Wellness

[cherry]

Diabetes: Are you over-monitoring your blood sugar?

Published Wednesday 12 December 2018

By Maria Cohut

Fact checked by Isabel Godfrey

Many people living with type 2 diabetes monitor their blood sugar levels on a daily basis, but does that really make a difference to health? A new study suggests that they may be over-monitoring.

Many people with type 2 diabetes are testing their blood sugar levels too often, new research finds.

According to a recent Centers for Disease Control and Prevention (CDC) report, about 30.3 million people in the United States live with diabetes, which equates to almost one in 10 individuals.

The most commonly diagnosed form of diabetes is type 2 diabetes, which, more often than not, does not require insulin injections.

Instead, people with type 2 diabetes can manage their condition by taking the appropriate medication.

A drug that doctors often prescribe for this form of diabetes is metformin, which helps people keep their blood sugar levels under control.

As keeping blood sugar in check is so important in diabetes, endocrinologists advise people with this condition to perform regular, simple blood tests that they can do at home with the appropriate devices.

However, emerging evidence suggests that many people living with type 2 diabetes may be erring too much on the side of caution and taking these tests too often, without deriving any real benefits from doing so.

A new study by researchers from the University of Michigan in Ann Arbor suggests that a significant percentage of people with type 2 diabetes test their blood sugar levels at least twice a day.

These findings, which appear in the journal JAMA Internal Medicine, indicate that U.S. citizens or, in some cases, their insurance plans may pay excessive amounts of money for the supplies they require for unnecessary testing.

Too many prescriptions for test strips

Dr. Kevin Platt, who is in the Department of Internal Medicine at the University of Michigan, led a team who looked at the insurance data of 370,740 people with type 2 diabetes. The researchers specifically assessed how these individuals had been filling test-strip prescriptions for blood sugar tests following the updated guidelines that the Endocrine Society and Society of General Internal Medicine issued in 2013.

These guidelines recommended that people with type 2 diabetes reduced the frequency of at-home blood sugar level tests.

Which foods help stabilize insulin and blood sugar?

Learn what to eat to keep your blood sugar levels under control.

Read now

In their analysis, the researchers only looked at people with diabetes who did not require insulin or take medication that increases hypoglycemia (low sugar levels) risk. However, they did include people who took no medicine for the regulation of blood sugar, as well as those who took medicine that did not require them to check their blood sugar levels frequently.

The researchers found that "86, 747 (23.4 percent) of [the people in the study cohort] filled three or more claims for test strips during the course of the year." They also noted that "more than half of these individuals," equivalent to 51,820 people or 14 percent of the study population, were "potentially using the supplies inappropriately."

Of these people, "32,773 individuals were taking agents not considered to be a risk for causing hypoglycemia (e.g., metformin hydrochloride) and 19,047 had no claims for any antidiabetic medications," the authors write.

'Reducing the use of unnecessary care'

Dr. Platt and team explain that once a person taking blood sugar medication has determined the dosage that works best for them, they no longer have to test their sugar levels on a daily basis.

However, the study findings indicate that even the people who did not need to take daily blood tests were still using an average of two test strips per day.

The researchers believe that people may keep on taking the tests to allow them to keep a log of their blood sugar levels and feel more in control of their condition.

However, they are spending a lot of money in doing so, whether it be on insurance plans or out of their own pocket in the absence of insurance.

"The median claims cost for test strips was $325.54 [...] per person per year" in the case of people with an insurance plan, the researchers write, and the cost is likely to be even greater for those without insurance.

"Healthcare costs and access to care are an important issue for many Americans," says Dr. A. Mark Fendrick, the study's senior author.

"The savings that result from reducing the use of unnecessary care — such as needless home blood sugar testing — can create 'headroom' to spend more on those clinical services that we need to buy more often."

Dr. A. Mark Fendric

[cherry]

hoe Insole May be a Help for Patients with Diabetic Foot Ulcers

NOVEMBER 27, 2018

Diabetic ulcers commonly result from high blood sugar damaging nerves, which takes away feeling from the toes or feet.

Without the ability to feel pain, hits and bumps tend to go unnoticed and skin tissue breaks down, forming ulcers. A lot of sugar in the bloodstream, along with dried skin as a consequence of diabetes, further slow the ulcer healing process.

Recently, Purdue researchers developed a shoe insole that could help make the healing process more portable for the 15% of Americans who develop ulcers as a result of diabetes. The researchers used lasers to shape silicone-based rubber into insoles, and then create reservoirs that release oxygen only at the part of the foot where the ulcer is located. 

"Silicone is flexible and has good oxygen permeability," Hongjie Jiang, a postdoctoral researcher in electrical and computer engineering said in a press release about the research. "Laser machining helps us to tune that permeability and target just the wound site, which is hypoxic, rather than poison the rest of the foot with too much oxygen."

According to the team's simulations, the insole can deliver oxygen at least 8 hours a day under the pressure of someone weighing about 117-179 pounds. But the insole can be customized to take on any weight, the researchers noted.

The team envisions a manufacturer sending a patient a pack of pre-filled insoles customized to his or her wound site, based on a "wound profile" obtained from a doctor's prescription and a picture of the foot.

Next, the researchers want to create a way to 3D print the whole insole, rather than printing a mold first and then laser-machining a pattern. They also plan to test the insole on actual diabetic ulcers, to further gauge how well they advance the healing process.

For more on this, see the video below.



Reference 

Jiang H, Ochoa M, Jain V, Ziaie B, et al.  A laser-customizable insole for selective topical oxygen delivery to diabetic foot ulcers. Materials Res Soc Communications. 2018; 8(3): 
 1184-1190.

[cherry]

ewsroom – Published on: December 13, 2018

Diabetic Amputations May Be Rising in the United States

Mary Caffrey

The report in Diabetes Care, the official journal of the American Diabetes Association, comes after reports of rising rates of diabetes and obesity among young adults and soaring insulin costs, which may mean diabetes is not being effectively treated.

Lower-limb amputations may be rising in the United States after decades of decline, according to data published in Diabetes Care, the official journal of the American Diabetes Association.

The study, which evaluated hospitalization rates for nontraumatic lower extremity amputation in the years 2000 to 2015 using data from the National Health Interview Survey, evaluated estimates for populations with and without diabetes.

Poorly controlled blood sugar that occurs in diabetes can limit blood flow to the lower legs and toes, causing nerve damage that people with the disease may not sense until problems have already developed. People with advanced diabetes may develop wounds or sores that do not heal and eventually result in loss of the damaged toe or portion of the foot or leg.

Cardiologist Foluso A. Fakorede, MD, who practices in the Mississippi Delta, recently wrote about the dangers of untreated peripheral artery disease and amputation risk for The American Journal of Managed Care®.

“Each year, approximately 200,000 non-traumatic amputations occur. African Americans are 4 times more likely to experience diabetes-related amputation than whites. In the United States, every 17 seconds someone is diagnosed with diabetes, and everyday 230 Americans with diabetes will suffer an amputation,” Fakorede wrote. “Throughout the world, it is estimated that every 30 seconds a leg is amputated. And 85% of these amputations were the result of a diabetic foot ulcer.”

After years of decline, the rate of amputations increased by 50% between 2009 and 2015 to 4.6 for every 1000 adults, the authors found. They noted that the increase was especially sharp among young adults (age 18 to 44 years) and those in middle age (45 to 64 years). These groups are more likely to be uninsured than people age 65 or older, who qualify for Medicare.

The report coincides with reports that claims data show more young people are being diagnosed with diabetes and obesity, as well as efforts by advocacy groups and Congress to address soaring costs of insulin over the past decade. Doctors and patients alike say patients are rationing insulin and skipping doses, putting their long-term health at risk, and the American Diabetes Association has made addressing insulin costs a priority.

Researchers found that for every 1000 adults with diabetes younger than 45, the number of amputations fell from 2.9 to 2.1 from 2000 to 2009, then soared to 4.2 in 2015.

This week, FDA Commissioner Scott Gottlieb, MD, warned that insulin would be reclassified from a drug to a biologic to increase competition and drive down prices.

Reference

Geiss LS, Li Y, Hora I, Albright A, Rolka D, Gregg EW. Resurgence of diabetes-related nontraumatic lower extremity amputation in the young and middle-aged adult US population [published online November 8, 2018]. Diabetes Care. https://doi.org/10.2337/dc18-1380.

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[cherry]

The future of treating Type 1 diabetes

There are few conditions that science has made such a fundamental impact on as Type 1 diabetes - the first use of insulin in the 1920s transformed it from a death sentence into something people can live with.

But even today, Type 1 diabetes typically involves a lifetime of daily injections and, on average, people with it die younger than the rest of the population. This is why we urgently need more research into the condition.

Continue reading the main story Diabetes: type 1 vs. type 2

• Diabetes is a condition where the body cannot regulate blood sugar levels, because of problems with the hormone insulin
• In type 1 diabetes, the body is unable to produce any insulin
• In type 2 diabetes, not enough insulin is produced or the insulin that is made by the body doesn't work properly

• Diabetes explained
• The mum and kids who all have diabetes

Islet Cell Transplants

One of the most exciting areas of research is islet cell transplants. These involves taking the islet cells - the cells in the pancreas that produce insulin - from dead donors and putting them into people with Type 1 diabetes, whose own islet cells have stopped working.

Diabetes UK funded the UK's first 15 islet cell transplants. It is now available on the NHS and 34 people have benefited since 2005.

The treatment is very effective. However, there are still issues to solve. The transplanted cells only last for a few years; there is a very limited supply of cells; and it is difficult to stop the body rejecting them.

We are already funding research that will help to solve these issues. The results should make islet transplants more successful and available to more people in the next few years.

Artificial pancreas

We are also funding research into the artificial pancreas, a combination of electronic devices that work together to monitor and adjust insulin levels, like the pancreas does in people without diabetes.

We have funded tests to see if this system works in a clinic. Those tests were successful, so the next stage is to test this system when people use it at home. If those small trials are successful, the final step before this can become a widespread treatment is to test it in large numbers of people.

There is also the real prospect of bringing an end to Type 1 diabetes altogether by using vaccine-type approaches to prevent it developing.

This is likely to take much longer, but is set to be a key focus for research over the next decade. If successful, it would be a landmark discovery of the same magnitude as the first use of insulin.

Dr. Matthew Hobbs is the Head of Research for Diabetes UK

The future of treating Type 2 diabetes

We now know that the problem in type 2 diabetes relates to high fat levels in the pancreas and the liver. When calorie intake is sharply decreased - either by a diet, or by weight loss surgery - the fat levels in these organs decreases and it has been shown that the function of the pancreas and liver returns to normal.

The diagnosis of type 2 diabetes may in future be regarded as a medical emergency. The body's metabolism is being "gummed up" by excess fat in important organs. The concept of emergency surgery is familiar to all. We should become accustomed to the concept of emergency medical therapy - a very low calorie diet to achieve a drop in body weight of 15% within weeks.

Insulin was first used in the 1920s

Given that such emergency action can restore normal metabolism, further research on the best way to keep weight steady after the short period of weight loss is urgently required.

This definitive treatment for type 2 diabetes will only be possible for those who recognise the importance of escaping from the shadow of diabetes, with its risks to eyesight, limb and life. However, there will always be a need for better medical treatment which can improve high blood glucose levels, and indeed be used in people with very long duration diabetes who may be more resistant to the beneficial effects of major weight loss.

Developing new drugs

There are interesting possibilities amongst the new, and not so new, drugs on offer.

Some drugs increase the amount of glucose which is lost in the urine.

How about a single injection each week which could help the body respond more appropriately to food, and at the same time would help with weight control? This is what the so-called GLP-1 agonists do - drugs which mimic a naturally occurring gut hormone, that tell the body to produce more insulin and the brain to stop eating. These are already available, and a long-acting injection is well on its way.

Curb your blood sugar

You can also improve blood sugar levels after meals without using drugs. There are two important approaches.

Firstly, if a small, protein rich snack is taken first thing in the morning, and breakfast is delayed for two hours, the rise in blood glucose after breakfast is reduced by about one half. This is called the second meal effect and although it has been recognised in non-diabetic individuals for almost a century, it has only recently been shown to work in people with type 2 diabetes.

Secondly, if you go out for a half hour walk after a meal (or do any physical activity) then the rise in blood glucose will be very much less compared to just sitting in a chair. This is because muscle tissue takes up glucose more rapidly during exercise, and the meal time rise in glucose is blunted.

Professor Roy Taylor was Professor of Medicine and Metabolism at Newcastle University, and is now Director of the Newcastle Magnetic Resonance Centre.

[cherry]

With the holiday season upon us, you’ve got the good—fun holiday parties, the bad—illness, and the ugly—cold weather and fewer hours of sunlight. When you have a child with diabetes, the holidays and winter months in general can be stressful.

I’ve seen for many kids with diabetes, blood sugars rise as the temperature drops. This can largely be blamed on snow, ice, and freezing conditions which discourage outside play or really leaving the house at all. With less exercise, there is a need for more insulin to cover food. Here are some recommendations for children with diabetes to ensure they stay healthy during the holiday season.

Warm up the body

Exercise lowers blood sugar, helps the body use insulin better, keeps body temperature warm, and can even help with mood. There are lots of ways to get active without ever leaving the house. Encourage your kids to try a yoga session or other online class or activity, climb the stairs for 10 minutes, dance to their favorite music, play an active video game—or even clean their room. Try bundling up, too, and go outside to walk shovel, sled, or ice skate with the family! Don’t forget to keep your insulin and meter at room temperature if possible.

Stay healthy

When kids with diabetes get sick, their diabetes can be tricky to control. If your child gets a cold, virus or flu and develop ketones, keep them home and follow sick day rules. Remember, sick kids often need more insulin, so check blood sugar every 2 to 4 hours and correct blood sugar frequently to keep numbers in range. Bodies heal much more quickly when blood sugars are in range. Contact your diabetes provider if ketones persist.

Encourage sleep and good habits

When children and adults get 7 to 8 hours of sleep each night, it helps to ward off pesky colds and more. Be sure to remind them to wash their hands frequently, and have the whole family get a flu shot.

Choose foods wisely

Healthy, balanced nutrition is one of the keys to success. Lots of fun holiday food is hard to count, but you can use your smart phone to look up carb counts for almost anything. Dose insulin correctly for what your child eats. Check blood sugar frequently at parties to make sure that you have balanced the insulin, fun food, and any activity.

Stews and soups with lots of delicious vegetables can help keep warm and are often the healthiest choices. Cooking does not necessarily have to be a chore, either. Getting kids actively involved in the process encourages them to try and hopefully enjoy the finished product. The benefit of cooking in your own kitchen is that you know exactly what goes into the meal. Be sure to make sure kids have veggies and fruit for every meal, if possible—five servings per day is the goal.

Keep spirits up

Encouraging kids and teens to spend time with others can help them ward off the winter blues. This may take some creativity when parents are busy with holiday preparation or if the weather is bad. Think about planning holiday gatherings with your child including some of their friends. This could include a cookie-making sleepover or a meet up at the sledding hill.

With a little planning and lots of blood sugar checks to make sure the numbers stay in range, you can make this this best holiday season yet! Make a big bowl of soup, count the carbs to give insulin, then bundle up and head outdoors for some fresh air! Philly in the winter is lots of fun and diabetes should never stop you!

Melissa Rearson, MSN, CRNP, is a pediatric nurse practitioner in the Diabetes Center and the Division of Endocrinology and Diabetes at Children’s Hospital of Philadelphia.

[cherry]

As we know, the holidays are very tough for many of our patients who have diabetes and/or obesity. They may have made some changes — big changes — in their eating habits, only to get in trouble over the long holiday season, then have a very difficult time getting back on track. The long holiday season can be a disaster to their health.

I have found that for most, having leftovers at home wreaks havoc. Many of my patients tell me it’s not just the one day of the holiday, but it’s the leftovers that get them. The leftovers seem to be “calling” them at all hours of the day and night and they can’t seem to stop eating what is in the house until it’s all gone. By then their sweet tooth or appetite have ramped back up and they have a very hard time getting back on track. Many even stop checking their glucose or weights, knowing that the numbers will be off and they don’t want to see.

I’ve found it very helpful to discuss getting rid of leftovers right away. I start the discussion even before the holiday.  We talk about not keeping leftovers in the house. My first advice is to throw them away, but this does not always go over well. Some people cannot for whatever their reason throw food away, no matter how “bad” they know it may be for them. Some will give it away. I’ve asked them why would they give food they know doesn’t promote their health to others, but this usually takes a while to “sink” in. If they can give it away, at least they feel like they have done something for their health.

I have seen patients no longer tempted by leftovers, but those who are do well giving it away or throwing it out.

Message is, you may very well help avert disasters by talking with patients about leftovers. Try it! It’s never too late.

Joy Pape, FNP-C, CDE
Medical Editor, DiabetesInControl

If you have a “Diabetes Disaster Averted” story, please let us know! If we feature your Disaster Averted in our Diabetes Clinical Mastery Series e-newsletter, you will receive a $25 gift card. Please click here to submit a short summary of the incident, what you feel you learned from handling the incident, and your name and title. If you prefer to remain anonymous, please let us know, but still give us your name and address (so we can send you the gift card).

Copyright © 2018 HIPER, LLC

[cherry]

Scientists at Joslin Diabetes Center now have shown that one amino acid, alanine, may produce a short-term lowering of glucose levels by altering energy metabolism in the cell.



Mary-Elizabeth Patti, MD, investigator in the Section on Integrative Physiology and Metabolism at Joslin Diabetes Center and associate professor of medicine at Harvard Medical School.

“Our study shows that it’s possible we can use specific nutrients, in this case amino acids, to change metabolism in a cell, and these changes in metabolism can change how cells take up and release glucose in a beneficial way,” says Mary-Elizabeth Patti, MD, an investigator in Joslin’s Section on Integrative Physiology and Metabolism and senior author on a paper about the work recently published in Molecular Metabolism.

Performed in cells and in mice, her group’s research began with an attempt to see what nutrients might activate a key protein called AMP kinase (AMPK), says Patti, who is also an associate professor of medicine at Harvard Medical School.

“AMPK is an enzyme in cells throughout the body that is activated when nutrient supplies are low, or in response to exercise,” she explains. “AMPK then causes a lot of beneficial changes in the cell, turning on genes that serve to increase energy production. AMPK is a good thing, and it also can be activated by a variety of treatments for type 2 diabetes, such as metformin.”

That raised a question for Patti and her colleagues: Could an amino acid switch on this beneficial enzyme?

The investigators began their study by testing many amino acids in rat liver cells (the liver is a crucial organ in glucose metabolism). “Alanine was the one amino acid that was consistently able to activate AMPK,” Patti says.

The researchers then confirmed that AMPK was producing some of its usual metabolic effects after alanine activation. Additionally, the activation could be seen in human and mouse liver cells as well as rat liver cells, and was present with either high or low levels of glucose in the cells.

Next, scientists gave alanine by mouth to mice and found that levels of AMPK rose in the animals. Moreover, if mice ate alanine before they  received a dose of glucose, their resulting blood glucose levels were significantly lower. And while glucose metabolism often behaves quite differently in lean mice than in obese mice, this mechanism was seen in both groups of mice.

Following up, the Joslin team found that the glucose lowering didn’t seem to be driven by increases in insulin secretion or decreases in secretion of glucagon, a hormone that increases glucose. Instead, AMPK was boosting glucose uptake in the liver and decreasing glucose release. Further experiments in cells demonstrated that the activated enzyme was altering the Krebs cycle, a central component of cell metabolism.

“All these data together suggest that amino acids, and specifically alanine, may be a unique potential way to modify glucose metabolism,” Patti sums up. “If it eventually turns out that you can do that by taking an oral drug as a pre-treatment before a meal, that would be of interest. However, this is early-stage research, and we need to test the concept both in mice and ultimately in humans.”

Yusuke Adachi of Joslin and Ajinomoto Company was first author on the paper. Other Joslin contributors included Ana Luisa De Sousa-Coelho, Charlie Aoun, Sandra Weimer, Hirokazu Takahashi, Chris Doherty and Laurie Goodyear. Co-authors also included Ikue Harata and Yasushi Noguchi of Ajinomoto, Xu Shi and Robert Gerszten of Beth Israel Deaconess Medical Center, and Karina Gonzalez Herrera and Marcia Haigis of Harvard Medical School. Lead funding came from Ajinomoto, the American Diabetes Association and the Lilly and Graetz Foundations.

[emmysmom]

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@cherry wrote:

Diabetes: Are you over-monitoring your blood sugar?

Published Wednesday 12 December 2018

By Maria Cohut

Fact checked by Isabel Godfrey

Many people living with type 2 diabetes monitor their blood sugar levels on a daily basis, but does that really make a difference to health? A new study suggests that they may be over-monitoring.

Many people with type 2 diabetes are testing their blood sugar levels too often, new research finds.

According to a recent Centers for Disease Control and Prevention (CDC) report, about 30.3 million people in the United States live with diabetes, which equates to almost one in 10 individuals.

The most commonly diagnosed form of diabetes is type 2 diabetes, which, more often than not, does not require insulin injections.

Instead, people with type 2 diabetes can manage their condition by taking the appropriate medication.

A drug that doctors often prescribe for this form of diabetes is metformin, which helps people keep their blood sugar levels under control.

As keeping blood sugar in check is so important in diabetes, endocrinologists advise people with this condition to perform regular, simple blood tests that they can do at home with the appropriate devices.

However, emerging evidence suggests that many people living with type 2 diabetes may be erring too much on the side of caution and taking these tests too often, without deriving any real benefits from doing so.

A new study by researchers from the University of Michigan in Ann Arbor suggests that a significant percentage of people with type 2 diabetes test their blood sugar levels at least twice a day.

These findings, which appear in the journal JAMA Internal Medicine, indicate that U.S. citizens or, in some cases, their insurance plans may pay excessive amounts of money for the supplies they require for unnecessary testing.

Too many prescriptions for test strips

Dr. Kevin Platt, who is in the Department of Internal Medicine at the University of Michigan, led a team who looked at the insurance data of 370,740 people with type 2 diabetes. The researchers specifically assessed how these individuals had been filling test-strip prescriptions for blood sugar tests following the updated guidelines that the Endocrine Society and Society of General Internal Medicine issued in 2013.

These guidelines recommended that people with type 2 diabetes reduced the frequency of at-home blood sugar level tests.

Which foods help stabilize insulin and blood sugar?

Learn what to eat to keep your blood sugar levels under control.

Read now

In their analysis, the researchers only looked at people with diabetes who did not require insulin or take medication that increases hypoglycemia (low sugar levels) risk. However, they did include people who took no medicine for the regulation of blood sugar, as well as those who took medicine that did not require them to check their blood sugar levels frequently.

The researchers found that "86, 747 (23.4 percent) of [the people in the study cohort] filled three or more claims for test strips during the course of the year." They also noted that "more than half of these individuals," equivalent to 51,820 people or 14 percent of the study population, were "potentially using the supplies inappropriately."

Of these people, "32,773 individuals were taking agents not considered to be a risk for causing hypoglycemia (e.g., metformin hydrochloride) and 19,047 had no claims for any antidiabetic medications," the authors write.

'Reducing the use of unnecessary care'

Dr. Platt and team explain that once a person taking blood sugar medication has determined the dosage that works best for them, they no longer have to test their sugar levels on a daily basis.

However, the study findings indicate that even the people who did not need to take daily blood tests were still using an average of two test strips per day.

The researchers believe that people may keep on taking the tests to allow them to keep a log of their blood sugar levels and feel more in control of their condition.

However, they are spending a lot of money in doing so, whether it be on insurance plans or out of their own pocket in the absence of insurance.

"The median claims cost for test strips was $325.54 [...] per person per year" in the case of people with an insurance plan, the researchers write, and the cost is likely to be even greater for those without insurance.

"Healthcare costs and access to care are an important issue for many Americans," says Dr. A. Mark Fendrick, the study's senior author.

"The savings that result from reducing the use of unnecessary care — such as needless home blood sugar testing — can create 'headroom' to spend more on those clinical services that we need to buy more often."

Dr. A. Mark Fendric

---

Since I eat basically the same thing every day...I will stop w/the daily testing in the mornings! Its enough giving myself a shot everyday..so this is good news! Less $$ too!

[cherry]

NEW YORK (CBSNewYork) – There could be a major advance towards a cure for diabetes.

Researchers at Mount Sinai are reporting on a drug cocktail that helps the body make more insulin-producing cells.

CBS2’s Dr. Max Gomez explains why that’s a critical part of a diabetes cure.

Type 1 and Type 2 diabetes are really different diseases, Gomez explained.

What they have in common is that eventually the diabetic runs our of insulin-producing cells called beta cells.

That’s when their blood sugar soars. So part of a diabetes cure has to be replacing or making more beta cells.

“I was always tired and hungry, thirsty and just couldn’t keep any weight on,” said Alex Seeman.

She didn’t realize it, but those are all classic signs of the Type 1 diabetes she was diagnosed with 19 years ago.

She wears an insulin pump and a continuous glucose monitor, but managing her diabetes is still a huge chore.

“I still test my blood six times a day, count every carb I eat, keep track of exercise,” she said.

In Type 1 diabetes, the immune system is destroying her insulin-making beta cells. A number of researchers are making progress towards shutting down that auto-immune destruction. But in order to make enough insulin to control blood sugar, a diabetic would still have to replace the beta cells.

Some scientists are trying transplants or stem cells.

“Those approaches probably aren’t enough to meet the need for millions of diabetics,” said Dr. Andrew Stewart of Mount Sinai Icahn School of Medicine.

So, Stewart reasoned that if both Type 1 and Type 2 diabetics still have some beta cells, even after many years, maybe there are medications that could induce those remaining cells to multiply and regenerate.

“We’ve identified a cocktail of drugs that increases the multiplication rate from 2 percent up to as much as 10 or 15 percent,” Stewart said.

In a major new study, Stewart argues that that’s enough to normalize blood sugar in diabetics. The drugs have made human beta cells replicate in petri dishes, transplanted mice and several other ways.

If this can be done in people like Alex, it would be a huge advance.

“I can’t imagine it, it would be a dream,” she said.

Like all drugs, this cocktail would likely have side effects.

Now the challenge is finding a way to deliver the drugs just to the pancreas, where the remaining beta cells live. One strategy is to attach the drugs to antibodies or other molecules that home in on markers on beta cells.

[cherry]

f you have diabetes and don’t properly manage your blood sugar levels, you might develop a type of nerve damage called diabetic peripheral neuropathy. And if this condition gets severe, you might lose so much sensation in your limbs that you could step on a sewing needle and not even know that it’s embedded in your flesh.

Yep, this troubling event actually happened, quite recently, to the grandmother of a Reddit user with the screen name kaylalorene, according to a post in the r/WTF channel. Accompanying a picture of the elderly woman’s shocking foot X-ray, kaylalorene wrote:

“My grandma had no idea she had a sewing needle in her foot. No telling how long it’s been in there. Skin was healed. It finally started rejecting yesterday and she had emergency surgery.”

When responding to the deluge of questions and comments garnered by their truly WTF post, the user confirmed that their grandma does have diabetes and that she only became aware of the needle when she observed visual signs of an infection in her middle toe and went to a doctor.

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Though the needle was safely removed – and will be put into a frame as a gag gift by her family members – kaylalorene’s grandmother was diagnosed with a hard-to-treat strain of Staphylococcus bacteria.

“She has staph and [is] still in the hospital. Lots of antibiotics,” the user shared.

In a comment summing up what all medically minded Redditors are thinking, a user named MommaChickens wrote: “This is an awesome X-ray for teaching the effects of diabetes. I hope your grandma recovers without a hitch: Just remember, the same condition that protected her from the pain will make it difficult to heal from the surgery.”

Peripheral neuropathy is thought to occur because diabetes induces abnormalities in the blood vessels that supply oxygen and nutrients to neurons in the peripheral nervous system. The exact mechanisms are unknown, but scientists hypothesize that the vessels become narrowed and/or damaged by the activity of certain molecules that accumulate in the bloodstream of diabetics (sorbitol and glycated cellular lipids and proteins).

Nerves in the fingers and toes are typically the first to be affected because they have the longest axons stretching out from the spinal cord, so there are more of them to get damaged.  

The impaired sensation characteristic of this condition is frequently accompanied by impaired wound healing. This happens because, in addition to inadequately providing for neurons, dysfunctional blood vessels can’t efficiently transport cellular repair signaling molecules and immune cells to injuries in peripheral tissue.

Thanks to this double whammy of neuropathy, cases like that of kaylalorene’s grandma are not uncommon. According to podiatrist Dr Leon Reber, complications from undetected foot wounds in diabetics are the leading cause of non-traumatic amputation.

“About 85 percent of non-traumatic amputations begin with a diabetic foot ulcer. Many of those amputations could have been prevented with proper foot care,” he told USA Today. “[Feeling] pain is a gift when it comes to feet.”