Recent Comments:
Diabetes control has improved dramatically in U.S.
The Diabetes Blog
Jun 27th 2007 8:45AM Just some observations:
1. Here is a more complete report by Quest Diagnostics, although it isn't a full scientific journal article: http://www.prnewswire.com/mnr/quest/28709/docs/Key_Facts_and_Findings_06.21.07_FINAL.pdf . I does break down the numbers a little though.
2. Lili, I wondered too if any of the drop in A1c might be attributable to a lowering of the thresholds for when you are considered a type II diabetic. I am not type II so I am not as up on the subject, but it seems to me like they are always lowering the requirements. If you are catching more people earlier, it seems like you would see lower A1c's. The article did show a decrease for type 1, too, so I don't know.
3. Melody - My last A1c cost $24 before insurance. My clinic has the machines that take a fingerstick and you get the readings in about 8 minutes, rather than having a blood draw done at the lab.
Basulin is better for avoiding hypoglycemic events
The Diabetes Blog
Jun 12th 2007 8:27AM Bettercell,
From my limited understanding of of the FDA works, I would say that this one is still in development, having just completed Phase IIa. I suspect that means there will be another phase II study and then a larger phase III study to work out safety and efficacy.
I love you, you're perfect, now change
The Diabetes Blog
May 25th 2007 8:26AM Bettercell, I am not sure that C-peptide and the other pancreatic peptides found in earlier animal insulin preparations weren't at least partly to blame for the allergic reactions people experienced. While porcine insulin only deviates from human insulin by one amino acid (which is no more than any of the analogs differ from human insulin, I might add), porcine C-peptide only shares about 70% the structure as its human counterpart. Newer, "more pure" animal insulins do produce fewer allergic reactions, but that purity is based on the removal of the other components besides the insulin molecule.
All that said, I 100% agree with you that c-peptide should be made available in a separate vial. Once that patent is expired, maybe the pharmaceutical companies will try to start making combo products to get a new drug that they can charge more for.
Type 2 + GM Insulin Antibodies = Insulin Dependent Diabetes
The Diabetes Blog
May 8th 2007 11:26AM I don't pretend to be an expert on type 2 diabetes, but I suspect that some doctor's prescribe insulin to type 2 patients with the intent to prolong beta cell function. Similar to the reason those with type 1 are prescribed insulin during the honeymoon period, the thought might be to extend the life of these cells by taking some of the pressure to produce insulin off and prevent "burn out". This is merely a conjecture on my part, but I just want to put it out there that there might be forces working in both directions. What needs to be proved is which is of greater clinical significance.
Not to say that Bettercell doesn't make a very valid point. I think diet and exercise modifications are probably most effective alone before the disease has progressed too far, so I would really like to see better screening for type 2.
Driver's Education for Insulin
The Diabetes Blog
May 1st 2007 7:14PM Hi Allie,
I am glad that animal insulin appears to be working so well for you so far. No more than 20 mg/dL change? Awesome!
I honestly never gave the subject of animal insulin much thought before. The financial considerations are definitely interesting. I am finding that it is very important in developing countries since despite GM insulin's initial claims, animal insulins remain much more economical. Makes a big difference in a country like India where health insurance is a rarity.
One thing I am wondering about though is the "purity" of your highly purified porcine insulin. It seems that the purity specifically relates to the proinsulin concentration; namely, an insulin can only claim to be pure if it has 10 ppm or less of proinsulin, and most these days have
Stem Cell Research Bill - Government through Guilt
The Diabetes Blog
Apr 21st 2007 8:46PM Thank you, TechRightGuy, for your support.
I admit that I wonder about the wisdom in continuing to discuss this subject with someone who does not offer the same amount of proof that he himself requires of others (and for some time now, I might add). I feel that I have kept an open mind, but it is hard to listen to someone’s ideas when you aren’t even sure what they mean half the time, and do not care to provide clarification when asked. A good discussion, like I feel I can get with talking to others who comment here, should really be a method for improving the understanding of both parties. I don’t feel as if I have been able to learn anything from this discussion, beyond what I have learned through my own research. I feel at least one more reply is in order, since I did promise to answer some questions directed at me. Whether my wisdom will get the better of my desire to debate, I will have to see.
Thanks again for your kind words.
P.S. Mr. Gracey, I wonder if you have had time to peruse the comments I left over at http://www.thediabetesblog.com/2007/04/03/the-honeymoon-period/ concerning the Diabetes Control and Complications Trials, since it is most applicable to your claims concerning Transient Supernormal Glycemia. They have gotten pushed down far on the blog, I know, so I can understand if you have missed them.
Is Human Synthetic Insulin a Cock Block?
The Diabetes Blog
Apr 17th 2007 4:10PM Hey Scott,
I totally agree, and I believe that is what I was trying to say in my first comment, however inarticulately. I guess now I am just curious how many of the differences between porcine, bovine, and human insulin is due to the difference in the structure of the actual insulin molecule, vs what is due to all the "impurities" in the mix, which may be beneficial molecules, like the C-peptide.
Thanks, Emily
Is Human Synthetic Insulin a Cock Block?
The Diabetes Blog
Apr 17th 2007 1:14PM Thanks for the info, BetterCell! Although I am not yet sure which I would chose (I don't eat meat for one thing), but I am disappointed that animal insulins aren't even an available option in the U.S. anymore, especially since the reasons were probably economic. True, you can import them, but that is a lot of legwork, and people should have the choice.
Is Human Synthetic Insulin a Cock Block?
The Diabetes Blog
Apr 17th 2007 10:49AM While it looks like there may be benefits to pork insulin there are a few questions that come to my mind:
1) Didn't some people have allergic reactions to porcine and bovine insulin? I was diagnosed in the 90's so there really wasn't much information on it, but how big of a problem was that really?
2) How variable is the potency of insulin derived from animal sources vs rDNA origin? Is there better control over the end product when this stuff is created in a lab?
3) What is the action profile of the animal derived insulins? I ask could we be limiting ourselves to an insulin that doesn't really match our food intake? I think most people have found that they prefer faster acting analogs (Novolog, Humalog, and Aphidra over Regular) and longer acting insulins that provide a truer basel source of insulin (Lantus and Levemir vs. NPH).
Perhaps we should be looking to modify rDNA based insulin based on something in porcine insulin. Is there a way to get the benefits of porcine insulin with the tools we have for manipulating human insulin?
The Honeymoon Period
The Diabetes Blog
Apr 16th 2007 6:49PM Nick, In response to your comment #3 above on “Transient Supernormal Glycaemia”
You have talked repeatedly on the subject “Transient Supernormal Glycaemia”, which you state is healthy condition seen in response to stress (where I take it that stress encompasses liberal nutrition, illness, and the use of at least some medications).
Seeing as this is a new theory to me, I will need to start by defining the terms. Supernormal glycaemia would refer to above average blood glucose, correct? (Also called hyperglycemia) What is our definition of “normal” or average blood glucose? (a mean value or range is ok) I have heard 70-110 mg/dL is average fasting range in a normal population. In the practical guidelines I have been given a rise 40-60 mg/dL after meals is acceptable and present in non-diabetics. How high then is Supernormal? Is there a cap to how high you can go above normal and still be “healthy”?
The other part of this term is “transient” which indicates that the supernormal glycaemia comes and goes, and is not present at all times. I will reference my own numbers – at diagnosis my HbA1c was 17.8, which roughly calculates to an average mean glucose of 550 mg/dL over a period of 2-3 months. With an average that high, how transient would supernormal glycaemia was? Since the term transient is somewhat subjective, would you further illuminate your meaning by describing the frequency and duration you describe? If I am to believe the numbers I had at diagnosis, I believe that my case was more one of “Sustained Supernormal Glycaemia”. Others I have spoken to with type 1 have related similar test results at diagnosis. At your request I will happily see if there are any peer reviewed papers that discuss the average blood glucose in type 1 diabetes at diagnosis.
The next part of your statement is that TSG is a “healthy” response of a stress adapted individual. The benefits you describe include protecting intracellular components from glycation, which they would be subject to if sufficient insulin were made available by the pancreas to let it cross the membrane. Could you please describe how this would manifest as symptoms in the patient? Since there are people who consistently have lower HbA1c’s than others (we tend to call them non-diabetics) then there is a population of people who experience less TSG, and they are likely to exhibit more or some sort of illness due to the lack of protection. Is there any evidence of non-diabetics (less TSG protection) suffering from some condition more than diabetics (more TSG protection).
Let’s examine the side effects of this protection which include “… distributing glucose to nerve cells [without insulin receptors]”. Surely, if excessive glucose can damage intracellular components in cells with insulin receptors, then they may also do so in those without insulin receptors? This is interesting because one of the most frequent complications of diabetes is in fact nerve damage, or neuropathy. I would suggest you look into the Diabetes Control and Complications Trials (DCCT) which was a multi-center trial carried out from 1983-1993 comparing conventional insulin therapy (1-2 shots a day) with intensive therapy (3-4 shots a day) in 1441 patients. The intensive therapy group had a mean HbA1c of 7.1 and the conventional therapy group a mean HbA1c of 8.9. In addition to HbA1c the intensive therapy group had significantly reduced risks of eye disease, kidney disease, and neuropathy.
I will send you to the following webpage, which has kindly amassed links to no less than 57 articles (the majority of them peer reviewed) discussing the significance of the results: http://www.bsc.gwu.edu/bsc/studies/dcctbib.html
Feel free to assess the data and draw your own conclusions, but it seems to me that risk of complications is correlated to higher HbA1c and that would suggest that “Transient Supernormal Glycaemia” is indeed very unhealthy. This is not to say that intensive insulin therapy does not have its drawbacks, namely hypoglycemia. I think that is, however, that is due to the imprecision associated with administering insulin in a few discrete injections on the basis of limited blood glucose data, rather than continuously in direct relation to blood glucose concentration as one’s own islet cells can do.
Sincerely,
Emily
