Is a functional cure for Type 1 Diabetes on the horizon? | Paul Laikind | TEDxSanDiegoSalon
What’s on the Horizon for Type 1 Diabetes?
In order to keep blood sugars in a safe range, people who have type 1 diabetes need to take insulin with every meal. While the insulin products that are currently available do a very good job of helping to manage blood sugar, they still have drawbacks. For one, they don’t act fast enough to match the rapid rise in blood sugar from a carbohydrate-loaded meal. Also, our bodies need a small amount of insulin working in the background at all times to prevent the development of a dangerous breakdown of fat that can lead to diabetic ketoacidosis, a buildup of toxic blood acids called ketones. None of the currently available insulin products consistently last a full 24 hours in type 1 diabetes.
If a person takes more insulin than necessary to offset the amount of carbohydrates consumed, blood glucose levels can drop too low, a condition known as hypoglycemia. In mild cases, symptoms may include dizziness, hunger, shaking and sweating. In severe cases, low blood sugar can cause weakness, lack of coordination, and loss of consciousness, all of which can lead to dangerous falls. Some people may go into a coma, which can trigger an irregular heartbeat and some types of inflammation which can damage organs and tissues.
A number of pharmaceutical companies are now working on newer forms of insulin that work much more quickly and others that last much longer, with a very consistent slow release into the body over a full 24-hour period. These products more closely mimic the way our pancreas would normally produce and use insulin to prevent dangerous swings in blood sugar levels. People would still need to use insulin with meals, but it would better match the rise in blood glucose levels and greatly reduce the risk of hypoglycemia. Some of the new long-acting insulin on the horizon would even allow someone to miss a dose and still maintain control of blood sugar the following day.
Smarter Insulin Pumps
Currently, people with type 1 diabetes need to test their blood glucose levels several times a day and then inject insulin, often via a pump with an insertion site implanted just under the skin, to keep blood sugar stable. In several years, however, the whole process may be automated by an “artificial pancreas” currently being developed by a number of scientists. The device would continuously monitor blood glucose levels and automatically deliver the right amount of insulin when needed.
The latest artificial pancreas models being tested have two separate devices that are inserted just under the skin. The measuring device is responsible for testing glucose levels and communicating them to the pump device, which would calculate the amount of insulin needed and infuse it at the appropriate rate to bring blood sugar levels back into a safe range. If levels get too low, the pump device would slow down the infusion rate. Some models being tested would also have the ability to inject glucagon, a hormone normally secreted from the pancreas that counteracts the effects of low blood sugar.
While the research has been promising, there are still several barriers to real-world use. We have the two separate pieces—the monitor and the pump—but researchers have not yet determined how to get them to “talk” to each other. A human is still needed to look at the monitor value, figure out how much insulin is needed, and push the pump button. The goal is to put the two pieces together and connect them with an automated algorithm.
There are other concerns as well. The current monitor measures the glucose level in the interstitial fluid—the fluid between the tissues of the skin—rather than the true blood glucose level. Glucagon is not stable for more than a few hours, and would have to be changed out of the pump several times a day. However, researchers are much closer to an artificial pancreas than ever before, and are optimistic about resolving these issues within the next several years.
There are other potential therapeutic options that may translate into successful therapies in the future, and research in humans is just getting underway to test their safety and effectiveness. These include pills that reduce blood sugar through excretion into the kidneys and urine, as well as biologic solutions which provide a replenishable source of functional insulin-producing cells. The latter are encapsulated in a package that acts as a barrier to the body’s immune system and is placed under the skin surface.
These studies are still in the early stages and final results are years away, but these exciting new options continue to offer hope for better, easier and more physiologic improvement of blood sugars in patients with type 1 diabetes. Patients who are interested in moving the needle forward on new discoveries might consider participation in clinical research studies in their region, which offer opportunities to try new approaches and assist in finding solutions for the future.
Athena Philis-Tsimikas, MD, is a board certified endocrinologist and corporate vice president for the Scripps Whittier Diabetes Institute at Scripps Health in San Diego.
Video: Using Gene-Editing to Cure Type 1 Diabetes
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