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Old 03-17-09, 05:12 AM   #1
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Diabetes cure a step closer?

I don't know if this is news to people on this forum or not, but as it seems that many people here suffer or know sufferers I thought I'd post it anyway.

http://www.telegraph.co.uk/health/he...ood-sugar.html
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Old 03-17-09, 06:25 AM   #2
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It may be closer than that. Dr. Denise Faustman at Massachusetts General Hospital in Boston works on Type I diabetes and has, quote,

In research published in 2001 in the Journal of Clinical Investigation and in 2003 in Science, Dr. Faustman and colleagues used a brief, non-toxic treatment to induce TNF-a in end-stage diabetic mice and permanently eliminate their disease. This therapeutic approach not only stopped the autoimmunity and restored normoglycemia, but also precipitated the regeneration of insulin-producing cells without the introduction of stem cells.

A human clinical trial is underway. Incidentally, Dr. Faustman was refused funding from all of the traditional diabetes funding sources. The treatment involves the use of a cheap anti-autoimmune drug.
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Old 03-17-09, 08:56 AM   #3
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That would be pretty sweet. Being insulin dependent seems a challenging way to go through life.
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Old 03-17-09, 09:12 AM   #4
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Being insulin dependent seems a challenging way to go through life.
To say the least! My father developed Type I diabetes at age 38 or so. Hmmm...I'm 34 and a clyde. Time to go for a ride...
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Old 03-17-09, 09:45 AM   #5
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As an insulin-dependent diabetic, I've been listening to these stories every couple of years since 1980. After 29 years, I've learned that researchers are way too optimistic about most of the stuff they're working on. I've seen read about at least a half-dozen "cures" that never went anywhere. Even the most promising stuff (ex: combining an insulin pump and a continuous glucose monitor to create a "closed loop" system that automatically monitors and adjusts blood sugar) doesn't seem to get enough research money or attention...
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Old 03-17-09, 10:40 AM   #6
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That would way too cool!! But, just in case, I will keep up my fund raising! Someone sponsor me!!
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Old 03-17-09, 01:04 PM   #7
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The closest to market procedure I have heard about was last year. It has been found that in many patents that underwent gastric bypass surgery that there type II diabetes was cured almost over night. They believe it has to do with the first 12 inches of the small intestine, as I recall.
I seem to have heard that a doctor had approval for testing the procedure just for the treatment of diabetes.
I am still waiting my turnů
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Old 03-17-09, 06:15 PM   #8
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As an insulin-dependent diabetic, I've been listening to these stories every couple of years since 1980. After 29 years, I've learned that researchers are way too optimistic about most of the stuff they're working on. I've seen read about at least a half-dozen "cures" that never went anywhere. Even the most promising stuff (ex: combining an insulin pump and a continuous glucose monitor to create a "closed loop" system that automatically monitors and adjusts blood sugar) doesn't seem to get enough research money or attention...
I think the problem isn't that there isn't enough money raised for research, there is plenty raised, it's just too much of it gets p****d away on stuff that has nothing to do with research, like renting fancy offices for the organization, or sending the well paid chair and board members on expensive junkets and fancy TV adverts to raise more money....
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Old 03-18-09, 04:01 PM   #9
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That would be nice. My mom first lost her kidney function, then her foot, and finally her life to this disease. From when her kidneys stopped functioning to her death took less than 2 years and from everything I've learned that is about average. I don't think most people have any clue how ruthless this desease is, I sure didn't.
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Old 03-18-09, 05:34 PM   #10
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As an insulin-dependent diabetic, I've been listening to these stories every couple of years since 1980. After 29 years, I've learned that researchers are way too optimistic about most of the stuff they're working on. I've seen read about at least a half-dozen "cures" that never went anywhere. Even the most promising stuff (ex: combining an insulin pump and a continuous glucose monitor to create a "closed loop" system that automatically monitors and adjusts blood sugar) doesn't seem to get enough research money or attention...
The closed loop pumps are supposed to be on the market in the next 2 years pending FDA approval.

To clarify the article: it is discussing Type I diabetes which is immune destruction of the pancreas. A cure for this disease would be fantastic because right now all we have is insulin replacement...for the rest of your life.

Type 2 diabetes is currently treatable/curable with exercise, diet, and ultimately weight loss (and rapidly via Gastric bypass surgery, apparently).
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Old 03-18-09, 05:51 PM   #11
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The closed loop pumps are supposed to be on the market in the next 2 years pending FDA approval.

To clarify the article: it is discussing Type I diabetes which is immune destruction of the pancreas. A cure for this disease would be fantastic because right now all we have is insulin replacement...for the rest of your life.

Type 2 diabetes is currently treatable/curable with exercise, diet, and ultimately weight loss (and rapidly via Gastric bypass surgery, apparently).
One thing folks need to remember, being insulin dependant does not always mean type I, Some type II diabetics, particularly those who are diagnosed at a younger age, and don't deal with it, end up to the point where the pills, don't work anymore, and they end up needing to take insulin....
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Old 03-18-09, 10:59 PM   #12
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One thing folks need to remember, being insulin dependant does not always mean type I, Some type II diabetics, particularly those who are diagnosed at a younger age, and don't deal with it, end up to the point where the pills, don't work anymore, and they end up needing to take insulin....
I absolutely agree.
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Old 03-21-09, 02:51 AM   #13
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The closed loop pumps are supposed to be on the market in the next 2 years pending FDA approval.

To clarify the article: it is discussing Type I diabetes which is immune destruction of the pancreas. A cure for this disease would be fantastic because right now all we have is insulin replacement...for the rest of your life.

Type 2 diabetes is currently treatable/curable with exercise, diet, and ultimately weight loss (and rapidly via Gastric bypass surgery, apparently).
It's not really a closed loop system is it? Its the pump and monitor combined into one package. The monitor will tell the pump to alarm if you have a high/low, rapid high/rapid low but it will not adjust for you. I would be too scared to give total control of my 11 y/o to a machine.
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Old 03-21-09, 10:30 AM   #14
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My wife has had type 1 for 35 years and this is interesting, except for the whole issue of poisoning the system with the treatment.
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Old 03-21-09, 10:45 AM   #15
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It's not really a closed loop system is it? Its the pump and monitor combined into one package. The monitor will tell the pump to alarm if you have a high/low, rapid high/rapid low but it will not adjust for you. I would be too scared to give total control of my 11 y/o to a machine.
It will actually be closed loop.

There are currently pumps on the market with continuous sensors that alarm if blood sugar is too low or dropping too fast.

The next pumps will incorporate the low/falling blood sugar information and automatically adjust the insulin infusion rate in response. I've heard the current pumps with continuous sensing are technically able to do this, it's an issue of which chip has been installed. It's possible that if you have a continuous sensing pump now, you won't need to get an entirely new pump, just a new chip installed.

The FDA has not approved the closed loop yet, but the process is happening. It of course may or may not get approved.
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Old 03-21-09, 11:44 AM   #16
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It will actually be closed loop.

There are currently pumps on the market with continuous sensors that alarm if blood sugar is too low or dropping too fast.

The next pumps will incorporate the low/falling blood sugar information and automatically adjust the insulin infusion rate in response. I've heard the current pumps with continuous sensing are technically able to do this, it's an issue of which chip has been installed. It's possible that if you have a continuous sensing pump now, you won't need to get an entirely new pump, just a new chip installed.

The FDA has not approved the closed loop yet, but the process is happening. It of course may or may not get approved.
I've been using an insulin pump since 1981 or '82. For that entire time period, researchers have been predicting that a closed-loop system was only 5 years away. I currently use a continuous glucose monitoring system. Accuracy and reliability are nowhere near good enough to allow implementation of a closed-loop system.

In addition, current (external) insulin pumps seem like a poor match for a closed-loop system. Insulin injected subcutaneously takes hours before it reaches peak effectiveness. That simply won't work for a closed-loop system, which is designed to monitor your blood sugar and then deliver insulin to compensate for any changes without any intervention from the user. The long lag between the time when a blood sugar spike is detected and effective insulin can be delivered would mean that the system is always "chasing its tail". A closed-loop system would need insulin that reaches peak effectiveness an order of magnitude faster or an implantable pump that delivers insulin to the blood stream much faster.
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Old 03-21-09, 03:54 PM   #17
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I think the problem isn't that there isn't enough money raised for research, there is plenty raised, it's just too much of it gets p****d away on stuff that has nothing to do with research, like renting fancy offices for the organization, or sending the well paid chair and board members on expensive junkets and fancy TV adverts to raise more money....
Well "plenty raised" isn't enough. Disease pathways aren't like a broken bike, we can't replace parts until it works.
It is true that the people at some foundations spend a lot of money on flying around advertising it and talking with government to increase support. I have found this to be worth while in every foundation I've worked with. Public perception has everything to do with research. If the public doesn't care, the politicians don't care. The NIH and other granting organizations will then reduce funding to divert to other areas the populace cares about.
Academic scientists work (in general) for low wages (yes that is a relative statement), generally don't get nice offices and often are stuck with labs from the 70's. The biggest problem, in my experience, is they don't get commitment of funding for a long enough period of time. Being told that you'll get $65k/yr for 3 years isn't long enough to do much. That will only pay for a junior technician and one grad student, nor reagents, no new equipment. When the money runs out, you've finally started to find interesting things and your student is finally competent. They need grants with longer commitments of funding, more per year would be nice too... but the length is more important.
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Old 03-22-09, 07:19 PM   #18
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I've been using an insulin pump since 1981 or '82. For that entire time period, researchers have been predicting that a closed-loop system was only 5 years away. I currently use a continuous glucose monitoring system. Accuracy and reliability are nowhere near good enough to allow implementation of a closed-loop system.

In addition, current (external) insulin pumps seem like a poor match for a closed-loop system. Insulin injected subcutaneously takes hours before it reaches peak effectiveness. That simply won't work for a closed-loop system, which is designed to monitor your blood sugar and then deliver insulin to compensate for any changes without any intervention from the user. The long lag between the time when a blood sugar spike is detected and effective insulin can be delivered would mean that the system is always "chasing its tail". A closed-loop system would need insulin that reaches peak effectiveness an order of magnitude faster or an implantable pump that delivers insulin to the blood stream much faster.
I agree with most of your points, although the rapid-acting insulins (Humalog and Novolog) are supposed to reach peak after about 30 minutes.

FWIW: I participated in a clinical trial for a 3rd-generation glucose monitor sensor. 8 hours of sitting in a chair with two sensors taped to my abdomen and blood samples (for direct glucose measurement) every 15 minutes. What a way to spend a day!

FWIW2: I've been Type 1 diabetic for 17 years. I developed it when I was 28- I was diagnosed two weeks after I got married. Still married, too.
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Old 03-23-09, 11:00 AM   #19
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I agree with most of your points, although the rapid-acting insulins (Humalog and Novolog) are supposed to reach peak after about 30 minutes.
I use Humalog. The data included with the insulin vials indicates that for subcutaneous injection "peak serum levels were seen 30 to 90 minutes after dosing". Once serum levels peak, it takes time for blood sugar to fall, however. According to the included graphs, blood sugar will reach its lowest level around two hours after the insulin is injected.

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FWIW: I participated in a clinical trial for a 3rd-generation glucose monitor sensor. 8 hours of sitting in a chair with two sensors taped to my abdomen and blood samples (for direct glucose measurement) every 15 minutes. What a way to spend a day!
I know the drill. I participated in insulin pump studies conducted by Baylor College of Medicine back in the early '80s. In those days, receiving an insulin pump meant a two-week stay in the hospital: one week of being poked and prodded so they could figure out the parameters for using the pump, followed by another week where they monitored your usage of the pump to make sure nothing went wrong.
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Old 03-23-09, 11:22 AM   #20
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I have been a Type 1 diabetic since 1953. Taking insulin is a bother, but hasnt stopped me enjoying my life. I raise money for diabetic research, but I think the killers like MS and cancer should get the top priority.
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Old 03-24-09, 11:03 PM   #21
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I use Humalog. The data included with the insulin vials indicates that for subcutaneous injection "peak serum levels were seen 30 to 90 minutes after dosing". Once serum levels peak, it takes time for blood sugar to fall, however. According to the included graphs, blood sugar will reach its lowest level around two hours after the insulin is injected.

That's why I said "supposed". Dang... you actually read the inserts in the insulin packages? That 2-point type shreds my eyes. But my vision was crap long before I became diabetic.
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Old 03-25-09, 08:00 AM   #22
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Well "plenty raised" isn't enough. Disease pathways aren't like a broken bike, we can't replace parts until it works.
It is true that the people at some foundations spend a lot of money on flying around advertising it and talking with government to increase support. I have found this to be worth while in every foundation I've worked with. Public perception has everything to do with research. If the public doesn't care, the politicians don't care. The NIH and other granting organizations will then reduce funding to divert to other areas the populace cares about.
Academic scientists work (in general) for low wages (yes that is a relative statement), generally don't get nice offices and often are stuck with labs from the 70's. The biggest problem, in my experience, is they don't get commitment of funding for a long enough period of time. Being told that you'll get $65k/yr for 3 years isn't long enough to do much. That will only pay for a junior technician and one grad student, nor reagents, no new equipment. When the money runs out, you've finally started to find interesting things and your student is finally competent. They need grants with longer commitments of funding, more per year would be nice too... but the length is more important.
The issue, and why it's sometimes difficult to raise money is this, If I raise $10,000,000 a year and spend $9,950,000 on research, I can probably find a cure within 5 years, AND a really good treatment delivery system in two. If I raise $10,000,000 a year and spend $9,950,000 on administration, nice offices, some nice junkets, and hiring a few close friends and giving them huge pay packets and fancy titles, then the chances of the research from my funding, finding a cure in the next 50 years is pretty slim. Not saying this is the way the ADA does it, but some of the organizations don't want to find a cure, because once a cure is found, the organization and it's highly paid people are no longer needed. Think about it, if a cure were found tomorrow for diabetes would you need the ADA, well no, because you would go to your doctor (s)he would do what was needed to cure it, and life would go on.
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Old 03-25-09, 08:19 AM   #23
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I use Humalog. The data included with the insulin vials indicates that for subcutaneous injection "peak serum levels were seen 30 to 90 minutes after dosing". Once serum levels peak, it takes time for blood sugar to fall, however. According to the included graphs, blood sugar will reach its lowest level around two hours after the insulin is injected.



I know the drill. I participated in insulin pump studies conducted by Baylor College of Medicine back in the early '80s. In those days, receiving an insulin pump meant a two-week stay in the hospital: one week of being poked and prodded so they could figure out the parameters for using the pump, followed by another week where they monitored your usage of the pump to make sure nothing went wrong.
One of the interesting things is, even for a non diabetic, it takes time for insulin to start working, if you take a non-diabetic and feed him/her a super high carb meal, their blood sugar will go up, in fact it can go way up, but if you check it 2 hours later it's normal again, because the bodies insulin delivery system kicked in and delivered insulin, this takes some time to deliver the insulin and for it to work.

A monitor and pump in one, controlling computer, would need to know 3 things, blood sugar, how much insulin it has already delivered, how much that affects the patient's blood sugar 2 hours down the road, so it can determine how much it still needs to deliver. For a non-diabetic this is taken care of by body function, in a type 1 diabetic the computer would need to know this. It also needs a way of telling the patient that it's reserve is low and needs to be refilled.
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Old 03-25-09, 08:55 AM   #24
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A monitor and pump in one, controlling computer, would need to know 3 things, blood sugar, how much insulin it has already delivered, how much that affects the patient's blood sugar 2 hours down the road, so it can determine how much it still needs to deliver. For a non-diabetic this is taken care of by body function, in a type 1 diabetic the computer would need to know this. It also needs a way of telling the patient that it's reserve is low and needs to be refilled.
Modern insulin pumps already know all three of these things. The problem is that one of them, current blood sugar level, must be entered manually or determined from a relatively inaccurate (+-20%) continuous glucose monitoring system (CGMS). Conspiracy theories aside, if we spent just a little more money on research I think it would be possible to perfect the closed-loop insulin pump in relatively short order and effectively cure diabetes for millions of people...
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Old 03-25-09, 05:23 PM   #25
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Modern insulin pumps already know all three of these things. The problem is that one of them, current blood sugar level, must be entered manually or determined from a relatively inaccurate (+-20%) continuous glucose monitoring system (CGMS). Conspiracy theories aside, if we spent just a little more money on research I think it would be possible to perfect the closed-loop insulin pump in relatively short order and effectively cure diabetes for millions of people...
There is an old saying in computers, garbage in, garbage out, if the monitor isn't accurate then a fully automated system obviously will not work well. Seems like an area where the company building the CGMS needs to work on the accuracy, if you could get it close, say +/- 1% or better, that's probably close enough.

** The following is brutally honest, diabetes killed my mother-in-law, so it's a disease that I don't want to pull punches on, so viewer discretion is advised. **

Then again for the majority of Type II diabetics the cure IS known, lose that extra 50 or 100lbs of body fat and the blood sugar will return to normal, but many people choose to take diabetic drugs because that is somehow easier, but the drugs don't work forever, and eventually they either end up on insulin or die from it, heart attacks and strokes, being common means of exit.

This stuff has been known for a long time, more recently gastric bypass has been discovered as a surgical solution to Type II, the surgery is expensive. You need to wonder whether it's cheaper, for insurance providers to cover the $20,000 cost of the surgery, or cover years worth of pills, repeated hospital visits, specialists, and general health deterioration until it kills the patient, in the end the cost is probably the same.

Yes the ramifications of Type II are the same as for Type I, the process is different and the underlying cause is different, but the result is the same.
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