Scott King

A question by e-mail:

Dear Mr. Scott King,

I'm a recently diagnosed type 2 diabetic. I managed to self diagnose rather early, however, already have a mild complication developing. I'm 'controlling' through diet, exercise, and oral meds.

After several months of *intense* study it finally became obvious to me that one definition of this disease could be simply be insulin secretion levels which fail to meet metabolic requirements. Type 1 diabetics have 100% hyposecretion, while Type 2 diabetics have at least 25% hyposecretion. T2s can reduce insulin requirements through diet, exercise, and oral meds but such measures cannot 'cure' them of the disease, and in a significant number of patients, insulin hyposecretion worsens until exogenous insulin is required.

Close, but many of us think that the initial problem in type 2 is a reduction in insulin sensitivity with compensating increase in insulin secretion. (For historical reasons the loss of sensitivity is called an increase in insulin resistance!) Only when the islets fail to make enough extra insulin do you get type 2.

In light of this, I read the Encelle description on the Islet Foundation website with *considerable* interest. When I called them I was stunned to find that, for the time being, work has been suspended due to lack of funds.

After the call I had to leave my office because I couldn't help crying. I can count on one hand the number of times in my adult life that I've cried, but the anger and frustration were overwhelming.

I've been lurking the Islet message board for awhile, and don't want to post yet, but simply don't know what to think. Could you please enlighten me: what's up with all this?

Mitch Funk

Scott's reply:

The problem, Mitch, is that the geometry of the Encelle device will not permit enough insulin secreting tissue to be implanted. They never got a dog off insulin. I honestly consider our sheet to be a better design.

Scott

P.S. See our evaluation at http://www.isletmedical.com/Pages/encell.htm

A question by e-mail:

Dear Mr. King:

I have a couple of questions:

(1) Have any of your executive or marketing staff contacted medical insurance companies to query about their coverage of such a cure/treatment? It would seem that with the long-term expense of diabetes they would sign you up with enthusiasm. Not long ago, though, 6.5 years to be exact, I had to request that my HMO cover glucose strips.

Scott's reply: I think it is likely they will pay, but we have not asked them yet. Their first question will be the length of time the treatment is effective, and we have not yet proven that.

(2) At this point in your research, can you safely estimate that the surgery to implant the sheet would be outpatient and that because of the laporascopic (sp?)procedure, minimal pain and scarring would occur?

Scott's reply: We think it is likely that all the surgery will be done with short incisions and minimal invasion.

(3) Are you researching possible tests/protocols/ methods for determining the longterm success of the sheets once implanted? I, in my layperson way, consider 5+ years without additional surgery to be successful.

Scott's reply: Yes. The main test will be serial metabolic workups. If the sheet is effective at 12 months, and the metabolic parameters at the same as 6 months, we can project it will work for years.

(4) You might want to include the cost of doctor visits, dialysis, eye surgeries, and so on in your table for the average annual cost for diabetic care. The table you currently have that includes test strips, insulin, etc. is a pretty ho-hum comparison (~$2500) to the suggested $20,000 for the sheet. If you add $12,000 for a vitrectomy or $15,000 for some other procedure, and then add the cost of supplies, your $20,000 for the sheet implant starts looking really comparable. I understand that an executive summary cannot include every data point but for longterm diabetics, annual cost is much more than just what the supplies cost.

Thanks for your time. By the way, I have had type 1 diabetes for 34 of my 36 years. I am cautiously hopeful about what your group is doing.

Sincerely,

Shelby Rinehart


Scott's reply: Thank you for your well considered comments. I hope we do not disappoint you.

Scott King

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Your Thoughts


Carolyn Robertson

A question by e-mail:

Dear Carolyn,

My nephew who has recently been diagnosed with diabetes, has his blood sugar level between 5 & 7 but is completey worn out all the time and angry, mood swings etc. He is 16 years old. when he first took insulin he was full of energy, but now is lacklustre. Is this normal.

Denise

Carol's reply:

I would encourage your nephew to speak to his physician and with his diabetes educator about his lack of energy. They are in best position to determine how to evaluate his symptoms. However, here are a few comments/suggestions

A glucose level of 5mmol (90mg) to 7mmol ( 126mg) is usually considered a acceptable blood glucose level. However, it is not likely that these values are consistent throughout the day.

1. Do these values represent pre meal results or post meal results? While the target glucose rise after meals is 40 to 60mg/dl, it can rise much higher. When that occurs, it would not be unusual for the individual to feel tired. A blood sugar level that is flucuating is also associated with mood swings.
2. If the blood sugar level is stable and does not rise or fall dramatically, I would consider other possibilites:

a. Thyroid disease can develop in patients who have Type 1 diabetes.

b. Developing a chronic disease, can be a very emotional experience. Grief, anger and depression can occur.


Carol

A question by e-mail:

Please help if you can. My 55 year young mother has been diagnosed with diabetes. She has been given so much information that we are COMPLETELY CONFUSED. I am trying to find her an example 5-day menu. To show her what she could possibly could eat. She and I are very confused about how much and what kind. Her Dr. has been very helpful and said that she can get a nutrienist but neither one of us can afford it. Please direct me to a sight or a book I can buy locally that gives example weekly menu planning!

Thank You Very Much!

Christy

Carol's reply:

Christy,

There is a good cookbook that is provides really good recipes despite the title of low fat. It is the:

Diabetic Low-Fat & No-Fat Meals in Minutes!
By M.J. Smith, R.D.

More than 250 delicious, easy, and healthy recipes and menus for people with diabetes, their families and their friends. Here is the most complete collection of delicious and easy low-fat and fat-free recipes in minutes from best-selling cookbook author M.J. Smith and the Juvenile Diabetes Foundation International. JDF gives more money to diabetes research than any other nonprofit, nongovernmental health agency in the world. This deluxe hardcover cookbook includes 63 days of diabetic menus and 16 pages of full-color photographs. Each recipe features a complete nutrition analysis, including diabetic exchanges.

The Regular Price is usually $19.95. However, it you are a JDF Member the price is $15.96

Carolyn

A question by e-mail:

Caroyln,

I'm on pills(Glucotrol XL, Glugophage) right now. I'm 50 yr. old white male, father of 3 kids. The doctor said next step is insulin. I don't want to go on insulin. I started running again about a week ago hoping to lose weight. I'm at 205 lbs. and want to get to 190lbs(5'11" Frame). as I feel that will reduced my level of medication. I like to eat but am trying to cut out pasta, bread, and potatoes. I'm also taking "Slim Fast",(3 times/week) to reduced my weight, However I tend to eat ice cream, in binges, even though I know it not good for me.

My questions, is it ok to have a high sugar level, 1 hour after eating, of 330, and then have it come down to 145? And it seems like my sugar level seems to be in more control in the afternoon. Since I,ve been on this medication my morning sugar readings have been in the 140-200 range, is this acceptable because I'm a diabetic? What do you think?

Joe

Carol's reply:

Joe,
Too much of anything is not good - blood sugar levels included. A target blood sugar level before meals should be less 120mg and one to two hours after meals, it should be less than 160mg.

Why should you be concerned? High glucose levels are associated with complications - both complications that affect the small vessels( eyes,kidneys and nerves) and complications that affect the larger vessels ( heart and brain). Even if the blood sugar levels falls to a better range several hours after eating, it does have a very negative effect for the time that it is increased.

I would agree with your physician. It is necessary that you lower your blood sugar and insulin is the method to do it. When the blood sugar is elevated ,your own insulin and the oral agents that you are taking do not work well. It is almost as if the presence of a very high glucose level is toxic to the system. High blood sugar levels make the system even more inefficient.

You should know that insulin used in a person with type 2 diabetes is often used to supplement his own insulin. Once the blood sugar levels lower, you may be able to add other oral agents and decrease of eliminate the insulin.

Good luck

Carol

A question by e-mail:

Hi!
I just came across this site tonight. I'm a 44-year-old woman who has had Type I diabetes for 28 years now, with no complications. I am a fanatic about blood sugar testing (and do it not less than 10 times per day). I exercise one hour per day - minimum. My first question is this: do you know of any companies that make pouches that would hold a FreeStyle meter and keep it warm in freezing temperatures? I often walk outside during the winter, and the meters won't operate when they're too cold. Even when it's not freezing out, the meters sometimes need to warm up.

Also - I've been on NPH insulin (a.m. and at bedtime), along with Regular (at dinner) and Humalog (at breakfast) for many years. I've only ever used NPH as my long-acting insulin. Ever since the human insulins became available, I need to eat lunch about 2.5 hours after I inject my NPH insulin. Have you ever heard of this? My doctor thinks she'd like to put me on Glargine, but it's not available yet. She also said Lente might be good at bedtime, while other diabetics tell me they prefer Ultralente. Any thoughts?

Thanks a lot

Signe in NJ

Carol's reply:

Hi, Signe

Have you thought about putting your meter in the inside pocket of your jacket? You might also consider checking a sports store. Look at the belts that are sold for runners to hold small items like keys or a wallet. Also look for pouches that are used to carry/store cannisters of fuel in the winter.

It sounds like your insulin plan is currently designed to accomodate both breakfast and lunch with one mixed injection. This arrangement of insulin will always require you to eat a lunch meal at a specific time and generally wants a snack both mid morning and mid afternoon. NPH does peak earlier than both lente and ultralente. You might discuss several options with your health team

1. Switch the AM NPH to lente . This might allow you to eat lunch 4to 5 1/2 hours after the morning injection. But it may also require a small carbohydrate snack after 2 to 3hr after the injection and again 7 to 8 hours after the injection.
2. Switch to AM ultralente and reduce the dose significantly. Add Humalog at lunch. This should eliminate the need for an AM snack and give you the flexibiltiy of eating your lunch when you want to eat it.


Carol.

P.S. Signe also look at my article on insulin prescriptions for more details regarding insulin regimes

A question by e-mail:

Dear Carolyn ,

I would like to know how an 11 year old with Type I diabetes can sleep late on weekends if she is on 2 injections of Insulin daily. Is there only one solution to the problem?

Also if she wishes to eat food high in fat and protein at a wedding party occasionally - how can she adjust her insulin dose at all?

Thank you.
Durrane
Karachi, Pakistan

Carol's reply:

Sleeping late for someone on insulin is an activity that can be done. However, a few facts regarding insulin and type 1 diabetes should be reviewed.

1. Individuals with type 1 diabetes are reliant on insulin for survival. The insulin is necessary 24 hours per day
2. A 2 dose insulin regime usually consists of both a short and long acting insulin that is timed to provide insulin for meals and insulin that is timed to provide for the ongoing need of the liver for insulin.
3. the limitation of sleeping late is the fact that the insulin taken the prior day will begin to wan. As the duration from the last dose increases the insulin's effectiveness begins to decrease and blood sugar levels can increase.
4. To sleep late, you have several options. Each of these need to be reviewed by your health care team and modified for the unique needs of your daughter
(1). You might be able to move the time of the long acting insulin that she takes in the evening to 10 to 12 midnight
(2) You might be able to add a dose of short acting insulin at 6 or 7am - that would extend the activity of the insulin
(3) You might be able to change the type of long acting insulin that she takes in the evening ( NPH to Lente or to Ultralente)
(4) You might want to discuss if she is a candidate for an insulin pump.

With the advent of insulin programs that are better matched to the daily patterns of the patient, it is possible for your daughter to alter her insulin to accomodate changes in the meal. However, I would recommend that you consult your team for guidance. To alter insulin and get results that you desire, it requires an advanced understanding of food and insulin and patience since the responses are not always the same.You and your daughter will need to become experts in problem solving. However, with your diabetes team, it can be done.

Carol

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