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.

Warning Signs for Insulin Dependent Diabetics

December 10th, 2010

Most type 1 diabetics get very good at managing their disease. They can identify when their blood glucose is too high or too low, and skillfully balance a mixture of short, intermediate and long-lasting insulin. They stay up to date on the latest innovations in diabetes control - from the insulin pen through the insulin pump to the implantable glucose monitor. They know the importance of the glycemic index and staying physically active. They deftly adjust their diabetes medication to counteract changes in diet, activity level, stress, illness, and even their menstrual cycle.

Another often overlooked aspect of successful diabetes control is educating family, friends and co-workers about diabetes danger signs that may require medical attention. An unexpected insulin spike or rise or drop in blood sugar can cause a medical emergency for an insulin dependent diabetic, and those close to them should know what to watch for and how to respond. According to WebMD, the following are diabetes symptoms that should never be ignored:

1) Extreme thirst or hunger, blurry vision or frequent urination. These are all warning signs of uncontrolled blood sugar which, if left unchecked, could lead to serious, even life-threatening, conditions.

2) Appearing "drunk". Appearing intoxicated can be a sign of low blood sugar. Low blood sugar can result from a medication such as long-acting insulin working too well. A diabetic in this condition may not realize the seriousness of the situation, and lose consciousness.

3) Infections, gum problems and foot wounds. Diabetics are prone to infection, including fungal infections and foot ulcers, and even a small cut or sore can be risky. It's important for diabetics to watch for skin rashes, practice proper foot care, and to see a doctor if a wound gets infected or is slow to heal.

4) Eye problems and changes in vision. Diabetics are also prone to retinopathy (damage to the retina of the eye), which can cause vision loss. Talk to your doctor about any changes in vision, eye pain, or visual disturbances like seeing spots or lights, and see an ophthalmologist yearly.

5) Symptoms of heart disease. Diabetics are at increased risk of heart disease, heart attack and stroke, and they and those close to them should be aware of and alert for symptoms such as chest pain, shortness of breath, nausea, anxiety, dizziness, sweating, and a rapid or irregular pulse. It's also possible to have heart disease and not have obvious symptoms, so your doctor should evaluate your risk factors regularly.

Advances in diabetes treatment and diabetes medication continue to increase both the quality of life and the life expectancy of both insulin dependent and non insulin dependent diabetics. And promising treatments such as an artificial pancreas, islet cell transplants, glucose monitoring "tattoos", novel ways of delivering insulin without insulin injections and even a diabetes vaccine are in the early stages or on the horizon. While it will never be a good thing to be diabetic, it's no longer the tribulation it used to be.

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.

Diabesity Epidemic Results in More Insulin Dependent Pets

January 24th, 2011

"Diabesity", the twin and entwined epidemics of obesity and diabetes, is not only striking Americans across the socioeconomic spectrum, it is also impacting our pets. As with humans, the number of domestic cats and dogs diagnosed with diabetes is increasing rapidly. About 1 in 400 domestic dogs and cats are believed to have diabetes, compared to just 1 in 2000 only 40 years ago.

Obesity is a major risk factor for diabetes in both people and animals. Obesity contributes to insulin resistance, a condition in which the body no longer responds effectively to insulin. The body overcompensates for the loss in insulin sensitivity by producing more and more insulin, straining and eventually damaging the insulin producing cells in the pancreas. Most people and animals have type 2 diabetes, the form in which their bodies become insulin resistant, as opposed to Type 1, in which an immune system disorder destroys the insulin-producing cells in the pancreas.

Common symptoms of diabetes in pets are similar to those in humans, and include increased thirst, frequent urination, increased appetite, weight loss, shivering, fatigue and chemical or fruity smelling breath. Diabetes control in pets is also much like that in people - a combination of diet, exercise and the same diabetes medication prescribed to humans. Some diabetic cats can be treated with oral diabetes medications, but most cats and almost all dogs require insulin injections. Diabetic dogs are usually treated with twice daily injections of intermediate-acting insulin, while cats usually require one or two daily injections of long-acting insulin.

Interestingly, scientists have discovered that it's not only people and pampered pets that are becoming increasingly obese. Combing through years of data, they discovered that both wild and domestic animals have been steadily gaining weight for decades. Lab rats and street rats have both gained weight, despite the fact that the lab rats' diet and activity levels remained constant. Monkeys in a primate research centre are actually taking in fewer calories than previous generations, but are gaining weight.

Calculating the odds of so many species randomly gaining weight as only one in 10 million, baffled scientists are proposing a number of causes:

1) Viruses - a common virus that causes colds, adenovirus-36, is known to direct stem cells to turn into fat cells.

2) Global warming - As temperatures rise, living creatures don't have to expend as much energy to keep warm.

3) Chemicals -endocrine disrupters such as the chemical tributyltin, flame retardants and the organic compounds PCBs and BPA have all been linked to obesity.

4) Sleep deprivation - Lack of sleep has been linked to weight gain. A related theory is that changes in the amount of time spent in light or dark environments changes eating habits.

5) Nitrates - Nitrates in processed foods and in dog food have been linked to weight gain.

It's most likely that a variety of environmental factors are driving the obesity epidemic and the related diabetes epidemic. The best way to combat "diabesity" for humans and pets alike remains a low carbohydrate and low glycemic index (dubbed insulin resistance) diet, adequate physical activity, and, if needed, insulin therapy.

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."

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.

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.

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.

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.

Travelling with Diabetes

February 15th, 2011

Diabetes control can be a trial, even when you are in a familiar location with all of your supplies at hand. Going to a foreign country, or even city, adds extra complications and can be daunting. With the proper planning, however, travel can be enjoyable and relaxing.

Before you go:

  • Get travel insurance
  • Check in with your health care provider to make sure that you are fit to travel, and get any vaccinations required for your destination
  • Fill any prescriptions you require (make sure you have twice what you need, just in case)
  • Bring copies of your prescriptions and a list of medications that you are taking
  • Research your destination for information on medical clinics and food options

En Route:

  • Check airline regulations concerning carry-on luggage
  • Keep prescriptions, diabetes medications and syringes on you at all times
  • Don't let your insulin or insulin pumps go through the x-ray — talk to the security staff beforehand and ask for a manual search of your medical supplies
  • Make sure all insulin and supplies are properly marked with a professionally printed label from the manufacturer or pharmacy
  • Syringes must have needle guards and be kept with your insulin
  • Alert the security staff if you are wearing an insulin pump as they will need to check it in person
  • Take time to stretch or walk around

While There:

  • Remember to keep time differences in mind when you check your blood sugar level. Talk to your doctor, as you may need to adjust the dosage of your long-acting insulin, depending on how many hours you gain or lose in your travels.
  • Always bring extra water and snacks on outings
  • Keep your diabetes medication in two separate places, just in case anything gets lost or stolen
  • Never go on hikes or to remote places on your own, and make sure that your travel buddy is aware of your condition

Whether you are going away for a weekend or a month, to a new city or a new country, the proper preparation can ensure an enjoyable trip. Bring extras of all your supplies, keep snacks and bottled water with you at all times, and when in doubt, ask your health care provider.

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.

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.

Poor Sleep in Diabetics Leads to 82% Higher Insulin Resistance

June 13th, 2011

man in bed

There are complex cause and effect relationships between sleep and diabetes. Poor sleep is considered a risk factor for diabetes, while diabetes is considered a contributor to poor sleep.

Sleep disorders such as insomnia, excessive snoring and obstructive sleep apnea are more common in people with type 2 diabetes. As a result, many diabetics don't sleep as well as people without the disease.

Recently, researchers conducting a study titled Cross-Sectional Associations Between Measure Of Sleep And Markers Of Glucose Metabolism Among Persons With And Without Diabetes" monitored the sleep patterns of 40 type 2 diabetics over six nights. They were first interviewed about their normal sleeping patterns, and blood samples were taken to measure their glucose and insulin levels.

Participants wore activity monitors on their wrists to measure their movements through the night. A poor sleep was defined by both the data from the wrist monitors, and the patient's description of how long it took them to fall asleep and how many times they woke up through the night.

The poor sleepers had significantly higher blood glucose levels in the morning - 23 percent higher than those who got a restful sleep. Even more striking, their blood insulin levels were 48 percent higher. The researchers crunched the two numbers to calculate that poor sleepers with diabetes had 82% higher insulin resistance than diabetics who were able to get a good sleep.

"Poor sleep quality in people with diabetes was associated with worse control of their blood sugar levels," said the study's lead author, Kristen Knutson, PhD, an assistant professor of medicine, "people who have a hard time controlling their blood glucose levels have a higher risk of complications. They have a reduced quality of life. And they have a reduced life expectancy."

The logical next step, according to the researchers, is to see if improving the quality of sleep in diabetics can help them lower insulin resistance give them better long term diabetes control and improve their quality of life.

"This suggests that improving sleep quality in diabetics would have a similar beneficial effect as the most commonly used anti- diabetes drugs," said Eve Van Cauter, PhD, professor of medicine and co-author of the study, which was recently published in Diabetes Care.

The researchers also want to solve the "chicken and egg" aspect of chronic poor sleep and chronic insulin resistance, and determine which leads to the other. In the meantime, they're suggesting that diabetics with insomnia add sleep treatment to their 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.

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.

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.

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.

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.<

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.<

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.<

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.<

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.<

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.

Diabetes Drug Byetta Approved as Add-On to Long Acting Insulin

October 20th, 2011

The US.Food and Drug Administration has approved a new use for Amylin Pharmaceuticals Inc. and Eli Lilly's BYETTA injection. BYETTA is now approved as an add-on therapy to insulin glargine, with or without metformin and/or a thiazolidinedione (TZD). It should be used in conjunction with diet and exercise for adults with type 2 diabetes who are not achieving adequate glycemic control on insulin glargine alone.

"This expanded use for BYETTA is important for clinical care, in that it provides a new option for the many patients with type 2 diabetes who are not achieving treatment goals," said John Buse, M.D., Ph.D., professor of medicine, director of the Diabetes Care Center and chief of the Division of Endocrinology at the University of North Carolina School of Medicine in Chapel Hill.

"BYETTA is well-suited for use with insulin glargine, offering a simple fixed-dose regimen that can help improve control of blood sugar overall and after meals. In a clinical trial, patients using BYETTA with insulin glargine achieved better glycemic control, without weight gain or an increased risk of hypoglycemia, compared to patients using insulin glargine alone."

BYETTA is not insulin and should not be taken instead of insulin. The diabetes medication should not be taken with short- and/or rapid-acting insulin. BYETTA should not be taken by type 1 diabetics, people with diabetic ketoacidosis or patients with a history of pancreatitis.

In the study supporting the expanded use, patients receiving insulin glargine, with or without metformin and/or a TZD, were randomized to receive BYETTA or placebo in addition to aggressive insulin titration. After 30 weeks of treatment, A1C decreased by 1.7 percentage points in patients adding BYETTA, compared with a decrease of 1.0 percentage point in patients treated with insulin glargine alone (p<0.001). A1C is a measure of average blood sugar over three months.

Nausea, which was the most common adverse event, occurred in 41 percent of patients treated with BYETTA compared with 8 percent of patients treated with insulin glargine alone.

BYETTA is an injectable diabetes medication that exhibits many of the same effects as the human incretin hormone GLP-1. GLP-1 improves blood sugar after food intake through multiple effects that work in concert on the stomach, liver, pancreas and brain.

BYETTA was the first glucagon-like peptide-1 (GLP-1) receptor agonist to be approved by the FDA for the treatment of type 2 diabetes, and is now the first and only GLP-1 receptor agonist approved for use in the U.S. as an adjunct to long-acting insulin glargine (Lantus), with or without certain oral agents.

The double-blind clinical trial evaluating BYETTA as an add-on therapy to insulin glargine was published in Annals of Internal Medicine.(i) In the study, 261 patients receiving insulin glargine with or without metformin and/or a TZD were randomized to receive BYETTA 10 micrograms or placebo. Patients who may have been at increased risk of hypoglycemia (A1C?8 percent) reduced their dose of insulin glargine by 20 percent.

Five weeks after randomization, all patients had insulin doses aggressively titrated to target fasting blood glucose. The primary endpoint was reduction in A1C; secondary endpoints included change in body weight along with other parameters of glucose control, cardiovascular health, hypoglycemia and patient-reported outcomes.

After 30 weeks of treatment, the proportion of participants achieving the target A1C?7 percent was 60 percent in the BYETTA group and 35 percent in the insulin glargine group (p<0.001). For the target A1C?6.5 percent, the proportions were 40 percent and 12 percent, respectively (p<0.001). Both groups showed lower fasting plasma glucose concentrations; however, after morning and evening meals, when BYETTA was administered, postprandial glucose control was significantly improved in patients treated with BYETTA, compared to placebo.

On average, weight decreased by 4 pounds in patients adding BYETTA, compared with an increase of 2 pounds in patients treated with insulin glargine alone (p<0.001). The greater improvement in A1C with BYETTA was not accompanied by an increase in hypoglycemia, compared to insulin glargine alone.

Diabetes Drug Byetta Approved as Add-On to Long Acting Insulin

October 20th, 2011

The US.Food and Drug Administration has approved a new use for Amylin Pharmaceuticals Inc. and Eli Lilly's BYETTA injection. BYETTA is now approved as an add-on therapy to insulin glargine, with or without metformin and/or a thiazolidinedione (TZD). It should be used in conjunction with diet and exercise for adults with type 2 diabetes who are not achieving adequate glycemic control on insulin glargine alone.

"This expanded use for BYETTA is important for clinical care, in that it provides a new option for the many patients with type 2 diabetes who are not achieving treatment goals," said John Buse, M.D., Ph.D., professor of medicine, director of the Diabetes Care Center and chief of the Division of Endocrinology at the University of North Carolina School of Medicine in Chapel Hill.

"BYETTA is well-suited for use with insulin glargine, offering a simple fixed-dose regimen that can help improve control of blood sugar overall and after meals. In a clinical trial, patients using BYETTA with insulin glargine achieved better glycemic control, without weight gain or an increased risk of hypoglycemia, compared to patients using insulin glargine alone."

BYETTA is not insulin and should not be taken instead of insulin. The diabetes medication should not be taken with short- and/or rapid-acting insulin. BYETTA should not be taken by type 1 diabetics, people with diabetic ketoacidosis or patients with a history of pancreatitis.

In the study supporting the expanded use, patients receiving insulin glargine, with or without metformin and/or a TZD, were randomized to receive BYETTA or placebo in addition to aggressive insulin titration. After 30 weeks of treatment, A1C decreased by 1.7 percentage points in patients adding BYETTA, compared with a decrease of 1.0 percentage point in patients treated with insulin glargine alone (p<0.001). A1C is a measure of average blood sugar over three months.

Nausea, which was the most common adverse event, occurred in 41 percent of patients treated with BYETTA compared with 8 percent of patients treated with insulin glargine alone.

BYETTA is an injectable diabetes medication that exhibits many of the same effects as the human incretin hormone GLP-1. GLP-1 improves blood sugar after food intake through multiple effects that work in concert on the stomach, liver, pancreas and brain.

BYETTA was the first glucagon-like peptide-1 (GLP-1) receptor agonist to be approved by the FDA for the treatment of type 2 diabetes, and is now the first and only GLP-1 receptor agonist approved for use in the U.S. as an adjunct to long-acting insulin glargine (Lantus), with or without certain oral agents.

The double-blind clinical trial evaluating BYETTA as an add-on therapy to insulin glargine was published in Annals of Internal Medicine.(i) In the study, 261 patients receiving insulin glargine with or without metformin and/or a TZD were randomized to receive BYETTA 10 micrograms or placebo. Patients who may have been at increased risk of hypoglycemia (A1C?8 percent) reduced their dose of insulin glargine by 20 percent.

Five weeks after randomization, all patients had insulin doses aggressively titrated to target fasting blood glucose. The primary endpoint was reduction in A1C; secondary endpoints included change in body weight along with other parameters of glucose control, cardiovascular health, hypoglycemia and patient-reported outcomes.

After 30 weeks of treatment, the proportion of participants achieving the target A1C?7 percent was 60 percent in the BYETTA group and 35 percent in the insulin glargine group (p<0.001). For the target A1C?6.5 percent, the proportions were 40 percent and 12 percent, respectively (p<0.001). Both groups showed lower fasting plasma glucose concentrations; however, after morning and evening meals, when BYETTA was administered, postprandial glucose control was significantly improved in patients treated with BYETTA, compared to placebo.

On average, weight decreased by 4 pounds in patients adding BYETTA, compared with an increase of 2 pounds in patients treated with insulin glargine alone (p<0.001). The greater improvement in A1C with BYETTA was not accompanied by an increase in hypoglycemia, compared to insulin glargine alone.

Tea for Diabetes Prevention

February 21st, 2012

A new study has been released detailing the benefits of black tea consumption. According to the study, which was published in the British journal Nutritional Bulletin, drinking 3 or more cups of black tea a day reduced the risk of both diabetes and heart disease.

Researchers believe this is due to black teas high levels of flavonoids. Flavonoids are a type of antioxidant, which is believed to contribute to the reduction of inflammation and promote good functioning of blood vessels. Flavonoids are most commonly found in fruits and vegetables. Drinking two cups of tea is equal to five servings of vegetables, or 300-400 milligrams of antioxidants.

Diabetes affects over 25 millions Americans each year. All of these patients are required to buy anti-diabetes medications for blood sugar regulation. It is also a risk factor for cardiovascular diseases. So be sure to drink your tea!

5 Vision Loss Prevention Tips for Diabetics

April 6th, 2012

Diabetic retinopathy is one of the leading causes of blindness in the United States. For diabetics, it is the leading cause. Diabetic retinopathy is the result of microvascular retinal changes in the eye. New veins and capillaries begin to grow. However, these new growths aren't healthy, and often bleed, which causes the customary vision-blurring and eye reddening. Here are the top 5 tips for preventing diabetic retinopathy.

1. Know the symptoms - Double vision, flashing lights, redness or blood in the eye, difficulty reading-all of these are symptoms of diabetic retinopathy. Be sure to schedule an optometrist appointment if you experience any of these. Early diagnosis is key to keeping your vision.

2. Regular eye exams - as soon as you are diagnosed with diabetes, be sure to make an appointment with your ophthalmologist. You may have been living with the disease for some time, raising your risk of diabetic retinopathy. After this, be sure to get regular eye exams. Your ophthalmologist will be able to catch any retinopathy before it becomes serious. We recommend annual exams for diabetics.

3. Maintain your blood sugar - if your blood glucose levels rapidly rise, it can actually change the shape of your eye's lens. This can cause blurred vision.

4. Exercise - overall wellness is important not just for your eyes, but to keep your diabetes in check. It also helps to maintain your blood pressure. High blood pressure can cause a cloudy lens and blurred vision. Be sure to talk to your doctor about the right exercise regimen for your body.

5. Protect your eyes - eye protection is important for everyone, not just diabetics. Remember to wear protective sunglasses when at the beach, on the water, and especially on the ski slopes. White snow's reflective quality can cause eye damage.