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Spectacular' diabetes treatment could end daily insulin injections

Hour-long procedure that stabilises blood sugar levels of sufferers of type 2 diabetes is still effective one year on, study shows

 
 
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Woman self-administering insulin with a hypodermic syringe.

Woman self-administering insulin with a hypodermic syringe. Photograph: Ian Hooton/Getty Images/Science Photo Library RF

A potential medical breakthrough that could put an end to the daily insulin injections endured by people living with diabetes has been unveiled by Dutch scientists.

By destroying the mucous membrane in the small intestine and causing a new one to develop, scientists stabilised the blood sugar levels of people with type 2 diabetes. The results have been described as “spectacular” – albeit unexpected – by the chief researchers involved.

In the hourlong procedure, trialled on 50 patients in Amsterdam, a tube with a small balloon in its end is inserted through the mouth of the patient down to the small intestine.

The balloon is inflated with hot water and the mucous membrane burned away by the heat. Within two weeks a new membrane develops, leading to an improvement in the patient’s health.

Even a year after the treatment, the disease was found to be stable in 90% of those treated. It is believed there is a link between nutrient absorption by the mucus membrane in the small intestine and the development of insulin resistance among people with type 2 diabetes.

Jacques Bergman, a professor of gastroenterology at Amsterdam UMC, said: “Because of this treatment the use of insulin can be postponed or perhaps prevented. That is promising.”

Bergman added of the procedure that it was “amazing that people suffer very little from this”.

He told the Dutch broadcaster Nederlandse Omroep Stichting: “With those people we see a spectacular improvement in blood sugar levels one day after the operation, before they even lose one kilo, which has put us on the track.

“Because the question now is whether this is a permanent treatment, or whether it is something that you have to keep repeating – something that in theory should be possible. We looked at whether we could stop their insulin, which is still ongoing, but the first results are truly spectacular, with the lion’s share of patients no longer using insulin after this treatment.”

The new discovery initially seems most suitable for borderline patients who already take pills but whose blood sugar level is high enough for doctors to advise that they inject insulin in the short term.

Apart from dispensing with insulin injections, researchers claim that those treated could benefit from a lower risk of cardiovascular disease, kidney failure, blindness and numbness in the hands and feet.

Scientists from Amsterdam UMC who presented their study at a conference in Vienna this week were said to be cautious but “jubilant” about the initial results.

People with type 2 diabetes aged between 28 and 75 are now being recruited for a larger study of 100 people.

n the UK live with a diagnosis of type 1 or 2 diabetes, an increase of 1.9 million since 1998. Type 1 diabetes is where the level of sugar in the blood is too high because the pancreas does not produce insulin.

Those with type 2 diabetes are not producing enough insulin. The impact can be controlled by changes to diet, but it is a progressive disease. Most people will need to take tablets or inject insulin after living with it for five to 10 years.

Nine out of 10 people diagnosed with diabetes have type 2. It is estimated that there are nearly 1 million people currently living with the condition who have yet to be diagnosed and that 12.3 million people are at an increased risk due high levels of sugar in their blood.

 
 
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cientists in Amsterdam trialled a procedure on people with type 2 diabetes to great effect. The researchers have described their findings as spectacular, but the full extent of long-term safety will still need to be shown.

The results come from a study on 50 people and indicate that the technique, which takes an hour to perform, is successful even a year on.

The procedure involves inflating a balloon with hot water inside the small intestine. This burns off the mucous membrane which lines the gut and, two weeks later, a new membrane grows. This process seems to improve blood sugar control and it was found that 90% of the patients still had stable blood sugars even a year after the treatment.

They conducted the experiment to explore the association between the mucus membrane absorbing nutrients in the small intestine and insulin resistance in those with type 2 diabetes.

Professor Jacques Bergman, from the research team, said: "Because of this treatment the use of insulin can be postponed or perhaps prevented. That is promising." Bergman added of the procedure that it was "amazing that people suffer very little from this."

Speaking to Nederlandse Omroep Stichting, a Dutch broadcaster, he added: "With those people we see a spectacular improvement in blood sugar levels one day after the operation, before they even lose one kilo, which has put us on the track.

"Because the question now is whether this is a permanent treatment, or whether it is something that you have to keep repeating - something that in theory should be possible. We looked at whether we could stop their insulin, which is still ongoing, but the first results are truly spectacular, with the lion's share of patients no longer using insulin after this treatment."

The findings from the study were presented at a conference which took place this week in Vienna. Next, the researchers will conduct a bigger study involving 100 people.

Type 2 diabetes can be prevented or placed into remission by lowering carbohydrates. So far over 370,000 participants have signed up to the Low Carb Program developed by Diabetes.co.uk and launched on World Diabetes Day 2015.

One-year results from the Low Carb Program, published in the summer, show one in four users put their type 2 diabetes into remission, with significant reductions in weight, HbA1c and medication use.

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July 2018 Will the future be needle-free for diabetics? A fear of needles is the obstacle keeping many diabetics from sticking to their medication requirements. There might however be a solution on the horizon.

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For many diabetics, one of the most dreaded aspects of managing their condition is the need to inject insulin multiple times a day. But Harvard researchers have discovered a way to deliver insulin in a pill, and it appears to work well, at least in rats.

In South Africa, 7% of adults aged 21 to 79 – 3.85 million people – have diabetes. A large proportion of these people remain undiagnosed.

According to the most recently released statistics from Stats SA, diabetes is also the second leading cause of death in South Africa. 

There are however still a lot of unanswered questions about the new pill: What is the proper dose compared to injected insulin? Will it be delivered uniformly? And, the biggest, will it work as well in people as in rats?

 

Delivering insulin through non-invasive means 

That's why more research is needed, said the study's senior author, Samir Mitragotri, a professor of bioengineering at Harvard University.

The report was published online June 25 in the Proceedings of the National Academy of Sciences.

"What we have shown is that we can deliver insulin, and that it is safe in the intestine. This would be a non-invasive, patient-friendly, easy-to-use treatment," he said.

Insulin is a hormone that helps usher the sugar from foods you eat into cells for use as fuel. People with diabetes often lack enough insulin to meet the body's needs, though the exact cause varies depending on the type of diabetes.

An oral insulin hasn't been available, because insulin gets digested in the stomach, Mitragotri said. But injectable forms, which can be delivered by a needle or through a small tube inserted under the skin and attached to an insulin pump are painful, which can lead people to skip their medication, he noted.

'It lowered blood glucose for at least 12 hours'

To develop an oral insulin, the researchers had a number of challenges. The first step in moving past these barriers was to put insulin in an ionic liquid, which Mitragotri likened to liquid salts. The insulin-ionic liquid combination was then covered with a coating that allows the pill to pass through the stomach intact. It's then dissolved in the small intestine.

From there, the oral insulin travels to the large intestine. With the help of the ionic liquids, the insulin molecules can get through the intestinal wall into the bloodstream.

Current insulins are good for about 28 days once they're out of the fridge. But the oral insulin is good for at least two months, and probably longer, Mitragotri said.

The researchers found a sustained drop in blood sugar (glucose) of up to 45 percent in the animals. "It lowered blood glucose for at least 12 hours," Mitragotri said.

More studies will need to be done, including in larger animals, before human trials could begin. But if all goes well, Mitragotri said that he expects human trials could begin in three to five years. It's hard to estimate what the cost of oral insulin might be, he added. But the ionic liquid and coating materials aren't expensive, so he expects it would be similar in cost to current insulins.

Image credit: iStock

 
 
 
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Diabetes is such a complicated disease.

I'd like to address the treatment of burning off the lining of the small intestine.

 

Your small intestine naturally produces a hormone when eating.

The hormone, GLP-1, assists pancreatic beta cells in producing insulin, it also regulates the liver in releasing too much sugar.    We don't know for sure why beta cells die off, it could be auto-immune related.   

 

The balloon method seems risky and may solve the simple problem but may buy more trouble than it's worth.   But I applaud the effort of researchers.

 

@cherry

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Time will tell. It is working so far. You can't be afraid to try new things, in research

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Vaccines are critical if you have diabetes October 13, 2018

 

Vaccines are critical if you have diabetes
(HealthDay)—If you have diabetes, you need all recommended vaccinations, the American Association of Diabetes Educators says.
 

Diabetes reduces the immune system's ability to fight certain infections. This raises the risk for serious complications from diseases that vaccines protect against—including flu, pneumonia, hepatitis B, tetanus and shingles.

"People with diabetes may be at higher risk of getting certain diseases and also serious problems from diseases that could've been prevented with vaccines," said Evan Sisson, an associate professor at Virginia Commonwealth University.

"Everyone should know what vaccines they need to protect themselves and discuss with their doctor whether they are up to date with the vaccines," Sisson said in an association news release.

The association offers these recommendations if you have diabetes:

  • The flu shot is the best protection against seasonal flu. For someone with diabetes, health complications from flu can include increased blood sugar levels, pneumonia, bronchitis, sinus infections and ear infections.
  • The Tdap vaccine protects against three serious diseases caused by bacteria: tetanus, diphtheria and pertussis (whooping cough). You should get the Tdap vaccine every 10 years.
  • The zoster vaccine reduces the risk of developing shingles and PHN (post herpetic neuralgia), serious illnesses for unvaccinated people as they age. If you're 50 or older, you should get the zoster vaccine.
  • Diabetes raises the risk for death from pneumococcal infections, which can include infections of the lungs, blood, ear, and lining of the brain and spinal cord. People with diabetes should get the pneumococcal vaccine once before the age of 65 and twice more after.
  • Hepatitis B can be spread through shared blood glucose meters, finger stick devices and other diabetes care equipment, so it's critical for people with diabetes to be vaccinated against hepatitis B. The vaccine is recommended for people younger than 60. People 60 or older should ask their doctor about the vaccine.

Explore further: Flu shot key for people with diabetes

More information: The U.S. Centers for Disease Control and Prevention has more on diabetes and vaccinations.

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ompared with multiple daily insulin injections, inhaled insulin was shown to provide benefits for adults with type 1 diabetes, including improved postprandial glucose levels, lower daytime glucose variability and less hypoglycemia, according to a study published in Diabetes Technology & Therapeutics.

“Ideally, use of an ultra-rapid-acting prandial insulin that closely mimics the time action profile of normal insulin secretion and human physiology will lower postprandial glucose excursions without any delayed hypoglycemia,” Halis Kaan Akturk, MD, assistant professor of medicine and pediatrics at the Barbara Davis Center for Diabetes at the University of Colorado Denver, and colleagues wrote. “The faster onset of action and shorter duration profile of [inhaled insulin (Afrezza, MannKind)], when compared with [rapid-acting insulin analogues], may provide a flexible approach for patients to optimize postprandial glucose control without an increased risk of hypoglycemia.”

Akturk and colleagues enrolled 60 adults with type 1 diabetes for at least 6 months to a 4-week pilot, randomized, multicenter trial from June to December 2017. All participants had HbA1c between 6.5% and 10%, had stable insulin dose and used insulin degludec (Tresiba, Novo Nordisk) or insulin glargine (Lantus, Sanofi) as basal insulin.

Participants were randomly assigned inhaled insulin (n = 26; mean age, 41 years; mean diabetes duration, 21 years; mean total daily basal insulin dose, 27.9 U; mean total daily bolus insulin dose, 21.8 U) or insulin aspart (n = 34; mean age, 42 years; mean diabetes duration, 19 years; mean total daily basal insulin dose, 22.7 U; mean total daily bolus insulin dose, 21.3 U). During the 4 weeks of the trial, participants wore real-time continuous glucose monitors; there were seven follow-up examinations, including four in-person visits and three by phone. Four participants in the inhaled insulin group dropped out of the trail or had missing data and were not included in the final analysis.

Using linear regression analysis of data from CGM, researchers observed a lower glucose standard deviation (P = .01) and percentage of time spent in hypoglycemia (HbA1c < 60 mg/dL, P = .02; HbA1c < 50 mg/dL, P = .04) in the inhaled insulin group vs. the insulin aspart group. Mean sensor glucose readings, percentage of time with HbA1c less than 70 mg/dL and percentage of time in hyperglycemia were nonsignificantly lower in the inhaled insulin group. Participants in the inhaled insulin group lost more weight (0.83 kg per day) compared with the insulin aspart group (0.57 kg per day; P < .0001).

Participants in the inhaled insulin group were further segmented based on adherence to the study protocol, with 15 of the original group meeting the compliance criteria. The researchers observed more time in range, lower glucose standard deviation and less time in hyperglycemia in the inhaled insulin-compliant group compared with both the insulin aspart (P = .009) and inhaled insulin-noncompliant (P = .03) groups. The inhaled insulin-compliant group also had lower postprandial glucose than the insulin aspart group (P = .05), but a relatively similar level compared with the inhaled insulin-noncompliant group.

Postprandial glucose levels differed the most between the two groups 60 to 90 minutes after a meal, with postprandial glucose levels increasing in the insulin aspart group during the first hour after a meal, and dropping to their lowest point for the inhaled insulin group, and for the inhaled insulin-compliant group, in particular.

The researchers also analyzed the effects of the two treatment types based on meal time. Although postprandial glucose levels were lower in the inhaled insulin group at breakfast (P = .04) and lunch (P = .001), the same significance was not found at dinner (P = .75).

“The potential reasons for this observation at dinnertime include the fear of hypoglycemia overnight — an experience that might be anticipated with an insulin with longer duration of action,” the researchers wrote. “However, as the vast majority of [type 1 diabetes] patients currently use subcutaneous [rapid-acting insulin analogue], many may be reticent to use postprandial corrections later in the day. As [inhaled insulin] has a shorter duration and a faster action profile compared with currently available mealtime injectable insulins, this may offer an advantage to both minimize the risk of nocturnal hypoglycemia and increase the use of supplemental or corrective doses before bedtime.” – by Phil Neuffer

 

Disclosures: The study was supported by MannKind. Akturk reports he received a research grant from MannKind related to this study. Please see the study for all other authors’ relevant financial disclosures.

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Re: Nov Diabetes news

[ Edited ]

Would any of you be willing to try the balloon method if you thought it would cure your diabetes?

 

 

I am not 100% sure that I would, but, I would like to consider it. If I could live out my life not worrying about blood sugar, I might be tempted

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A tip I always do is to make just the pumpkin custard ,no crust. It buys you a few less carbs that way. I also use my own spice mixture, which, I think is better than the jarred spice mix..I have never used anything but sugar, however, I am going to try splenda just as an experiment..I have read equal doesn't hold up to oven heat, and stevia has a bitter after taste

 

 
 
 
 
 
Directions
  1. Heat oven to 375 degrees. Allow pie crust to thaw at room temperature for 15 minutes.
  2. Combine eggs, pumpkin, evaporated milk, Splenda, and pumpkin pie spice in a large mixing bowl using an electric mixer on medium speed for approximately 1 minute.
  3. Pour this pumpkin mixture into the thawed pie shell. Bake pie on center oven rack for 35-40 minutes or until a knife inserted in the center comes out clean.
  4. Cool the pumpkin pie before cutting into 8 servings.
  5. Cooking time does not include time to cool.
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