Wednesday, August 28, 2013

More Type 2 Than Type 1 Insulin Users

There is an estimated 30 million people in the US who have diabetes. (This estimate appeared several years ago, so I'm sure it is a larger number now.) Approximately 10% are type 1, and 90% are type 2. That means there are 3 million people with type 1, and 27 million with type 2. All type 1 diabetics are completely insulin dependent, so that's 3 million insulin users who are type 1.

The following link reveals that more than 40% of type 2 diabetics use insulin. That means there are approximately 10.8 million type 2 diabetics who use insulin in the US. So there are more than 3 times as many type 2 insulin users, when compared to the 3 million type 1 insulin users.

It should be pointed out that type 2 diabetics who use insulin are not usually insulin dependent. Many of them need basal insulin to avoid high fasting numbers, but they do not use bolus insulin. They still produce some of their own insulin and do not require both basal and bolus insulins. There are type 2 diabetics, however, who need both basal and bolus insulin. There are at least two of my online friends who are type 2, and use an insulin pump, as well as a CGM.

Tuesday, August 13, 2013

Joslin 50 - Year Medalist Study

The following is the 2012 update of the Joslin 50 Year Medalist Study. It may be of interest to many of my Facebook friends. I participated in the Study in Dec, 2009. I copied and pasted this report. The report says there have been 550 participants, but there have been more than 850 participants. I think that may be the only error in the report.

"50 - Year Medalist Study Background

Hyperglycemia is a major cause of diabetic vascular and neuropathic complications. However, a significant number of diabetic patients, known as the Joslin 50-Year Medalists, remain free from various complications such as nephropathy and proliferative retinopathy after 50 years or more of diabetes.

Joslin Diabetes Center’s 50-Year Medal Program recognizes individuals who have lived with insulin-dependent diabetes for 50 or more years to honor their accomplishments in diabetes management.

For the first time, a large number of individuals who have survived fifty or more years with type 1 diabetes are being studied to determine factors, which may allow them to be resistant to the ravaging effects of diabetes. With support from JDRF, the Joslin Diabetes Center in Boston is currently studying Medalists from within the United States in an effort to identify these factors. We have been characterizing genetic, environmental, psychological and physiological factors, which may contribute to survival with extreme duration of diabetes. The Medalist population provides a unique opportunity to study individuals with extreme duration of diabetes.

In the first phase of the study, which took place seven years ago, we asked Medalists to complete an extensive medical history questionnaire and provide some laboratory data from their doctor. The results from these questionnaires and lab results provided the very interesting finding that close to 50% appear to have escaped serious complications, which occur in almost all diabetic patients by 30 years of duration. These complications include eye disease (retinopathy), kidney disease (nephropathy) and nerve disease (neuropathy). The results showed that as a group, Medalists have controlled their blood glucose levels very well for many years. In addition, hemoglobin A1c, a measure of chronic glucose control, does not seem to correlate with the various complications described above. These are very exciting findings which have been published in the journal Diabetes Care in 2007.

In the five years since the start of the second phase of the Joslin 50-Year Medalist study, we have studied approximately 550 Medalists with the support of JDRF. These Medalists traveled to Joslin Diabetes Center in Boston for the study. We have been examining the status of complications with respect to eye, kidney, nerve and heart function. Metabolic changes in blood and the ability to produce insulin in the Medalists are also studied. Genetic studies are underway to determine whether these extraordinary survivors have typical type 1 diabetes or a different, yet unknown type of diabetes. Data from over 500 people have been analyzed and have led to very exciting discoveries. These new findings have shown that most Medalists have clinical and laboratory findings consistent with “typical” type 1 diabetes. This includes genetic factors as well as other clinical characteristics, such as weight, high good cholesterol levels and relatively low body weight. The eye studies, which took pictures of the back of the eye, showed that about 40% of the Medalists do not have serious eye disease even after 50-80 years of type 1 diabetes and less than 10% of the Medalists have any kidney problems. From a complications point of view, these findings are very exciting since they showed that 40% of the Medalists have factors or genes, which are protecting the Medalists from developing diabetic eye disease.

In addition to the exciting findings regarding diabetic complications, the results from the Medalists have also yielded an unexpected finding regarding pancreatic functions. Surprisingly, over 66% of Medalists appear to still produce some insulin. This finding can be important and exciting since it suggests that some type 1 diabetic patients may still make insulin even after 50 years of diabetes. These findings have been confirmed through metabolic and post-mortem studies of generous Medalists. This raises the possibility that many type 1 diabetes patients have protection from beta-cell destruction. While our results so far have been promising more participants are needed to complete the picture of how 50-Year Medalists are able to defy the odds remaining free of complications and retaining some insulin production."

Saturday, August 3, 2013

Testing Type 1 Children At Night

I recently read posts made by moms of type 1 children. They are upset by a blog that appeared suggesting that moms are spoiling their children by testing them during the night, while they are sleeping.The blog was written by someon on the Diabetes Mine blog site. The quote stated that "“Yes, I think the new D-parenting style has created a generation of ‘spoiled brats.’”

In my opinion it is appropriate, and necessary, to test the children at night. I test myself at 1, and 4 AM as a 73 year old adult. If I don't I see occasional lows or highs then. Failing to catch one of the lows could result in a seizure, and not catching a high might cause keytones. I have not needed assistance with any highs or lows in many years because I test 12-15 times per day, including the nights. The more frequently I test, the more stable my control. My insurance no longer covers a CGM, so testing is very important.

Type 1 children have added complications of growth spurts, hormones, strenuous exercise, and irregular day to day schedules. I do not have those added factors in my situation, so I am more stable, but there are still some unexpected highs and lows. My schedule is very regular while I am retired. I usually eat, exercise, sleep and relax at the same times every day. That kind of consistency helps so much to keep my blood sugar in my desired range, but there are highs and lows that will sometimes occur when my schedule is disrupted. A child's schedule cannot be expected to be so routine like mine, so frequent highs and lows make frequent testing necessary...even at night.. I don't know why the blogger thinks it is unnecessary to test children at night, and that parents are spoiling them by testing then.

I have been T1 for 67 years, diagnosed in 1945, when I was 6. There was no meter to check blood sugar for my first 40 years. My mother had to rely on hearing me moaning and thrashing around in bed, across the hall from her bedroom. My hypos and seizures were frequent back then. I admire my parents for taking good care of me, and can only imagine the anxiety and worry they must have had, not having a clue when I was dropping low during the night. I am sure that my mom would have tested me during my sleep if there were meters available back then.