I haven't written a blog post for a while due to extreme work pressures. I've had many ideas for a post, but no time to do so.
I received an invitation from David and Elizabeth Edelman of Diabetes Daily to start a blog over there. This seemed like a great opportunity, so I've accepted. For now, I'll post in both places with different articles and topics. Eventually I'll have to decide how best to handle it.
I'm extremely happy to be joining David, Elizabeth and Amylia on the Diabetes Daily team and I look forward to writing more about diabetes technology and challenges.
I see this news is being reported in severalplaces. It's interesting because there's been so much talk about using stem cells to treat diabetes. Now Novocell says that they were able to use human stem cells to control diabetes in mice.
This approach is not yet perfect because some of the mice developed tumors. I'm guessing that we won't see anything come out of these labs for several years.
Recently I put together a table for my endo. It showed how my blood glucose numbers had changed month to month since I started using the Dexcom. I was able to use the Dexcom software to get this information, based on its readings.
I wanted to show it here for a few reasons. (And apologies to anyone who is vision impaired. Blogger does a lousy job with tables, so I had to post a screen snapshot of this.) First of all, my average (Mean column) is improving most months.
My standard deviation (SD column) is also improving. Here standard deviation indicates how tight my control is. It is now more accepted that tight control may mean less complications. If I can keep my standard deviation to about one-third of my average value, then my control is tight. And I'm nearly there.
In the last column I've shown my A1C values. Again there's improvement there, but not as much as the averages would predict. A blood glucose value of 135 mg/dL should give me an A1C of about 6.0%.
This is why I believe the Dexcom readings are lower than my true blood glucose values. And I blame that on the meter it's being calibrated against. Hence my impatience for the new Dexcom model.
It still amazes me how much those of us with diabetes focus on numbers. It's not like we have a choice. We test several times a day and then do some calculation with the numbers to decide how to correct (carbs or insulin). We try to guesstimate the amount of carbs in the food we're eating and how much insulin we need to cover this. We're constantly calculating to try and be substitute pancreases.
I look forward to the day when we're no longer forced to be math geniuses.
Birdie Loo has an inspirational post on her blog Aiming for Grace about looking for an antidote.
I like the idea of offsetting all the physical pain of diabetes with something that's enjoyable. What would I like to do? Just right now, I'm stuck for ideas.
In early January I visited the Mass General Hospital research lab where Dr. Denise Faustman is leading research into a possible cure for type 1 diabetes. I was there to give a blood sample for use in this research.
If you've ever met someone you've admired for a while, or maybe a rock or movie star, then you'll know how I felt as I spent time with her.
Over the last two years I've taken part in two bike rides to raise funds for this research. But now I had a chance to actually help support the research in a more direct way.
The lab is drawing samples of blood from people with type 1 diabetes, and 'healthy' volunteers. Because they're having trouble getting healthy volunteers, they ask everyone with diabetes to bring a volunteer with them. These folks must not be directly related to you, and not have any auto-immune diseases. I was fortunate that a friend of mine from work kindly offered to come with me. Paul is one of the founders of the yard sale search site GoYarding.com.
I met Dr. Faustman early in the morning. They do all the sample collection early in the morning so it doesn't interfere with work and school schedules. While we talked, she collected four test tubes of blood from me. She explained that some of this blood was tested using machinery they're developing and some was tested manually by one of the researchers. I believe that manual testing takes about one day to complete.
They're trying to accurately measure the amount of T cells that I have. Her theory is that these T cells are responsible for destroying my insulin producing beta cells. These cells also produce amylin. This is now available as an injectable drug called Symlin that I've written about several times.
You can see a short video of Dr. Faustman and an animation of how they believe the T cell process works on the Iacocca Foundation website.
Some of the blood is also sent to another research lab. They have a method for measuring autoantibodies in blood. She explained that autoantibodies are produced when beta cells are destroyed. So if these were found in my blood, that would indicate that my body had recently lost some beta cells. Which would mean that my body is still making beta cells, 35 years after I first got diabetes.
She hopes to start trials before too long where they will be administering low doses of BCG to see if this can destroy these T cells. BCG is used in Europe as an inoculation against tuberculosis, and is also used as an immunotherapy treatment for bladder cancer.
BCG has been around for a long time. As it's already approved for use as a medical treatment, it is likely that getting approval to use this for other purposes will be quicker and easier than for a new drug. It will probably also be less expensive.
Dr. Faustman's hope was that the FDA would permit trials with low number of subjects. This makes it easier to administer the trials because getting enough people is always a challenge and testing the outcomes is easier with smaller numbers.
She explained that there will likely be several trials with increasing doses, so they can determine if it works, and at what dosage levels. Clearly having automated measurement machinery will make this process a lot faster. They've been working on developing this machinery over the last few years.
I told her that it would be wonderful if they started a blog, even a low-volume one to keep everyone informed about their progress. But she's concerned that will take away from research time and also that the blog may draw a lot of comments that would need to be read and handled.
I imagine the entire lab must feel a little like Banting and Best after insulin was first discovered. They had hundreds of parents from around the world contacting them to try and get their children treated. And that was in the days before the internet and e-mail.
It was a real pleasure spending some time with Dr. Faustman and getting an update on their progress.
I have another appointment in September to get another blood draw. As Dr. Faustman pointed out, this is an easy way to get the latest news. And by then I hope to have completed another bike ride to support her exciting research. I can't wait!
After I published the post below, I received comments from several people that they were able to read the ADA web site using Firefox. I checked the site using Firefox on other PCs and they all worked successfully.
So I apologize to the ADA and my readers for not being more careful in checking my facts before blogging about it. That was sloppy of me and I'll be more fastidious before I make an accusation again.
Original post follows: You've probably seen the news reports about the sudden cancellation of the ACCORD trial. And I'll post about that separately.
I read an e-mail from the American Diabetes Association about this news and it invited me to see the ADA statement about this issue. So I clicked and found the Page Not Found page at the ADA site.
That didn't make sense, I clicked on link in the left-hand menu and was again taken to the Page Not Found page. When I opened the same pages in Internet Explorer the contents are displayed correctly. But if I try this with the Mozilla Firefox browser, none of them display. Which is difficult, because Firefox is the browser I prefer to use.
According to one site, Firefox is used by about 17% of the people browsing the web. That's a lot of folks looking for diabetes information that can't get to it on the ADA site.
To me seems like a step backwards in reaching out to people. Come on ADA, how about supporting all major browsers, not just the one from Microsoft?
Intensive blood sugar control - dangerous in type 2 diabetes?
You may have seen the news about changes in the ACCORD Trial. This is a clinical study of adults with type 2 diabetes who are at a higher risk for cardiovascular disease.
Some of the people in the trial were following an intensive approach to managing their blood sugar. The aim was to keep their A1C results below 6%. Others in the trial were following a 'standard treatment' with a target A1C between 7% and 7.9%. This second range is much closer to what most people with type 2 diabetes achieve.
Over 10,00 people were taking part in the trial. Over about a four year period 257 people in the intensive group died, compared to 203 people in the standard treatment group. This was equivalent to 3 additional deaths per 1,000 participants per year. And both of these death rates were lower than similar populations in other studies.
About half of the additional deaths were due to cardiovascular disease, the rest were from other issues such as cancer. But it's not clear why these happened.
Because of safety concerns about this increase, the NHLBI who sponsors the trial has decided to stop using the intensive treatment approach and have all participants use the standard one with it's less demanding A1C goals.
If you want more information about the trial and what has changed, the NHLBI has an excellent FAQ page.
And remember, if you have type 1 diabetes, these findings don't apply to you. You should still aim for the best blood glucose control you can safely achieve.
Update: Kelly Close of Close Concerns has a good blog post about this trial, it's also worth reading.
The ACCORD Trial has its own web site, which gives more details about what the study was attempting to find out. From this page you can see that 5,128 people were in the intensive blood glucose control group and 5,123 people were in the standard blood glucose control group.
If you'd like to see other coverage of this situation across the diabetes internet, the diabetes search engine returns a lot of interesting hits for "ACCORD trial".
Today is the presidential primary day for many states in the US. And my good friend Manny has issued a challenge to the presidential candidates. Are they prepared to make funding for research and treatment of diabetes a National Priority.
This may not seem too important if you don't have diabetes. But remember that a recent study(PDF) showed that in 2007 the US spent over $174 billion dealing with diabets.
How much is that? More than was spent in Iraq supporting the military and dealing with situation there. Or about $580 for every person in the US, that's $2,320 for a family of four. For one year's treatment.
If you'd like to make your opinion heard on this, please complete the Diatribe survey about diabetes and its importance.
Oh, and do please vote in the primaries. It's important to make your opinion count.
The title of the interview is 'Living with (and paying for) diabetes'. When he was asked about what he's learned about the costs of living with this chronic disease, he answered
They're extensive. In some cases, some diabetics tell me the spend about $10,000 a year on this thing. You're talking about your blood glucose meter, you're talking about the test strips that are required for that (and I do as many as seven to 10 tests a day), but there are other things as well: you've got you're insulin, you've got your needles, you've got the lancets you need to poke your finger -- again 7 to 10 times a day -- and so you have a lot of fixed costs attached to a chronic disease.
He also talks about the $1 per strip cost. Maybe with his focus on publicizing the costs something may happen.
One of these days some company will wake up to the idea that they can provide accurate strips for $0.50 each and capture a big share of the market. I can't wait for that to happen.
Diabetes: technology, devices, software, and other stuff.
About Me
Name: Bernard Farrell
Location: Massachusetts, United States
I was born in Ireland and now live in the US.
I have had Type 1 diabetes for over 35 years. I struggle with my blood sugar, the same as most people with diabetes.
I wear a Cozmo 1800 insulin pump and a Dexcom SEVEN CGM to track my blood glucose levels. I also take Symlin to help control my post-meal blood sugars.
I'm blessed by God, and every day brings the possibility of a cure.
