Diabetes Could Be Cured With Cells Retrained to Produce Insulin

Researchers at Columbia University Medical Center have developed a way that could potentially cure type 1 diabetes by retraining gastrointestinal cells into insulin producing cells. While stem cells have been used in many of the attempts to create the necessary replacement cells, scientists have been unable to get them to function as they needed. This new research has found that changing the function of existing cells may restore the same type of insulin production expected in a healthy body. This new technique has already proven effective in lab mice and new studies using human tissue are showing promise.

Type 1 diabetes occurs when the immune system attacks the pancreatic beta cells that produce insulin. Once these cells are eliminated the body is no longer able to create the substance necessary for natural functioning, and individuals afflicted with the disease are forced to inject the required drug. In order to effectively adjust dosage, these individuals have to calculate how it will affect their body based on dietary intake, exercise amount and blood sugar levels in order to prevent dangerous drops or spikes in glucose. Scientists have been attempting to replace the lost pancreatic cells in a way that would respond to bodily changes automatically and prevent the need for injections and complex dosage calculations.

Previous experiments using stem cells have successfully generated cells that can produce insulin, but to this point they still cannot be made to function the same way as the naturally occurring pancreatic beta cells that react to changes in sugar levels. When mouse cells, or even human cells, have been retrained with this new method, research has shown that insulin is only produced in response to the presence of sugar, which corresponds with the natural functioning of the original pancreatic cells lost in the development of diabetes mellitus type 1.

The new technique that could cure diabetes deactivates the FOXO1 gene that prevents gastrointestinal cells from producing insulin and results in a cell that has been retrained to also be glucose-responsive. Once the FOXO1 gene is deactivated, it takes roughly one week for the affected cells to begin production of the hormone, but only in response to glucose levels rather than constantly as converted stem cells have done to this point. This slight difference in glucose response based insulin delivery versus constant delivery could mean the difference between curing the disease and killing the afflicted person due to hypoglycemia, commonly known as low blood sugar.

While this new research indicates great promise, the process is not yet complete. In order to turn a technique that could cure diabetes into a process that does, a drug must be developed that can effectively deactivate the FOXO1 gene in the necessary cells, so they are retrained to produce insulin. Once such a drug is created it will then have to be tested extensively to ensure both its effectiveness and a lack of dangerous side-effects. However long this process may be, though, science appears to be one step closer to winning the battle.

Low carb diets help diabetes and multiple sclerosis in new studies

Low carb diets have been shown to trump low fat plans for weight loss. Now new research is pointing to the benefits of low carb diets for several diseases. Most recently, a group of scientists and physicians have discovered that low carb diets represent the best initial intervention for diabetes, reported Science Direct on July 16.

The experts involved in the new report cite evidence that low carb diets lower high blood glucose and allow patients to reduce or, in some cases, eliminate their medication. And while low carb diets are effective for diabetes regardless of whether patients lose weight, the researchers also concluded that "nothing is better for weight reduction."

Side effects can pose problems with medication. However, the researchers also discovered that no such side effects result from low carbohydrate diets. They cited 12 points indicating that low carb diets are the most effective therapy for diabetes, beginning with hyperglycemia.

Noting that dietary carbohydrate restriction has the greatest effect on decreasing blood glucose levels, the researchers also pointed to the ongoing epidemics of obesity and type 2 diabetes. The calorie increases in the typical American diet occurring during these epidemics are primarily due to increased carbohydrates.

On average, Americans eat about 500 calories more each day than we did 30 years ago, and much of that increase comes from foods high in sugar and grains, according to a new study. And while more experts are blaming high carb processed foods for our obesity epidemic, low-carb diet gurus have been earning increased attention and respect for new studies showing that low-carb high fat (LCHF) and high protein diets are most effective for weight loss.

Based on the latest data, the Standard American Diet (SAD) includes a small amount of dairy, a slightly more generous serving of produce and protein and lots of oils, fats, sugar and grains. "It's hard to pinpoint why exactly it's increased," Jeanine Bentley, the social science analyst responsible for the USDA's food availability database, said about the added calories. "But it probably comes from an increase in processed and fast foods."

Franziska Spritzler, RD, CDE, believes that low carb high fat ketogenic diets are beneficial for weight loss and diabetes. In an exclusive interview, she noted that her clients have experienced improvements that parallel the new study. "I have seen several people with diabetes experience remarkable improvement in blood sugar control after adopting this way of eating,” she said.

Conducting his own research, Dr. Stephen Phinney, also believes that ketogenic diets are the most appropriate approach for diabetes. "Given both the healthcare costs and the medical risks associated with type 2 diabetes and metabolic syndrome, plus the immediate improvements (if not complete remission) in these diseases with a well-formulated ketogenic diet, this diet should be the primary (aka first) therapy that doctors and dietitians recommend," he said in an interview.

And the benefits of ketogenic diets may also extend to multiple sclerosis (MS) in some studies. However, in contrast to the significant body of research pointing to high fat low carb diets for diabetes and weight loss, the ideal plan for MS is more controversial, reported the St. Louis Post-Dispatch on July 17.

The MS Center of St. Louis, a partner of Mercy Hospital St. Louis, has been active in educating people with multiple sclerosis and their families. Mercy dietitian Rebecca Doss feels that significant evidence does not exist to recommend any special diet.

However, some studies have shown that vitamin D may reduce the risk. Doss feels that eating a high fiber diet may help but argues against saturated fat. But several physicians disagree.

Dr. Terry Wahls, author of "The Wahls Protocol: How I Beat Progressive MS Using Paleo Principles and Functional Medicine," has conducted new studies showing that high fat low carb ketogenic Paleo dietsare most effective. In an exclusive interview, she revealed that she began her research when she developed MS herself.

"After 20 years as a vegetarian, I read through the scientific studies and decided that the Paleo Diet as an intervention had merit. I added meat back to my diet and removed grain, dairy and legumes. I continued to slowly decline. The following year my doctors told me that my disease had transitioned to secondary progressive multiple sclerosis. I took the recommended chemotherapy; I got the tilt/recline wheelchair and even took Tysabri, but continued to slowly decline," she recalls.

Dr. Wahls used the Paleo diet as a template, then customized it "to get 31 nutrients that science said my brain cells needed to thrive. That is when the magic began to happen."

Within only three months, her fatigue diminished significantly. "Within six months I could walk throughout the hospital without a cane and my neurologist agreed that I could taper and discontinue my disease modifying drugs. And within 12 months I was able to do an 18-mile bike tour with my family."

For years, ketogenic diets have been used to control seizures. Recently, for example, a family revealed how their little boy, who suffered from 50 seizures daily, found relief from a ketogenic diet.

But Dr. Wahls feels the potential goes beyond epilepsy, diabetes and MS. "Ketogenic diets are being studied as treatment for other neurological and psychiatric disorders including brain cancer, ALS, Parkinson’s, MS, dementia, bipolar, depression and schizophrenia," she said. In her research currently, Dr. Wahls is seeking how to balance nutritional needs with the focus on ketosis.

Also arguing in favor of high fat low carb diets for MS is Dr. David Perlmutter, creator of the "Grain Brain" diet. He lists several case studies on his Web site showing that halting grains and sugar while boosting fat and protein made a dramatic difference for their MS.

One woman recalls that her "signs of MS started in 1988, but it wasn’t until 2004 that I had an attack that left me disabled and forced to retire from a career I loved in education. I have gone through periods of being in a wheelchair, using a walker, and walking with a cane. Today, thanks to going grain-free, I rarely have to use even a cane."

Diabetes: Let Food Be Thy Medicine

Type 2 diabetes can be cured! There! I've said it. Why, in our modern society where this disease is the seventh leading cause of death, does such a statement get suppressed from the general public?

Both major health entities, medical professionals and Big Pharma, fail to get the word out that withnutritional guidance combined with patient motivation, Type 2 diabetes can be reversed. But the word is beginning to get out. Some of the prominent physicians who are in the forefront of speaking out about reversing diabetes include Dr. Joel Fuhrman, Dr. Mark Hyman, and Dr. John McDougall -- all not afraid to say the word cure. It can be done, and they have done it.

Diabetes is not a bug we catch. Most of us know it's the foods we eat that create the dysfunction within, but it's the elephant in the room; some don't know what an elephant is, but most just do not want to look at it.

Let me offer two main conceivable reasons why the public isn't being told:

1. Curing it involves natural nutrition (without the help of drugs), something the medical community knows about and does little with. The typical scenario is doctor discovering that the patient does indeed have type 2 diabetes, instructing the patient to lower sugar consumption, yet will need to take diabetic medications the rest of his or her life.

2. The strong-arm pharmaceutical companies want their diabetes drugs to continue bringing in billions.

Advertisement spending by the pharmaceutical industry was $2.4 billion in 2011, as reported by Nielsen TV. The diabetes drug Lantus had total sales of $7.8 billion in 2013. The forecast for theworldwide diabetes drug market is $47.2 billion by 2017.

This falsehood of only being able to "maintain" the disease for the life of the patient is also unfortunately perpetuated by every major diabetes organization. Upon visiting their websites -- theAmerican Diabetes Association, The Diabetes Research Institute Foundation, Diabetic Living Magazine-- the common theme throughout is that there is no cure for diabetes.

The American Diabetes Association's website (diabetes.org) proclaims, "diabetes is a chronic disease that has no cure," and "eating well-balanced meals is an essential part of taking better care of yourself and managing diabetes." Instead of advising that diabetics stop eating refined grains and sugars, the suggestion on their site is: "Save money by buying less soda, sweets and chips or other snack foods." The Diabetes Research Institute Foundation claims they are "the best hope for cure." They offer many suggestions on managing diabetes, but not how to overcome it. "There is a lot you can do to stay well and remain healthy with diabetes."

The Diabetic Living website gives recipes that include refined sugar and refined flour, as well as artificial whipped toppings and the like.

Even Webmd.com tells us, after all the research and advances in diabetic treatments, "there is no cure for Type 1 nor Type 2 diabetes."

Being privy to successful turnarounds myself with my diabetic clients, I can say it definitely is possible. Being honest, even though it can be done by changes in diet and lifestyle, it is a struggle for many to get there, as well as a struggle to stay there; half of them will most likely revert because resistance to the outside influences and offerings of the restaurants, food manufacturing companies and supermarkets is difficult. It requires diligence and dedication to stay on the wagon for those who have been diabetic for so long, and therefore can fall off the wagon at any time. It's no different for those on the brink of diabetes currently who are continuing to eat refined foods, and soon will join the club. But when patients learn the whys of diabetes, and the horrible consequences of the disease, by rights the incentive should be there.

The culprits behind the onset of diabetes are most definitely refined, processed foods. These include refined sugars, refined flours and refined oils. It's the bakery goods, the hamburger and hot dog buns, and the foods deep-fried in trans fats and additives of highly processed oils. These surround us at all times in restaurants and supermarkets, and because of convenience, we fall for it. What also contributes is a lack of fresh fruit and vegetable fiber that so many avoid in their meals. As with smoking, to quit is to quit. To cure diabetes, quitting all refined foods is a must.

In various reports, there is a definite correlation between the introduction and proliferation of high fructose corn syrup, the rise in polyunsaturated fats, and the decline of animal fats, and the rise in diabetes. In 2012, over one-third of our children were overweight or obese; 80-90 percent of Type 2 diabetics are overweight or obese, which explains the recent popularity of the term diabesity.

It's these influences all around us that make it so difficult to maintain a healthy body. This is why it comes back to us individually to be mindful of what we put into our bodies. The task of preparing more and more of our own foods is more important than ever.

The medical community should be in the forefront of directing patients toward better, natural foods, and, if need be, advising that any diabetic contact a certified nutritionist to help guide them away from diabetes. Any doctor who is still writing the prescriptions for diabetes drugs for their patients at the onset of discovering elevated blood sugar, and not offering advice on food and nutrition, needs to refresh his or her memory of a quote from Hippocrates, considered to be the father of western medicine: "Let food be thy medicine and medicine be thy food."

Kellion Victory Medal for Brian’s 50 years with diabetes

WHEN you're diagnosed with diabetes, there's not a lot to celebrate.

But when you've been living with the disease for more than 50 years - it's an achievement worth boasting about.

Leichhardt resident Brian Leslie has had Type 1 diabetes since 1964.

The retired photographer said living with diabetes in those days was no easy task.

"In the mid-1960s, not many people - doctors included - knew much about Type 1 diabetes and the treatments and lifestyle changes required to live with the condition," he said.

"When I was diagnosed, there was no support for people with diabetes because it was so rare, there were certainly no low-calorie food or drinks.

"Decades before that, those with diabetes were probably looking at a death sentence. Back then it was called 'the wasting disease' where little could be done."

At 72, Mr Leslie said he owed his overall good health to the support and care of his wife of 32 years, Glenys.

"Without her, my life and outlook for the future would be significantly different," he said. "She has always been there, watching out for warning signs which would indicate a hypoglycemic attack and helping me avoid them."

Mr Leslie was recently awarded a Kellion Victory Medal as part of World Diabetes Day celebrations.

The award marks a huge personal triumph, commemorating those who have lived with diabetes for 50, 60 and 70 years or more.

The Victory Medal was presented by Diabetes Queensland president Dr Maarten Kamp who said he looked forward to honouring recipients each year. Dr Kamp said the award was a reminder people can still live a long and productive life.

More information from diabetesqld.org.au/

Kellion Victory Medal

The Kellion Victory Medal is named after Claude Kellion. When diabetes claimed the life of his son John, Claude, a successful businessman, established the Kellion Diabetes Foundation in John's memory. Funds raised through the foundation contribute to Diabetes Australia Research Trust projects.

4 effective ways to beat diabetes

Standard diabetes prevention advice (lose weight, exercise, eat better) is not getting through to — or even worse, is letting down — millions of North Americans! The proof is in shocking new statistics from the Centers for Disease Control and Prevention: 29 million Americans now have Type 2 diabetes, and 86 million more have prediabetes, a 10 percent jump in just two years.

That means more than 1 in every 11 Americans has Type 2 diabetes and is at increased risk for heart attack, strokes, vision loss, nerve damage, kidney failure, even amputation of toes, feet or legs, along with higher odds for depression, dental trouble, pregnancy complications and high vulnerability to the flu and pneumonia.

The 1 in 3 Americans with prediabetes face huge health risks, too: Having elevated blood sugar levels AT ALL ups the chance for a heart attack or stroke, cognitive problems, depression and sexual problems. Plus, within three years, 15 percent to 30 percent of people with prediabetes will develop full-blown Type 2.

In the 1970s, about 4 million Americans had Type 2 diabetes. While the number of those with Type 1 diabetes (caused by an autoimmune attack that stops the body’s production of insulin) has grown slightly, the prevalence of Type 2 — caused by inactivity, being overweight, unhealthy food choices and perhaps a genetic predisposition — has soared. YOU can turn this epidemic around by taking steps that will make your diabetes-stopping habits stick.

Here are four “betcha didn’t think of these” obstacles that may be what’s keeping you from effectively applying the standard advice of “move more, eat better, lose weight.”

1 Stress pumps up blood sugar.

Learn to chill.

Stress increases your blood sugar by switching on your body’s “fight or flight” response and by making you reach for foods that widen your waistline (a diabetes risk) and mute your body’s ability to use blood sugar. You can tame tension by getting plenty of sleep, learning a relaxation technique that works for you (deep breathing, meditation, progressive muscle relaxation) and making time for friends and family.

2 Overcrowded days make healthy choices difficult. Do what you can.

Discouraged because you can’t fit in a half-hour walk today? Don’t be. Grab a 10-minute walk at lunchtime. No time to meditate before you rush off to a morning meeting? Use that 15-minute wait before your boss shows up to do a short, relaxing breathing exercise. Gotta feed the family fast before another hectic evening of activities and homework? Hit the supermarket salad bar instead of the fast-food drive-thru.

3 Unhealthy food choices follow you through your day.

Make over your whole food environment.

Start at home by banishing the Five Food Felons: trans and saturated fats, added sugars and syrups and refined grains. Replace those villains (all of which mess with healthy blood sugar levels) with 100 percent whole grains; good fats found in nuts, avocados and olive and canola oils; fruit; vegetables, especially leafy greens; and salmon or ocean trout. These good foods contain fiber, mono- and polyunsaturated fats, vitamins, minerals and other nutrients that help regulate blood sugar and reduce the bodywide damage that diabetes and prediabetes can wreak.

Don’t stop there. Pack healthy lunches for yourself and your kids. And keep healthy snacks on hand at work and in the car. We love baby carrots, a handful of nuts or a juicy piece of sun-ripened fruit, along with water or herbal tea.

4 Don’t go it alone!

Working with a diet and/or exercise buddy is a proven to help you get better results. Sign up for diabetes education classes in your community. Got prediabetes? Check out the diabetes prevention programs (cdc.gov has lists) offered by YMCAs, hospitals, community centers and houses of worship.

Insulin therapy for type 2 diabetes 'may do more harm than good'

A new study published in the journal JAMA Internal Medicine suggests that for older patients with type 2 diabetes, medications to lower blood sugar levels may "do more harm than good."

Approximately 25.8 million people in the US have diabetes, with type 2 diabetes accounting for 90-95% of all cases.

Type 2 diabetes is characterized by insulin resistance - the inability of the body to produce enough insulin or use the hormone effectively, which causes high blood sugar levels. Over time, high blood sugar levels can cause kidney, eye or heart diseases, nerve damage or stroke.

Diagnosis of type 2 diabetes is usually determined through a blood test that measures hemoglobin A1c levels in the blood. This test reveals the average level of glucose the patient has had in their blood over the past 3 months.

In the US, type 2 diabetes is diagnosed when hemoglobin A1c levels reach 6.5% or higher. The higher A1c levels are, the greater the risk of other health problems.

Sometimes the condition can be managed through changes in diet, but other patients with type 2 diabetes may need medication - such as insulin or metformin - to help lower their blood sugar levels, and ultimately, reduce the risk of diabetes complications.

But the researchers of this latest study, from University College London (UCL) in the UK, the University of Michigan Medical School and the Ann Arbor Veterans Affairs Hospital, MI, claim that the benefits of such treatment - particularly for people over the age of 50 - may not always outweigh the negatives.

"In many cases, insulin treatment may not do anything to add to the person's quality life expectancy," says study co-author John S. Yudkin, emeritus professor of medicine at UCL. "If people feel that insulin therapy reduces their quality of life by anything more than around 3-4%, this will outweigh any potential benefits gained by treatment in almost anyone with type 2 diabetes over around 50 years old."

For their study, led by Sandeep Vijan, professor of internal medicine at the University of Michigan Medical School, the team assessed 5,102 patients in the UK with type 2 diabetes who managed their condition through the use of insulin pills or injections.

Over a 20-year follow-up, the researchers looked at how the treatments affected patients' overall quality of life and whether they were effective in reducing their risk of diabetes complications.

They then compared the reduced risk of such complications with the burden of using diabetes medications and the side effects associated with them.

According to the researchers, they found that the benefits of insulin therapy for patients with type 2 diabetes are very much dependent on their age at treatment initiation and the potential side effects, rather than their blood sugar levels.

For example, they estimate that a person with type 2 diabetes who begins insulin therapy at age 45 and lowers their hemoglobin A1c levels by 1% may experience an extra 10 months of healthy life.

But for a patient who starts treatment for type 2 diabetes at age 75, they estimate the therapy may only gain them an additional 3 weeks of healthy life. The researchers say this prompts the question - is 10-15 years of pills or injections with possible side effects worth it?

Prof. Yudkin comments:

"Ultimately, the aim of a treatment is not to lower blood sugar for its own sake but to prevent debilitating or deadly complications. If the risk of these complications is suitably low and the burden of treatment correspondingly high, treatment will do more harm than good. The balance between the two can never be defined by a simple figure like blood sugar level."

The team says their findings apply to type 2 diabetes patients with hemoglobin A1c levels below 8.5%. But they note that patients with levels above 8.5% may be likely to see greater benefits from insulin therapy, as they are at greater risk of diabetes complications.

However, the team concludes that using a patient's hemoglobin A1c levels alone to judge whether they will benefit from insulin therapy is a "fundamentally flawed strategy."

"Instead," they add, "each glycemic treatment decision should be individualized, mostly on the basis of the patients' views of the burdens of therapy, with age and initial level of glycemic control important secondary considerations."

"Currently, we are failing our patients by not recognizing that their preferences and views of treatment burden are the most important factors in helping them make glycemic treatment decisions that are best for them."

Earlier this year, Medical News Today reported on a study published in the journal PLOS One, in which researchers took to Mount Everest in order to show how hypoxia - low oxygen levels in the body - isassociated with development of type 2 diabetes.

Written by Honor Whiteman

FDA Approves Inhaled Diabetes Medication

People with type 1 or 2 diabetes now have a new means of getting their medication, with the U.S. Food and Drug Administration's approval on Friday of the first inhaled medicine for the blood sugar disease.

The drug, Afrezza, "is a new treatment option for patients with diabetes requiring mealtime insulin," Dr. Jean-Marc Guettier, director of the Division of Metabolism and Endocrinology Products in the FDA's Center for Drug Evaluation and Research, said in an agency news release on Friday.

He said that Afrezza's approval "broadens the options available for delivering mealtime insulin in the overall management of patients with diabetes who require it to control blood sugar levels."

Diabetes falls into two main categories: type 1, an autoimmune illness which is often inherited and involves a dysfunction of insulin-producing cells in the pancreas; and type 2, which develops over time and is tied closely to obesity. Between 90 percent and 95 percent of diabetes cases are of the type 2 variety, according to the U.S. National Institutes of Health.

The FDA estimates that almost 26 million Americans -- about 8.3 percent of the population -- now live with diabetes, which can lead to dangerous complications such as heart disease, vision loss and nerve and kidney problems. Many patients must take injected insulin daily to maintain healthy blood sugar levels.

Afrezza's approval came after a study involving more than 3,000 people -- approximately 1,000 with type 1 diabetes and nearly 2,000 with the type 2 form of the illness.

For people with type 1 disease, researchers compared the effectiveness of Afrezza in adult patients against that of fast-acting insulin (aspart), used in both cases alongside basal insulin (long-acting insulin). Over 6 months, the combo of long-acting insulin and Afrezza met required treatment effectiveness in terms of blood sugar control, the FDA said.

For patients with type 2 diabetes, researchers combined Afrezza with standard diabetes pills and compared the use of the inhaled drug at mealtimes against the use of standard medications plus a placebo. At six months, the Afrezza-plus-standard medications combination produced better results overall, the FDA said.

The agency stressed that Afrezza should never substitute for long-acting insulin, and patients with type 1 diabetes must use the drug in combination with long-acting insulin. Smokers should avoid Afrezza, as well, the agency said, and the drug is not to be used in the treatment of a condition called diabetic ketoacidosis.

People with certain lung conditions should also not use Afrezza, due to a dangerous complication called acute bronchospasm. For this reason, the FDA has ordered a warning be placed on the product's labeling to caution people with chronic obstructive pulmonary disease (COPD) from using the drug. The FDA is also advising that people with asthma avoid Afrezza for the same reason.

According to the agency, the most common side effects from Afrezza were hypoglycemia (low blood sugar), cough, and throat pain or irritation.

The FDA is also ordering that "post-marketing studies" be conducted to track the safety and effectiveness of Afrezza in children, and to see if there is any connection between the use of Afrezza and any lung cancers.

A Novel Approach to Treating Type 2 Diabetes: Short-Term Intensive Insulin

Type 2 diabetes is a progressive disease with worsening beta cell function over time.  Traditional treatment of type 2 diabetes begins with oral medications, including metformin, sulfonylureas, or DPP-4 inhibitors and then progresses to GLP-1 agonists and/or insulin injections. Dr. Mariela Glandt, an endocrinologist and director of the Diabetes Medical Center in Tel Aviv, however, uses a short course of intensive insulin therapy in order to “reset” beta cells and help them return to an earlier and more manageable stage of the disease. 

Beta cell function declines in response to multiple factors in type 2 diabetes, and insulin therapy has been shown to counteract several of these. For example, treatment with insulin can reduce glucotoxicity – the toxic effects of excess sugar in the blood, lipotoxicity (due to chronically elevated free fatty acids), inflammation, and resistance to incretins.

Studies[1] have shown the effectiveness of short-term intensive insulin therapy (IIT) early in the presentation of type 2 diabetes. Dr. Glandt is applying this same concept to treat diabetes years after the original diagnosis.  In her private practice she has brought over 80 patients with complicated diabetes to a place where their diabetes is much easier to manage, and they have near normal HbA1c’s.

When did you start treating patients with intensive insulin therapy?

It all started when a patient with a 10-year history of diabetes and an A1c of 14% came into my office.  His previous doctor had prescribed Janumet, a combination pill of metformin and sitagliptin, a few months prior to the visit, but still there was no improvement, and he was exhausted and hopeless.  I suggested he stay on the medication he was taking, but told him that in addition to his current medication, from now on he should behave as if he has type 1 diabetes, meaning he would take insulin with everything he ate (including snacks).

I started treating my new patient with low doses of insulin and made the corrections slowly because I knew that if l lowered his blood sugar too fast he would feel bad, as if he were hypoglycemic, although he really wasn’t.  I told him to come to the clinic every week, and we slowly fine-tuned his insulin regimen.  At first I increased and increased the insulin doses, then after a while of his blood sugar levels being near normal, he started to need less and less insulin.  After 6 weeks, I was able to peel off the insulin entirely and he ended right back on his original medication, Janumet.  Now, more than two years later, he is still on Janumet with A1c of 6.9%. 

Since then I’ve treated dozens of patients this way and I am shocked by the successful results.  On average my patients have been diabetic for 10 years and on average their A1c is 9.8% at the beginning of treatment.  After 6 months the average A1c is 6.9%

Most patients who have A1c of 14% are placed on insulin? What’s different about your treatment?

I think the key point is that the insulin has to be taken in such a way as to really bring the blood sugar close to normal levels.  Most patients like this would be started on insulin and would probably be kept on it for the rest of their lives.  It is the fact that my patients take insulin like a patient who has well treated type 1 that allows the pancreas to start working, as I see by the fact that they don’t need insulin anymore and still their sugars are well-controlled

What is the mechanism behind this?

A few studies (see footnote 1) conducted on patients close to the time of diabetes diagnosis show that when insulin is given this way for a few weeks, the patients can revert to a state of no-diabetes for one to two years.  It is believed to be due to the fact that the beta cells improve their function when they are no longer smothered in sugar. High glucose levels are toxic to cells (glucotoxicity), which means that the cells are stunned and cannot secrete insulin appropriately. Generally, these cells are not dead and can go back to working if given the opportunity.  As I often say, “give beta cells a chance.”

Since these patients have had diabetes for many years, what are your expectations after the intensive insulin therapy?

Some beta cell deterioration is reversible and some is not.  It seems to depend on how long the patient was exposed to hyperglycemia and the degree of hyperglycemia.

Those who are recently diagnosed are able to come off medications for one to two years and remain in good control. Those who have had diabetes for ten years (which is the average I see in my clinic) are able to significantly improve their insulin secretion, but must continue to take simpler medications, that don’t require frequent checking of blood sugar levels because they don’t lead to hypoglycemia.

So what medications are used after the intensive treatment is over?

Unless there is a contraindication most patients are kept on metformin- a very safe and well known drug.  In addition, GLP-1 agonists such as liraglutide seem to be very effective – they help with both weight maintenance and keep blood glucose levels in the range of normal without putting the patient at risk for hypoglycemia.  The downside of GLP-1 agonists is that they are expensive.

Many patients come to me already on a GLP-1 agonist, but because their glucose levels are high, the GLP-1 agonist is not working.  However, as soon as the glucotoxicity goes away with the insulin treatment, the GLP-1 agonist starts to work and patients even start to complain of the usual side effects as if they had just started taking the medication.  I often have to lower the dose of GLP-1 when I start intensive insulin therapy just so patients won’t suddenly get the side effects. There is a paper[2]that shows that when beta cells are exposed to hyperglycemia for a long time they lose the GLP-1 receptors.  When they are re-exposed to normal sugars then the beta cells regain the GLP-1 receptors.  This helps to explain the phenomenon I often see in clinical practice.  Suddenly, a medication like liraglutide, which was described to me by the patient as “it did nothing for me” is now very effective.

Are you really able to stop the insulin on all patients?

Certainly not on all patients, but in those who I don’t manage to take off the insulin entirely, they often remain only on a low dose of long acting insulin. Eating a low carb diet and doing some kind of physical activity – of course – significantly improves the chances of coming off insulin, even if the patient has been a diabetic 20 years. 

It seems like you have to bring the patients’ blood sugar levels quite close to normal for this to work. In these patients who on average have had diabetes for 10 years, are you not concerned about the data from studies like the ACCORD trial[3] which showed that bringing glucose to near-normal levels in patients with long history of diabetes increased cardiovascular risk.

[The goal of ACCORD (the part that checked the impact of glycemia) was to determine whether cardiovascular disease event rates could be reduced by intensively treating glucose levels.  There were two arms of the study – one aiming for A1C <6  an the other 7–7.9%] 

It is, of course, something I have given a lot of thought to, but my understanding from trials like the ACCORD trial is that low A1C is unlikely to account for the increased risk of mortality.   In fact, rapid reduction of A1C from high levels did not increase risk of death.  Participants who were unable to reduce A1C after starting the intensive strategy and continued to have average A1C >7% seemed to be at greater risk than those with average A1C <7% using the same strategy or than those with A1C >7% using a standard strategy.[4]

At my clinic I have always seen the glucose levels decrease relatively slowly, but surely, with no hypoglycemic events because the insulin is given in a physiological way, and the treatment includes very frequent contact with the doctor, nurse, and dietician. 

A recent publication from the ACCORD trial actually showed that the intensive arm  (which reached HbA1c levels below 6.5% ) had great glucose control more than one year after therapy is relaxed[5], which is similar to my findings.  

How do you convince patients to take 4 shots a day (at a minimum)?

It’s not so hard because most of these patients are tired of feeling that diabetes is uncontrolled, doing damage, and that they can’t do much about it.  The good news is that the plan is to be on insulin for one to two months.  Because it is temporary, it’s easier to accept. The interesting part is that many patients actually enjoy the process because insulin becomes a tool that empowers them and gives them back control over their life (even for those on multiple shots a day for years). I achieve this with the help of a glucometer called Insulinx, which has a built in sliding scale and recommends to the patient how much insulin to take according to what I program in it, and the dose is something that I change on a weekly basis. It’s a very helpful tool.  

How long does the diabetes stay well controlled after they stop the insulin? 

We know from the trials (see footnote 1) done in patients with new onset diabetes that the beta cell improvements seen after intensive insulin therapy decline over time.  In our practice we’ve seen over the last two years that overall patients are able to stay with A1c under 7%, particularly if they are on GLP-1 agonist.  A  study by Ravi Retnakaran  presented at the America Diabetes Assoication’s Scientific Sessions Conference in Chicago last month showed that liraglutide after a short course of intensive insulin therapy preserved the  beta cell function gained after a short course of intensive insulin therapy. 

The exception is in cases where patients have other reasons to go off track, for example intermittent illness, such as an asthmatic patient who requires high doses of steroids.  In some cases A1c starts to go slightly up and the patients themselves request a “booster” (another short course of intensive insulin therapy).

The ongoing RESET IT trial[6] investigates the effect of administering a short course of intensive insulin therapy every three months –i.e., using insulin as both the initial and maintenance therapy.  It will be interesting to see the results of that.

This whole process seems like a lot of work for you and the patients, but the results are so impressive.  I assume it’s all worth it.

For me it’s worth it because I see how the patients react. At the beginning it’s tough because of the amount of injections. But as patients gain control over their lives and they feel great because they are no longer tired due to the chronic hyperglycemia, I sometimes have to convince them that it’s time to stop.

U doctors think a cheap pill for gout may delay onset of diabetic kidney disease

Paul Wild has been a reliable research volunteer at the University of Minnesota for 20 years, participating in two landmark studies that changed the standard of care for diabetes, a disease that afflicts more than 24 million Americans.

“Looking back, it was probably the best thing I ever did,” said the 61-year-old Mendota Heights dentist.

Now, Wild is among 480 patients being recruited for a $24 million, 3½-year test to see whether a medication that has been used routinely to prevent gout can delay the onset of potentially fatal kidney disease in patients with Type 1 diabetes.

If the study succeeds, the medication, called allopurinol, could be to diabetic kidney disease what baby aspirin is to heart attacks, said Dr. Luiza Caramori, an endocrinologist helping to oversee the study at the U. The drug could delay the need for dialysis and kidney transplants by eight to 10 years, she said, saving thousands of lives and tens of millions of dollars in medical spending.

Diabetes has reached epidemic proportions in the United States, with rates increasing so fast that researchers predict 1 in 3 Americans born after 2000 could develop either type 1 or type 2. As many as 30 percent of diabetics will develop serious kidney disease within 10 to 20 years of their diagnosis, making it the leading cause of kidney failure in the United States. And because the waiting list for a kidney is so long, hundreds of patients die each year waiting for a transplant.

While the U study is limited to subjects with Type 1 diabetes, Caramori said positive findings will likely benefit the far more common Type 2 diabetics, as well.

“It’s amazing that in the past 20 years we’ve basically made no progress in delaying kidney disease in patients with diabetes,” she said. “It’s also disappointing and scary, because the rates of complications are quite high in these patients.”

Type 1 diabetes occurs when the immune system destroys the body’s ability to produce insulin. It affects fewer than 1 in 10 diabetics. The much more common Type 2 often results from genetic predisposition, coupled with obesity and lifestyle factors, leading initially to resistance to the body’s own insulin.

The U is one of seven U.S. sites and two international locations recruiting participants for the study, which is being led by Dr. Michael Mauer, a professor of pediatrics and medicine at the U’s medical school, and Dr. Alessandro Doria, an epidemiologist at Joslin Diabetes Center and associate professor at Harvard Medical School.

If allopurinol works as expected, it could become the standard treatment for treating diabetic kidney complications, Doria said in comments released last year.

Study seeking volunteers

Results from three small preliminary studies indicate that allopurinol shows real promise. It suppresses the production of an enzyme, xanthine oxidase, a result of metabolic activity, which can lead to excess acid in the urine. The World Health Organization lists it as an essential medicine for health systems.

It’s also cheap and has been used in the Untied States for nearly 50 years to prevent gout flare-ups.

The study seeks volunteers between 18 and 70 who’ve been diagnosed with Type 1 diabetes for at least eight years and who are concerned about possible kidney disease.

Although allopurinol is generally safe, researchers will screen study applicants for possible drug interactions and for a genetic profile that puts some at risk for a rare, serious skin disease.

The study will assign subjects randomly to two equal groups. They will get either allopurinol or a placebo — neither the patients nor their doctors will know which — and they’ll have to visit a study center or a site working remotely with the centers 17 times over three years for a variety of procedures and tests.

The U is one of nine institutions known as the Preventing Early Renal Function Loss in Diabetes (PERL) Consortium, which received the $24.3 million grant from the National Institute of Diabetes and Digestive and Kidney Diseases, a division of the National Institutes of Health (NIH). The nonprofit Juvenile Diabetes Research Foundation also is contributing to the PERL study.

Caramori said that leading diabetic researchers are involved and that they have big hopes for it.

FDA Approves Inhaled Insulin

The FDA has approved inhaled insulin to treat type 1 and type 2 diabetes.

The insulin, called Afrezza, is a rapid-acting insulin and is meant to be taken at mealtime or soon after.

“Today’s approval broadens the options available" for delivering insulin in people with diabetes, Jean-Marc Guettier, MD, director of the FDA's Division of Metabolism and Endocrinology Products, says in a news release.

The FDA estimates that 18.1 million people have diabetes. About 7 million more are undiagnosed, the agency says.

This is the third time the drug was up for FDA approval. Its maker, MannKind Corporation, conducted additional safety studies after the first two attempts.

Patients with type 1 diabetes will need to use the drug in combination with long-acting insulin. Patients with type 2 diabetes will use it in combination with oral medications.

Afrezza carries a warning as it may cause a sudden tightening of the chest.  It is not recommended for people with asthma or COPD. It is also not recommended for people that smoke or for the treatment of diabetic ketoacidosis.

"Our expectation is it should be priced comparably to current fast-acting insulins delivered in pen form," says Matthew Pfeffer, a spokesman for MannKind.

DIABETES IN THE US

In 2012, 29.1 million Americans, or 9.3% of the population, had diabetes.

It was the seventh leading cause of death in the United States in 2010.

In 2012, the total costs of diagnosed diabetes in the United States was $245 billion

After adjusting for population age and sex differences, average medical expenditures among people with diagnosed diabetes were 2.3 times higher than what expenditures would be in the absence of diabetes.

Combining two different medications could help patients with Type 1 diabetes at least partially regain the ability to produce their own insulin, the University of Florida study has shown.

Dr. Michael Haller, a pediatric endocrinologist, likens his approach to treating Type 1 diabetes to a game of cops and robbers. 

First, he ferrets out problematic cells of the immune system that could be behind a patient’s inability to produce insulin and wipes them out with a medication called Thymoglobulin, a drug initially developed for use in organ transplantation. 

Then he uses a medication called Neulasta, a drug designed to improve the lives of people with certain forms of cancer, to stimulate the production of new and potentially beneficial immune cells.

Haller presented the results of the study on Sunday at the annual meeting of the American Diabetes Association in San Francisco.

'The treatment is almost like trying to hit the reset button on the immune system,' Haller said. 

'We’re trying to wipe out the bad cells and stimulate the good cells at the same time.'

Haller treated 17 adult Type 1 diabetes patients for two weeks with the cocktail therapy and then followed them for a year. 

Another eight patients were given a placebo. 

The drug could help reverse the effects of Type 1 diabetes, meaning patients will not need to inject insulin (pictured)

By the end of the year, the patients treated with the cocktail had increased their ability to produce insulin. 

This indicates that the Thymoglobulin was successful in killing the bad immune system cells, and the Neulasta was successful in stimulating new, healthy immune cells. 

The researchers also say the patients’ ability to produce insulin indicates they had an increase in beta cells, the cells responsible for producing insulin in the pancreas.

'The treatment seemed to stimulate insulin production in people with established Type 1 diabetes made the researchers 'cautiously optimistic,'' Mark Atkinson, a co-investigator in the study, said.

'The results that Dr. Haller saw in his first study are profound.'

The study was also novel in that it worked with patients who had been long diagnosed with the disease. 

Typically, studies examine patients who are newly diagnosed and still have a reasonable number of beta cells producing insulin. 

The patients in Haller’s study had been living with Type 1 diabetes between four months and two years.

'The model has mostly been to test therapies aimed at beta cell preservation in people who have just been diagnosed,' Haller said. 

'But obviously, the majority of patients living with the disease have been living with the disease for a long time, so people become disenfranchised from the research process. 

'We’re interested in making life better for these patients.'

Co-investigator Dr. Desmond Schatz said: 'Despite tremendous strides in our understanding of the natural history of Type 1 diabetes, we are as yet unable to cure and prevent the disease,' Schatz said.

'This study is a step in that direction, toward a biological cure.'

Health in the CNMI: The diabetic brain - Marianas Variety

ONE physician I follow fairly regularly is Dr. Mercola. He always has interesting things to say, and his views are often controversial. Still, he is smart and is worth paying attention to.

In a recent column, Mercola says not only can type II diabetes be reversed (other doctors have said the same) but that insulin is not quite as beneficial to a diabetic as medical science would have us believe.

What Mercola says may be important to the diabetics in the commonwealth. As always, check with your physician. A link to the full report is at the end of this story.

Dr. Mercola writes:

“In the United States, nearly 80 million people, one in four, has some form of diabetes or pre-diabetes. Worse, both type 1 and type 2 diabetes among children and teens has skyrocketed.

“The most recent data reveals that, between 2001 and 2009, incidence of type 1 diabetes among children under the age of 19 rose by 21 percent. Incidence of type 2 diabetes among children aged 10-19 rose by 30 percent during that same timeframe.

Conventional medicine has it wrong

“Statistics such as these point to two very important facts. First, it tells us that diabetes cannot be primarily caused by genetics, and secondly, it suggests that something we’re doing — consistently and en masse — is wrong, and we need to address it.

“In this case, that “something” is a seriously flawed diet and lack of physical activity.

“Conventional medicine has type 2 diabetes pegged as a problem with blood sugar rather than the underlying problem of improper insulin and leptin signaling. The reality is that diabetes is a disease rooted in insulin resistance and perhaps more importantly, a malfunction of leptin signaling, caused by chronically elevated insulin and leptin levels.

“This is why the medical community’s approach to its treatment is not getting anywhere. Treating type 2 diabetes with insulin is actually one of the worst things you can do.

“Recent research has come to the same conclusions that Dr. Ron Rosedale warned us about nearly a decade ago, which is that treating type 2 diabetes with insulin can lead to the development of type 1 diabetes.

“And, not only are conventionally trained doctors wrong about the cause of the disease, but they continue to pass along seriously flawed nutritional information as well, which allows the disease to increase to epidemic proportions.

“A study published in the June 30, 2014 issue of JAMA Internal Medicine concluded what Dr. Rosedale has been saying for two decades, that insulin therapy in type 2 diabetic patients may indeed do more harm than good.

“‘In the U.S., type 2 diabetes is diagnosed when hemoglobin A1c levels reach 6.5 percent or higher. The higher A1c levels are, the greater the risk of other health problems. Sometimes the condition can be managed through changes in diet, but other patients with type 2 diabetes may need medication — such as insulin or metformin — to help lower their blood sugar levels, and ultimately, reduce the risk of complications.’

“But the researchers of this latest study claim that the benefits of such treatment — particularly for people over the age of 50 — may not always outweigh the negatives.

“‘In many cases, insulin treatment may not do anything to add to the person’s quality life expectancy,’ says study co-author John S. Yudkin. ‘If people feel that insulin therapy reduces their quality of life by anything more than around 3-4 percent, this will outweigh any potential benefits gained by treatment in almost anyone with type 2 diabetes over 50 years old.’

“A growing body of research suggests there is a powerful connection between your diet and your risk of both Alzheimer’s disease and glaucoma via similar pathways that cause type 2 diabetes. Alzheimer’s disease was tentatively dubbed ‘type 3 diabetes’ in early 2005 when researchers learned that the pancreas is not the only organ that produces insulin. Your brain also produces insulin, and it is necessary for the survival of your brain cells.

“A drop in insulin production in your brain may contribute to the degeneration of your brain cells. Studies have shown that people with lower levels of insulin and insulin receptors in their brain often have Alzheimer’s disease. Researchers have now discovered that insulin does far more than simply regulating blood sugar. Your brain does not require glucose, and actually functions better burning alternative fuels, especially ketones. In fact, Dr. Rosedale believes that it is the constant burning by the brain of glucose that is primarily to blame for Alzheimer’s and other brain disorders.

“Insulin is actually a ‘master multitasker’ that helps with neuron glucose-uptake, and the regulation of neurotransmitters, like acetylcholine, which are crucial for memory and learning. This is why reducing the level of insulin in your brain impairs your cognition. Other research shows that type 2 diabetics lose more brain volume with age than expected. This kind of brain atrophy is yet another contributing factor for dementia. ‘Brain diabetes’ may also be responsible for glaucoma, according to a report by Medical News Today.

“The recent paper titled ‘Glaucoma: diabetes of the brain - a radical hypothesis about its nature and pathogenesis,’ published in Medical Hypotheses explores glaucoma and related neurodegenerative diseases from many perspectives and comes up with a multifaceted and internally coherent concept of glaucoma being ‘the diabetes of the brain.’

“It’s becoming increasingly clear that the same pathological process that leads to insulin resistance and type 2 diabetes may also hold true for your brain. As you over-indulge on sugar and grains, your brain becomes overwhelmed by the consistently high levels of glucose and insulin that blunts its insulin signaling, leading to impairments in your thinking and memory abilities, possibly causing brain damage.

“Additionally, when your liver is busy processing fructose (which your liver turns into fat), it severely hampers its ability to make cholesterol, an essential building block of your brain that is crucial for optimal brain function. Indeed, mounting evidence supports the notion that significantly reducing fructose consumption is a very important step you can take to prevent Alzheimer’s disease.”

Because we have many diabetics in the commonwealth, some of whom may be interested in reading the full text of Dr. Mercola’s article, visit www.mercola.com The diabetes article is right at the top of the home page.