Comments on: Diabetes: Past, Present, Future http://www.solvingdiabetes.org/2009/07/27/diabetes-past-present-future/ A site dedicated to solving diabetes. Sat, 14 Aug 2010 23:12:33 +0000 http://wordpress.org/?v=2.9.2 hourly 1 By: JPMarat http://www.solvingdiabetes.org/2009/07/27/diabetes-past-present-future/comment-page-1/#comment-61 JPMarat Tue, 28 Jul 2009 00:40:05 +0000 http://www.solvingdiabetes.org/?p=276#comment-61 The better fate of diabetics on the old regimen of multiple doses per day of fast-acting insulin compared with those who added NPH insulin to their treatment raises many interesting issues. I have tried using just Clear insulin to imitate the life of a type 1 diabetic in the mid-1920s and found it impossible to achieve anything other than a huge blood glucose level, primarily because the effect of short-acting insulin ran out over night. One theory about why those on the Clear insulin regimen did better than patients later taking NPH plus Clear is that the former patients experienced one or more hypoglycemic episodes every day by having nothing other than an iterated insulin bolus treatment available to them, and this may have interrupted the processes by which hyperglycemia causes vascular damage. A smoother blood sugar profile, in contrast, may have allowed these processes to continue without interruption. This explanation is inconsistent, however, with recent research, which shows that glucose homeostasis seems to be nearly as important to patient health as more normal glucose levels. Since solid organ transplant immunosuppressive triple-therapy now quadruples the incidence of cancer among organ recipients, as well as increasing their risk for atherosclerosis, neuropathy, dyslipidemia, and liver disease -- to name just a few conditions -- it is obviously foolish to trade diabetes for any treatment requiring immunosuppression unless the patient already requires an organ transplant for other reasons. The shortage of human islets or pancreatic tissue for transplant further strengthens the case against this approach. Only efforts to treat diabetes by encasulated islets seem to offer reasonable hope for the immediate future. The better fate of diabetics on the old regimen of multiple doses per day of fast-acting insulin compared with those who added NPH insulin to their treatment raises many interesting issues. I have tried using just Clear insulin to imitate the life of a type 1 diabetic in the mid-1920s and found it impossible to achieve anything other than a huge blood glucose level, primarily because the effect of short-acting insulin ran out over night. One theory about why those on the Clear insulin regimen did better than patients later taking NPH plus Clear is that the former patients experienced one or more hypoglycemic episodes every day by having nothing other than an iterated insulin bolus treatment available to them, and this may have interrupted the processes by which hyperglycemia causes vascular damage. A smoother blood sugar profile, in contrast, may have allowed these processes to continue without interruption. This explanation is inconsistent, however, with recent research, which shows that glucose homeostasis seems to be nearly as important to patient health as more normal glucose levels.

Since solid organ transplant immunosuppressive triple-therapy now quadruples the incidence of cancer among organ recipients, as well as increasing their risk for atherosclerosis, neuropathy, dyslipidemia, and liver disease — to name just a few conditions — it is obviously foolish to trade diabetes for any treatment requiring immunosuppression unless the patient already requires an organ transplant for other reasons. The shortage of human islets or pancreatic tissue for transplant further strengthens the case against this approach. Only efforts to treat diabetes by encasulated islets seem to offer reasonable hope for the immediate future.

]]>