Will Insulin in a Pill Soon Become a Reality?

Since insulin was first discovered and isolated for therapeutic use nearly 100 years ago, most everyone with insulin-dependent diabetes has had to rely on exogenous insulin, given in the form of injections, whether via an insulin pump or multiple daily shots every single day of their lives (inhalable insulin was approved by the FDA in 2014, but its use is not widespread).

While research and development have come a long way in that time, the reality for millions (and over 7 million people in the United States alone) has been thousands upon thousands of invasive injections, oftentimes causing scarring, bruising, and pain. However, that may be about to change.

Researchers from the New York University in Abu Dhabi have successfully developed a pill using nanomaterial layers that disseminate insulin in rats safely without being destroyed by their stomach acids. This could be life-changing for the millions of people around the world who rely on insulin to live.

“Imagine being able to take insulin in a pill instead of injecting it a couple of times a day,” said first author Farah Benyettou, a research scientist in the Trabolsi Research Group at the New York University in Abu Dhabi. “The insulin was loaded in a system that protects it from the acidic environment of the stomach. Once in the body, the system can sense the blood sugar level and can release the loaded insulin on demand.”

A pill form of insulin has the potential to radically change the daily management of diabetes for the better: It would make treatment easier for children and people with a fear of needles, safer for both patients and clinicians in hospital and clinic settings, more effective, and patient-friendly.

Nearly 30% of people with diabetes rely on insulin injections, and while it might not be for everyone, this revolutionary advancement would be the first of its kind in the world.

Other attempts at orally administering insulin have been made in the past but faced roadblocks in the gastrointestinal tract, where stomach acids and bile quickly destroy insulin and any effectiveness it has.

This is different from common type 2 diabetes drugs like Metformin that aren’t insulin but simply improve the efficacy of insulin that their body already makes.

The research team in Abu Dhabi thinks it has solved the problem of the insulin-destroying stomach bile issue by encapsulating insulin within nCOF nanoparticles in a capsule that is resistant to such acids but responsive to sugar, reacting quickly when it senses blood glucose in the body is rising but survives the dangerous journey down the G.I. tract to reach the bloodstream.

This new advancement also has the potential to reduce or eliminate low blood sugars, as the release of insulin shuts off as soon as it senses blood sugars have fallen. This creates a helpful feedback loop and prevents an overdose of insulin, which for many, is an almost a daily occurrence on injections, where people are constantly walking a balance beam to prevent both high and low blood sugars in a world of stress, meals, exercise, and normal everyday living.

While this is all excellent news, it’s important to remember that the study’s success was only observed in rats, and human bodies are very different. The team will next test different nanomaterials to see what may be appropriate for human trials, and potentially, widespread market availability.

“Our revolutionary technology developed at NYUAD will dramatically improve the well-being of diabetic patients worldwide in a very simple and straightforward way,” says senior author Ali Trabolsi, an associate professor of chemistry at the New York University in Abu Dhabi.

While taking a daily insulin pill may is far from a functional cure, managing diabetes could become easier than ever, especially if the threat of low blood sugars is greatly reduced or eliminated.

The team hopes that diabetes management can soon be a lot less stressful, painful, and dangerous for the millions of people around the world who currently rely on insulin.

Source: diabetesdaily.com

The Latest on Eylea: A Leading Treatment for Diabetes-Related Retinopathy

This content originally appeared on diaTribe. Republished with permission.

By Kira Wang

New results on Eylea, a treatment for diabetes-related retinopathy, show that the therapy reduces the risk of more serious eye complications when used for prevention.

Key findings were recently published on Eylea, a common therapy in the US used to treat several eye conditions including diabetes-related eye disease. According to Dr. Jennifer Sun (co-chair of the Diabetic Retinopathy Clinical Research Network), 60% of patients may not know they have some form of early-stage diabetes-related retinopathy which may not affect one’s ability to see. The clinical trial was focused on prevention: does early Eylea treatment of diabetes-related retinopathy result in better vision later on? The answer may not yet be clear – while Eylea was found to reduce specific vision-threatening complications, it did not meaningfully improve vision outcomes in the published study.

Eylea is an approved treatment for diabetes-related macular edema and diabetes-related retinopathy, two of the eye complications associated with diabetes. Eylea is an anti-VEGF therapy, meaning that the drug blocks VEGF, a protein that is necessary for new blood vessel growth. The medication is injected into the eye by an ophthalmologist every four to 16 weeks, depending on the severity of the eye disease.

The trial looked at 328 adults with early-stage diabetes-related retinopathy (also called non-proliferative diabetes-related retinopathy) and excellent vision. At the beginning of the study, about half of the eyes received Eylea injections every 16 weeks, and the other half received a placebo injection (which included no medication). The preliminary data were reported through two years. The study will continue for a total of four years.

The researchers were studying two main outcomes in these eyes:

  • Changes in the anatomy of the retina (for evidence of either a more advanced stage of diabetes-related retinopathy, called proliferative diabetes-related retinopathy, or the development of swelling called center-involved diabetes-related macular edema). These can be thought of as structural changes in the eye.
  • A functional difference in participants’ ability to see, known as their visual acuity. See below for key findings after two-years:

The trial found that Eylea led to improved anatomical outcomes and reduced the risk of more serious eye complications:

  • Eylea reduced the risk of developing complications by 68% when compared to the placebo. The probability of developing any complication was 16% in the Eylea group and 44% in the placebo group.
  • Individually, participants taking Eylea were 66% less likely to develop more advanced stages of diabetes-related retinopathy (proliferative diabetes-related retinopathy) and 64% less likely to develop macular edema with vision loss.
  • People receiving placebo injections were five times more likely to need additional treatment (with Eylea) with worsening of the eye disease.
  • There was no difference in the vision quality of either group after two years (excellent vision in 75% of the treatment group and 72% of the placebo group).

The four-year results of the trial will be important in determining whether the higher rate of complications in the placebo group might eventually lead to more vision loss in that group. If this is the case, treating diabetes-retinopathy in its earliest stages with Eylea may present a long-term benefit for vision.

There are several treatment options for diabetes-related eye disease, including oral medications, laser treatments for the eyes, and therapies like Eylea. Increasingly, surgical techniques are being used for less advanced stages of diabetes-related eye disease. Other novel strategies are also being investigated to avoid needing regular injections into the eye.

More information is needed before Eylea can be considered for use as a widespread tool to prevent worsening of diabetes-related retinopathy. Dr. Sun’s bottom line for clinicians and patients? “With regular follow-up and rigorous evaluation, the chances of continuing to have good vision, even with severe non-proliferative diabetic retinopathy and moderate non-proliferative diabetic retinopathy, are excellent. I don’t think this study says that early treatment should be routinely given yet. It is important to hang tight and wait for four-year results.”

The most important action people with diabetes can take is to have an annual dilated eye exam, in addition to managing glucose, blood pressure, and cholesterol levels. If diabetes-related eye disease worsens, there a number of options that can be used to prevent vision loss. To learn more about protecting your eyes and treating eye disease, check out our series: Caring For Your Eyes.

Source: diabetesdaily.com

Amylin: The Forgotten Hormone

Most everyone knows that when someone has type 1 diabetes, their pancreas lacks the ability to produce the hormone insulin (or their pancreas doesn’t make enough insulin, as in the case of type 2 diabetes). What isn’t so well known is that the pancreas also produces another helpful hormone called amylin that people with diabetes also lack! A crucial hormone that was once unknown and not prescribed for diabetes management is now recommended for most people with diabetes to take via injection. So, what is it? This article will describe what Amylin is and why it is important.

What Is Amylin?

Amylin is an amino acid polypeptide hormone that is released by the pancreas at the same time as insulin, although in much smaller quantities (at a ratio of approximately 1:100).

Amylin is a crucial hormone that acts as a sidekick to insulin in people without diabetes. It is produced by the pancreas and helps inhibit glucagon secretion, preventing the rapid spike in blood sugar, and also helps slow gastrointestinal emptying and curbs appetite.

The hormone assists insulin in controlling postprandial blood sugars. Unfortunately, people with diabetes not only lose the ability to produce insulin, but they also lose the ability to produce amylin as well.

Why Is Amylin Important?

People without diabetes don’t have to worry as much about controlling their appetite, managing hormonal levels, or juggling their blood sugars because they naturally produce both insulin and amylin. Amylin inhibits the release of glucagon when eating (preventing blood sugar spikes), slows the digestion of food from the stomach, and curbs appetite.

People with diabetes can sometimes struggle with these issues due to lacking both hormones, but for patients in the United States, amylin analogs are available (via a daily or weekly injection before meals) to mimic the functions of this important hormone.

The Benefits of Amylin Analogs

Amylin analogs, like Symlin (approved in 2005 for use in the United States), have been shown to cause weight loss, lower HbA1c levels, and reduce the average amount of insulin needed to manage blood sugars in people with diabetes. Amylin analogs can be used to treat both type 1 and type 2 diabetes in conjunction with insulin therapy. Although not approved for use in children, several studies have shown that amylin analogs are safe and effective when taken by adolescents. Doctors may prescribe amylin analogs off-label to children under the age of 18.

People with diabetes can take injectable amylin analogs before meals to help with postprandial blood sugar levels and help manage both appetite and weight gain.

Potential Side Effects

The most common side effects of amylin are:

  • Nausea
  • Vomiting
  • Headache
  • Hypoglycemia (especially if used in conjunction with insulin)

These side effects typically occur at the beginning of treatment and decline as the body adjusts to the medication.

Research shows that the regular use of amylin analogs in people with diabetes lowers HbA1c levels, fasting blood glucose levels, triglycerides and cholesterol levels, increases time-in-range (TiR), and helps people with diabetes manage their appetite and lose weight. It also reduces blood sugar variability, helping to prevent long-term complications. Talk with your doctor about whether incorporating amylin analogs into your diabetes management therapy is a good choice for you

Source: diabetesdaily.com

New Therapy to Treat Type 1 Diabetes Rolls Out Clinical Trial

Type 1 diabetes is an autoimmune condition whereby the person’s own immune system attacks the pancreatic cells that produce insulin. Insulin signals for glucose uptake into cells, a carefully regulated and important process, that when disrupted, can lead to an array of health complications, and without treatment, results in death. Many advances in the care of type 1 diabetes have been made in the last century; however, there is no cure for the condition, and patients rely on frequent blood glucose monitoring and insulin injection or infusion therapy to survive.

We have been closely following the work of Dr. Bart Roep and his colleagues at the City of Hope over the last several years. We first spoke to him at the 79th American Diabetes Association (ADA) Scientific Sessions in 2019.

“Dr. Roep has dedicated his professional life to trying to cure type 1 diabetes. Over an almost 30-year career, he has earned numerous prestigious awards and is perhaps most well-known for his work discovering how T-cells recognize specific antigens on beta cells in the context of type 1 diabetes pathogenesis. Currently, he is Chan Soon-Shiong Shapiro Distinguished Chair in Diabetes and the founding chair of the Department of Diabetes Immunology within City of Hope’s Diabetes & Metabolism Research Institute. Dr. Roep is also the director of the Wanek Family Project for Type 1 Diabetes.”

The immune system coordinates defenses against pathogens (like viruses and bacteria) via intricate cross-talk between different immune cells in the body. It is also able to recognize the host (self-tolerance) and under normal circumstances, should not attempt to destroy the person’s own cells (with the exception of special circumstances, like cancerous cells, for instance).

Photo by iStock

For the treatment of autoimmune conditions, like type 1 diabetes, much research is ongoing in an effort to “re-write” some of the “programming” and cellular cross-talk thought to be responsible for autoimmune attack. The “inverse vaccine” for the treatment of type 1 diabetes attempts to do just that in the following process:

  1. Immune cells are taken from patients and “re-educated” in the test tube to improve self- tolerance
  2. These cells are injected back into the patient, in hopes that they will not longer drive autoimmune attack, but rather “educate” the immune system to tolerate the person’s own beta cells

Last year, we reported that the initial safety and tolerability studies appeared promising.

Now, additional clinical trials are poised to begin:

“The vaccine is made using one’s own immune cells (dendritic cells) and a beta cell protein. The vaccine may teach the immune system to stop attacking the beta cells, which may help the beta cells recover and make enough insulin to control blood sugar levels. The vaccine may also help reduce future type 1 diabetes related complications.”

It is a very exciting time for type 1 diabetes as we move from just treating the symptoms to actually trying to stop the disease,” Roep remarked in a recent press release.

What are your thoughts on this research? Would you participate in the trial?

Source: diabetesdaily.com

Type 2 Diabetes and Insulin: What to Expect

Whether you’ve been newly diagnosed or have been living with type 2 diabetes for a long time, you may know that it is often a progressive disease. The longer someone lives with type 2, the more likely they are to need insulin therapy to manage their blood sugars. Often, but not always, people with type 2 diabetes start the management of their condition with exercise and diet alone, and then may progress to oral medications like Metformin, before finally (over the course of months or even years) requiring insulin to manage their blood sugar levels.

If this happens, you and your doctor will need to come up with a new treatment plan. But what can you expect? This article will describe what will and what won’t happen, and how to prepare when adding insulin therapy to your diabetes management.

There Is No Need to Panic

It’s important to remember that you haven’t done anything wrong if you get to a point where you need insulin therapy. Physicians used to prescribe insulin to people with type 2 diabetes as a last resort, but in recent years are prescribing it much sooner, due to the benefits of more stringent blood sugar management to prevent complications.

Since type 2 diabetes is often a progressive disease, many with the condition will require insulin at some point. You didn’t fail at diabetes management, and insulin is no punishment. Adding insulin therapy to your management toolkit is just another way to better meet HbA1c goals, enjoy better blood sugars, improve your quality of life, and even extend your life. Embrace it!

Insulin Does Not Inherently Make You Gain Weight

There is a common myth that insulin makes you gain weight. And this line of thinking is simply false. Here’s the connection between insulin and weight gain: When you take insulin, glucose from food is better able to enter your cells, making your blood sugar level drop. But if you take in more calories (eat more) than you need, your cells will also get more glucose than they need, and anything extra is stored as fat.

But this is obvious: the same process happens to people who do not have diabetes. People also believe that insulin causes weight gain because at diagnosis, people might be underweight (as a symptom of the disease), and finally getting the insulin they need into their bodies makes them gain the much-needed weight back. There are many side effects of insulin, but if you eat right, exercise, and take it as prescribed, extra weight gain is not one of them.

You Will Experience More Low Blood Sugars

One well-known and common side effect of insulin, however, is hypoglycemia. If you’ve traditionally managed your diabetes with exercise and diet alone, you may have rarely, if ever, experienced low blood sugar. Even oral diabetes medications, such as Metformin, rarely cause low blood sugars when taken on their own, but insulin is a whole different story.

You will need to work with your doctor to fine-tune your management, so you are able to take enough insulin to manage high blood sugars, while not taking too much where you will drop too low. It is a learning process, and it will take time.

Be better prepared by always carrying a snack on you, and making sure to check your blood sugar more often to prevent lows. Symptoms of low blood sugar include:

  • Dizziness
  • Slurred speech
  • Confusion
  • Extreme fatigue
  • Sweating
  • Rapid heartbeat

Symptoms of severe low blood sugar include:

  • Seizure
  • Loss of consciousness

Severe low blood sugar always requires immediate emergency medical attention and 911 should be contacted right away. Ask you doctor about a prescription for Glucagon,  an emergency injection that can be used to bring blood glucose levels up in case of an emergency.

Your Medical Bills Will Go Up

Diabetes is a costly disease, as of 2017, was the most expensive chronic disease in the United States, costing over $327 billion dollars per year. While diet, exercise, and even oral diabetes medications are cheaper ways to manage type 2 diabetes, insulin is one of the most expensive chronic disease medications on the market in the United States, averaging around $285 per vial.

Be prepared for higher costs at the pharmacy counter, especially if your physician prescribes you fast-acting, analog insulins like Humalog, Novolog, or Fiasp. Cheaper, human-insulins are available over the counter at places like Walmart, although they are much slower-acting, are much older, and their efficacy may not be as good as modern insulins.

Make sure to sign up for health insurance, and make sure your insurance plan will cover prescription insulin at a decent out-of-pocket cost. See if you are eligible for Medicaid or Medicare for more affordable coverage.

If available, make sure to take advantage of your employer’s Health Savings Account (HSA) and work with your doctor to make sure you have been prescribed insulin that you can comfortably afford for the long-haul. More resources for affording insulin can be found here.

You Will Need Additional Support

Adding insulin therapy to your diabetes management is a big decision. You will need extra emotional, mental, and even physical support during this time. Insulin therapy is expensive, and the toll of managing low blood sugars for the first time can be tough. Insulin injections can sometimes hurt, finding new injection sites can be hard without a second set of eyes, counting carbohydrates more closely is time-consuming, and fighting off stigma and shame is real and can be hard on everyone. It is a big adjustment.

Getting support from family and friends, joining a diabetes support group, or simply becoming more engaged in the diabetes community can really help during this time. Make sure to enlist friends and family to help you, and be open and honest with them about your worries and struggles. Adding insulin therapy to your management is meant to help, not hurt, but it’s easier when you’re not doing it alone.

Insulin Can Improve the Quality of Your Life

When taking insulin, it is crucial that you work with your doctor and follow your treatment plan to better meet your health goals. The transition from managing with diet and exercise alone or solely taking oral medications to insulin therapy can be challenging, but with a growth mindset and preparation for what lies ahead, you can thrive on insulin therapy and vastly improve the quality of your life.

Source: diabetesdaily.com

Virta Health: An Unparalleled Leader in Reversing Type 2 Diabetes

Type 2 diabetes is a condition characterized by high blood glucose levels due to the inability to effectively utilize insulin (insulin resistance). It is well-known that it is often possible to reverse type 2 diabetes by adjusting lifestyle factors, in particular, through dietary changes and sustained weight loss. However, many patients are not able to achieve this.

Virta is a company that was founded in 2014 and has made it their mission to help people reverse their type 2 diabetes. In their program, “most patients achieve blood sugar control while removing medications like insulin, often in a matter of weeks.”

The program centers around utilizing a very low-carbohydrate (ketogenic) diet, tailored specifically to meet each patient’s need. The dietary change can help facilitate both weight loss, and improve blood glucose levels, often quickly, allowing for discontinuation of various blood glucose medications under medical supervision.

In addition to a health coach”, blood sugar testing supplies, a “smart scale”, the company offers a variety of educational resources, community engagement among patients, and personalized advice provided by medical experts.

“Powered by technology and data science, physicians and nurses provide expert medical care, when and where patients need it, via Virta’s custom-designed app medical records system.”

One of the main reasons that a very low-carbohydrate diet can work so well for many people with diabetes is depicted below.

Photo credit: Virta Health

In fact, a very low-carbohydrate approach as an integral part of diabetes management is becoming more and more accepted and recommended by medical professionals and health organizations. Learn more about the most recent research and recommendations about low carb for diabetes here:

Low-Carb for Type 1 Diabetes

Low-Carb for Type 2 Diabetes

Low-Carb for Pre-Diabetes

Check out some of the very impressive Virta clinical study outcomes in patients who utilize the program:

Additionally, the researchers noted weight loss as a “side-benefit”, with patients losing an average of 30 lbs., or 12% of their body weight, a clinically-significant result that was maintained at the one-year mark since the start of the trial. Even more strikingly, participants experienced significant cardiovascular disease risk reduction, lower blood pressure levels, lower levels of inflammation, and lower risk for fatty liver disease.

Of course, all these health improvements also translate to cost savings for both patients and health insurance providers. Many employers and health plans are now working with Virta to increase patient access to this treatment approach. To get started, you can fill out a short form to schedule a free call to determine the next steps in the process.

With superior success to a traditional diabetes care approach already established, Virta aims to continue to broaden its reach with the challenging and very admirable goal of “reversing type 2 diabetes in 100 million people by 2025.

Have you heard of or participated in this program? What are your thoughts on carbohydrate restriction as a primary means to achieve weight loss and tighter blood sugar management? Please share your thoughts in the comments below!

Source: diabetesdaily.com

Great News: Trials Show Some Diabetes Drugs Can Actually Protect Your Kidneys

This content originally appeared on diaTribe. Republished with permission.

By Matthew Garza, Eliza Skoler, and Rhea Teng

More people with diabetes are taking drugs like Jardiance and Farxiga, originally developed to lower glucose in people with type 2 diabetes, because the latest data confirms that these drugs can protect your kidneys. A therapy still under investigation, finerenone, has been developed to protect the kidneys of people with and without diabetes

Recent research is showing that certain drugs can benefit your kidneys if you have type 2 diabetes. Diabetes is the leading cause of chronic kidney disease (CKD), and many people don’t receive adequate treatment for this condition, so advancements in therapy to treat and prevent kidney disease are important for the 800 million people worldwide who live with chronic kidney disease. We bring you some of the newest findings on finerenone, Jardiance, and Farxiga – three medications that have been shown to protect the kidneys in people with decreased kidney function, including those with diabetes and CKD.

Note: The latest results on Jardiance and Farxiga confirm earlier findings on two other SGLT-2 inhibitors – Invokana and Steglatro – which clearly show the kidney and heart benefits of this class of medication. As a result, SGLT-2 inhibitors are recommended for treating kidney disease in many people with diabetes. SGLT-2 inhibitors were a focus of the recent American Society of Nephrology’s virtual kidney conference. As research has shown an increased number of benefits of these medications – in terms of glucose levels, weight loss, hypoglycemia reduction, and heart and kidney health – new guidelines have rapidly developed (since 2013) for the use of these drugs in people with type 2 diabetes. And, in the case of Farxiga, SGLT-2s can also protect the kidneys in people without diabetes.

Finerenone

Finerenone is currently being tested to treat CKD in people with type 2 diabetes – it’s a new type of drug (called a non-steroidal MR antagonist) that interferes with the receptors that cause kidney cells to retain, or hold onto, excess salt and water. In the FIDELIO-DKD trial, almost 6,000 people with type 2 diabetes and kidney disease received either finerenone or placebo (a “nothing” pill) and were enrolled in the study for over two and a half years. The results from the trial demonstrated the benefits of finerenone:

  • Finerenone significantly reduced the risk of severe kidney outcomes by 18% over two and a half years.
  • Finerenone reduced the risk of severe heart outcomes by 14%, compared to the placebo.

The FIDELIO-DKD trial showed this medication to be helpful for people with type 2 diabetes. Given these positive results, finerenone has been submitted to the FDA and the European Medicines Agency for approval as a CKD treatment option for people with type 2 diabetes.

Jardiance

New findings from the EMPEROR-Reduced trial showed that Jardiance, an SGLT-2 inhibitor, improved heart and kidney outcomes in adults with heart failure with reduced ejection fraction (HFrEF, or a reduced ability to pump blood out of the heart), regardless of whether they had chronic kidney disease at the start of the trial. Of the 3,730 people enrolled in the trial – with or without type 2 diabetes – participants taking Jardiance showed:

  • A 22% reduced risk for severe heart outcomes among people with CKD, and a 28% reduced risk in those without CKD.
  • A 47% reduced risk for severe kidney outcomes in those with CKD, and a 54% reduced risk in those without CKD.

The variation in risk reduction was determined to be due to chance, rather than a difference in health outcomes between people with and without CKD. These results show that even though CKD increases a person’s risk for heart issues, Jardiance lowered that risk to the level of people without CKD.

Farxiga

New analysis of the DAPA-CKD trial found that Farxiga, another SGLT-2 inhibitor, protects the kidneys regardless of the cause of kidney disease, in people with or without type 2 diabetes. This builds on the positive results presented earlier this year on Farxiga’s ability to treat people with heart disease and CKD.

Why is this important?

More than 800 million people around the world live with chronic kidney disease, including 45 million people in the US (almost 14% of the US population). The need for effective medications that work for everyone, including those with or without diabetes, is high. Treatment with SGLT-2 inhibitors – or non-steroidal MR antagonists – could be key to helping these people.

Organizations like the American Diabetes Association and the European Association for the Study of Diabetes now recommend that people with type 2 diabetes and kidney issues be treated with SGLT-2 inhibitors or GLP-1 agonist medications. If you have diabetes or kidney disease, talk with your healthcare team about which of these treatment options may be helpful for you.

It’s important to catch kidney disease early so that it can be treated. If you have diabetes, ask your healthcare team to test your kidney function every year. To learn more about preventing kidney disease, view diaTribe’s helpful infographic. You can also read about UACR and eGFR, the two lab tests that are commonly used to evaluate kidney health.

Source: diabetesdaily.com

Injection Device Helping a Family Manage New Diabetes Diagnosis During COVID

Injection Port Device Help Family Whose Son Lives with Diabetes

Jennifer, like many others, has worried about her family’s health during the coronavirus pandemic.

In June, she was diagnosed with COVID-19. Shortly after, her 13-year old son Mason started feeling ill. Unsure if he too had contracted the virus, they visited their local emergency room. Soon after, the family was informed that Mason was living with type 1 diabetes. In this post, Jennifer discusses her family’s experience and the ways they are managing Mason’s diabetes during the global pandemic.

Mason came to me and said he didn’t feel right. Upset tummy, sinus issues, and a small headache. We took him to a local emergency room, and sure enough his rapid test was positive for COVID-19. The doctors also said that his sugar was pretty high. They asked if I could watch his levels at home over the next couple of days and if his sugars remained high, then I should call our family doctor. We left the ER on Tuesday evening. By Thursday, I called our doctor because his sugars never went below 200 mg/dL. We were put in touch with an endocrinologist, who advised us to take him to the hospital where he was diagnosed with diabetes. 

As a parent, all fears set in. I was worried that I didn’t know enough about diet and medication. I worried about if my son would ever feel normal again.

I was surprised that Mason was able to start giving his own insulin almost immediately, and he preferred it that way. In the three months since he was diagnosed, I have probably only given 10 shots! 

I was introduced to the i-Port Advance™ injection port through a Facebook page. I posted that we were having issues with him taking too much insulin before meals, and then he was too full to finish what he had dosed for. Several parents came back and suggested we try an injection port! I called my doctor’s office the next day and they were super excited to let him try it.

Almost immediately, Medtronic sent us a box of the i-Port Advance™ injection port to try at no-cost. I could not express my happiness! I was thankful the company was willing to let us try the port before we purchased. As a parent, this was such an amazing feeling and it was one of the first easy experiences we had since Mason was diagnosed! 

Mason fell in love with the injection port, and so did I! When he used the port, it was the first time since he was diagnosed that he didn’t feel like an outcast. Although he is incredibly diligent with what he eats and doesn’t take advantage of his insulin, he is a kid! He wants little treats, he wants to hang out with friends his age, and eat cupcake or have snow cones from time to time. All of which he had stopped because he hated sticking himself all the time and taking shots in front of people. Now, he can take a little extra insulin if he needs to. He can hang out with friends and not feel like an outsider because he can’t eat what they do! I’m also happy because he is building up less scar tissue with 1 stick every 3 days compared to 12-15 injections.

As a parent, I’ve been so happy to watch his outlook change. He knows that he can manage this disease and he isn’t constantly worried with taking another shot! 

Mason’s family enrolled in the 12-day evaluation program offered by Medtronic. To learn more, click below.

GET STARTED

The testimonial above relates an account of an individual’s experience using a Medtronic device. The account is genuine, typical and documented. However, this individual’s experience does not provide any indication, guide, warranty or guarantee as to the response or experience other people may have using the device. The experience other individuals have with the device could be different. Experiences can and do vary. Please talk to your doctor about your condition and the risks and benefits of Medtronic devices.

Safety Information: i-Port Advance injection port

i-Port Advance injection port is indicated for patients who administer or receive multiple daily subcutaneous injections of physician prescribed medications, including insulin. The device may remain in place for up to 72 hours to accommodate multiple injections without the discomfort of additional needle sticks. i-Port Advance injection port may be used on a wide range of patients, including adults and children. For more, please see http://www.medtronicdiabetes.com/important-safety-information.

Source: diabetesdaily.com

Marijuana as a Treatment for Neuropathy: Emerging Evidence

Marijuana, or cannabis, has a long history of human use. Although it remains federally illegal, many states have opened the door to medical, and even recreational use legislation. Notably, more and more research studies are being conducted on the medicinal properties of cannabis, and a growing body of evidence now supports the relevance and efficacy of this plant and its compounds in the treatment of various health conditions.

Here, I focus on a common diabetes complication, peripheral neuropathy, and the emerging scientific evidence for the use of marijuana to reduce pain associated with this condition. If you want to learn more about marijuana and diabetes in general, please check out our recently updated and comprehensive resource:

Marijuana and Diabetes: What You Need to Know

What is Neuropathy?

Over time, high blood glucose levels can damage blood vessels and affect nerve function. A common complication of long-standing diabetes, especially for those who have chronically high blood glucose levels, is neuropathy. Neuropathy occurs due to nerve damage from high blood glucose levels and patients often experience numbness, tingling, and pain (most often occurring in the legs and feet).

Common treatment strategies include optimizing glycemic management to help prevent disease progression, as well as pain management with medications like Lyrica (pregabalin), Neurontin (gabapentin), and sometimes with certain antidepressants.

Research Shows Cannabis Is a Promising Treatment

Recent research points to the potential benefits of cannabis for the treatment of peripheral neuropathy pain. According to Way of Leaf, nine states – Arkansas, Connecticut, Missouri, Montana, New Mexico, New York, North Dakota, Pennsylvania, and West Virginia – already list neuropathies as a “qualifying condition” for medical marijuana use.

Experts say that there is now “substantial evidence” that cannabis is effective in treating chronic pain. So far, at least three studies have evaluated the efficacy in the treatment of diabetic peripheral neuropathy.

For example, one preliminary randomized clinical trial conducted in 2015 identified a “dose-dependent reduction in diabetic peripheral neuropathy pain” in patients whose pain was not alleviated by other treatment strategies. This study focused on the effects of inhaled cannabis. Interestingly, another clinical trial that evaluated the efficacy of Sativex, an oral spay containing cannabis-derived ingredients (THC and CBD), did not find a significant improvement in pain reduction as compared to the placebo arm in their analysis.

It is possible that there are additional compounds that contribute or synergize with the known active compounds to deliver the therapeutic effects. Experts explain:

“Currently, there is a debate about the so-called “entourage effect” which refers to the idea that compounds other than cannabinoids in marijuana (i.e. terpenes and flavonoids) are important in its therapeutic effects. This idea has wide lay-popularity, but little scientific evidence to support it.”

Overall, while more research is needed, there is increasing evidence that cannabis can be useful for treating neuropathic pain:

“The scientific literature demonstrates some efficacy of medical marijuana/cannabis in the treatment of chronic neuropathic pain. Clinical trials of different routes of administration (sublingual, oral, smoked, and vaporized) have demonstrated analgesic benefit in the treatment of this costly and disabling condition and some treatment guidelines for neuropathic pain recommend consideration of cannabinoids as a second or third line agent.”

They also note the potential financial challenges that may come with using cannabis to treat neuropathy:

“As expenses for medical marijuana are not covered by health plans and are out-of-pocket, knowing the cost-effectiveness of medical marijuana may impact patients’ decisions regarding its use. Based on a recent published article, inhaled cannabis appears to be cost-effective when used as second or third-line treatment in chronic neuropathic pain.”

Summary

The medicinal properties of cannabis have been described for thousands of years, and now more and more modern research study outcomes suggest that cannabis and cannabis-based treatments are effective and well-tolerated for a variety of ailments. So far, several studies have shown that cannabis-based treatment approaches for neuropathy are effective, although additional investigation is warranted.

What do you think? Please share your thoughts on your experiences with neuropathy in the comments below. Have you tried or considered using this type of alternative treatment?

References

Heimerl K; “Medical Marijuana and Cannabidiol (CBD): Perception vs Facts” (2019) American Academy of Osteopathy (OMED 2019) http://files.academyofosteopathy.org/CME/OMED2019/Heimerl_MedicalMarijuana.pdf

Mechtler L, Ralyea C, Hart P, Bargnes V; “Medical Cannabis in the Treatment of Neuropathy” (2020) Neurology, 94(15S). https://n.neurology.org/content/94/15_Supplement/5020

Nemergut G; Marijuana (2019) Pain, pp. 315-319. https://link.springer.com/chapter/10.1007/978-3-319-99124-5_69#enumeration

Robinson-Papp J. and Dehbashi S; “Medical Marijuana for Peripheral Neuropathy” (2019) Neuropathy Hope Newsletter, Western Neuropathy Association. P.1 https://pnhelp.org/application/files/1415/6081/5051/WNAENews0719L.pdf

Wallace MS, Marcotte TD, Umlauf A; “Efficacy of Inhaled Cannabis on Painful Diabetic Neuropathy” (2015) Journal of Pain 16(7): 616-627. https://pubmed.ncbi.nlm.nih.gov/25843054/

Source: diabetesdaily.com

The Future of Insulin Therapy: New Tech For Better Outcomes

Advances in insulin types and delivery systems over the last few decades have aimed to improve blood glucose management and quality of life for people with diabetes. From improvements to insulin pumps and continuous glucose monitoring (CGM) systems, to new insulin formulations, and automation of insulin delivery, the technological developments in the diabetes world have been numerous and fast-paced.

What other new products and technologies can we expect in the future? The medical company Thermalin has many exciting ideas and ongoing developments on the horizon.

Thermalin was started approximately ten years ago by Michael Weiss, MD, PhD, Distinguished Professor and Chair of The Department of Biochemistry & Molecular Biology at the Indiana University School of Medicine. Dr. Weiss has decades of experience, and an extensive publication record, with a particular focus in insulin physiology. One of the primary goals of his company is to develop “new forms of insulin that will lower the burden of insulin use, increase patient adoption of and adherence to insulin therapy, improve patient lives and outcomes, and lower the cost.”

Products in Development

At this time, researchers are investigating several approaches that aim to lessen the burden of insulin therapy and improve outcomes. Some of the potential products and technologies they are working on include:

  • Small insulin pumps that will be about one-fourth the size of what is currently available. They are expected to have broad compatibility with a variety of smart devices and integrate with CGMs. Moreover, the pumps will come pre-filled and is expected to last for up to one week. Excitingly, a prototype has already been developed.
  • A variety of stable insulin preparations (no need for refrigeration). In particular, efforts on ultra-rapid and concentrated insulins are ongoing, with several products poised to begin clinical trials soon.
  • “Smart” basal insulin that will respond to changes in blood glucose levels. This product is still early in the stages of development.

Thermalin has recently announced that they received a grant from the NIH that should enable them to move forward with one of their ultra-rapid insulin candidates. Importantly, the development and approval of temperature-stable insulin will also allow for improvements to insulin pump technologies. Devices could then come pre-filled, and users could enjoy longer wear time without worrying about insulin integrity.

Altogether, temperature-stable insulin analog, along with smaller pumps that are technologically advanced but also less burdensome to wear, may help patients view pump therapy more favorably. The company points out a particular population that may benefit on their website:

“Many patients prefer to inject themselves privately before meals rather than wear a visible stigma of their disease. Good treatment habits are frequently developed in childhood but too often are lost in the teenage years; for body-conscious teenagers, a pump that is too visible just won’t be used. This means many patients will not adopt the new, automated pumps that can significantly improve blood sugar control.”

They also note the importance of shelf-stable insulin, and particularly in the developing world:

“In many parts of the developing world, patients do not have refrigerators and live long distances from clinics. Further, many of these clinics are not well served by “cold chain” distribution.  This means these patients do not have a reliable supply of needed insulin.”

We will continue to follow the development of these new products and update you as they begin to progress through clinical trials.

What do you think about these advances? What would you like to see come about in diabetes technology in the next decade? Please share your thoughts in the comments; we love hearing from our readers!

Source: diabetesdaily.com

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