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Scott King
April 26, 2000. A question by e-mail:
I would like to know what problems you anticipate encountering when implanting the islet sheets in people with islet or insulin autoantibodies.
Regards,
Ellen
Scott's reply: Ellen--This is a serious issue that we think has been misunderstood.
First, the autoimmune disease that causes type 1 diabetes is primarily cellular and not humoral. That means that cells destroy islets, not antibodies. So we believe you can prevent repetition of the autoimmune response by rigorously excluding cells.
Second, the allograft response, that is the reaction of a human to a different human's islets, has significant cellular and humoral components. The crucial concept of the design of our sheet is to prevent any contact between host and islet cells, thus preventing cellular attack and minimizing humoral response.
You can learn more at:
http://www.isletmedical.com/Pages/coverall.htm
Scott King
April 24, 2000. A question by e-mail:
Congratulations on your continued success with the dogs. I noticed that the news and information section of the Children with Diabetes(in addition to the Scott King article in Diabetes Interview) have finally started to acknowledge your work. Being the father of an 8 year old with type 1(going on 4 years), I have been watching the progress of your company for a while. Realistically, how far are you from any type of human trials(assuming the dogs continue to do well)? Optimistically, what is your next step? Thanks for taking the time to read this.
Richard
Scott's reply: Thanks for your support. The amazing thing to me is that we are on plan! I revised our plan in fall of 1999. The skeletal schedule is located at:
http://www.isletmedical.com/Pages/plan.htm
Specifically:
- May 9: third pilot dog (allograft)
- June/July: begin preclinical GLP safety and efficacy dog series.
- December 2000: submit IND to FDA
- June 2001: clinical trial.
Very ambitious, but that's us.
Scott King
April 19, 2000. A question by e-mail:
This is great news (about the latest experiments in Cincinnati) and the transparency of experiments makes me feel confidant that it is real.
I have been following your comments regarding encapsulation techniques in the past. You must have read Dr. Sun's report in the Journal of Clinical Investigation and listed on the TIF web site; was this an exaggerated report?
I'm just trying to understand how research reports appear great and then fizzle.
Most of all, good luck on continued successes. If you form a research foundation just let me know where to send my check.
Tim
Scott's reply: I assume you mean the encapsulated porcine islets in monkeys experiment. No one has reproduced it, and Sun has not published a followup so everyone is ignoring it.
In science, nothing surprising is true unless it is reproduced in two laboratories. We will be working with a second islet laboratory by the middle of the year to assure that there is no "magic" about Cincinnati. Then, at some point, we will offer to make sheets for any reputable islet research who wants to reproduce the results. That outa satisfy 'em.
Good question!
Scott
April 11, 2000. A question by e-mail:
Hi Scott,
Are you going to attempt to get funding for your research through the J.D.F or elsewhere?I know all the red tape you must go through first...It WOULD take someone innovative and brilliant to find a cure for diabetes! Well Scott At the ripe old age of 42,I've finally concluded we're put on this earth for a reason,perhaps yours is to find the answer to diabetes. THANKYOU!
Alison
Scott's reply: Thank you for your kind note. Yes, we asked JDF for funding, but our proposal was rejected. We put the proposal and the JDF's reviewers comments on our web site:
http://www.isletmedical.com/Pages/jdf99.htm
The problem as I see it is that the JDF has become a funder of academic research. Academic research is designed to expand knowledge, not to cure disease.
Some people I know who have worked to raise money for JDF are incensed that they have not given us funding. I will be in NYC in early May and have offered to meet with JDF but have not yet heard.
Anyway, we can do it without JDF money!.
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Your Thoughts
Carolyn Robertson
Why is my blood sugar higher in the morning than at bedtime?
There are many reasons why your blood sugar may increase overnight. To understand them, you need to consider the body’s normal processes. First, insulin is required 24 hours a day – daytime and nighttime, waking and sleeping. And second, nature is committed to maintaining the status quo – a blood sugar level that does not vary by more than 40 to 60mg/dl. If your blood sugar increases overnight, ask the following questions:
- Could your insulin levels be too low? Perhaps, there is not enough insulin to match the body’s basic need. Most individuals with Type 1 diabetes will need 10 to 25% of their total insulin dose overnight.
- Could your insulin’s activity be too short? Perhaps, your insulin is peaking during the night and you are running out of insulin by the morning. The action curves of NPH, Lente and Ultralente vary among the individual users.
- Could your insulin level be too high? If the insulin dose lowers the blood sugar too dramatically while you are asleep, your system may overcompensate by releasing glucose from your liver causing the blood sugar level too rise too much by morning. ( rebound).
- Could your insulin’s activity be too long? Perhaps, your insulin is peaking mid morning rather than before you wake up.
- Could you be experiencing a blood sugar fall during the night? Activity, alcohol consumption and the residual effects of evening insulin could cause the glucose level to lower in the early hours of the night. When this occurs, the blood sugar may rebound.
- Do you have widely fluctuating blood sugar levels during the day? The impact of blood sugar levels that vary by more than 60 mg/dl could last for as long as 24 hours. A lowered blood sugar level at lunch yesterday can impact you blood sugar the next morning!
- Could the snack you eat at bedtime be overwhelming your insulin dose?
To answer these questions, you should test your blood sugar several times overnight. If you take long acting insulin at bedtime, check the blood sugar at the time of the bedtime dose, 2hrs later, again 5 hours later at wake up and 2 hours after wake up. You should expect that the 2hour blood sugar is the same or slightly higher than bedtime; the 5hour result is the same or slightly lower than bedtime; the wake up result should be the same as the 5am and the post wake up test should stay stable.
If you take your long acting insuln at supper, then check your blood sugar level at bedtime, 7 – 8 hours after the supper long acting insulin, 10 hours after the supper insulin, at wake up and 2hrs post wakeup. You should expect that the 8 hour blood sugar is the same or slightly higher than bedtime; the 10 hour result is the same or slightly lower than bedtime; the wake up result should be the same as the 10hour result and the post wake up test should stay stable.
Why does my blood sugar level increase when I get sick?
During times of illness, injury or even stress, the body has the capacity to mobilize glucose to provide the system with a rapid source of energy. This energy allows the system to react to the challenge and correct the problem. Usually, the system initiates a series of chemical prompts that stimulate the liver to releases glycogen (stored glucose) into the circulation. The liver can also manufacturer glucose if the glycogen stores are depleted or inadequate. The release of glucose into circulation should be followed by a corresponding release of insulin. In diabetes, the release does not occur causing the blood sugar levels elevate. As a consequence, illness often requires an adjustment of the individual’s usual insulin prescription.. If you are taking Humalog, taking a higher dose may not remedy the situation. Since the liver generally outputs the glucose over a prolonged period of time, Humalog is not likely to last long enough. Many patients have found that they need either to take an extra dose of Humalog every 2 hours or they need to temporarily add Regular insulin.
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