The Five Insulin Types

December 5th, 2010

Insulin is divided into 5 types: rapid-acting, short-acting (or fast acting), intermediate-acting, long-acting and pre-mixed insulin. The different types of insulin vary in the amount of time until they begin to work (onset), how long they take to achieve the greatest blood concentration and effectiveness (peak) and how long they continue to control blood sugar (duration). The effects of insulin, including onset, peak and duration times, vary from individual to individual and from day to day.

Depending on the brand, rapid-acting insulin has an average onset of from 5 to 15 minutes, peak of 30 minutes to 3 hours, and duration of 3 to 5 hours. It's normally injected with meals, and used in combination with a longer acting insulin.

Short-acting insulin (also called regular insulin) has an average onset of 30 minutes to an hour, peak of 2 to 4 hours, and duration of 4 to 8 hours, depending on if it's injected or used in an insulin pump. It's taken 30 minutes to an hour before a meal, and may be combined with long-acting insulin.

Intermediate-acting insulin (also called NPH insulin or lente insulin) has an average onset of 2 to 4 hours, a peak of 4 to 10 hours, and duration of 10 to 18 hours. It's often used in combination with rapid or short-acting insulin.

The effects of long-acting insulin (sometimes called background insulin or basal insulin) typically cover a full day. There are two types of long-acting insulin: insulin glargine (Lantus) and insulin detemir (Levemir). Typical onset for Lantus is within 4 to 6 hours. Lantus is delivered steadily and so does not peak, and has an average duration of 24 hours.

Typical onset for Levemir insulin is between 2 to 3 hours. Levemir peaks slightly between 8 to 10 hours, and the duration is dose-dependent, between 6 to 23 hours. Long-acting insulin is often used in combination with rapid or short-acting insulin, or an oral diabetes medication in the case of type 2 diabetics.

Premixed insulin is a combination of short and intermediate-acting insulin in the same vial or insulin pen. It's normally taken twice a day before meals.

Researchers Bioengineer Cells from Testicles to Produce Insulin

December 15th, 2010

Researchers have briefly "cured" Type 1 diabetes in lab mice using cells extracted from the testicles of deceased human donors. The spermatogonial cells used in the experiment normally produce sperm in men. Scientists extracted them from the donors, bioengineered them to act like the beta cells in the pancreas that produce human insulin, and transplanted them into mice. The transplanted cells successfully secreted insulin, reducing blood sugar levels in the mice for about a week.

While exciting, the breakthrough doesn't yet amount to a cure for insulin dependent diabetes in humans. "These cells don't secrete enough insulin to cure diabetes in humans yet," cautions the study's senior researcher G. Ian Gallicano, an associate professor at Georgetown University Medical Center. However, Gallicano is hopeful that transplanting the spermatogonial cells into different parts of the body may lead to longer blood sugar control. "We know spermatogonial stem cells have the potential to do what we want them to do," says Gallicano, and we know how to improve their yield."

The researchers chose to work with spermatogonial cells because they behave a lot like human eggs, and can be chemically instructed to behave like embryonic stem cells. Stem cells are unspecialized or "undifferentiated" cells that have the potential to develop or differentiate into many different types of cells.

Earlier attempts to transplant insulin-producing beta cells (also called islet cells) found in the pancreas achieved some success, but islet cells transplants are handicapped by the body's autoimmune system's attempts to destroy the new tissue, which it sees as an invader. While they no longer require diabetes medication, islet cell transplant recipients must take powerful immunosuppressive drugs with undesirable side effects, including an increased risk of infection and cancer. A major benefit of spermatogonial cell transplants is that they avoid arousing an auto-immune response.

One obvious disadvantage is that the procedure can only be performed in males, although the fundamental approach might be applicable to the female counterpart of sperm-producing cells, oocytes. Another concern is the potential for spermatogonial cell transplant recipients to develop a type of tumor called a teratoma, associated with the abnormal development of germ (reproductive) cells. But Gallicano is convinced that it would take many more spermatogonial cells than would be required to produce insulin to cause such a tumor.

Gallicano and his fellow researchers are hopeful that they've taken the first step towards reducing diabetic hyperglycemia in humans and eliminating the need for diabetes drugs. This gives hope to the almost 24 million Americans with diabetes, one of the leading causes of death in the US. There are two main types of diabetes: type 1, which requires lifelong insulin injections; and the much more common type 2, which can be controlled by diet, exercise, and, if needed, oral diabetes medication. Both types must be managed carefully to avoid serious complications.

Islet Transplantation Eliminates the Need for Insulin Injections

December 15th, 2010

laboartory equipment

Islet cells are sugar-sensing cells in the pancreas that release insulin in order to maintain normal blood sugar levels in the body. In type 1 diabetes, the cells can no longer make insulin because the body's immune system has destroyed them. Type 1 diabetics must take daily insulin injections, usually a complex combination of short and long acting insulin.

Islet cell transplantation involves removing insulin-producing cells from a donor pancreas and transferring them into a person with diabetes. It's a non-surgical procedure in which the donated cells are inserted through a needle directly into the liver. Scientists developed the procedure in the 1960s, but the first islet transplantation attempts didn't take place until the 1990's. To everyone's disappointment, only 8% of the first transplants were successful. The problem was the same faced in other organ or tissue transplants - the recipient's immune system recognized the islets as foreign invaders, and attacked them. Adding to the problem, the anti-rejection drugs in use at the time interfered with insulin's effectiveness.

Canadian researchers at the University of Alberta (U of A) made a major breakthrough in 1999. Using sophisticated islet collection and preparation techniques and improved anti-rejection drugs, they achieved an impressive initial 100% success rate for the first month. But most of their patients eventually had to return to insulin injections as the transplanted islets lost their ability to function, although taking lower doses.

Over ten years later, islet transplantation is still an experimental procedure. Rejection issues remain, and it's difficult to obtain the typically 1 million islet cells needed for one procedure - the equivalent of two pancreases. Islet transplants are currently being performed at 17 research centers across the US, but are not widely available. The procedure is normally restricted to type 1 diabetics between the ages of 18 and 65 who have had diabetes for more than 5 years and have trouble with blood glucose control, resulting in serious complications.

In a successful islet cell transplant, the donor islets make insulin and release it into the patient's bloodstream. They also monitor and stabilize blood sugar levels, eliminating the need for daily insulin injections and frequent blood sugar monitoring. But islet transplant patients must take strong anti-rejection drugs for the rest of their lives, many of which have serious side effects. Unfortunately, most patients need more than one transplant to produce enough insulin that they can stop taking insulin injections. Although islet transplants still fall short of a cure, a successful procedure improves the quality of life of the patient, and lowers the risk of serious long-term diabetes complications such as stroke, heart disease, kidney disease, and eye and nerve damage.

Progress continues to be made towards better anti-rejection drugs, and improved methods to transplant the cells. Researchers are also attempting to obtain donor islets from other sources such as animals, and even trying to grow islet cells in the laboratory. The University of Wisconsin Health Centre claims about 80% of patients receiving an islet transplant have been able to stop taking insulin completely, and that those that still need insulin injections achieved better glucose control. As the procedure is still so new, the longest known period of insulin independence following a US transplant is 4 years. The pioneering U of A program reports that 15-20% of their patients remain insulin independent for 5 years after treatment, and these results are improving.

In the meantime, most Type 1 diabetics will continue to control their condition with diet, exercise, lifestyle changes and a combination of short and long acting insulin, and to follow the developments in islet transplants with great interest.

Injection-Free Insulin Inhaler Awaiting FDA Approval

January 24th, 2011

A new injection-free insulin inhaler is awaiting FDA approval for the treatment of both type 1 and type 2 diabetes. Insulin can't be taken orally, as digestive juices break it down before it can be used by the body. Currently, the only means of delivering insulin are subcutaneous insulin injections or intravenously.

AFREZZA is an ultra-rapid acting inhaled insulin developed by MannKind Corporation. It uses patented Technospere technology to deliver powdered insulin from a thumb-sized device into the lungs. The lungs are an effective option for delivering diabetes medication, largely because of their huge surface area (about the size of a single tennis court).

AFREEZA is a short-acting mealtime insulin, meaning type 1 diabetics will need to combine it with long-acting insulin for complete diabetes control. Clinical trial participants using the new insulin inhaler experienced less hypoglycemia and weight gain than did controls using a standard combination of long-acting glargine insulin and twice a day 70 30 insulin injections.

Generex Biotechnology Corporation also has a rapid-acting insulin spray in clinical trials. Oral-lyn is a buccal spray insulin which is absorbed through the buccal mucosa (mucous membranes on the inside of the cheeks), bypassing the lungs and quickly entering the blood stream. The inhaled insulin is sprayed in the mouth just before meals, delivering about one unit of human insulin per spray. If approved, it may be the only medication needed by many type 2 diabetics.

Oral-lyn's patented inhalation device resembles an asthma inhaler. Steven Elkman was an Oral-Lyn study participant who successfully managed his type 2 diabetes with the experimental spray insulin. Elkman loved how discreet the inhaler is. "Nobody really notices because so many people use inhalators for asthmatic medication," he says, "It doesn't really attract any attention."

The FDA actually approved the first inhaled insulin, called Exubera, to treat type 1 and type 2 diabetes in 2006. It was a short-acting powdered form of recombinant human insulin, delivered into the lungs through an insulin inhaler. But the new system of insulin delivery never really caught on, and Pfizer dropped the novel diabetes medication from the market a year later. AFREZZA is easier to use, faster acting and boasts better bioavailability than Exubera, enabling diabetics to achieve better insulin levels using smaller amounts.

Patients in clinical trials of the new inhaled insulins have reported enhanced quality of life, overall satisfaction, and greater acceptance of being insulin dependent. Dr. Larry Deeb, a pediatric endrocrinologist from the University of Florida College of Medicine, says that finding an alternative to insulin injections is crucial, especially for children and the needle-phobic. "Insulin administration is a huge issue for people with diabetes," he stresses, "You have to appreciate the fear [of injections]. Insulin omission is one of the major issues in diabetes."

Innovative Insulin Delivery Patch-Pen About to Hit the Market

January 24th, 2011

In a recent Loyola University study out of Maryland, 60% of diabetics admitted to occasionally skipping doses of their diabetes medication, 20% admitted to regularly skipping their medication, and one-third of respondents admitting to dreading their insulin injections.

Most diabetics who give themselves insulin injections use traditional syringes or the newer insulin pens. Although insulin pens can be used more discreetly than insulin syringes, insulin dependent diabetics often find it inconvenient and/or embarrassing to inject their insulin in public.

A California company, Calibra Medical, has developed a new insulin delivery system designed to save diabetics the "occasional social challenges" of daily mealtime injections. The new device, Finesse, is a small plastic patch-pen roughly 2 inches long and an inch wide that is attached to the skin like a bandage. It can be worn under your clothes, and remains attached during routine activities like sleeping, exercising and even showering.

Patients use a syringe to pre-fill the patch-pen with a three-day supply of insulin, and simply push two buttons to dispense a dose of fast-acting insulin when needed. The insulin is delivered in seconds through a miniature, flexible plastic tube inserted painlessly into the skin. The device can be operated through your clothing for discreet dosing. The device would not replace the need for long-acting insulin injections.

"Most patients want to eliminate the social embarrassment, elaborate preparation before each dose and the many daily needle sticks required by syringes and insulin pens," says Calibra Medical's Charman and CEO, Jeffery Purvin. "Like expensive insulin pumps, Finesse provides fast, discreet, needle free dosing. Yet it accomplishes this with the simplicity, safety and affordability of syringes or insulin pens."

Finesse recently received FDA approval, and should be on the market soon. Calibra is also working on a patch-pen that would deliver a .05 unit insulin dose for children.

Kudzu Used as Diabetes Medication in Chinese Medicine

January 24th, 2011

Kudzu is a herb used in Chinese medicine to treat diabetes mellitus, alcoholism, colds, fever, menopausal symptoms and neck or eye pain. It's also referred to as kudsu, pueraria, or Japanese arrowroot. Both the flowers and the root have medicinal properties.

There is evidence that one of several isoflavones in kudzu, puerarin, improves insulin resistance. Kudzu appears to have additive effects when used with diabetes medication, assisting in lowering blood sugar levels. Puerarin's ability to thin the blood and improve blood flow is also believed beneficial in diabetic retinopathy.

According to research published the Journal of Agriculture and Food Chemistry in 2009, researchers from the University of Alabama who addied kudzu root extract to the diets of laboratory rats think the herb could be valuable in treating metabolic syndrome. Metabolic syndrome is a group of risk factors that contribute to heart disease, stroke and diabetes mellitus.

The researchers say that the puerarin in kudzu regulates blood sugar levels by directing it away from fat cells and blood vessels to places in the body where it is beneficial, like muscles. "Our findings show that puerarin helps to lower blood pressure and blood cholesterol," reports the study's lead author, Dr. J. Michael Weiss, "But perhaps the greatest effect we found was its ability to regulate [blood sugar]."

"Kudzu root may prove to be a strong complement to existing medications for insulin regulation or blood pressure," adds the study's co-author Dr. Jeevan Prasain, "Physicians may be able to lower dosages of such drugs, making them more tolerable and cheaper."

Kudzu was first brought to the US from Japan in the late 1800s. It can now be found in many parts of the country, most commonly in the south eastern regions, where it has become an unwelcome weed. It's a climbing, trailing vine whose out of control growth makes it quite invasive, earning it the names "the mile a minute plant", and "the vine that ate the South". Southerners claim that they must keep their windows closed at night to keep the kudzu out.

During World War II, American forces seeking a fast-growing plant to camouflage their equipment introduced kudzu to Fiji and nearby Vanuata, where it is now also a major weed. Kudzu remains respected and enjoyed in China and Japan, where it is a common ingredient in medicines and foods.

Because of its impact on blood sugar, it's important that diabetics taking either oral diabetes medication or insulin injections monitor their blood glucose levels carefully if taking the herb. Because kudzu has estrogenic effects, it should not be taken along with tamoxifen or by anyone with hormone sensitive cancer.

Super Long Acting Insulin Developed in India

January 25th, 2011

man with syringe
Scientists from India's National Immunology Institute (NII) have developed a new long-acting insulin that can control blood sugar in animals for up to 120 days with a single insulin injection. In contrast, the most effective long-acting insulin on the market today is only effective for a maximum of 18 hours.

The new diabetes medication, dubbed supramolecular insulin assembly-II, or SIA-II, is a "prodrug - a drug administered in an inactive form that becomes active after being administered. Prodrugs are generally better absorbed, distributed, and metabolized than active drugs.

Both bovine and human insulin versions of SIA-II are faring well in animal testing, and the researchers have every expectation that they will perform equally well in clinical trials in humans. "Personally speaking, SIA-II can straight away go to human trials," says NII Director Professor Avadhesha Surolia, "It is pretty safe, as we have not modified the insulin, nor is any addictive used."

The insulin's long lasting effects are due to a unique process called protein folding, in which bovine or human insulin is altered or "misfolded" to form a supramolecule which is protected from the body's enzymatic action. This protection allows the molecules to be stored in the body and be slowly released over long periods of time.

The NII team has been working on the patented SIA-II technology for two years, and recently entered into what Surolia calls "one of the biggest licensing deals from any academic institution in India", licensing the technology to Life Science Pharmaceuticals from Connecticut. A subsidiary of Life Science, Extended Delivery Pharmaceuticals, will be continuing trials of the new diabetic medication.

Experts speculate that the superlative long-term blood glucose control achieved with the use of the novel diabetes medication may indicate some level of recovery of the insulin producing cells in the pancreas that normally stop functioning in insulin dependent or type 1 diabetes.

There is some debate as to whether the super long-acting insulin will be of more benefit to type 1 or type 2 diabetics. India, dubbed "the diabetes capital of the world", has over 50 million diabetics, most of them type 2. Some Indians are paying an average one-quarter of their family income for their current diabetic medication. "Our motivation was to reduce the burden of diabetes," says Surolia, "It doesn't matter whether it's type 1 or 2."

Alcohol and Diabetes Control

January 25th, 2011

people drinking

As a general rule, Type 1 diabetics are cautioned against drinking alcohol, primarily because of alcohol's effect on blood sugar (glucose) levels. The liver gives priority to eliminating what it sees as a toxin from the body, interfering with its ability to produce blood glucose. Moderate amounts of alcohol can cause a rise in blood sugar, but increased consumption can quickly cause hypoglycemia, or low blood sugar, and can continue to affect blood sugar levels for 8 to 12 hours after drinking.

Interestingly, the effects of alcohol are so similar to the effects of hypoglycemia that a diabetic suffering an episode of serious hypoglycemia can appear drunk. Symptoms include confusion, lack of coordination, dizziness, sleepiness and loss of consciousness. This is one reason it's recommended that Type 1 diabetics wear medic-alert identification - to make sure that a case of hypoglycemia is not mistaken for a case of "one too many". Severe hypoglycemia can be life threatening, and prompt and proper treatment is essential.

Hypoglycemia is most common in diabetics who take diabetic medications such as insulin or oral diabetes drugs that increase insulin production. Common causes of low blood sugar among diabetics are late, skipped or inadequate meals; exercise, and drinking alcohol. This is why it's necessary to time your insulin injections or oral diabetes medications around your meals and activities. It's also why long-acting insulin is essential in keeping blood sugar levels even through the night, when they can dip perilously low.

Frequent episodes of hypoglycemia can lead to a condition called hypoglycemia unawareness, in which the body stops releasing stress hormones such as epinephrine in response to a dip in blood sugar. As a result, diabetics with hypoglycemia unawareness (most often Type 1 diabetics) do not experience the usual early warning signs of low blood sugar.

The American Diabetes Association has some advice for Type 1 diabetics who decide to drink:

  • Check with your doctor or dietician first to make sure you can drink safely.
  • Be sure to tell your doctor if you drink more than once or twice a week - it may effect his or her decisions around which types of insulin to prescribe you.
  • Diabetics with high blood pressure or triglyceride levels should not drink alcohol. Alcohol adds to hypertension, and even two drinks a week can increase the amount of triglycerides in the blood.
  • Alcohol can worsen diabetic nerve damage and diabetic eye disease.
  • Men should limit themselves to two drinks a day, and women to one.
  • Never drink alcohol on an empty stomach. It's best to drink with a meal, or at least a snack.
  • Drinking right after exercising is not recommended, as exercise can also decrease blood sugar.
  • Test your blood glucose before you drink, and never drink when your blood sugar is low. Test it again before you go to bed.
  • Be alert for any signs of low blood sugar.
  • Use low calorie, sugar free mixers with your alcohol.
  • Sip your drink slowly, and alternate with sips of a non-alcoholic beverage.
  • Wear your medic-alert identification when drinking.
  • Be aware that drinking may lessen your resolve sticking to a diabetes-friendly diet, making you more likely to "cheat" or overindulge.

Injection Port Offers an Alternative for Insulin Delivery

February 1st, 2011

pin cushion

While most insulin dependent diabetics grow used to giving themselves multiple injections each day, there are many who would welcome an alternative insulin delivery system. An insulin pump is one such alternative, but some diabetics dismiss them as too expensive, too prone to malfunction, or just too complicated.

A less high tech (and thus less expensive) insulin delivery system is an injection port. An injection port, also called an indwelling catheter, is an FDA approved disposable medical device that is inserted just under the skin, providing a way to administer insulin injections without multiple skin punctures. The device is suitable for both type 1 and type 2 diabetics who take insulin.

An injection port contains a tiny, flexible plastic tube called a cannula, which is inserted into the skin's fatty tissue with one quick, firm push with an "introducer needle" - said to be equivalent to the prick of an insulin syringe. The introducer needle is then removed, leaving the port attached to the skin with an adhesive, and the cannula just under the skin in the fatty tissue. One manufacturer is about to release the i-port Advance, which combines a port with a built-in injector device to eliminate the need for manual insertion.

Once the port is in place, further insulin injections can be delivered with a syringe or an insulin pen directly into the port and through the cannula, eliminating the need to pierce the skin. The port can remain in place for up to 72 hours, and handle up to 75 injections. It can be worn while bathing, swimming and exercising. As the slogan forthe i-Port says, "It takes the shots for you."

Injection ports are popular with diabetics who are new to injecting insulin, those who are needle phobic, and those who are prone to bruising at the injection site. Diabetics struggling with these issues often skip meals to avoid having to take insulin injections, or skip a needed injection to avoid the discomfort or inconvenience. They are also popular with those who have to administer insulin injections to children.

Ports are small and discreet. They are usually worn on the abdomen, but can also be worn places like the arm, thigh or buttocks. One such port, insuflon, is inserted at a 20 to 45 degree angle and worn like an IV, making it ideal for people with little fatty tissue.

Drawbacks include the risk of infection at the insertion site, and the potential for poor medication delivery if the cannula becomes bent or crimped. The manufacturers suggest diabetics test their blood sugar levels two to four hours after each insulin injection to ensure that the device is working properly. The cost of an insulin port is covered by many insurance companies.

Injection Port Offers an Alternative for Insulin Delivery

February 1st, 2011

pin cushion

While most insulin dependent diabetics grow used to giving themselves multiple injections each day, there are many who would welcome an alternative insulin delivery system. An insulin pump is one such alternative, but some diabetics dismiss them as too expensive, too prone to malfunction, or just too complicated.

A less high tech (and thus less expensive) insulin delivery system is an injection port. An injection port, also called an indwelling catheter, is an FDA approved disposable medical device that is inserted just under the skin, providing a way to administer insulin injections without multiple skin punctures. The device is suitable for both type 1 and type 2 diabetics who take insulin.

An injection port contains a tiny, flexible plastic tube called a cannula, which is inserted into the skin's fatty tissue with one quick, firm push with an "introducer needle" - said to be equivalent to the prick of an insulin syringe. The introducer needle is then removed, leaving the port attached to the skin with an adhesive, and the cannula just under the skin in the fatty tissue. One manufacturer is about to release the i-port Advance, which combines a port with a built-in injector device to eliminate the need for manual insertion.

Once the port is in place, further insulin injections can be delivered with a syringe or an insulin pen directly into the port and through the cannula, eliminating the need to pierce the skin. The port can remain in place for up to 72 hours, and handle up to 75 injections. It can be worn while bathing, swimming and exercising. As the slogan forthe i-Port says, "It takes the shots for you."

Injection ports are popular with diabetics who are new to injecting insulin, those who are needle phobic, and those who are prone to bruising at the injection site. Diabetics struggling with these issues often skip meals to avoid having to take insulin injections, or skip a needed injection to avoid the discomfort or inconvenience. They are also popular with those who have to administer insulin injections to children.

Ports are small and discreet. They are usually worn on the abdomen, but can also be worn places like the arm, thigh or buttocks. One such port, insuflon, is inserted at a 20 to 45 degree angle and worn like an IV, making it ideal for people with little fatty tissue.

Drawbacks include the risk of infection at the insertion site, and the potential for poor medication delivery if the cannula becomes bent or crimped. The manufacturers suggest diabetics test their blood sugar levels two to four hours after each insulin injection to ensure that the device is working properly. The cost of an insulin port is covered by many insurance companies.

Lantus versus Levemir

February 2nd, 2011

insulin syringe

Choosing a long-acting insulin can be daunting, especially since both Lantus (insulin glargine) and Levemir (insulin detemir) are similar in many respects. There are a few key differences that will help you and your doctor make the decision about which insulin to use.

Both Lantus and Levemir are injected subcutaneously, either with a syringe or insulin pen, and both can be used with fast-acting insulin at meal times to aid with diabetes control. Neither forms of long-acting insulin should be diluted, or mixed with other insulin products. Lantus and Levemir have a 1:1 ratio, but will be accepted by the body differently from patient to patient; any changes to diabetes medication and dosage should always be discussed with a doctor.



Lantus

Lantus (insulin glargine) is marketed as a "peakless" insulin option, with an 18-26 hour action period. It is injected once a day, at the same time every day to maintain regularity. One of the biggest advantages of Lantus is that, due to its lack of peak, it decreases the risk of nocturnal hypoglycemia.

Some doctors suggest that Lantus be taken twice daily, even though it is approved to be taken once daily. Lantus may not be the best option for people with irregular schedules, as its long action time gives less control (it can take up to three days to complete its action). As with other long-acting insulin, Lantus can be used with fast-acting insulin at meal times.

Levemir

Levemir (insulin detemir) is a long-acting insulin with a 9-12 hour action period. It is injected twice a day, morning and night. Because one of its peak periods can occur at night, when glucose levels are often lower, it poses an increased risk of nocturnal hypoglycemia, and should not be used by patients with hypoglycemia.

Levemir has the advantage or greater diabetes control, because it is taken more frequently. And while patients using Levemir often use a higher insulin dosage, they often experience less weight gain than patients using Lantus.

Choosing a long-acting insulin comes down to what works best for the individual in question, taking into account the body's interaction with the insulin, as well as factors such as lifestyle and eating habits.Any decision involving diabetes medication should be made with the help of a doctor or other health-care provider.

Long-Acting Insulin Best at Controlling Blood Sugar

February 3rd, 2011

blood glucose testing

As type 2 diabetes progresses, oral diabetes medication doses typically need to be adjusted upwards over time, and a good many type 2 diabetics can expect to end up insulin dependent. There does not appear to be any clear consensus on how best to introduce insulin injections in addition to oral diabetes medications - three times a day with meals, twice daily injections, or a single daily long-acting insulin injection.

Professor Rury Holman, director of the Diabetes Trial Unit at Oxford University, was the principal investigator of a large scale study conducted to determine how best to introduce insulin to control blood sugar levels as type 2 diabetes progresses. "Type 2 diabetes is a progressive condition with the majority of patients eventually requiring insulin therapy," Holman explains.

Holman and his fellow researchers recruited over 700 type 2 diabetes patients whose current medications were not effectively controlling their blood sugar levels. The patients were divided randomly into three groups to compare the effectiveness of the different insulin dosing regimens, and monitored for three years. After the first year, those patients who were still not achieving the necessary blood glucose control were moved to a more complex insulin therapy.

At the end of the three years, the researchers concluded that once-a-day basal insulin and three-times-a-day mealtimes injections were both more effective at controlling blood sugar levels than twice-daily insulin injections. In addition, those who took the once-daily basal insulin had fewer incidents of low blood sugar than those taking three-times-a-day mealtime insulin.

As a result, the researchers advise those beginning insulin therapy to start with a basal insulin, and add a mealtime insulin if required for what they term "the best combination of effectiveness, safety, and treatment satisfaction". "This large scale study strengthens guidelines recommending adding a basal insulin to oral agents when glycemic targets are not met," says Holman.

Texas Researchers Hopeful They Can Eliminate the Need For Insulin Therapy

February 4th, 2011

dna strand

Research conducted at the University of Texas Southwestern Medical Center raises the exciting prospect of eliminating the need for insulin in type 1 diabetics by "turning off" the hormone glucagon, which plays a major role in blood sugar regulation.

Like insulin, glucagon is a hormone secreted by the pancreas. Glucagon has the opposite effect of insulin, increasing blood glucose levels rather than lowering them. The pancreas releases glucagon when blood sugar is low, causing the liver to release glucose into the blood stream, and stimulating the release of insulin.

Glucagon prevents low blood sugar in healthy people, but causes high blood sugar in people with type 1 diabetes, whose pancreas can't produce enough insulin to counteract its effect. A synthetic version of glucagon is used to treat severe low blood sugar, or hypoglycemia, in diabetics in emergency situations.

The UT Southwestern researchers genetically altered laboratory mice so that they lacked working glucagon receptors and couldn't react to glucagon. They then gave the mice the glucose tolerance test used to diagnose diabetes. Mice with normal insulin levels but non-working glucagon receptors responded normally to the test.

When their insulin-producing islet cells were destroyed and they lacked both insulin and the ability to use glucagon, they were still able to stabilize their blood sugar, again testing normally. Blocking the action of glucagon essentially made insulin unnecessary for the mice - despite the lack of both glucagon and insulin, the mice did not develop diabetes.

"We've all been brought up to think insulin is the all-powerful hormone without which life is impossible," says researcher and professor of internal medicine Dr. Roger Unger, "But that isn't the case. This doesn't mean that insulin is unimportant - it's essential for normal growth and development. But in adulthood, at least with respect to glucose metabolism, the role of insulin is to control glucagon. If you don't have glucagon, then you don't need insulin."

Insulin injections have been the treatment of choice for type 1 diabetes since its introduction in 1922. But insulin is a treatment, not a cure, and can't restore normal glucose tolerance as blocking the glucagon receptors did in the laboratory mice. It now appears that insulin's benefit results from its suppression of glucagon, and that the blocking of glucagon action restores glucose tolerance to normal.

In the next all-important step, the researchers will be studying the mechanism behind the results to determine how to turn off the glucagon receptors in humans. "If these latest findings were to work in humans, injected insulin would no longer be necessary for people with type 1 diabetes," states Dr. Unger, "If diabetes is defined as restoration of glucose homeostasis to normal, then this treatment can perhaps be considered very close to a cure."

Texas Researchers Hopeful They Can Eliminate the Need For Insulin Therapy

February 4th, 2011

dna strand

Research conducted at the University of Texas Southwestern Medical Center raises the exciting prospect of eliminating the need for insulin in type 1 diabetics by "turning off" the hormone glucagon, which plays a major role in blood sugar regulation.

Like insulin, glucagon is a hormone secreted by the pancreas. Glucagon has the opposite effect of insulin, increasing blood glucose levels rather than lowering them. The pancreas releases glucagon when blood sugar is low, causing the liver to release glucose into the blood stream, and stimulating the release of insulin.

Glucagon prevents low blood sugar in healthy people, but causes high blood sugar in people with type 1 diabetes, whose pancreas can't produce enough insulin to counteract its effect. A synthetic version of glucagon is used to treat severe low blood sugar, or hypoglycemia, in diabetics in emergency situations.

The UT Southwestern researchers genetically altered laboratory mice so that they lacked working glucagon receptors and couldn't react to glucagon. They then gave the mice the glucose tolerance test used to diagnose diabetes. Mice with normal insulin levels but non-working glucagon receptors responded normally to the test.

When their insulin-producing islet cells were destroyed and they lacked both insulin and the ability to use glucagon, they were still able to stabilize their blood sugar, again testing normally. Blocking the action of glucagon essentially made insulin unnecessary for the mice - despite the lack of both glucagon and insulin, the mice did not develop diabetes.

"We've all been brought up to think insulin is the all-powerful hormone without which life is impossible," says researcher and professor of internal medicine Dr. Roger Unger, "But that isn't the case. This doesn't mean that insulin is unimportant - it's essential for normal growth and development. But in adulthood, at least with respect to glucose metabolism, the role of insulin is to control glucagon. If you don't have glucagon, then you don't need insulin."

Insulin injections have been the treatment of choice for type 1 diabetes since its introduction in 1922. But insulin is a treatment, not a cure, and can't restore normal glucose tolerance as blocking the glucagon receptors did in the laboratory mice. It now appears that insulin's benefit results from its suppression of glucagon, and that the blocking of glucagon action restores glucose tolerance to normal.

In the next all-important step, the researchers will be studying the mechanism behind the results to determine how to turn off the glucagon receptors in humans. "If these latest findings were to work in humans, injected insulin would no longer be necessary for people with type 1 diabetes," states Dr. Unger, "If diabetes is defined as restoration of glucose homeostasis to normal, then this treatment can perhaps be considered very close to a cure."

Insulin Shock Therapy Once Used to Treat Schizophrenia

February 7th, 2011

electric shock

It's not widely known that large doses of insulin were commonly used in psychiatric institutions in the 1940s and 1950s to treat schizophrenia and other mental illness. Insulin shock therapy was regarded as the treatment of choice for schizophrenia for about twenty years, enjoying uncritical acceptance in Europe and America.

The "treatment" was considered a type of shock therapy. Patients were given regular insulin injections to produce five or six diabetic comas a week for weeks at a time. Insulin therapy continued until the patient improved, or until 50 to 60 comas had been induced.

The originator of insulin shock therapy, also known as insulin coma therapy, was Dr. Manfred Sakel. The Polish doctor stumbled upon the therapy accidentally while working in Vienna, when a patient in whom he'd provoked an insulin coma showed a remarkable improvement in her mental functioning.

Sakel practiced and popularized insulin therapy in Europe, and introduced it to the US after he emigrated from Austria to New York in 1936. The practice of insulin dosing continued into the 1960s in America, and for much longer in countries like China and the former Soviet Union.

Sakel believed that the seizures and unconsciousness experienced by psychiatric patients undergoing an insulin-induced hypoglycemic episode resulted in dramatic change in their mental state. In his own words: "My supposition was that some noxious agent weakened the resilience and the metabolism of the nerve cells-blocking the cell off with insulin will force it to conserve functional energy and store it to be available for the reinforcement of the cell."

Sakel claimed that close to ninety percent of his patients improved with insulin shock therapy, but his methods were later called into question and discredited as unscientific. In particular, Sakel was accused of "cherry picking" the patients most likely to improve using insulin therapy, and providing them with extra attention and support.

Patients were said to have been terrified of the procedure, which is now considered to be inhumane. Severe hypoglycemia such as that induced by Sakel can result in permanent brain damage and even death. Some of his insulin therapy patients did indeed suffer adverse effects, including fatalities. While today's antipsychotic medications are not without their side effects, thankfully they are much safer and more effective than anything available just a couple of decades ago.

Insulin Shock Therapy Once Used to Treat Schizophrenia

February 7th, 2011

electric shock

It's not widely known that large doses of insulin were commonly used in psychiatric institutions in the 1940s and 1950s to treat schizophrenia and other mental illness. Insulin shock therapy was regarded as the treatment of choice for schizophrenia for about twenty years, enjoying uncritical acceptance in Europe and America.

The "treatment" was considered a type of shock therapy. Patients were given regular insulin injections to produce five or six diabetic comas a week for weeks at a time. Insulin therapy continued until the patient improved, or until 50 to 60 comas had been induced.

The originator of insulin shock therapy, also known as insulin coma therapy, was Dr. Manfred Sakel. The Polish doctor stumbled upon the therapy accidentally while working in Vienna, when a patient in whom he'd provoked an insulin coma showed a remarkable improvement in her mental functioning.

Sakel practiced and popularized insulin therapy in Europe, and introduced it to the US after he emigrated from Austria to New York in 1936. The practice of insulin dosing continued into the 1960s in America, and for much longer in countries like China and the former Soviet Union.

Sakel believed that the seizures and unconsciousness experienced by psychiatric patients undergoing an insulin-induced hypoglycemic episode resulted in dramatic change in their mental state. In his own words: "My supposition was that some noxious agent weakened the resilience and the metabolism of the nerve cells-blocking the cell off with insulin will force it to conserve functional energy and store it to be available for the reinforcement of the cell."

Sakel claimed that close to ninety percent of his patients improved with insulin shock therapy, but his methods were later called into question and discredited as unscientific. In particular, Sakel was accused of "cherry picking" the patients most likely to improve using insulin therapy, and providing them with extra attention and support.

Patients were said to have been terrified of the procedure, which is now considered to be inhumane. Severe hypoglycemia such as that induced by Sakel can result in permanent brain damage and even death. Some of his insulin therapy patients did indeed suffer adverse effects, including fatalities. While today's antipsychotic medications are not without their side effects, thankfully they are much safer and more effective than anything available just a couple of decades ago.

Why Have Insulin Jet Injectors Never Really Caught On?

February 18th, 2011

An insulin jet injector sounds like a great idea. Intended to be a less painful way of delivering insulin than the traditional insulin syringes or insulin pens, they deliver a fine jet of insulin under such high pressure that it is able to penetrate the skin without a needle.

The first insulin jet injector, dubbed the "peace gun", was invented by a doctor in the 1940s for mass immunization of American troops. It was used right up until 1997, when it's use was discontinued because of concerns around cross-contamination from multiple users. According to all reports, the peace gun was efficient, but painful.

The jet injector was first offered for individual use in 1979. A modern insulin injector looks similar to an insulin pen, but larger. There are a number of different models, but the typical insulin injector consists of three pieces - a metal pen-like delivery device, a disposable plastic nozzle, and a disposable adapter to connect the injector to an insulin vial. The insulin injector has a dosing dial that allows individual users to select their correct dosage.

The metal injector is designed to last for years, and the detachable nozzle and adapter are intended for multiple uses before disposal. The air pressure is created by either a powerful spring device or a nitrogen or cartridge dioxide cartridge. The devices have adjustable pressure settings so users can select the one that is most effective while causing them the least discomfort.

There are some obvious benefits to a needle free jet injection system, the most apparent being the option for the needle phobic to avoid needles. Other advantages are the speed and ease of use, safety (no bent or broken needles, or "sharps" to dispose of ), less risk of contamination, a better spread of insulin into the subcutaneous tissue, no scar tissue build up at the injection site, and no need to keep buying syringes.

So why do so few diabetics use them? The number one reason seems to be pain. Although some people find a needleless injection quite tolerable, many find the pressure required to force the insulin through the skin most uncomfortable. It's not uncommon for the skin at the injection site to bleed, swell and/or bruise.

Another major factor is the initial cost (at least several hundred dollars) although this is offset by the fact that users don't have the ongoing expense of syringes. Not all insurance companies cover the cost of an insulin injector, and many of those that do require a letter from your doctor.

Jet injectors are also more cumbersome and less portable than insulin syringes or insulin pens, not just because they're larger and heavier, but also because users also need to carry an insulin vial (which requires refrigeration), the adapter and, with some models, the nozzle along with it.

It takes more time to set up an insulin injector than it does to fill a syringe. Unlike a syringe or insulin pen, an insulin injector requires maintenance, and has to be taken apart and sterilized on a regular basis. Some people are put off by the noise made by the compression system during use.

There are insulin injectors specially designed for use in children, and even one for dogs and cats, the Zoe Pet Jet. Those who have managed to find a comfortable setting on their jet insulin injector seem quite happy with the devices, and urge new users not to give up if they're not initially comfortable using one.

New Ultra Long Acting Insulin Could End the Need for Daily Injections

February 18th, 2011

insulin syringe

Danish pharmaceutical giant Novo Nordisk has completed clinical testing of a new generation of ultra long acting insulin, called insulin degludec. More than 10,000 type 1 and type 2 diabetics from 40 different countries participated in 17 different trials.

Trial results consistently showed Degludec to be as effective in lowering blood sugar as the current most widely used long acting insulin, Sanofi-Aventis' Lantus (insulin glargine), with no difference in adverse effects.

More importantly, trial participants given Degludec experienced significantly fewer episodes of hypoglycemia than those given Lantus, especially potentially dangerous night time hypoglycemia. Trials with type 2 diabetics saw a decrease in nighttime hypoglycemia of over 35 percent, and trials with type 1 diabetics of 40 percent.

Degludec is effective for up to 40 hours, roughly twice as long as insulin glargine. Lantus is said to be effective for 18 to 26 hours, although some users report a shorter efficacy. The only other long acting insulin on the market, Novo Nordisk's Levemir (insulin detemir), has a similar action period. Like Lantus and Levemir, Degludic's action is flat, without pronounced peaks in effectiveness.

The new insulin is released so slowly and steadily into the body that it may allow some diabetics to go from daily injections to just three injections a week. Degludic's long and steady action is attributable to the fact it forms a "depot" of soluble multi-hexamers when injected under the skin, from which the insulin is slowly and steadily absorbed into the body.

At the same time, Novo Nordisk is also developing Degludec Plus, the first combination of a long acting insulin (or basal insulin) with a rapid acting (or bolus) insulin, insulin aspart. Until now, it hasn't been possible to combine a basal insulin and a bolus insulin in one single injection.

Lantus (insulin glargine) currently leads the market, generating sales of almost $4 billion a year globally. Levemir (insulin detemir) lags far behind in sales. Now that the phase 3 trials have been completed, Novo Nordisk will be seeking FDA approval for both Degludec and Degludec Plus in 2011, and hopes to begin marketing the new diabetes medications in 2013. Degludec is expected to be marketed at a higher price than Lantus, because of its reduced incidence of hypoglycemia and potential need for less frequent insulin injections.

For more information on Degludec and Degludec Plus, click this Global Medical News video link.

New Ultra Long Acting Insulin Could End the Need for Daily Injections

February 18th, 2011

insulin syringe

Danish pharmaceutical giant Novo Nordisk has completed clinical testing of a new generation of ultra long acting insulin, called insulin degludec. More than 10,000 type 1 and type 2 diabetics from 40 different countries participated in 17 different trials.

Trial results consistently showed Degludec to be as effective in lowering blood sugar as the current most widely used long acting insulin, Sanofi-Aventis' Lantus (insulin glargine), with no difference in adverse effects.

More importantly, trial participants given Degludec experienced significantly fewer episodes of hypoglycemia than those given Lantus, especially potentially dangerous night time hypoglycemia. Trials with type 2 diabetics saw a decrease in nighttime hypoglycemia of over 35 percent, and trials with type 1 diabetics of 40 percent.

Degludec is effective for up to 40 hours, roughly twice as long as insulin glargine. Lantus is said to be effective for 18 to 26 hours, although some users report a shorter efficacy. The only other long acting insulin on the market, Novo Nordisk's Levemir (insulin detemir), has a similar action period. Like Lantus and Levemir, Degludic's action is flat, without pronounced peaks in effectiveness.

The new insulin is released so slowly and steadily into the body that it may allow some diabetics to go from daily injections to just three injections a week. Degludic's long and steady action is attributable to the fact it forms a "depot" of soluble multi-hexamers when injected under the skin, from which the insulin is slowly and steadily absorbed into the body.

At the same time, Novo Nordisk is also developing Degludec Plus, the first combination of a long acting insulin (or basal insulin) with a rapid acting (or bolus) insulin, insulin aspart. Until now, it hasn't been possible to combine a basal insulin and a bolus insulin in one single injection.

Lantus (insulin glargine) currently leads the market, generating sales of almost $4 billion a year globally. Levemir (insulin detemir) lags far behind in sales. Now that the phase 3 trials have been completed, Novo Nordisk will be seeking FDA approval for both Degludec and Degludec Plus in 2011, and hopes to begin marketing the new diabetes medications in 2013. Degludec is expected to be marketed at a higher price than Lantus, because of its reduced incidence of hypoglycemia and potential need for less frequent insulin injections.

For more information on Degludec and Degludec Plus, click this Global Medical News video link.

Six Warning Signs of Diabetic Ketoacidosis

February 22nd, 2011

Ketoacidosis is a diabetic emergency which occurs as a result of a lack of insulin. Without insulin, the body is unable to use sugar for energy. Unable to use sugar, the body burns its fat stores for energy.

As the fat is broken down, byproducts called ketones are released, building up in the blood and urine. Ketones are acid waste products, and are dangerous at high levels. Blood sugar rises as the liver produces more glucose in an attempt to fuel the body, causing further acidity.

A diabetic who experiences two or more of the following warning signs, and has high glucose readings (over 300mg/dl) should contact their doctor or go to the hospital immediately:

  1. Breath that smells like fruit or nail polish remover
  2. Labored breathing (gasping)
  3. Pronounced thirst
  4. Stomach or abdominal pain
  5. Nausea and vomiting
  6. Flushed complexion

Diabetic ketoacidosis (DKA) usually develops slowly over 24 hours, starting with symptoms such as fatigue, mental stupor, decreased appetite, loss of appetite, headache, and fading consciousness. Often the symptoms of ketoacidosis lead to an initial diagnosis of type 1 diabetes.

Once the patient starts vomiting, their condition can deteriorate very quickly. If treatment is delayed, the diabetic can fall into a life threatening coma. Ketoacidosis is especially dangerous in the elderly.

Immediate treatment involves an insulin injection to reduce blood glucose levels, and the administration of fluids and electrolytes to combat the dehydration that accompanies DKA. The average adult DKA sufferer loses about one and a half gallons of fluid.

Ketoacidosis is a concern for insulin dependent type 1 diabetics, but occurs much less frequently in type 2 diabetics. Diabetics who are Hispanic or African American are more at risk of DKA. DKA is more common in children and adolescents, and, for unknown reasons, slightly more common in women.

DKA is often the result of an illness. Diabetic ketoacidosis can also result from:

  • A missed insulin dose
  • Incorrect insulin dosing
  • A malfunctioning insulin pump
  • An increased need for insulin (sometimes as a result of a growth spurt in children)
  • Infection
  • Surgery
  • Trauma
  • Heart attack
  • Use of cocaine

Diabetics can easily test their urine for ketones are using a test strip similar to a glucose test strip. Ketone testing should be done whenever the blood sugar is higher than 240 mg/dl, during an illness or health crisis such as a stroke, during pregnancy, and whenever a diabetic is experiencing nausea and/or vomiting. Diabetics who are ill should check their ketones every 4 to 6 hours to ensure adequate diabetes control.

DKA can largely be avoided with proper diet and self care when diabetics are ill or otherwise at risk, including adjusting insulin levels when needed. Before the introduction of insulin injections in the 1920's, DKA was almost always fatal. Since the 1950s, the mortality rate has, thankfully, been reduced to between one and ten percent.

Adjusting to Life With Childhood Diabetes

March 14th, 2011

It's hard enough to cope with parenting an adolescent, and if you throw juvenile diabetes into the mix it may feel impossible. Educate yourself, make a plan with your diabetes team, and keep lines of communication open between you and your child, and you can go back to disagreeing about things like dating and borrowing the car.

Signs and Symptoms

Because of the changes your child will experience with puberty, the signs and symptoms may be difficult to recognize, so regular check-ups are important. Type 1 diabetes usually shows up at 10 to 12 years of age in girls and around 12 to 14 years of age in boys, but may present earlier or later. Some of the symptoms of diabetes in children are:

  • Fatigue
  • Extreme weight loss
  • Increased appetite
  • Increased thirst and frequent urination
  • Irritability

If you notice these signs in your child, it is important to talk to your doctor so that she can run tests. If the tests confirm that your child has diabetes, he may need to go straight to the hospital to get help stabilizing his blood sugar levels. Your doctor and other health care professionals will work with you to make a plan to maintain those healthy blood sugar levels. This may include diabetes medication, insulin injections and diet and exercise changes.

Making Changes

As you make the necessary lifestyle changes continue to talk to your child so that he is aware of what he needs to do, and more importantly, why he needs to do it. Giving him the tools and information he needs to fully understand the situation will help him to make healthy decisions down the road.

Ease into the changes so that the transition is not too jolting. If your child is inactive, start with small amounts of activity as a family every day. Buy whole grain products instead of white flour, and try to incorporate vegetables or fruit at all meals.

Attitude

Stay calm when discussing your child's diabetes with him. Instead of focusing on what he won't be able to do, or all the things that will change, focus on all the things that he will continue to be able to do. He will still be able to have fun with his friends, play sports and go to school. Get him involved in meal planning and, when you and your child feel he is ready, let him do his own insulin injections. If he feels he still has independence it will make the adjustments easier on everyone.

New Hormone Pathway May Replace Insulin Therapy for Diabetes

March 28th, 2011

Researchers have discovered a hormone pathway that they are hopeful may eventually lead to new type 1 diabetes treatments to replace insulin therapy. Currently, America's approximately one million type 1 diabetics rely on multiple insulin injections per day to control their blood sugar.

The pathway involves a hormone with insulin-like characteristics called fibroblast growth factor 19 (FGF 19). Unlike insulin, FGF 19 does not cause excess glucose to be stored as fat, also raising the prospect of a new anti-obesity treatment.

To read the whole story, click here >Science Daily<.

New Hormone Pathway May Replace Insulin Therapy for Diabetes

March 28th, 2011

Researchers have discovered a hormone pathway that they are hopeful may eventually lead to new type 1 diabetes treatments to replace insulin therapy. Currently, America's approximately one million type 1 diabetics rely on multiple insulin injections per day to control their blood sugar.

The pathway involves a hormone with insulin-like characteristics called fibroblast growth factor 19 (FGF 19). Unlike insulin, FGF 19 does not cause excess glucose to be stored as fat, also raising the prospect of a new anti-obesity treatment.

To read the whole story, click here >Science Daily<.

Six Simple Tips for Parents of Children with Diabetes

April 5th, 2011

boy playing

Juvenile diabetes can make it difficult for a child to live a "normal" life. With diabetes medication, insulin injections, diet restrictions, and all the symptoms that can accompany diabetes, it may feel like your kid's life is ruined, but there are some simple things you can do to make his life easier.

1. Snacks: setting a no-snack rule is likely going to backfire, so encourage healthy but tasty snacks. Try low fat crackers with peanut butter, apple slices with low fat cheese, or fruit smoothies with berries and milk. Make an effort to combine grains, proteins, fruits and vegetables at every meal, and talk to your kid about the importance of controlling blood glucose levels. He should be able to make healthy food decisions when you are not there to guide him, so help him learn.

2. Create a routine. Eating at regular times will help to keep your child's glucose levels under control. Use this opportunity to build in fun activities to get the whole family moving, like going for a walk after supper or riding bikes to school. It will be easier to keep track of spikes or drops in glucose levels this way, and it is less likely that you or he will forget something like his diabetes medication, insulin injections, or even a meal.

3. Exercise. Don't make exercise a burden, instead take advantage of children's natural desire to move. Play soccer, play tag, climb trees, ride bikes- If it gets your kid moving, have fun with it. If your kid sees you having fun while being active, he'll be more inclined to join in.

4. Talk to other parents so that your child can participate in sleepovers, birthday parties and other activities, just like any other kid. With the right tools and information, it shouldn't be too hard for them to accommodate your child's needs. Offer to send healthy snacks that everyone can enjoy, or just send something for your child.

5. Set an example. Eat healthy meals and exercise, and your kids will follow your lead. On top of that, you will be healthier and able to enjoy spending time with your kids for longer.

6. Educate your child about juvenile diabetes. Make sure he understands the nature of his condition, the importance of monitoring his blood glucose levels, and the genuine need for insulin for diabetics.

Juvenile Diabetes: How to Talk to Your Child about a Diabetes Diagnosis

April 11th, 2011

insulin injection

Finding out that your child needs insulin injections can be shocking and terrifying. It is easy to go into panic mode and think about all the worst case scenarios, but it is important to stay calm, especially in front of your child. Children take their cues from the adults around them, and if your child sees you panicking about his illness he will likely panic too. Acknowledge that this is scary for him, and that things are going to change, but let him know with your voice and your actions that it will be okay and that you will be there to help him every step of the way.

Stay Calm

Once you have a diabetes diagnosis for your child you will want to sit down and talk to him and help him understand what is going on. Nurses and doctors may explain certain things to him at his appointment or at the hospital, but he will likely be overwhelmed by everything that is going on and will need to have things explained again. There are a few important things to remember when having this conversation, but above all else show your child that you love and support him.

Focus on the Positives

Don't start out with a list of things your child is not allowed to do or eat. Let him know that there will be changes, but that he will still be able to play with his friends and participate in the activities he loves. Talking to your child about his illness in a positive and encouraging way will reassure him it is not the end of his world as he knows it. Remind him that he is not alone, that there are many other children with diabetes, and that his family and friends will be there to support him.

Talk about Diabetes Medications

Talking about diabetes medications and insulin for diabetics can be difficult, especially with younger children. While it is tempting to just tell your child to take it "because it will make him better", or "because the doctor says so", it is important that your child knows why he is taking the medication. Keep the explanations of the diabetes medications simple, so that he is not overwhelmed or confused; he does not need to know the complex science, only what the drugs do to keep him healthy and why they are so important. If he understands the changes he is making in his life he will be able to make decisions on his own when you are not there.

You or another adult will need to give you child his insulin injections until he is old enough to do it himself. Remain firm, calm and matter of fact when giving insulin injections. Long acting insulin has a different pH than types of insulin, and some children complain that long acting insulin shots "sting" if given too quickly. Some parents use an ice cube to numb the injection site. Many prefer using the smaller, more convenient insulin pens over insulin syringes.

Juvenile Diabetes: How to Talk to Your Child about a Diabetes Diagnosis

April 11th, 2011

insulin injection

Finding out that your child needs insulin injections can be shocking and terrifying. It is easy to go into panic mode and think about all the worst case scenarios, but it is important to stay calm, especially in front of your child. Children take their cues from the adults around them, and if your child sees you panicking about his illness he will likely panic too. Acknowledge that this is scary for him, and that things are going to change, but let him know with your voice and your actions that it will be okay and that you will be there to help him every step of the way.

Stay Calm

Once you have a diabetes diagnosis for your child you will want to sit down and talk to him and help him understand what is going on. Nurses and doctors may explain certain things to him at his appointment or at the hospital, but he will likely be overwhelmed by everything that is going on and will need to have things explained again. There are a few important things to remember when having this conversation, but above all else show your child that you love and support him.

Focus on the Positives

Don't start out with a list of things your child is not allowed to do or eat. Let him know that there will be changes, but that he will still be able to play with his friends and participate in the activities he loves. Talking to your child about his illness in a positive and encouraging way will reassure him it is not the end of his world as he knows it. Remind him that he is not alone, that there are many other children with diabetes, and that his family and friends will be there to support him.

Talk about Diabetes Medications

Talking about diabetes medications and insulin for diabetics can be difficult, especially with younger children. While it is tempting to just tell your child to take it "because it will make him better", or "because the doctor says so", it is important that your child knows why he is taking the medication. Keep the explanations of the diabetes medications simple, so that he is not overwhelmed or confused; he does not need to know the complex science, only what the drugs do to keep him healthy and why they are so important. If he understands the changes he is making in his life he will be able to make decisions on his own when you are not there.

You or another adult will need to give you child his insulin injections until he is old enough to do it himself. Remain firm, calm and matter of fact when giving insulin injections. Long acting insulin has a different pH than types of insulin, and some children complain that long acting insulin shots "sting" if given too quickly. Some parents use an ice cube to numb the injection site. Many prefer using the smaller, more convenient insulin pens over insulin syringes.

Insulin Therapy Changing With New and Improved Insulin Delivery Methods

April 14th, 2011

An old insulin syringe
Not that long ago, being insulin dependent meant you had to carry around a syringe and a vial of insulin to deliver your insulin injections, making sure to keep them refrigerated. There are now a variety of methods for insulin delivery on the market, and some promising new developments on the horizon. These include:

1) Insulin pens. Most types of insulin are now available in convenient prefilled pens. Some insulin pens are entirely disposable when empty, and others use a replaceable insulin cartridge, usually containing 300 units. There is a dial on one end to set your desired dose. The pens offer discreet, push button insulin delivery. Some claim the injections are more comfortable than from a needle that has already been dulled by insertion into an insulin vial. Many people prefer to use an insulin pen if they are caring for a diabetic child or pet.

2) Insulin pumps. Insulin pumps are a device about the size of a pager that adhere to the skin and are worn 24/7. Insulin pumps contain an insulin reservoir, a battery powered pump, and a programmable computer chip that allows the user to control insulin dosing.

The pumps is attached to a thin plastic tube called a cannula, which is inserted just under the skin to deliver insulin subcutaneously and continuously. Insulin pump technology is constantly being improved upon. The newer pumps are smaller, and can "communicate" and interact with a continuous blood glucose monitor and computer software for state of the art blood sugar control.

3) Insulin jet injectors. Insulin jet injectors deliver a fine jet of high pressure insulin directly through the skin. The main advantage is that that the insulin delivery system requires no needles. The major disadvantage is that many diabetics find the force required for the insulin to permeate the skin is painful, and may cause bruising. Jet injectors have been on the market since 1979, but have yet to become popular.

4) Insulin patch. The FDA has just approved a new insulin delivery patch. The new device, Finesse, is a small plastic patch-pen roughly 2 inches long and an inch wide that is attached to the skin like a bandage. It can be worn under your clothes, and remains attached during routine activities like sleeping, exercising and even showering.

Patients use a syringe to pre-fill the patch-pen with a three-day supply of insulin, and simply push two buttons to dispense a dose of fast-acting insulin when needed. The insulin is delivered in seconds through a miniature, flexible plastic tube inserted painlessly into the skin. The manufacturer, Calibra is also working on a patch-pen that would deliver a .05 unit insulin dose for children.

5) Inhaled insulin. The FDA approved the first insulin inhaler, Exubera, in 2006. It was a short-acting insulin delivered to the lungs through a device similar to an asthma inhaler. But it never achieved market success, and was discontinued a year later.

But research on inhaled insulin continued, and two new forms are poised to hit the market. One is an insulin inhaler, AFREZZA, which is awaiting FDA approval. The other is an insulin spray which is absorbed through the mouth, called Oral-Lyn. Oral-Lyn is in Phase 111 clinical trials in Europe and North America.

Despite some obvious advantages to the new insulin delivery methods, tried and true insulin syringes remain the most popular way to deliver insulin injections with most insulin dependent diabetics, who no longer consider injections a big deal.

Insulin pens, insulin pumps, and insulin jet injectors are all more costly than insulin syringes, and not always covered by medical insurance.Not all types of insulin are available in insulin pens, and you can't mix insulin types in a pen.

Insulin pumps can kink or otherwise malfunction, posing the danger of inaccurate insulin dosing, and are just too "high tech" for some diabetics. Many diabetics remain skeptical of devices like insulin inhalers and sprays after Exubera's spectacular lack of success.

Still, with the advances being made in insulin pumps, and the pending introduction of an improved inhaled insulin and the insulin patch, the world of insulin therapy is definitely changing - and most would say for the better.

Insulin Therapy Changing With New and Improved Insulin Delivery Methods

April 14th, 2011

An old insulin syringe
Not that long ago, being insulin dependent meant you had to carry around a syringe and a vial of insulin to deliver your insulin injections, making sure to keep them refrigerated. There are now a variety of methods for insulin delivery on the market, and some promising new developments on the horizon. These include:

1) Insulin pens. Most types of insulin are now available in convenient prefilled pens. Some insulin pens are entirely disposable when empty, and others use a replaceable insulin cartridge, usually containing 300 units. There is a dial on one end to set your desired dose. The pens offer discreet, push button insulin delivery. Some claim the injections are more comfortable than from a needle that has already been dulled by insertion into an insulin vial. Many people prefer to use an insulin pen if they are caring for a diabetic child or pet.

2) Insulin pumps. Insulin pumps are a device about the size of a pager that adhere to the skin and are worn 24/7. Insulin pumps contain an insulin reservoir, a battery powered pump, and a programmable computer chip that allows the user to control insulin dosing.

The pumps is attached to a thin plastic tube called a cannula, which is inserted just under the skin to deliver insulin subcutaneously and continuously. Insulin pump technology is constantly being improved upon. The newer pumps are smaller, and can "communicate" and interact with a continuous blood glucose monitor and computer software for state of the art blood sugar control.

3) Insulin jet injectors. Insulin jet injectors deliver a fine jet of high pressure insulin directly through the skin. The main advantage is that that the insulin delivery system requires no needles. The major disadvantage is that many diabetics find the force required for the insulin to permeate the skin is painful, and may cause bruising. Jet injectors have been on the market since 1979, but have yet to become popular.

4) Insulin patch. The FDA has just approved a new insulin delivery patch. The new device, Finesse, is a small plastic patch-pen roughly 2 inches long and an inch wide that is attached to the skin like a bandage. It can be worn under your clothes, and remains attached during routine activities like sleeping, exercising and even showering.

Patients use a syringe to pre-fill the patch-pen with a three-day supply of insulin, and simply push two buttons to dispense a dose of fast-acting insulin when needed. The insulin is delivered in seconds through a miniature, flexible plastic tube inserted painlessly into the skin. The manufacturer, Calibra is also working on a patch-pen that would deliver a .05 unit insulin dose for children.

5) Inhaled insulin. The FDA approved the first insulin inhaler, Exubera, in 2006. It was a short-acting insulin delivered to the lungs through a device similar to an asthma inhaler. But it never achieved market success, and was discontinued a year later.

But research on inhaled insulin continued, and two new forms are poised to hit the market. One is an insulin inhaler, AFREZZA, which is awaiting FDA approval. The other is an insulin spray which is absorbed through the mouth, called Oral-Lyn. Oral-Lyn is in Phase 111 clinical trials in Europe and North America.

Despite some obvious advantages to the new insulin delivery methods, tried and true insulin syringes remain the most popular way to deliver insulin injections with most insulin dependent diabetics, who no longer consider injections a big deal.

Insulin pens, insulin pumps, and insulin jet injectors are all more costly than insulin syringes, and not always covered by medical insurance.Not all types of insulin are available in insulin pens, and you can't mix insulin types in a pen.

Insulin pumps can kink or otherwise malfunction, posing the danger of inaccurate insulin dosing, and are just too "high tech" for some diabetics. Many diabetics remain skeptical of devices like insulin inhalers and sprays after Exubera's spectacular lack of success.

Still, with the advances being made in insulin pumps, and the pending introduction of an improved inhaled insulin and the insulin patch, the world of insulin therapy is definitely changing - and most would say for the better.

Insulin Therapy Can Help Avoid Diabetic Neuropathy

May 19th, 2011

Diabetic neuropathy is a common complication of both type 1 and type 2 diabetes, especially in those who have had diabetes for some time. Diabetic neuropathy, or nerve pain, is nerve damage related to high blood sugar levels. Up to 70 percent of diabetics will develop some sort of neuropathy.

There are four types of diabetic neuropathy - peripheral, proximal, autonomic and focal. The symptoms will vary depending on the type you have, but the first signs are usually numbness, tingling and/or pain in the outer limbs - hands, feet, legs and arms.

Peripheral neuropathy is the most common type. Symptoms get worse at night, and include muscle pain and cramping, loss of sensitivity to temperature or pain, and increased sensitivity to touch. Uncontrolled peripheral neuropathy increases the risk of foot ulcers, infection, and even amputation.

The one and only way to treat diabetic neuropathy is to control your blood sugar levels. A major long-term study established that neuropathy was less common in those diabetics controlling their condition through insulin injections. For a comprehensive overview of diabetic neuropathy, including tips on how to prevent and control it, read The Complete Guide to Diabetic Neuropathy at endocrineweb.

Insulin Therapy Can Help Avoid Diabetic Neuropathy

May 19th, 2011

Diabetic neuropathy is a common complication of both type 1 and type 2 diabetes, especially in those who have had diabetes for some time. Diabetic neuropathy, or nerve pain, is nerve damage related to high blood sugar levels. Up to 70 percent of diabetics will develop some sort of neuropathy.

There are four types of diabetic neuropathy - peripheral, proximal, autonomic and focal. The symptoms will vary depending on the type you have, but the first signs are usually numbness, tingling and/or pain in the outer limbs - hands, feet, legs and arms.

Peripheral neuropathy is the most common type. Symptoms get worse at night, and include muscle pain and cramping, loss of sensitivity to temperature or pain, and increased sensitivity to touch. Uncontrolled peripheral neuropathy increases the risk of foot ulcers, infection, and even amputation.

The one and only way to treat diabetic neuropathy is to control your blood sugar levels. A major long-term study established that neuropathy was less common in those diabetics controlling their condition through insulin injections. For a comprehensive overview of diabetic neuropathy, including tips on how to prevent and control it, read The Complete Guide to Diabetic Neuropathy at endocrineweb.

Weird Warning for Diabetics With Pets

June 24th, 2011

Jack Russell terrier

The Director of the Amputation Prevention Center at the Valley Presbyterian Hospital in Van Nuys, Dr. Lee C. Rogers, has a warning for diabetic pet owners who have suffered a loss of feeling due to nerve damage.

The warning stems from an incident in which a two-year-old Jack Russell terrier chewed off the infected big toe of its owner while she slept. The 48-year-old Des Moines woman woke in the morning to find part of her toe missing, and blood on her bed and her pet's face.

"She didn't feel it at all," said Rogers, a podiatrist who treated the woman, "When she woke up, there was blood all over the place." Rogers eventually had to amputate the woman's leg after she developed an infection - leaving her a double amputee.

Rogers is now cautioning diabetics who have lost feeling in their limbs to cover their feet and any wounds while sleeping. "Pets have a tendency to lick wounds, and that simple lick can turn into a bite if there is no response from its owner," warns Rogers, adding that there has also been cases of dog's saliva infecting their owners with dangerous bacteria.

About 60 to 70 percent of diabetics have some sort of nerve damage, or diabetic neuropathy, due to poor diabetes control. Diabetic neuropathy results from years of high blood glucose levels, and often begins with a loss of sensation in the feet.

Diabetic neuropathy is a leading cause of amputation, although staff at the Amputation Prevention Center have achieved a limb salvage rate of 96 percent since opening its doors in January of 2010. The Center uses cutting-edge technology and a unique team approach. It recorded an average healing rate of 52 days in its 350 patients the first year, less than half the national average of 120 days.

Oddly, this is not the first known incident of this type. Last year a Michigan man with type 2 diabetes lost part of his big toe when his Jack Russell bit it off after the man passed out from a night of drinking. Doctors who treated him after the incident said they would have had to amputate the toe anyway.

Diabetic neuropathy is not an inevitable part of having diabetes. It can be avoided, or at the very least, minimized with proper diabetes control. Both type 1 and type 2 diabetics can control their condition with lifestyle changes like diet and exercise, careful blood glucose monitoring, and oral diabetes medication insulin injections if needed.

Inexpensive TB Vaccine could be a Revolutionary Diabetes Drug

June 28th, 2011

An inexpensive vaccine that's been used for over 90 years to combat tuberculosis may have the ability to reverse type 1 diabetes. Although the early results were met with skepticism, seven studies in mice over the last ten years have established that the generic drug BCG (bacillus Calmette-Guerin) can prevent immune system T cells from destroying insulin-producing cells, allowing the pancreas to regenerate and once again produce insulin.

A research team from the Massachusetts General Hospital Immunobiology Laboratory led by Dr. Denise Faustman, PhD, successfully reproduced the results in a small group of human subjects, using very small doses of the vaccine. Those diabetics receiving the vaccine, all of whom had been Type 1 for an average 15 years, showed both a decrease in pancreas cell-destroying T cells, and an increase in the insulin precursor C-peptide - an indicator of insulin production.

The results were temporary, and it is likely that the vaccination would have to be repeated on a regular basis. The team believed using higher doses would have led to a more positive effect, but trial dosages were limited by the FDA. They are now negotiating with the FDA to use higher concentrations in a larger trial.

Type 1 diabetes is an auto-immune condition in which the body attacks its own insulin-producing beta cells in the pancreas. The body needs insulin to fuel itself and regulate blood sugar, so type 1 diabetics must take daily insulin injections to manage their blood sugar levels.

BCG works by increasing the levels of an immune system protein called tumor necrosis factor, or TNF. High levels of TNF block other parts of the immune system from attacking the body, especially the pancreas. This is a major shift in direction in diabetes treatment, as it was not previously believed possible to restore pancreas function in insulin dependent diabetics.

Doctors and researchers are surprised and excited at the unanticipated prospect of controlling the immune system to restore the body' ability to produce normal insulin levels. "If this is reproducible and correct, it could be a phenomenal finding," enthuses Dr. Robert Henry of the University of California, San Diego.

The research was largely funded by the Iacocca Foundation, founded in 1984 by auto manufacturer magnate Lee Iacocca and his daughters after his wife died from diabetes complications at age 57. The Foundation has committed to continued financial assistance for phase II clinical testing of the potentially revolutionary diabetes medication.

Consider an Online Canadian Pharmacy When You Buy Lantus

June 30th, 2011

Lantus is a popular basal, or long acting, insulin used in the treatment of both type 1 and type 1 diabetes mellitus. The diabetes medication is suitable for both adult and pediatric patients with Type 1 diabetes, and for adults with Type 2 diabetes who require long-acting insulin injections to control hyperglycemia.

Lantus long acting insulin has some key benefits: it is used only once daily, it has no pronounced peak; it lowers basal glucose levels for a full 24 hours; and it can be used with oral diabetes medications and/or short-acting insulin for better diabetes control. One of the biggest advantages of Lantus is that, due to its lack of peak, it decreases the risk of nocturnal hypoglycemia.

Lantus (insulin glargine), marketed by Sanofi-Aventis, currently leads the long acting insulin market, generating sales of almost $4 billion a year globally. Lantus is available in both conventional vials and the discreet and convenient pre-filled Lantus SoloSTAR insulin pen.

Many diabetics help manage the cost of daily insulin injections by buying their diabetes medication from a Canadian online pharmacy. The Canadian government regulates prescription drug prices, and does not allow pharmaceutical companies to engage in expensive direct to consumer marketing, helping to keep drug prices lower.

The Canadian government also allows drug companies to manufacturer cheaper (but chemically identical) generic versions of brand name drugs sooner than in the States. Canadian pharmacies are anticipating they will be able to provide their customers with affordable generic Lantus in the near future, so revisit longactinginsulin.com for updates.

It is not uncommon for a prescription purchased through a Canadian online pharmacy to be 50% cheaper than one purchased in the US, and not unheard of for it to be up to 90% cheaper. To buy Janumet online from a Canadian pharmacy, you must have a current valid prescription.

Be sure you are dealing with a reputable online Canada pharmacy by ensuring it does not offer drugs without a prescription, does not sell controlled substances such as narcotics, has clear contact information including a physical address, has a licensed pharmacist available to answer questions, and is accredited by the Canadian International Pharmacy Association.

Like all types of insulin, Lantus is only part of a complete program of diabetes treatment that may also include diet, exercise, weight control, and regular blood sugar monitoring. Any decisions about your diabetes medication should be made together with your doctor or another health care professional.

What is Brittle Diabetes?

July 4th, 2011

Brittle diabetes is an uncontrolled form of type 1, or insulin dependent, diabetes. It's also referred to as uncontrolled or labile (open to change) diabetes. While most diabetics experience some fluctuations in blood sugar, brittle diabetics have dramatic, regular, yet unpredictable swings in glucose levels, even when doing their best to control their condition with insulin injections, exercise and diet.

These wildly fluctuating blood glucose levels can result in either high blood sugar (hyperglycemia) or low blood sugar (hypoglycemia). Symptoms of hypoglycemia include:

  • trembling
  • dizziness
  • cold sweats
  • tiredness
  • weakness
  • headache
  • blurred vision
  • racing or pounding heart
  • irritability
  • confusion

Severe low blood sugar can result in disorientation, convulsions, and loss of consciousness.

Symptoms of hyperglycemia include:

  • thirst
  • headache
  • blurred vision
  • frequent urination
  • trouble concentrating
  • fatigue

Hyperglycemia is frequently accompanied by ketosis, or elevated levels of ketones. Ketones are compounds caused by the breakdown of fatty acids in the body.

Ketosis is not normal, but it's not necessarily harmful. However extreme ketosis can lead to ketoacidosis, a dangerous condition in which the blood's ph is lowered to very acidic levels. Ketoacidosis can result in a life threatening diabetic coma. One telltale sign of ketoacidosis is a fruity or nail polish remover-like odor on the diabetic's breath (caused by acetone, a byproduct of ketone breakdown).

Luckily, only about 2 percent of diabetics suffer from brittle diabetes. It is most common in young (aged 15 to 30) women, especially overweight women. Brittle diabetes can be caused or made worse by:

  • poor diabetes control (high sugar diet, missing doses of diabetes medication)
  • gastrointestinal absorption problems
  • poor insulin absorption
  • thyroid problems (hypothyroidism)
  • adrenal gland problems
  • drug and alcohol interactions
  • hormonal imbalances
  • stress
  • depression

Brittle diabetes often has to be treated in a hospital, where food intake, insulin injections, and blood sugar levels can be closely controlled and monitored. As there may be a psychological component to brittle diabetes, psychotherapy is helpful in some cases.

More Progress Made Towards the Development of an Artificial Pancreas

July 7th, 2011

Researchers are continuing to make progress in the development of an artificial pancreas for insulin dependent type 1 diabetics. An artificial pancreas is an automated, closed-loop system consisting of a continuous glucose monitor, a glucose meter to calibrate the monitor, and an insulin pump.

With the help of a sophisticated computer system, an artificial pancreas produces insulin and controls blood sugar in a diabetic much as a normal pancreas does in a person without diabetes. The sophisticated system senses when the body needs insulin, calculates the dose needed, and delivers automatically, eliminating the need for insulin injections.

To read more about several recent advances towards the development of an artificial pancreas on WebMD, >CLICK HERE<.

FDA Panel Recommends Against Approval of new Diabetes Medication

July 27th, 2011

diabetes medication

A panel of Food & Drug Administration advisors has voted 9 to 6 against the approval of the new oral diabetes drug, dapaglifozin. Dapaglifozin was developed by Bristol-Myers Squibb, and was to be marketed by AstraZeneca. The panel expressed concerns about both the medication's safety and its effectiveness, especially in the elderly.

Dapaglifozin proved as effective as current oral diabetes medications in otherwise healthy diabetics, but was not as effective in those with impaired kidney function. The panel was primarily concerned about a potential risk of breast and bladder cancers. In a two-year study, there were nine cases of bladder cancer and nine cases of breast cancer in the just under 5478 patients taking the new diabetes medication, compared to only one case of bladder cancer and one case of breast cancer in the 3156 patients in the control group.

There were also indications of possible kidney damage, and increased risks of genital and urinary tract infections. The panel also complained of insufficient data on which patient population the diabetes drug was best suited to, and on potential interactions with other medications.

Dapaglifozin belongs to a class of medications called SGLT2 inhibitors. SGLT2 inhibitors work by inhibiting the return of glucose filtered by the kidneys to the blood stream, redirecting it through the urinary tract to be excreted in the urine. It's believed the resulting high sugar levels in the urine is the cause of the increase in genital and urinary tract infections.

One advantage of SGLT2 inhibitors is that they work independently of insulin injections, allowing for more freedom in combining them with other diabetes medications. People taking dapaglifozin in clinical trials also lost an average of five pounds, and experienced a slight drop in blood pressure.

The panel recommendation will not only likely result in the FDA rejecting the diabetes medication, but it will also effect the approval of similar SGLT2 inhibitors being developed by a number of other major pharmaceutical companies, including Johnson & Johnson, GlaxoSmithKline, Boehringer Ingelheim and Eli Lilly.

The panel is calling for more clinical studies of the proposed diabetes drug. The FDA will make a final decision by the end of October, 2011, but given the panel's request for more trials, the approval of dapaglifozin is expected to be about two years away.

Helping Friends to Understand Diabetes

August 4th, 2011

explaining insulin dependent diabetes

About.com Diabetes Guide Gary Gilles has written an excellent post titled Helping Friends to Understand Diabetes - Answers to 9 Common Questions. The post is aimed at insulin dependent type 1 diabetics, and tackles common myths and questions about blood glucose testing, insulin injections, diabetes and diet, and episodes of low blood sugar.

The post begins with:

Educating friends about your type 1 diabetes can be challenging. Many myths still exist about diabetes and you can do yourself a big favor by trying to replace those myths with accurate information. Here are nine of the most common questions your friends might be thinking and how to answer them.

To read the 9 common questions and Gilles helpful suggested answers on About.com, >CLICK HERE.<

Arthritis Drug a Future Diabetes Medication?

August 9th, 2011

A collaborative group of researchers including the American Diabetes Association and the Juvenile Diabetes Research Foundation has been testing the medication abatacept (CTLA4 immunoglobin fusion protein) as a possible treatment for type 1 diabetes. Abatacept, better known by its brand name Orencia, is FDA approved to treat autoimmune diseases such as rheumatoid arthritis and multiple sclerosis.

Type 1 diabetes is an autoimmune disease in which T-cells in the body's immune system mistakenly attack the insulin producing beta cells in the pancreas. With the pancreas producing little or no insulin, type 1 diabetics must rely on insulin injections to regulate their blood sugar levels. Those type 1 diabetes who continue to produce some insulin have an easier time keeping their blood sugar in the normal range, and have less risk of diabetes complications.

Abatacept blocks the activation of the immune system's aggressive and destructive T-cells. The researchers hoped the medication would protect the remaining beta cells in the pancreas from being destroyed, allowing them to continue to make at least a little of their own insulin.

Researchers recruited 112 newly diagnosed type 1 diabetics aged 6 to 45, all of whom still had some functioning beta cells. Two thirds of the participants were given abatacept intravenously over two years, and one third was given a placebo. The two-year study ended recently, although participants will be followed up for another two years. Initial results are encouraging, with the participants who received the abatacept showing 59% more insulin production than the control group.

"I have spent my career on the quest to find a treatment and cure for type 1 diabetes, and thus it was very gratifying when we unblinded the clinical results and discovered that abatacept had benefit," said principle investigator Dr. Tihamer Orban. "From my experience though," he cautioned, "abatacept is not likely to be the complete answer, and type 1 diabetes patients will likely benefit from cocktail combinations with other drugs. This synergistic approach has a great future."

Orban's is the CEO of the clinical stage biotechnology company, Orban Biotech. Orban Biotech has launched a pre-clinical study evaluating the combination of abatacept with the company's antigen-based therapy insulin B chain vaccine. The vaccine, which is entering into a Phase II trial, is designed to arrest the autoimmune response and re-establish tolerance towards insulin, preserving the body's own insulin production.

This study is one of several which show promise of novel ways to improve diabetes control, and perhaps free insulin dependent diabetics from the need for frequent insulin injections and other diabetes medication.

Mealtime Insulin Injections May be Replaced by an Insulin Inhaler

August 12th, 2011

There's good news for insulin dependent diabetics who rely on fast-acting mealtime insulin injections to keep their blood sugar under control. MannKind Corporation has the go-ahead to continue clinical testing of its investigational inhaled insulin, AFREZZA. The drug maker and the FDA met to confirm the protocols for two new studies, one in type 1 diabetics, and one in type 2 diabetics.

AFREZZA is an ultra-rapid acting inhaled insulin which uses patented technology to deliver powdered insulin from a thumb-sized device into the lungs. The lungs are an effective option for delivering diabetes medication, largely because of their huge surface area (about the size of a tennis court).MannKind focuses on the discovery, development and commercialization of therapeutic products for patients with diseases such as diabetes and cancer. Now in late stage clinical investigation, AFREEZA is its lead product candidate. Shares of the company jumped 20% at the news that the design of the follow-up clinical trials had been confirmed.

MannKind has been seeking approval for its new generation diabetes medication since March of 2009, but was asked twice to run additional clinical trials in order to provide the FDA with more information. One of the approval delays was due to the drug maker updating the design of its insulin inhaler after applying for approval of the earlier design. The FDA was concerned that there was not enough data to support a switch to the new generation device, and asked that both models be tested together.

Clinical trials of the initial design of the insulin inhaler were promising. Participants reported being pleased with the innovative insulin delivery device, and experienced less hypoglycemia and weight gain than did controls using a standard combination of long-acting insulin glargine and twice a day 70 30 insulin injections.

Insulin can't be taken orally, as digestive juices break it down before it can be used by the body. Currently, the only means of delivering insulin are subcutaneous insulin injections or intravenously. Because AFREEZA is a short-acting mealtime insulin, type 1 diabetics will need to combine it with long-acting insulin injections for complete diabetes control.

Dr. Larry Deeb, a pediatric endocrinologist from the University of Florida College of Medicine, says that failure to comply with regular insulin dosing is one of the major issues in diabetes, often because of the discomfort and inconvenience of insulin injections. Deeb says that finding an alternative insulin delivery method is crucial, especially for children and the needle-phobic.

Should it be approved, AFREEZA would be the second inhaled insulin to hit the market. Pfizer received approval to market a similar product, Exubera, several years ago, but, surprisingly, the product never caught on with diabetics, and was withdrawn from the market a year later.

AFREZZA is easier to use, faster acting and boasts better bioavailability than Exubera, enabling diabetics to achieve more satisfactory insulin levels using smaller amounts. Despite Exubera's unexpected failure, AFREEZA is expected to be a blockbuster diabetes drug when it becomes available.

How to Give an Insulin Injection

August 29th, 2011

For those newly diagnosed insulin dependent diabetics, or those caring for someone newly diagnosed, WebMD has developed a six-step "Action Set" on giving an insulin injection to your self or to someone else.

The instructional guide, found online in the Diabetes Health Center, starts with basic information on insulin therapy, and then leads into detailed information on preparing an insulin dose and giving an insulin injection. The information links to illustrative slideshows demonstrating the techniques.

>CLICK HERE< to view the Action Set and slideshows on giving an insulin shot on WebMD.

Home Urine Test Measures Insulin Production in Diabetics

August 31st, 2011

A simple home urine test has been developed which can measure if patients with type 1 and type 2 diabetes are producing their own insulin. The urine test replaces multiple blood tests in hospital and can be sent by mail, as it is stable for up to three days at room temperature. Avoiding blood tests will be a particular advantage for children with diabetes.

The urine test measures if patients are still making their own insulin even if they take insulin injections. Researchers have shown that the test can be used to differentiate Type 1 diabetes from Type 2 diabetes and from rare genetic forms of diabetes.

One woman with a genetic form of diabetes whose urine test revealed that she was still making her own insulin was able to stop taking insulin injections after 14 years of insulin treatment. To read more about this promising home urine test on ScienceDaily, >CLICK HERE.<

Do You Need a Diabetes Emergency Survival Kit?

September 1st, 2011

Essential Preparedness Products (EPP) is marketing an emergency survival kit designed specifically for diabetics. The Diabetic med-Ecase is light weight, watertight, airtight, crush resistant, and will float in water.

The survival kit comes complete with glucose tablets, alcohol swabs, a syringe container, an ice pack, a log book to track insulin injections, diabetes medication bottles and a 7-day pill dispenser. Water purification tablets can be purchased as an add-on..

The rugged yellow case has customized compartments for insulin vials, insulin syringes, insulin pens, blood sugar meters, glucagon, and blood and ketone testing stripes. Users fill them with their own personal diabetes medication and supplies.

EPP focuses on emergency preparedness for those with serious medical conditions, creating customized med-Ecases containing necessary medications and supplies in preparation for an emergency, natural disaster, or just travel. Their Diabetic med-Ecase can be ordered online through the EPP website for $69.99.

Does Using Long Acting Insulin Increase Cancer Risk?

September 6th, 2011

long acting insulin

According to the FDA, five recent studies of a possible link between insulin glargine (marketed as Lantus long acting insulin) and the growth of cancerous cells have failed to shed more light on the subject. Calling the studies "inconclusive", the FDA said it was continuing to work with the long acting insulin manufacturer, Sanofi-Aventus, to determine whether there is an increased risk of cancer for users of insulin glargine.

The concerns arose because Lantus' ability to act as a long acting insulin arises from its prolonged interaction with the insulin-like growth factor-I receptor (IGF-IR). IGF-IR overactivity has been linked to many types of cancer. That begs the question - could long acting insulin glargine be associated with cancer because of its continual interfacing with IGF-IR?

While the debate about the possible cancer risk associated with long acting insulin continues, the American Diabetes Association, the American Association of Clinical Endocrinologists and two similar European governing bodies are reassuring insulin dependent diabetics that there is no need to change their insulin glargine treatment.

To read more about the controversial long-acting Lantus insulin clinical studies on diabeticlive.com, >CLICK HERE.<

Mysterious Fetal Tissue Helps Grow Insulin Producing Beta Cells

September 7th, 2011

A somewhat mysterious soft tissue found in the fetus during early development in the womb plays a pivotal role in the formation of mature beta cells, the sole source of the body's insulin. This discovery, made by scientists at University of California, San Francisco (UCSF) and Texas A&M University, may lead to new ways of addressing Type 1 and Type 2 diabetes.

As reported in the journal PLoS Biology, during the late stages of development in mice, this fetal tissue -- called the mesenchyme -- secretes chemicals. Those chemicals enable insulin-producing beta cells to mature and expand. Remove this mesenchyme tissue, the researchers found, and the mice do not grow their full complement of beta cells.

This work provides researchers with an immediate tool for research and diabetes drug discovery. By identifying the chemicals that this tissue secretes, scientists may be able to create new beta cells in the body or in the test tube - something currently beyond the reach of medical science that could potentially eliminate the need for insulin injections.

To read the full article on ScienceDaily, >CLICK HERE.<

Insulin Jet Injectors Evolving

September 12th, 2011

Despite lackluster success to date, the market research firm Kalorama is predicting that the worldwide market for jet injectors will double over the next five years. Jet injectors are a needleless drug delivery system that distribute a fine jet of medication under such high pressure that it is able to penetrate the skin.

"Needle-free devices have come a long way to the present state and are playing an increasingly important role in the novel drug delivery technology markets," Kalorama drug delivery analyst Mary Anne Crandall wrote in a report titled Needle-Free Drug Delivery Markets. She predicts that their ease of use, safety and cost effectiveness, combined with evolving technology, will result in a future boom in jet injector sales.

"Needle free has been a part of insulin marketing for some time," says Crandall, "And now we are also seeing it with vaccines and [other] treatments." There are now over a dozen FDA approved needle-free jet injectors on the market, most designed for specific purposes such as administering vaccines, delivering hormone treatments, and administering growth hormone to children.

Bioject's VitaJet has traditionally been marketed as an insulin jet injector, although it is now being promoted for other home injection applications. There are insulin jet injectors specially designed for children, and even one for dogs and cats, the Zoe Pet Jet.

There are still some limitations to widespread usage of jet injectors. For example, jet injectors can't efficiently administer drugs intramuscularly. They are well suited to delivering subcutaneous insulin doses, but existing jet injectors are cumbersome compared to an insulin syringe or insulin pen, and require maintenance.

Currently, cost is also an issue, although Crandall believes prices will erode in the near future, spurring further sales. While initially expensive, jet injectors are designed to last for years. The pressurized gas cartridges needed to power many jet injectors (others use a spring loaded device) are an ongoing expense.

The number one issue may be discomfort. Although some diabetics find a needleless insulin injection quite tolerable, many find the pressure required to force the insulin through the skin painful. Some report bruising, swelling and even bleeding at the injection site, although that may be the result of an incorrect injector setting.

There are some obvious benefits to a needle free jet injection system, the most apparent being the option for the needle phobic to avoid needles. Other advantages are the speed and ease of use, safety (no bent or broken needles, or "sharps" to dispose of ), less risk of contamination, a better spread of insulin into the subcutaneous tissue, no scar tissue build up at the injection site, and no need to keep buying syringes.

"Needle-free jet injection devices can and should play a major role in solving the problems of needle stick injuries and needle phobia in the United States," according to Crandall. With the industry aware of and working on the drawbacks of the promising drug delivery devices, Crandall is probably right.

New Disposable Insulin Delivery Device About to Hit the Market

September 14th, 2011

Valeritas, an American medical technology company focused on the development and commercialization of innovative drug delivery solutions, is poised to begin marketing a new disposable insulin delivery device called the V-Go Disposable Insulin Delivery Device.

The V-Go is designed to provide an alternative to multiple daily insulin injections for adult type 2 diabetics using basal-bolus insulin therapy. The V-Go delivers a continuous preset rate of basal insulin (20, 30 or 40 units of insulin per 24 hours) and allows for on demand bolus dosing at mealtimes (in two unit increments up to 36 units).

Users fill the V-Go with their desired insulin dose using an included disposable filling accessory, the V-Go EZ Fill. The small, lightweight (about 1 ounce when full) device delivers insulin subcutaneously for 24 hours, after which it is replaced with a new one. The discreet device is worn under a patient's clothing, and should not be exposed to direct sunlight or high temperatures, although it can be submerged in up to three feet of water.

The non-electronic V-Go was tested using both Humalog insulin lispro and Novolog (insulin aspart), and achieved FDA approval at the end of 2010. The company has been pursuing financing to market it ever since, and has just announced that it has raised $150 million to bring the V-Go Disposable Insulin Delivery Device to market.

"Millions of adult patients suffer from type 2 diabetes and require insulin," says Valeritas CEO Kristine Peterson, "We believe the V-Go will be an important treatment option to assist in the management of their diabetes." To visit the V-Go site and to sign up for email updates on the availability of the innovative insulin delivery device, >Click Here.<

Insulin Nasal Spray Tested as an Alzheimer's Treatment

September 16th, 2011

insulin nasal spray

Ateam of Department of Veteran Affairs (VA) researchers were intrigued by studies that suggested that low levels of insulin in the brain could contribute to Alzheimer's disease. The researchers, led by Dr. Suzanne Craft, decided to test the benefits of restoring normal insulin levels in the brains of Alzheimer's patients.

Insulin is an important hormone which plays a major role in turning blood sugar into energy for cells. A lack of insulin, or an inability to properly use it, results in diabetes. Diabetes is a known risk factor for Alzheimer's, although the connection is not yet clear.

Alzheimer's is a disease in which cognitive functioning declines over time, causing progressive memory loss, loss of motor and language skills, impaired reasoning, emotional instability, and eventually full-blown dementia. The disease is associated with abnormal protein deposits in the brain called plaques.

The VA team used an insulin nasal spray that could deliver insulin rapidly and directly to the brain without increasing insulin levels elsewhere in the body. They recruited 104 adults with mild amnestic cognitive impairment or mild to moderate Alzheimer's disease. They divided the participants into three groups, with one group receiving 20 international units (IU) of insulin, one receiving 40 IU, and the third receiving an inactive saline placebo. The insulin dose or placebo was delivered daily through a nasal spray for four months.

Memory, cognition and functioning ability tests were conducted on the participants both before and after the four month period. The patients in the treated groups showed an increase in brain glucose metabolism following insulin therapy. Both insulin doses improved the patients' general cognition and functioning about 20%, and the 20 IU insulin dose also improved memory. The group receiving the placebo showed a slight decline in cognitive abilities. The treatment did not result in any major side effects, although some participants did report a mild headache or a runny nose.

Insulin appears to protect the brain against the toxic effects of beta-amyloid, the protein behind the brain plaques present in Alzheimer's. It also prevents the formation of a toxic form of the protein tau, a biomarker for Alzheimer's found in the cerebrospinal fluid. Insulin also promotes cell repair and growth, which may also help combat degenerative brain disease.

VA Chief Research and Development Officer Dr. Joel Kupersmith says, "VA researchers are exploring a number of possible approaches to help prevent of effectively treat this devastating disease, and these are among the most promising results to date." The research is even more important and encouraging because there is currently no effective treatment to delay or treat Alzheimer's disease.

There are a great many unanswered questions about the connection between insulin and Alzheimer's, and it's still premature to consider insulin a new treatment. Researchers still don't know much of the daily insulin injections required by many diabetics gets into the brain, and what effects it may have in the brain of the average diabetic.

Researchers are calling for further studies to explore the use of insulin to treat Alzheimer's, and to hopefully establish an optimal insulin dosage and dosing schedule. Any treatment which could improve the lives of the estimated 5.4 million Americans that suffer from Alzheimer's and their caregivers can not come soon enough.

Overcoming Injection Anxiety

September 20th, 2011

Have you or someone close to you been newly diagnosed as an insulin dependent diabetic? Are you anxious about giving yourself or your dependent insulin injections? Many diabetics say that giving themselves an insulin injection is the hardest part of the condition.

Or perhaps you're an experienced diabetic who hasn't kept up to date on the latest insulin delivery methods like spring loaded syringes, insulin pens and insulin jet injectors. Skipping doses of diabetes medication can lead to poor blood sugar control and diabetes complications. WebMD feature writer Stephanie Watson offers some practical advice in an article titled Overcoming Objections to Injections.

Overcoming Injection Anxiety

September 20th, 2011

Have you or someone close to you been newly diagnosed as an insulin dependent diabetic? Are you anxious about giving yourself or your dependent insulin injections? Many diabetics say that giving themselves an insulin injection is the hardest part of the condition.

Or perhaps you're an experienced diabetic who hasn't kept up to date on the latest insulin delivery methods like spring loaded syringes, insulin pens and insulin jet injectors. Skipping doses of diabetes medication can lead to poor blood sugar control and diabetes complications. WebMD feature writer Stephanie Watson offers some practical advice in an article titled Overcoming Objections to Injections.

Edible Film a Possible Insulin Delivery Platform

September 22nd, 2011

In another promising development in the world of diabetes medication, the specialty pharmaceutical company MonoSol Rx is testing its unique PharmFilm as a possible oral insulin delivery platform. PharmFilm is a quick-dissolving film that can be impregnated with medication and placed under the tongue or against the inside of the cheek. The medication is quickly absorbed into the bloodstream through the mouth's mucosal membranes.

The FDA has already approved two applications of the edible film - Zuplenz to treat nausea and vomiting, and Suboxone to treat opiod dependence. MonoSol Rx is now testing two new applications for PharmFilm, one dispenses a drug to treat ADHD, and the other delivers insulin for diabetics.

Currently, insulin can only be administered through injection, as it is destroyed by acids in the digestive system. Because the postage stamp sized insulin film dissolves so quickly in the mouth, the diabetes medication bypasses the digestive tract and passes directly into the circulatory system.

MonoSol Rx and Midatech are just two of many companies racing to develop different ways to administer insulin without injections, including insulin patches, insulin inhalers, and insulin nasal sprays.

The insulin film can be manufactured in different sizes to accommodate different insulin dosages. The advantages of a dissolving insulin film for insulin dependent diabetics (especially children with diabetes and their caregivers) are obvious - no insulin injections; precise insulin dosing; a convenient, discreet and portable medication, and instant onset of action.

MonoSol Rx is collaborating with Midatech Group Ltd, a leading edge nanotechnology company which develops biocompatible nanoparticles (tiny synthetic molecules that are designed to carry and deliver drugs) to bring the oral diabetes medication to market. The insulin film has been successfully tested transbuccally (inside the cheek) in pigs and monkeys, and the partners plan to begin human trials this year.

A spokesperson for Midatech Group said, "The results of insulin PharmFilm in our primate study validate the film delivery of active insulin across the buccal mucosa for the first time. In addition, we have preclinical proof-of-concept that these results can be achieved in a controlled dose precisely tailored to suit individual needs. We anticipate results from our human clinical trials, slated to commence in the second quarter of 2011, to revolutionize treatment methods and insulin delivery for diabetics worldwide."

According to the Centers for Disease Control, nearly 24 million people in the United States are currently living with diabetes - the seventh leading cause of death in the country. Many of these diabetics (about 30%) are, or will become, insulin dependent and require insulin injections. Many are struggling with complications involving their heart, kidneys, nerves, eyes, and circulation.

Insulin is a hormone which moves blood sugar into the cells to give the body energy. Diabetics either don't produce any insulin (type 1 diabetes), can't make enough insulin, and/or can't properly make use of the little insulin they do produce (type 2 diabetes).

A Humorous Account of Caring for a Diabetic Cat

September 23rd, 2011

cat with diabetes

Megan Radford has written a humorous post titled Babysitting a Diabetic Cat, or How I Learned That Karma Bites Back for the website DiabetesDaily. A diabetic herself, Radford was the obvious choice to care for her sister's diabetic cat (who requires twice daily insulin injections and occasional glucose testing) when her sister went away. The post begins:

I am the friend who is used to needles. The one who doesn't flinch or faint at sight of blood or sharp things. When my sister asked me to take care of her diabetic cat for a week while she and her husband were out of town, I blustered and puffed about like nobody's business. "No problem!" I said with gun-slinging fervor. "Piece of cake!" With a wink and the fingers twisting into an okee-dokee gesture, I delivered the final blow with a wry smile: "It's not like I'm afraid of needles or anything!"

To read more about Radford's adventures in cat sitting, and learn how karma bit her back, >Click Here.<

Woman Murders Husband with Massive Insulin Injection

September 29th, 2011

The prosecutor in Alicante, Spain has requested a prison term of 29 years for a woman accused of murdering her husband with a lethal insulin dose.

Fifty-one-year-old Gregoria CS, a Spanish woman on diabetes medication since 1998, was responsible for administering medication to her husband, Juan Antonio GC, diagnosed with HIV.

Gregoria allegedly first dosed her husband with insulin on March 30th, 2007 after a family row, resulting in his admission to hospital in a hypoglycemic crisis. He remained in hospital for a month.

On a second occasion on June 28th, 2010, she injected her sleeping husband in the neck with a massive dose using three insulin pens, and when he woke up smothered his cries for help with a pillow.

The next morning the couple's children raised the alarm when their father would not wake up.He was transferred to hospital in Elche with severe hypoglycemia and was stabilized, but remained in a vegetative state until his death on February 4th, 2011.

The woman had accused her husband of psychological abuse. The prosecutor's requested term of imprisonment comprises 11 years for the first murder attempt and 18 years for the second.

From the online newspaper, RoundTownNews.

Is It Safe To Reuse An Insulin Syringe?

September 30th, 2011

Is it safe to reuse an insulin syringe? Bethany from California asked this question of Conditions Expert Dr. Otis Brawley on the health website CNN Health. Dr. Otis' answer reads in part:

"Insulin syringes are expensive, and many patients want to reuse needles to save money. Many also reuse the lancets used to prick the skin and draw blood to measure blood sugar.

You are right that the reuse of insulin syringes and lancets is dangerous. A used needle can have bacteria from the skin in and on it. Bacteria can contaminate the bottle of insulin when reinserted into the bottle. The bottled insulin is a growth medium that can allow the bacteria to reproduce. Insulin is stored in a refrigerator to prevent bacterial growth.

Certain types of bacteria when injected can be especially devastating and can even cause death. In the U.S., several thousand diabetic patients die each year due to bad sterile technique causing abscesses, skin infection and sepsis, which is generalized infection involving the blood.

There are some insulin injection devices that are designed to be reused. Insulin for these devices comes in cartridges with a needle. A new cartridge and needle is used with each dose. The cartridge system is not very useful for the patients who have to mix immediate and long acting insulin at a dose.

All of these risks [of diabetes complications] can be reduced through good blood sugar control, good diet, exercise, and taking diabetes medications properly. Mild diabetes can be controlled through diet and exercise. Moderate disease often requires oral diabetes medications, and more severe Type 2 disease requires oral diabetes medicines and insulin injections."

To read Dr. Otis' answer in its entirety, including sound advice on avoiding diabetes complications, >Click Here.<

$100,000 Reward Offered for Glucose-Sensitive Insulin

October 3rd, 2011

The Juvenile Diabetes Research Foundation (JDRF) announced a $100,000 Challenge for the development of a new glucose-sensitive insulin medication that will be used in the treatment of patients with diabetes. The JDRF is a global organization that promotes awareness of Type 1 diabetes in addition to sponsoring research into new treatments for diabetes and educating diabetics about how to properly manage the disease.

The JDRF is utilizing the InnoCentive.com platform to issue the challenge. InnoCentive is a service that connects businesses and organizations seeking solutions to problems in a wide variety of fields with scientists and research teams who develop solutions custom-tailored for the "challenge."

The best solution is awarded a cash prize, usually between $10,000 and $100,000. The JDRF's challenge will award $100,000 to any research group that develops a diabetes medication that improves blood sugar management, lessens the need for frequent blood sugar testing, and reduces the risk of diabetic complications.

The winning solution will be a glucose-responsive insulin medication that senses glucose levels in the blood of the patient and automatically releases insulin into the bloodstream when necessary. A glucose-sensitive medication would require fewer insulin doses - a single dose a day, or even less - and would reduce the burden of frequent blood sugar testing and insulin injections for diabetics.

According to Aaron Kowalski, Ph.D., assistant Vice President of Treatment Therapies at the JDRF, "Insulin treatment requires diligent monitoring and burdensome administration, often several times a day, every day. This remains the only way to regulate blood sugar levels for the millions of individuals with insulin dependent diabetes worldwide. Although research has propelled the development of better and faster-acting insulins, the disease is still hard to control because of the way insulin is administered to patients."

"What we need is sophisticated insulin that will take the guesswork out of managing diabetes by developing a novel insulin that works in the same way insulin works in people without diabetes," continued Dr. Kowalski. "By fostering novel approaches from diverse problem solvers within and outside the diabetes field, we hope this Challenge with InnoCentive will help speed progress toward the development of glucose-responsive insulin - progress urgently needed by people with diabetes."

InnoCentive.com is headquartered in Waltham, Massachusetts. The company's founders were first inspired to create a service connecting businesses with qualified researchers in 1998, and launched InnoCentive in 2001.

Enhanced Long Acting Insulin to Challenge Lantus

October 4th, 2011

(From Bloomberg Businessweek) Drugs to treat diabetes, mostly injectable insulin, have become a $34 billion annual business crowded with manufacturers of relatively similar products. Novo Nordisk wants to stand out from the pack. Following the example of consumer product companies, the Danish drugmaker is betting that it can add product enhancements to basic insulin and command higher prices in wealthier nations.

Explains Chief Executive Officer Lars Sørensen, pounding his desk for emphasis: "A country like the US ought to be able to offer people the most modern insulins and not giving them Third World insulins." Novo Nordisk, which gets half its $11.1 billion sales from insulin, this year is seeking U.S. and European regulatory approval for its newest treatment, degludec, in a bid to unseat Sanofi's Lantus as the world's best-selling diabetes medication.

Sørensen says degludec is "the fundamental part" of a strategy to boost Novo Nordisk's sales by shifting patients in developed nations from older, cheaper types of insulin that must be taken just before mealtimes to more expensive chemically altered versions that are absorbed more slowly and act longer.

Degludec's advantage is that it can be administered at any time, providing diabetes patients with greater flexibility, whereas Lantus insulin must be injected at the same time every day, although not necessarily at mealtimes. Trial results presented at a conference in Lisbon in September showed that degludec works as well as Lantus at controlling blood sugar.

To read the full article on Bloomberg Businessweek, >Click here.<

Novo Nordisk Files for Approval of Ultra Long Acting Insulin

October 5th, 2011

Insulin

Novo Nordisk today announced the submission to the U.S. Food and Drug Administration of two new drug applications for ultra-long-acting insulin degludec and the co-formulation, insulin degludec/insulin aspart. These insulin analogs have been developed for the treatment of people with type 1 and type 2 diabetes.

"We are very excited about being able to file for the approval of insulin degludec and insulin degludec/insulin aspart now also in the US," said Mads Krogsgaard Thomsen, Executive Vice President and Chief Science Officer at Novo Nordisk. "This is another significant milestone for Novo Nordisk and for the millions of people with diabetes who require insulin injections."

As with the European applications submitted on September 26, the U.S. filings are based on results from the BEGIN and BOOST clinical trial programs, which involved nearly 10,000 type 1 and type 2 diabetes patients. Data from the trials have shown insulin degludec to lower blood glucose levels, while demonstrating a low rate of hypoglycemia, especially at night.

The trials also showed that insulin degludec can be administered once daily at any time of the day with the possibility to change the insulin injection time from day to day according to the needs of the individual patient.

Novo Nordisk intends to make both diabetes medications available in a prefilled insulin delivery device. In the clinical trials, insulin degludec was studied in insulin pens that could either deliver up to 80 units or in a concentrated formulation up to 160 units in a single injection.

Insulin degludec is an ultra-long-acting basal insulin analog discovered and developed by Novo Nordisk. It forms multi-hexamers upon subcutaneous injection, resulting in a soluble depot from which there is a slow, continuous and extended release of insulin degludec. This may contribute to a lowering of blood glucose levels and low rates of hypoglycemia, especially at night.

Insulin degludec/insulin aspart contains the ultra-long-acting basal insulin degludec with a bolus boost of insulin aspart. Insulin degludec/insulin aspart is the first and only soluble insulin co-formulation of ultra-long-acting insulin degludec and insulin aspart providing both fasting and post-prandial control.

Novo Nordisk Files for Approval of Ultra Long Acting Insulin

October 5th, 2011

Insulin

Novo Nordisk today announced the submission to the U.S. Food and Drug Administration of two new drug applications for ultra-long-acting insulin degludec and the co-formulation, insulin degludec/insulin aspart. These insulin analogs have been developed for the treatment of people with type 1 and type 2 diabetes.

"We are very excited about being able to file for the approval of insulin degludec and insulin degludec/insulin aspart now also in the US," said Mads Krogsgaard Thomsen, Executive Vice President and Chief Science Officer at Novo Nordisk. "This is another significant milestone for Novo Nordisk and for the millions of people with diabetes who require insulin injections."

As with the European applications submitted on September 26, the U.S. filings are based on results from the BEGIN and BOOST clinical trial programs, which involved nearly 10,000 type 1 and type 2 diabetes patients. Data from the trials have shown insulin degludec to lower blood glucose levels, while demonstrating a low rate of hypoglycemia, especially at night.

The trials also showed that insulin degludec can be administered once daily at any time of the day with the possibility to change the insulin injection time from day to day according to the needs of the individual patient.

Novo Nordisk intends to make both diabetes medications available in a prefilled insulin delivery device. In the clinical trials, insulin degludec was studied in insulin pens that could either deliver up to 80 units or in a concentrated formulation up to 160 units in a single injection.

Insulin degludec is an ultra-long-acting basal insulin analog discovered and developed by Novo Nordisk. It forms multi-hexamers upon subcutaneous injection, resulting in a soluble depot from which there is a slow, continuous and extended release of insulin degludec. This may contribute to a lowering of blood glucose levels and low rates of hypoglycemia, especially at night.

Insulin degludec/insulin aspart contains the ultra-long-acting basal insulin degludec with a bolus boost of insulin aspart. Insulin degludec/insulin aspart is the first and only soluble insulin co-formulation of ultra-long-acting insulin degludec and insulin aspart providing both fasting and post-prandial control.

Should You Take a "Vacation" From Your Insulin Pump?

October 6th, 2011

insulin syringe

A veteran insulin pump user wrote a thought-provoking post for HealthCentral.com about "taking a vacation" from insulin pumping. It begins:

By Kelsey Bonilia

"One of the ideas I'd been mulling over in the weeks leading up to my endocrinologist appointment was taking a pump vacation.I'd experienced several frustrating pump site malfunctions (the cannula kept kinking during insertion) that left me with stubbornly high blood sugars for hours.It was maddening to have poor blood sugar control because of my insulin delivery system.Also, after nearly five years of insulin pumping, I just wanted the freedom of life without a little medical device tethered to me.

Upon discussion with my doctor, I made the comment "I know that the pump is best..." to which he replied, "For some people, but it's not inherently better." He knows that I eat a fairly disciplined diet and still test my blood sugar 10-12 times a day, so he agreed that switching to insulin injections would be fine for me. He prescribed Humalog and Lantus insulin pens, which I'd never used before.It was kind of exciting to open the boxes of pens and learn how to use a new device!"

Kelsey plans to update the pros and cons of switching to insulin injections after using an insulin pump for almost five years. To read this and future posts on HealthCentral.com, >Click Here.<

New Ultra Fast Acting Insulin Does Well in Clinical Trials

October 26th, 2011

insulin syringe

Halozyme Therapeutics, Inc., a San Diego-based pharmaceutical company, recently announced that its new "ultrafast" insulin, PH20, worked just as well as Humalog in two Phase 2 clinical trials. PH20 is an insulin analog, a type of insulin that is not produced by the human body, but functions the same way as the insulin that the body produces.

The injectable insulin analog was as effective as another insulin analog - Eli Lilly's Humalog - at controlling blood sugar levels. In addition, PH20 was more effective than Humalog at controlling post-meal blood glucose levels. Rates of hypoglycemia were similar in PH20 insulin users, and the hypoglycemic episodes that did occur were generally mild and no more serious than those experienced by patients using Humalog.

Researchers studied the effects of the investigational diabetes medication on controlling blood sugar levels in two clinical trials conducted on about 220 participants. One study involved patients with Type 1 diabetes, and the other involved patients with Type 2 diabetes. There was a 50 percent increase in the number of patients who regularly met guidelines for healthy post-meal blood glucose levels among those using PH20 insulin injections.

PH20 insulin is delivered using rHuPH20, or recombinant human hyaluronidase enzyme. Much of Halozyme's work is based on the subcutaneous delivery of medications with rHuPH20, which the company says decreases costs, increases efficiency, and makes medication more convenient for patients.

Halozyme said that it will be pursuing worldwide distribution of PH20, suggesting that it may be partnering with a larger pharmaceutical manufacturer.

New Ultra Fast Acting Insulin Does Well in Clinical Trials

October 26th, 2011

insulin syringe

Halozyme Therapeutics, Inc., a San Diego-based pharmaceutical company, recently announced that its new "ultrafast" insulin, PH20, worked just as well as Humalog in two Phase 2 clinical trials. PH20 is an insulin analog, a type of insulin that is not produced by the human body, but functions the same way as the insulin that the body produces.

The injectable insulin analog was as effective as another insulin analog - Eli Lilly's Humalog - at controlling blood sugar levels. In addition, PH20 was more effective than Humalog at controlling post-meal blood glucose levels. Rates of hypoglycemia were similar in PH20 insulin users, and the hypoglycemic episodes that did occur were generally mild and no more serious than those experienced by patients using Humalog.

Researchers studied the effects of the investigational diabetes medication on controlling blood sugar levels in two clinical trials conducted on about 220 participants. One study involved patients with Type 1 diabetes, and the other involved patients with Type 2 diabetes. There was a 50 percent increase in the number of patients who regularly met guidelines for healthy post-meal blood glucose levels among those using PH20 insulin injections.

PH20 insulin is delivered using rHuPH20, or recombinant human hyaluronidase enzyme. Much of Halozyme's work is based on the subcutaneous delivery of medications with rHuPH20, which the company says decreases costs, increases efficiency, and makes medication more convenient for patients.

Halozyme said that it will be pursuing worldwide distribution of PH20, suggesting that it may be partnering with a larger pharmaceutical manufacturer.