Diabetes - a cure?

DrIndy

I've been posting quite a few responses here, but may as well join in with a thread or two......

People with Type I diabetes have no insulin because the immune system has attacked the cells that produce it. As a result, without regular insulin injections, they get very high sugar levels which does damage to many organs in the body, including the eyes, kidneys and nerves. They are also much more likely to have heart disease.

They are also in danger of getting a very low blood sugar level which can kill if they take too much insulin by mistake.

There is a new therapy on the cards where Islet cells from the pancreas (the cells that produce insulin) are infused from an organ donor to replace the lost islet cells.

http://www.diabetes.ca/Section_About/isletcell.asp

Thoughts?

ArthurDent

Personalized treatments such as this, as sucessful as they are, are never going to be made available to all and sundry due to cost implications.

I think in the long term it is more likely that non-invasive treatments for diabetes such as the inhalable insulin products by Nektar and Pfizer have a better chance at improving peoples lives./Still quite a few hurdles to overcome - not the least of which are the antibodies produced and the risks to the lungs of long-term administration.

Also there are quite a few companies working on oral formulations that will be used to treat diabetes - again probably 3-5 years from market.

mike65

Every 6 months or so the media go big on the latest diabeties treatment breakthrough. Except every time it is'nt. This has applications but as said its a damned expensive "cure". Esp as the new ilets may well need topping up every so often. The need to take pills to ward of the anti bodies is another issue. Clearly for those who merit the treatment its a good thing but for "normal" diabetics its not a runner.

Pancreatic transplants are another route of limit valve for much the same reasons - availibility and anti-rejection drugs. In the lonmg term the best to hope for is gene therepy which can stop the condition being passed on.

Mike.

CathyMoran

Would be very cautious about gene therapy - when you are inserting DNA into cells you do not know what you may let loose. There is also the issue of having kids afterwards. The latest therapy sounds good for Type 1's who can have a hard time of things keeping it under control when everything from stress, excercise to food can vary insulin needs. The inhalable insulin may not work for everyone - some people developed allergies as a result of the pig insulin of 20 years ago - taking it via a spray is not the natural way of things - it would be different if the medication was going directly into the lungs. The pen with its faults looks like the best method for type 1s at the moment - more creative use of the longevity and affectiveness of the insulin types in the system may help as would not evasive continious blood sugar monitoring with an inulin feedback mechanism. The islet transplant does give some hope, though it may take a long time to filter through. All diabeties treatments are expensive - even the long term health gains of effective treatments would outweigh the cost of them.

NeilJ

Prehaps the biggest threat with gene therapy is the risk of activating an oncogene and causing cancer. I was told recently that a child in the UK (I think, not 100% sure) was successfully cured of SCID through gene therapy which was quite impressive as previous attempts in France resulted in the patients getting Leukamia (sp?) and dieing. So who knows. To be honest I think the only really true concern is the lack of control in the area along the chromosome where the gene is inserted. Once we have a handle on that I don't see too much by way of future problems.

Neil

edanto

DrIndy wrote:

There is a new therapy on the cards where Islet cells from the pancreas (the cells that produce insulin) are infused from an organ donor to replace the lost islet cells.

That's a pretty great idea, could be some problems with immune system rejection in the short term, but they've nailed that with other organs, so it might just be a matter of time. Then you've got the problem of not having enough pancreas donations to help everyone.

Something else that might appear in time is a technology that's being researched out at dcu/beaumont hosp. In labs, they've been able to isolate the right type of cells from donated pancreas' and then grow up more of them. With more research, it might be possible to transplant the harvested cells into a large number of patients and let them start making their own insulin again.

There's gotta be a better way though. Surely there's a changable reason that so many people are getting diabetes, especially as the baby boomers go pear shaped. Is it diet, excercise?

Should doctors be able to recommend (well, forcefully suggest!) excercise if someone's doing themselves damage early in life and running the risk of getting diabetes in a decade?

kinda gone off topic.. shunt it please psi if it should be new thread.

anyroads.. the lab based research should continue apace.. I just sometimes wonder if more government money should be spent on preventitive medicine - the type that big pharma doesn't stand to make a profit from.

DrIndy

Something else that might appear in time is a technology that's being researched out at dcu/beaumont hosp. In labs, they've been able to isolate the right type of cells from donated pancreas' and then grow up more of them. With more research, it might be possible to transplant the harvested cells into a large number of patients and let them start making their own insulin again.

Stem Cell research is the way to go. It offers theoretically a biological cure for everything. I fully support stem cell research. Where traditional regimens with drugs was like using a hammer to crack a nut, biological therapy is like using a fine needle instead.......

edanto wrote:

There's gotta be a better way though. Surely there's a changable reason that so many people are getting diabetes, especially as the baby boomers go pear shaped. Is it diet, excercise?

Should doctors be able to recommend (well, forcefully suggest!) excercise if someone's doing themselves damage early in life and running the risk of getting diabetes in a decade?

There are two main different types of diabetes, Insulin Dependent and Non-Insulin Dependent or more specifically Type 1 and Type 2

Type 1 is the immune system attacking the islet cells and this is what this would be a cure for.

Type 2 is what you are correctly referring to - it is a distinctly different disease even though both result in high blood sugar levels. Type 2 is Insulin Resistance, where your pancreas produce more and more insulin until they fail - but your peripheral tissues such as your muscle are resistant to the effect of insulin and thus do not take up as much glucose. This depends on your genes and how overweight you are, diet and exercise is very important. People with this can manage on diets or tablet and only need insulin in extreme cases. There is also evidence that people who change their lifestyle before the symptoms are manifest can completely reverse the disease.

The interesting thing is the connection between diabetes (type 2!), high blood pressure, high cholesterol and heart disease - the so called Metabolic Syndrome (or Syndrome X)

http://www.mayoclinic.com/invoke.cfm?objectid=798C9801-F667-4D98-96977EC9575499AE&dsection=1

edanto

cheers for explaining the difference between Type I and II, I'd kindof mixed them up a bit.

So, it's great that the research continues to try to find cures for Type I, but I guess I'm really wondering about the best way for people to avoid Type II and the rest of the symptoms associated with the metabolic syndrome. I hadn't heard of them all being lumped into one syndrome like that but it makes sense.

Is there a good way to help people avoid this illness? The most important thing to change, ahead of diet and excercise, has to be attitude. But if people are told, 'oh, you can't eat this stuff anymore' and 'get out and excercise 4 times a week', they won't - they'll just resist because no-one likes being told what to do.

What I'm asking is, what kind of things would convince people to change their own attitudes to avoid adult-onset problems like the metabolic syndrome?



is there a case for legislation, like there was for the smoking ban?

have a look at this story from new scientist.

that was finnish initiative to reduce heart disease by promoting a healthier lifestyle. could something like that work here?

DrIndy

Thats is a very valid point. A great number of significant health breakthroughs have been through societal changes, not directly by medical intervention.

Cholera was effectively eradicated in the modern world by using proper sewage systems. TB has been greatly reduced by people having better living conditions and importantly better nutrition. the same goes for many childhood ailments like Rickets.

In this case, changing society views is critical, but it is an uphill struggle - hence all the controversy over a "Fat Tax" on unhealthy foods and also banning junk food advertisement during childrens TV time.

By staying at an ideal body weight, eat well, stop smoking, get exercise, cut down on salt - significantly helps.

Of interesting note - when pregnant, due to the increased demands on their bodies that increase blood sugar - women can "unmask" diabetes when pregnant aka gestational diabetes. Many eventually become diabetic (Type 2).

Suggestions for improving health in ireland?

DrIndy

NeilJ wrote:

Prehaps the biggest threat with gene therapy is the risk of activating an oncogene and causing cancer. I was told recently that a child in the UK (I think, not 100% sure) was successfully cured of SCID through gene therapy which was quite impressive as previous attempts in France resulted in the patients getting Leukamia (sp?) and dieing. So who knows. To be honest I think the only really true concern is the lack of control in the area along the chromosome where the gene is inserted. Once we have a handle on that I don't see too much by way of future problems.

Neil

This is an interesting point - although not strictly concerning Diabetes!

It is amazing how much the immune system functions to prevent cancer - there are views there that the reason people get cancer in the first place is a defect in the immune system as much as a defect in an oncogene setting the chain reaction off.

People who are immunosuppressed (immune system depleted) such as people who have had kidney or liver transplants, taking immunosuppresives, have AIDS or been treated for leukaemia (cancer of the blood) or lymphoma (cancer of the immune system) have a significant risk of getting certain cancer types such as Leukaemias, Lymphomas, skin cancer (not melanoma - which comes from moles) and cancers caused by viruses (like cervical cancer)

This is because the immune system is not hunting the cancer cells down as it is downregulated.

A dramatic example of this is people with certain types of leukaemia. When they have a bone marrow transplant to cure them of the disease, they sometimes develop the original cancer again. If the T-Cells (immune cells that specifically activate the immune system against bacteria, viruses and cause tissue rejection in transplants) - are harvested from the original bone marrow donor and infused into the patient, they get a significant remission (up to 70%!).

This is because the T-Cells even though they should attack the whole body because its "foreign" instead specifically attack the cancer cells and do very little to the recipient.

Biologic

There is a new therapy on the cards where Islet cells from the pancreas (the cells that produce insulin) are infused from an organ donor to replace the lost islet cells.

I also saw a news report on it. They stressed the drawbacks of harsh immuno-suppressants and the fact that , given the current level of donors, only about 12 people could be treated in the UK per annum. Also, the diabetes isn't totally erradicated. The first test subject said he still needed to watch what he ate and had to carry insulin (could just be a temporary precaution).
I'm no expert in the diabetes field but whats wrong with an insulin-loaded armband with the ability to detect blood sugar levels. It could regulate your insulin automatically. I'm sure his has been tried, but does anyone know why it isn't used?

DrIndy

That is also something on the cards, to create an automatic glucose level detector and dynamically dispense insulin. From what I understand, there are troubles making a detector sensitive enough for use.

The trouble with this technology is it is a number of years from completion and there are many other hormones involved which regulate glucose.