Tag: type 1 diabetes

New drug can delay the onset of type one diabetes

kaitiscotland3 Comments
Photo by RODNAE Productions on Pexels.com

Adapted from Medscape Nov 20 2022 by Miriam E Tucker a freelance journalist from Washington DC.

At last humans have caught up with mice!

Since my son was diagnosed with type one diabetes, some 28 years ago, it has been possible to reverse type one diabetes in mice. At last the huge effort to find a suitable agent to use in humans, and particularly children, has been approved by the FDA.

Thank you everyone who has contributed to this marvellous discovery. The Juvenile Diabetes Research Foundation was set up with this end point in mind and they have been successful in the development of the new drug which they helped fund. The thing is that now such an agent is available, we need to be able to find the people who would most benefit from taking the drug. Thus screening for early type one diabetes is going to become crucial.

The new drug is called Teplizumab-mzwv (Tzield, Provention Bio) and it is a anti-CD 3 monoclonal antibody. It was approved in Nov 17 21 and is the first human disease modifying therapy for impeding the prevention of type one diabetes. It delayed onset by around 2 years and longer in some subjects.

It is given by an intravenous infusion once daily for 14 days and costs around $200,000 dollars for the course of treatment.

It is licensed for children over the age of 8 years. The group it is targeting is those who are asymptomatic but who have raised blood sugar levels and at least two type one diabetes antibodies. Most of those screened are first degree relatives of type ones. The JDRF is offering a screening blood test for $55. But because 85-90% of people who do develop type one diabetes don’t have a first degree relative, screening will need to be developed further.

In Bavaria, Germany, screening of all schoolchildren for type one diabetes has been done, and the organisers said that a major benefit, was that education about the signs of diabetes occurred so that diagnosis occurred before Diabetic Ketoacidosis developed. This is known to cause deaths and wears out the pancreas much faster.

In another study 2 year olds and 6 year olds in the USA and western Europe were screened for islet autoantibodies and this detected almost all of those children who developed type one diabetes by mid adolescence.

Using a genetic risk score at birth has been suggested as more cost effective by Dr William Hagopian of the Pacific Northwest Research Institute in Seattle. 10% of newborns have HLA genes that can identify 80% of those who will get childhood type one diabetes.

My comment: I’m particularly pleased to see that the JDRF has been successful because if my son has offspring they have a one in three chance of developing type one diabetes in childhood. As time goes on, it is to be hoped that the interventions will become cheaper and more effective.

Babyhood antibiotics increase the risk of type one diabetes in childhood

kaitiscotland1 Comment
Photo by CDC on Pexels.com

Adapted from Diabetes in Control Antibiotic Treatment increases risk for type one diabetes by Chardae Whitner May 15 2021

Both prenatal and first year of life antibiotic exposure may increase the risk for developing type one diabetes in childhood.

It is believed that early life risk factors which include antibiotic treatment can influence the risk of type one diabetes by affecting the gut microbiome. This affects the development of the immune system. Type one diabetes children have been found to have lower microbial diversity in their gut compared to children without diabetes. Antibiotic exposure in early life delays microbiota maturation.

Sweden has the highest rates of type one diabetes in the world despite a relatively low antibiotic prescription rate. They studied siblings, some affected by diabetes and some not. They looked at antibiotic prescriptions, mode of delivery, sex, birth year and genetic predisposition to type one diabetes. The children studied were born between 2005 and 2013. 797,318 children were studied.

Overall 800 prescriptions for antibiotics were issued in the first year of life. These were most commonly for ear infections, then respiratory tract infections, urinary tract infections, and then skin and soft tissue infections.

Exposure to antibiotics prenatally was associated with an increase in type one diabetes in childhood of 1.15 (so weakly associated). Antibiotic exposure in the first year of life raised this a little to 1.19. (still weak. You would need to have 1,475 babies have antibiotics to have one extra case of childhood diabetes before the age of ten).

Siblings of type ones have a risk of 1.36, so this is a stronger risk than antibiotic exposure.

Caesarian section did give an increased rate of type one diabetes in childhood but sex, genetic predisposition and birth year did not. The risk was 1.10 in vaginally delivered babies and 1.60 in the little caesars. So this was again a bit stronger than sibling risk.

Wernroth, Mona-Lisa et al. Early childhood antibiotic treatment for otitis media and other respiratory tract infections is associated with risk of type one diabetes. Diabetes Care May 2020.

My comment: My son Steven has type one diabetes and had a strong family history on his dad’s side of autoimmune disorders including type one diabetes in several generations. He also was a caesarian section delivery and also had a peri-orbital skin infection when he was about seven months old that required antibiotics. Poor wee soul! These days no one gets a caesarian section without a good reason and antibiotics are well thought out. There isn’t much you can do about being a sibling of someone with diabetes. What you can do is take vitamin D in pregnancy and give it to your children from birth onwards.

#WorldDiabetesDay

Emma7 Comments

Happy #WorldDiabetesDay to you! This year’s theme is Family and Diabetes. While the day (and the month) is more aimed at raising awareness of the undiagnosed condition and family members looking out for the signs of diabetes in partners, parents, siblings etc., my day will reflect on my family and how thankful they make me.

I was diagnosed with type 1 at the age of nine (there I am, just post-diagnosis on the right). Since then, diabetes care has come along in leaps and bounds. In those days, you used syringes made of glass, tested your urine and not your blood and relied heavily on your body and not a machine to tell you what was wrong. (Ah, the young yins! Don’t know they’re born…)

As a nine-year-old weeping copiously at the prospect of no sweeties or birthday cake again ever, I wasn’t 100 percent au fait with what was now going on with my body. I scared the living daylights out of my parents several times by fainting first thing in the morning. The most memorable time when I jumped up on the kitchen window ledge to let our pet cat in and fell off it. Onto a stone floor.

Bite me…

As biting my tongue often went along with fainting, my dad would try to stop me by inserting his own hand. I bit that instead.

Still, my parents were a game pair—happy to downplay the condition so I never felt disadvantaged. It took me until my 20s to realise I had a chronic illness. Duh, I know, but diabetes never felt that way to me growing up. My mum’s favourite cry was, “Have you got your Dextrosol?” whenever I left the house. (Again, the young yins. Not having to use Dextrosol for their hypos.) But other than that, they never mentioned it as a limiting factor or felt I could not do anything because of the diabetes. Fair enough, I announced no plans to be an athlete, truck driver or pilot, but they waved me off to a university in another country, a kibbutz, solo living and more without fuss.

Whenever I called home or visited, questions concentrated on my job, my personal life, what I was doing… diabetes never took centre stage.

Then, as I got older they generously funded a pump for me for a few years. When it gave up the ghost, I decided against further funding as I didn’t want to take any more of their money. They would have handed it over gladly. And still would, even though there are no longer two of them…

Ah, the mood swings…

Any family member of someone who has diabetes will raise a wry eyebrow if you talk about the mood swings. Figures, after all, that if you have a chronic illness tiredness is a frequent friend of the not very nice sort. It makes you sullen and snappy. Who better to take that out on than your nearest and dearest?

Then, there are the ‘hypo experts’; mums and partners who can tell you are hypo before it strikes you the excessive yawning is more to do with plunging blood sugar levels than a late night the day before. Grr. Double grr because they are almost always right.

I have my own little circle of mood bearers—once upon a time my mum, dad and sisters. (Still my poor old mum to some extent). Nowadays, my husband. He’s awfully good at spotting hypos. Awfully brilliant at lots of other things too. Running upstairs to bring me supplies when I run out of needles and other equipment. Keeping me in jelly baby supplies. Factoring in blood glucose checking stops whenever we are out and about. Finding me ice-cold water when high blood sugars kick in. Accepting that I am terrifically rubbish at late nights, which means we do not go out that much. (Tip—I organise a lot of things for a Sunday afternoon.) Checking restaurants to see if they offer low-carb options before booking them.

Diabetes does not come alone. Yes, it includes tiredness and a whole slew of other complications you do your best to avoid. But if it takes a village to raise a child, it takes warm, supportive, kind and patient folks to nurture a diabetic.

Here’s to them all—my family. Thank you thank you thank you.

#LowCarb Vegetarianism and other adventures

Emma14 Comments

meat-free alternatives Maybe it’s the Extinction Rebellion folks gluing their hands to pavements, disrupting flights and parking their uncooperative crusty* posteriors on roads throughout central London.

Or it could be the underlying anxiety about eating meat that has always bothered me since I took it up again after more than 20 years of vegetarianism. But lately I have drastically cut down on the amount of it I’m eating and embraced the substitutes.

Vegetarianism and particularly veganism aren’t natural fits with a low-carb diet, the one I follow because I believe it’s the best one for helping people with type 1 and type 2 diabetes manage their blood sugar levels. Heck, the good Doctor Morrison and I even wrote a book about it!

Quorn slices

But the meat substitutes have come much further than the last time I ate them. Quorn makes decent fake ham slices. Cauldron sausages and marinated tofu work for me too—all of them low carb, though not as low-carb as the real thing. Even the Diet Doctor—the best source of everything you need to know about a low-carb diet in general—recognises that many people do want to follow a low-carb diet that they can square with their conscience and the website offers low carb vegetarian and even vegan plans these days.

While I question some of the health claims people make for a plant-based diet (and I’m picky about the word being used to mean ‘veganism’—I’ve always based the bulk of my diet around vegetables), poor Mama Earth’s resources will run out far too quickly if meat consumption continues at its current levels.

As I have no children, I can tick that big box on the green credentials list but the other two are eating a plant-based diet and not flying anywhere. As someone who’s not that fussed about travel, the latter might be easily achieved too. That just leaves me with what I choose to eat. As I don’t do absolutes any more, opting to be a vegetarian with limited dairy most of the time is what appeals.

Low-carb vegetarian recipes

How about you? Have you changed your diet because of environmental concern s or do you plan to? We do have veggie options on our website if you are looking for low-carb meat-free recipes. They include low-carb curried cauliflower cheese, aubergine and pepper parmigiana, baba ghanoush, Tofu with teriyaki sauce and crustless spinach and feta quiche.

*As Boris Johnson called them. Maybe he was attempting ‘wit’ as a distraction from the chaos he is in midst of creating in the UK.

Diabetes and the roller-coaster ride

Emma7 Comments

Just a quickie from me this week… I thought I’d share an interesting info-grab with you. The flash glucose monitoring system collects all sorts of info which is easy to see at a glance, such as your daily graph.

The graph shows you how often you have been in or out your target blood sugar range. The Monday one here (right) is me on holiday. Happy days, eh? Let’s loosen the reins on low-carb eating as boy, do the Cretans know how to do miraculous things with potatoes. While over there, I tasted what must count as the BEST CHIPS IN THE WORLD. A bold claim, I know.

And Wednesday is me back from holiday, determined to jump back on the low-carb wagon*. Goodness me, those graphs tell their own story, hmm? From wild jumps—the roller-coaster ride, to a far more sedate and steady line. A week’s potato bingeing is fun, but long-term I prefer to stick with the graph that doesn’t soar and plummet all over the place.

 

*Sorry for all the mixed metaphors.

Seven observations on using the FreeStyle Libre for a week

Emma7 Comments

hand holding FreeStyle libre meter
You will prise this from my cold, dead hand…

Blood, I miss the sight of you… I’d gotten used to those tiny beads that popped from the tips of my fingers several times a day. This week, not so much.

And as misses go, it’s a rubbish one, right?

As the proud new owner of a FreeStyle Libre (may the universe rain her blessings down on NHS Greater Glasgow and Clyde), I know the much-vaunted advantages. Ability to test more often and easily. Probable positive effect on your HbA1c levels (the long-term measure of blood glucose in the body) and reduced likelihood of complications.

Here, then, are my observations on the lesser quoted points you notice when you wear one…

  1. I’m clumsy as heck. Yes, I keep bumping into door frames. Maybe I always have walked into them on a regular basis but when I hit my right arm (the one I’m wearing the sensor on) off a door frame, I notice. Three times in the first four hours of wearing it.
  2. The absence of black dots. Those of us who’ve spent our lives doing five or six blood tests a day (see above) can hold out fingers tips covered in tiny black dots. Occasionally, the skin peels away in protest. Three days in and mine VANISHED.
  3. Oh, the joy of the night-time test! You wake up, roll over, grab the sensor from our bedside table and wave it in the direction of your arm. Voila! The result. No messing around opening that wee case up, taking out the tube of sticks, popping it open, finding a stick and taking three attempts to insert it into meter, pricking your finger and missing the stick with the dot of blood, etc. And all done in the dark because you don’t want to disturb your other half.
  4. No more vampire impressions. I did blood tests on public transport, in offices, when out and about, in the gym, the cinema, the pub, restaurants and more. And I was discreet about it, but when your finger bleeds you suck it to get rid of the excess, right? Some folks think that is disgusting or that you should always wipe it on a tissue or surgical wipe. Who has the foresight to carry all that around as well as everything else?
  5. Having to remind yourself you can test whenever the heck you want. I’ll get used to the feeling quickly but I’m still adjusting. Shall I test again? No, no I only pricked my finger an hour ago and I’m only prescribed XX amount of sticks every months so no… Stop right there, lady. Shall I run the meter over my sensor again? Yes, yes, yes!*
  6. Staring at your graph. Oh the fascination of watching what your blood sugar levels get up to over eight hours. Telling yourself you will record this properly, oh yes you will, and work out patterns so you can make educated adjustments, rather than relying on guesswork.
  7. Missing the sight of blood. As you might have guessed, the intro to this piece was a big, fat lie. I’m one hundred percent happy that bloody fingers are a thing of the past (ish, you still have to do some).

* Ten’s the recommendation, in case you were wondering. Too many’s not good on the sanity levels.

My people all together – #type1diabetes

Emma6 Comments

blood testing equipment type 1 diabetesEver sat in a room and thought, “I am with my people”? That was my experience this week as I attended an education session the NHS had put on; my attendance a condition for prescription of the Abbot FreeStyle Libre.

I doubt I’ve ever been in a room with so many other type 1 diabetics. Sure, type 1 is a hidden condition. Perhaps others travel on trains with me or flit about the offices of the University of Glasgow dropping their test strips wherever they go?* Still, my original statement holds. I reckoned on about 200 people there, with perhaps a third of them partners or parents.

All shapes and sizes

I arrived at the Queen Elizabeth University Hospital early and watched in fascination as folks trooped in to the lecture theatre. We come in all shapes and sizes—all ages, all colours and all creeds. Who were the ones with diabetes? I put it down to those of us who carried our precious bag—the FreeStyle Libre and the doctor’s letter handed out when we registered—tightly. I’d expected lots of young people, but that wasn’t the case. The average age, I reckon, was mid to late 30s. Every time I saw someone who looked a lot older come in, I cheered silently.

Take that, reduced life span, and shove it where the sun don’t shine.

Our session took the form of a PowerPoint presentation by one of the diabetologists at the hospital, followed by some Q and As. I didn’t bother asking anything. As an introvert, I’m not going to raise my hand in a room that full of folks—even if they are my people. But there were plenty who didn’t suffer from shyness who dived in.

Can you scan your sensor through clothes? Yup. (So handy!)

Can you swim with it? Yes, but only half an hour is recommended. (Seriously, do people swim for longer than that? It’s the world’s most boring form of exercise unless you’re in open water.)

How long does it take for the prescription to come through once you hand the letter to your doctor? About 48 hours.

Can you connect it to your phone? Yes—there’s an app for it.

What happens if it keeps falling off? Some people have slippier skin than others. Thankfully, the two times I tried the sensor it stayed in place for its allotted fourteen days.

Talking to my people

I longed to talk to my people, but didn’t. See above-mentioned introvert tendencies. Who would I have chosen? The Indian girl who talked about running, exercising and wearing a sensor? The man behind me who asked if the Libre 2—the one with alarms that sound if your blood sugar levels go up or down too rapidly—would be available for us in the future? The glamorous young couple where I couldn’t work out which one would hold out the fingers covered in black dots from too much finger-pricking?

No. The one I’d have picked out was the woman I guessed to be in her late 30s who came in with an older man and woman I took to be her mum and dad. I watched her sit down near me and wiped away a wee tear. That might have been me once upon a time, attending with my lovely, supportive ma and pa. My father died nine years ago and how I’d love to have shared this new, wonderful development in diabetes care with him.

Session over, my precious bag and I got onto the bus to go home. “A new chapter, Emma B,” I said to myself. “How terribly exciting.”

*About to become a non-problem. Yay!

Type 1s in the US dreading their 26th birthday

Emma5 Comments

insuline supplies on the Diabetes Diet websiteSometimes a story pops up which serves as a timely reminder of how lucky we in the UK are (catastrophic, undemocratic political shenanigans which might lead to insulin shortages anyway notwithstanding)…

This week’s news feature that popped out to me was a BuzzFeed article about Millennial type 1s in the US, forced to come off their parents’ health insurance at the age of twenty-six. Insulin prices in the US tripled from 2002 to 2013 and a recent study found its average annual cost increased from $3,200 to $5,900 a year from 2012 to 2016. Unregulated capitalism—always a good thing, hmm?

Most Millennials, the article pointed out, have to contend with the long-felt after-effects of the 2008 financial crisis, debts left over from college or university and the gig economy where it is hard to get health insurance in the first place. Or there are jobs that don’t have insurance, the insurance doesn’t cover diabetes or the deductibles are so high, the insurance isn’t worth the paper it’s written on.

Rationing insulin

The reporter spoke with a number of twenty-six-year-olds forced into rationing insulin and using syringes and lancets repeatedly to try to keep costs down. One mentioned skipping meals so he didn’t need to take at least one dose a day, and another said her insurance didn’t cover the insulin she’d previously used. The one it sanctioned made her feel ill.

Why the age of twenty six? As the article states, outgrowing your parents’ health insurance has always been an issue for young adults with chronic health conditions. The Affordable Care Act of 2010 allowed them to stay on that insurance until they got to twenty-six—a universal deadline.

Even government-sponsored insurance is so “stupid expensive” one person quoted in the article said, it’s not worth it.

Different career path

And what about job choices? Again, those featured in the article spoke about sacrificing what they really wanted to do for a job or career path that offered sufficient financial reward or great insurance in order to get the life-saving medication they need.

Twenty-five-year old Allie Marotta told BuzzFeed she fears the approaching deadline.

“Being postgrad, figuring out your career,” she said, “all of that is crazy to begin with, and then adding the layer of worry about medical stuff and having it be a life-or-death situation, literally a life-or-death situation all the time.

“It shouldn’t be this hard. You see other countries doing it and it’s not this hard. There’s no reason for this to be the way that it is.”

Diabetes and the ol’ green monster

Emma14 Comments

Me this week. Not attractive, I know

Ah, the green monster… It surfaced this week, startling me with its intensity. I’m talking about jealousy and the mean feelings I experience occasionally in relation to diabetes.

Every week, the mighty search engine that is Google picks out the week’s diabetes news for me. Most of the time, it includes new research, a dose of doom and gloom where scientists and doctors reinforce the lower life expectancy/increased likelihood of contracting a nasty side effect (Gee, thanks folks) and a Daily Express article telling you to eat this food to avoid diabetes*.

This week’s offerings included a video on the BBC where a teenage type 1 spoke about the pump she wears which uses artificial intelligence to monitor her blood sugars and keep them within normal range, and how it will allow her to soar through life. She’s one of the first type 1s to get this pump on the NHS.

Believe me, I know a one minute 55 second film clip tells nothing like the full story. I don’t know the extent of the teenager’s medical background. Her mother, the video showed, found it hard to sleep at nights because she was so worried about her daughter’s overnight hypos. I get it, I get it, I get it…

No awards for long service

But the horrible green monster reared up anyway. “It’s always the young ones,” I muttered, bad-temperedly. There might even have been a self-pitying tear or two. “What about me—don’t I get an award for long service? Thirty seven years with this ruddy condition! There are empty jelly baby packets in landfill sites all over Scotland to prove it**. I wouldn’t mind soaring myself.”

The nasty bout of whingeing was in part triggered by a letter I received this week relating to my progress on the flash glucose monitoring (FGM) waiting list. At my appointment at the diabetic clinic in September last year, the doctor put me on that oh so elusive list. The waiting list was only the start. After that, a mandatory half-day educational course takes place and then a letter wings its way to your GP requesting they prescribe FGM. Still there I was. ON THE LIST!!!

“Happy days, Emma!” I said to myself as I skipped out of the clinic, phoning my mum and then husband to share the good news. They whoop-whooped too.

Patience, not one of my virtues

I waited. And waited. “Well, I suppose those half-day courses are over-subscribed,” I said to myself. Friends, patience isn’t among my virtues but I held off writing to the good doctor to request a situation update until the beginning of March. The letter I got in return said there is a cap on funding and until that increases, I’m on a static waiting list.

Again, I get it. Times are tight, but every other type 1 I know sports one of those FGM thingies on their arm, included blasted Theresa May. (Admittedly, I don’t know that many type 1s.)

Here’s the thing—I never envy other people their non-diabetes status. A long time ago, my brain must have told my heart jealousy over the impossibility/unlikeliness of a cure in my lifetime was too much of a wasted effort. But when I read of other diabetics and their access to the latest tools and tech, I glow so green I’m practically radioactive.

The blessings of perspective

Fortunately, perspective kicked in after twenty minutes or so of mumping and moaning to myself. In the US, two senators have launched an investigation into rising insulin prices (585 percent from 2001 to 2015 for Eli Lilly’s Humalog, for instance), and this in the world’s wealthiest country. Many people have tried swapping insulin types and brands, changing to something that might not work as well for them or worse, stopping it or rationing it.

In addition, part of my work at the moment involves communications for a health-based project in two African countries where access to any diabetic medication is seriously limited, and knowledge of how to treat the condition not as wide-spread as it is in the developed world.

I don’t have the latest up to date equipment, but I do have insulin (Brexit fears aside), plenty of test strips and all the other bits and pieces I need. The green monster surfaces from time to time, as I’m sure it does with you. Let it do its whinge-y bit and then remind Madam Monster we do live in the best of times for people with diabetes (country dependent of course). If I’d been born 100 years earlier, I wouldn’t have made my 11th birthday. So, Emma 1, Jealousy 0.5.

*Yet to click on that one as I assume it’s click bait.

**They will outlive me.