the patient goes to the pharmacy. It is then the pharmacy’s responsibility to record the prescription, including the drug, the dose, and even the name of the prescribing doctor. This info identifies the doctor and what the doctor prescribed. In many states, this info can be legally sold by pharmacies as prescriber-identifiable (PI) data. Many times, the data is sold to data mining companies, such as IMS Health. Data mining is the detailed sorting and analysis of the information. Mined data is a valuable source of information for many purposes, such as clinical research and marketing. The mining companies can then be turned around and sell this precious info to other businesses and agencies, such as pharmaceutical companies. And so to reiterate, Vermont statute 4631 was created to prohibit pharmaceutical companies from purchasing this data for marketing, while other forms of use by other groups was allowable.
It’s important to note at this point, that the laws allow the legal gathering and sale of PI data and that it only restricted Big Parma from buying the information marketing. The reason the Vermont Attorney General and petitioners wrote the statute was to limit a process called “detailing”. Many legislatures felt that allowing Big Pharma to purchase the data would lead to companies targeting specific doctors with visits and invitations for lectures and meeting, all of which would encourage them to use their drugThis is a process called “detailing”. By this detailed marketing approach that targets the prescribers, Big Pharma could potentially raise drug prices and manipulate the drug market at the physician level.
However, companies that mine the data and agencies that use the data claimed that the restriction was an unfair discrimination and infringed on the right to Freedom of Speech. In this context, the respondents (IMS Health, et al.) claimed that communication and therefore speech was being restricted unfairly due to assumed interests and actions of the pharmaceutical industry. SCOTUS agreed with IMS Health in the case.
Each side had several major supporters (see the list and the briefs written by the groups at the Vermont Office of the Attorney General). Supporters of §4631 argue that limiting Big Pharma protects patient identifiable data that could be backtracked by the PI data and prevents the manipulation of the medical system of prescription. Opponents of §4631 question the legality of the reason for limiting Big Pharma and worry that the statute could lead to limiting other groups as well.
On example is clinical research. Clinical researchers routinely use data from pharmacies and hospitals to evaluate efficacy of drugs and benefits of therapies. The data goes into the planning process of new clinical trials so that clinicians are not constantly reinventing the clinical wheel by repeating work that was already done. To reduce the waste of unnecessary repetitive clinical trials, many believe it would behoove the general public to allow clinicians access to PI data, which could give valuable information in the types of prescriptions being used in the public and how it might impact therapeutic approaches. If Big Pharma is restricted from using PI data because of a negative assumption then a door may to opened to enable the restriction of many groups, including clinical research.
On the other hand, Big Pharma is big business. Billions of dollars are used annually to market and manage the drugs doctors already prescribe. Big Pharma routinely encourages brand name pharmaceuticals even when generic versions are available. By allowing access to PI data, many groups argue that we are allowing Big Pharma access to a very direct form of info for marketing groups to specifically and more efficiently target doctors. Even though the doctors have the final say in what they prescribe, Big Pharma could dramatically influence their decision and foster a system where the patient’s best interest isn’t the highest priority and public health is second to the quest for higher profit.
Overall, SCOTUS decided that the state of Vermont could not restrict the use of legally obtained information for only Big Pharma companies. Simply put, IMS Health argued that you can’t restrict just one group from an otherwise open and legal system – that’s discrimination and it’s unconstitutional. This case was a benchmark for many questions and cases to come as legislation starts to tackle healthcare in the US as a major issue. Several policy programs are centered on assessing current treatment and therapies and the accessibility of database information to clinicians, which returns us to similar questions of who should have access to what kinds of information.
An interesting story about this struggle has been growing out of Vermont. In 2007, Vermont enacted a law to restrict how Big Pharma uses information bought from pharmacies. These restrictions only applied to Big Pharma marketing. According to §4631 (see Vt. Stat. Ann., Tit. 18, §4631), pharmaceutical companies are forbade from buying prescriber identifiable data for the purpose of marketing. Statute 4631 is meant to prevent a tactic called detailing and the manipulation of drug costs and prescriptions. Data mining companies, as well as pharmaceutical industries and many other agencies, claimed the law infringed on the Freedom of Speech in the First Amendment. The Supreme Court of the United States (SCOTUS) heard the case in April 2011 and a decision was handed down on June 23rd 2011. (Outline of case here) (Decision outlined here)
In the end, Vermont lost the case of Sorrell, Attorney General of Vermont, et al. vs IMS Health Inc., et al.
Justice Kennedy of SCOTUS wrote,
“Vermont argues that its prohibitions safeguard medical privacy and diminish the likelihood that
marketing will lead to prescription decisions not in the best interests of patients or the State. It
can be assumed that these interests are significant. Speech in aid of pharmaceutical marketing,
however, is a form of expression protected by the Free Speech Clause of the First Amendment.
As a consequence, Vermont’s statute must be subjected to heightened judicial scrutiny.
The law cannot satisfy that standard. “
I will define a few key vocabularies so that we can fully appreciate the case and the verdict. First, when doctors write a prescription, the patient goes to the pharmacy. It is then the pharmacy’s responsibility to record the prescription, including the drug, the dose, and even the name of the prescribing doctor. This info identifies the doctor and what the doctor prescribed. In many states, this info can be legally sold by pharmacies as prescriber-identifiable (PI) data. Many times, the data is sold to data mining companies, such as IMS Health. Data mining is the detailed sorting and analysis of the information. Mined data is a valuable source of information for many purposes, such as clinical research and marketing. The mining companies can then be turned around and sell this precious info to other businesses and agencies, such as pharmaceutical companies. And so to reiterate, Vermont statute 4631 was created to prohibit pharmaceutical companies from purchasing this data for marketing, while other forms of use by other groups was allowable.
It’s important to note at this point, that the laws allow the legal gathering and sale of PI data and that it only restricted Big Parma from buying the information marketing. The reason the Vermont Attorney General and petitioners wrote the statute was to limit a process called “detailing”. Many legislatures felt that allowing Big Pharma to purchase the data would lead to companies targeting specific doctors with visits and invitations for lectures and meeting, all of which would encourage them to use their drugThis is a process called “detailing”. By this detailed marketing approach that targets the prescribers, Big Pharma could potentially raise drug prices and manipulate the drug market at the physician level. However, companies that mine the data and agencies that use the data claimed that the restriction was an unfair discrimination and infringed on the right to Freedom of Speech. In this context, the respondents (IMS Health, et al.) claimed that communication and therefore speech was being restricted unfairly due to assumed interests and actions of the pharmaceutical industry. SCOTUS agreed with IMS Health in the case.
Each side had several major supporters (see the list and the briefs written by the groups at the Vermont Office of the Attorney General). Supporters of §4631 argue that limiting Big Pharma protects patient identifiable data that could be backtracked by the PI data and prevents the manipulation of the medical system of prescription. Opponents of §4631 question the legality of the reason for limiting Big Pharma and worry that the statute could lead to limiting other groups as well.
On example is clinical research. Clinical researchers routinely use data from pharmacies and hospitals to evaluate efficacy of drugs and benefits of therapies. The data goes into the planning process of new clinical trials so that clinicians are not constantly reinventing the clinical wheel by repeating work that was already done. To reduce the waste of unnecessary repetitive clinical trials, many believe it would behoove the general public to allow clinicians access to PI data, which could give valuable information in the types of prescriptions being used in the public and how it might impact therapeutic approaches. If Big Pharma is restricted from using PI data because of a negative assumption then a door may to opened to enable the restriction of many groups, including clinical research.
On the other hand, Big Pharma is big business. Billions of dollars are used annually to market and manage the drugs doctors already prescribe. Big Pharma routinely encourages brand name pharmaceuticals even when generic versions are available. By allowing access to PI data, many groups argue that we are allowing Big Pharma access to a very direct form of info for marketing groups to specifically and more efficiently target doctors. Even though the doctors have the final say in what they prescribe, Big Pharma could dramatically influence their decision and foster a system where the patient’s best interest isn’t the highest priority and public health is second to the quest for higher profit.
Overall, SCOTUS decided that the state of Vermont could not restrict the use of legally obtained information for only Big Pharma companies. Simply put, IMS Health argued that you can’t restrict just one group from an otherwise open and legal system – that’s discrimination and it’s unconstitutional. This case was a benchmark for many questions and cases to come as legislation starts to tackle healthcare in the US as a major issue. Several policy programs are centered on assessing current treatment and therapies and the accessibility of database information to clinicians, which returns us to similar questions of who should have access to what kinds of information.
Saturday, June 25, 2011
Hoping to cure diabetes through the Edmonton Protocol
Hundreds of thousands of people live with diabetes. Diabetes causes people to have high blood sugar because their bodies either don’t produce the right amount of insulin or are resistant to the insulin they're making. For us to understand diabetes, we must start with understanding insulin and how it works in people without diabetes.
Insulin is a very critical hormone that regulates the amount of glucose that is in our bloodstream from the carbohydrates and sugars we eat. Glucose comes from breaking down the carbohydrates and sugars we eat to provide energy for our bodies; however, insulin is needed to move the glucose from the bloodstream to the cells. Insulin allows the liver and muscle cells to accept glucose from the bloodstream and keep the blood glucose level at a healthy level. Cells will use the glucose to either store energy as fats or glycogen (glucose molecules linked together in long chains) or to use it for energy right away through glycolysis.
Now we will consider a diabetic. Type 1 Diabetes (T1D) is when a person has stopped making insulin completely. T1D is commonly called “Juvenile Diabetes” and requires insulin to be manually taken, usually as an injection. Type 2 Diabetes (T2D) is when a person has become resistant to insulin and sometimes isn’t making enough insulin. T2D can develop from being unhealthy, overweight, elderly, or having a genetic predisposition (meaning it can “run in the family”). Sometimes T2D can be treated by diet or medication alone, but ~40% of T2D patients will also use injected insulin to manage their diabetes as well.
For myself, I consider T1D and T2D very different diseases. Mainly because of when and how they develop and are treated. But for now, I will talk about one treatment that was first tried to treat T1D.
The EDMONTON PROTOCOL was developed at the University of Alberta in Edmonton, Canada and was first published in 2000. The procedure was used by doctors to cure T1D by transplanting insulin-producing cells into patients with T1D. Islet cells produce insulin and grow on the pancreas of non-diabetic people, but people with T1D don’t have islet cells because of an autoimmune response that has destroyed all of their islet cells and caused their T1D. By transplanting new islet cells from deceased donors, doctors from the University of Alberta hoped to give patients a new way to produce insulin and hopefully cure them of diabetes.
The protocol was to give donor islet cells to recipient diabetics through an infusion using the portal vein. The portal vein is a special vein that is not connected to the heart, but rather runs through the abdomen and ends at the liver. There the transplanted islet cells attach and continue to grow and produce insulin from the liver (see picture, from NIDDK). Of the original recipients, 10% of them are still free from requiring insulin shots and most of the others require much less insulin than before the transplant. The doctors believe that the reason islet cells didn’t continue working for many of the patients was because their bodies attacked the islet cells as foreign material (a common transplant problem) or that they slowly lost the islet cells through the same process that caused their T1D originally.
To overcome the transplant problems, doctors had patients take immunosuppressant drugs to reduce transplant rejection. After the initial trial, doctors added an antibody treatment to prevent rejection. The antibody treatment (daclizumab) blocks the body’s immune system from creating new antibodies that would attack the islet cells. By preventing the attack, doctors believe the islet cells were allowed to attach and begin growing without being rejected by the patient’s immune system.
The addition of the antibody treatment seems to have worked very well and from several dozen procedures, ~74% of the patients that received the antibody treatment are still free from diabetes after 5 years or more. This is incredible news for people with T1D! The Edmonton protocol has many advantages including minimally invasive surgery and relatively high curative rates past 5 years. Doctors hope to improve the Edmonton protocol by using improved anti-rejection techniques or using the patient’s own stem cells to create islet cells identical to the patient, which could prevent rejection entirely.
Overall, the Edmonton protocol is an incredible example of the powerful possibilities of curing diabetes and ending a terrible disease that costs our medical system millions of dollars and thousands of lives.
Read more about the Edmonton Protocol online...
Global News – Toronto
2006 International Trial of the Edmonton Protocol for Islet Transplantation
Insulin is a very critical hormone that regulates the amount of glucose that is in our bloodstream from the carbohydrates and sugars we eat. Glucose comes from breaking down the carbohydrates and sugars we eat to provide energy for our bodies; however, insulin is needed to move the glucose from the bloodstream to the cells. Insulin allows the liver and muscle cells to accept glucose from the bloodstream and keep the blood glucose level at a healthy level. Cells will use the glucose to either store energy as fats or glycogen (glucose molecules linked together in long chains) or to use it for energy right away through glycolysis.
For myself, I consider T1D and T2D very different diseases. Mainly because of when and how they develop and are treated. But for now, I will talk about one treatment that was first tried to treat T1D.
The EDMONTON PROTOCOL was developed at the University of Alberta in Edmonton, Canada and was first published in 2000. The procedure was used by doctors to cure T1D by transplanting insulin-producing cells into patients with T1D. Islet cells produce insulin and grow on the pancreas of non-diabetic people, but people with T1D don’t have islet cells because of an autoimmune response that has destroyed all of their islet cells and caused their T1D. By transplanting new islet cells from deceased donors, doctors from the University of Alberta hoped to give patients a new way to produce insulin and hopefully cure them of diabetes.
The protocol was to give donor islet cells to recipient diabetics through an infusion using the portal vein. The portal vein is a special vein that is not connected to the heart, but rather runs through the abdomen and ends at the liver. There the transplanted islet cells attach and continue to grow and produce insulin from the liver (see picture, from NIDDK). Of the original recipients, 10% of them are still free from requiring insulin shots and most of the others require much less insulin than before the transplant. The doctors believe that the reason islet cells didn’t continue working for many of the patients was because their bodies attacked the islet cells as foreign material (a common transplant problem) or that they slowly lost the islet cells through the same process that caused their T1D originally.
To overcome the transplant problems, doctors had patients take immunosuppressant drugs to reduce transplant rejection. After the initial trial, doctors added an antibody treatment to prevent rejection. The antibody treatment (daclizumab) blocks the body’s immune system from creating new antibodies that would attack the islet cells. By preventing the attack, doctors believe the islet cells were allowed to attach and begin growing without being rejected by the patient’s immune system.
The addition of the antibody treatment seems to have worked very well and from several dozen procedures, ~74% of the patients that received the antibody treatment are still free from diabetes after 5 years or more. This is incredible news for people with T1D! The Edmonton protocol has many advantages including minimally invasive surgery and relatively high curative rates past 5 years. Doctors hope to improve the Edmonton protocol by using improved anti-rejection techniques or using the patient’s own stem cells to create islet cells identical to the patient, which could prevent rejection entirely.
Overall, the Edmonton protocol is an incredible example of the powerful possibilities of curing diabetes and ending a terrible disease that costs our medical system millions of dollars and thousands of lives.
Read more about the Edmonton Protocol online...
Global News – Toronto
2006 International Trial of the Edmonton Protocol for Islet Transplantation
Subscribe to:
Posts (Atom)