Sunday, July 28, 2019

Nasal Glucagon

A new form of Glucagon is now available, through the nose, and not by injection.
"On July 24, the FDA approved Baqsimi, the first non-injectable emergency treatment for severe episodes of hypoglycemia. Submitted for approval by Eli Lilly and Company, this powder form of glucagon is administered into the nose, and comes in a single-use dispenser.
Once administered, Baqsimi works to rapidly increase blood glucose levels by stimulating the liver to release accumulated glucose into the bloodstream.
Glucagon is the standard treatment in situations of severe hypoglycemia, but until now, all approved treatments have come in the form of an injection. Injectable glucagon has been available for several decades, but is not shelf-stable at room temperature and therefore requires mixing a powder and liquid with a syringe, which can be intimidating and prone to user error in emergency situations.
'People who are living with diabetes are at risk of their blood sugar levels falling below the normal range. There are many products on the market for those who need insulin, but until now, people suffering from a severe hypoglycemic episode had to be treated with a glucagon injection that first had to be mixed in a several-step process,' said Janet Woodcock, M.D., Director of the FDA’s Center for Drug Evaluation and Research.
Baqsimi was evaluated in two studies of 83 and 70 adults with diabetes respectively, during which a single dose of the nasal powder was compared to a single dose of glucagon injection. The FDA reported that Baqsimi was satisfactory in increasing blood glucose levels. A pediatric study of 48 patients with Type 1 diabetes also saw similar results.
Notably, Baqsimi does not need to be inhaled and therefore can be administered to an unconscious person suffering from severe hypoglycemia.
'This new way to administer glucagon may simplify the process, which can be critical during an episode, especially since the patient may have lost consciousness or may be having a seizure. In those situations, we want the process to treat the suffering person to be as simple as possible,' added Woodcock, M.D.
Representatives from Eli Lilly have indicated that Baqsimi should be available in U.S. pharmacies within a month. The U.S. list price for a Baqsimi one-pack will be $280.80, which is the same price as injectable glucagon. Beyond Type 1 is hopeful the new drug will be widely covered by all insurance plans that currently cover injectable glucagon.
'Severe hypoglycemia is an unpredictable event for people with diabetes that can happen anytime, anywhere. It’s an experience that can be very stressful and difficult for those helping a person in a low blood sugar emergency,' said Dr. Sherry Martin, Vice President of Lilly Medical Affairs. 'The FDA’s approval of Baqsimi may help people prepare for these moments with an innovative product that has the simplicity of nasal administration.'
According to a press release, Lilly is in discussions with insurance providers to make the nasal glucagon available to as many people as possible. Additionally, the company is offering a savings card through the end of 2020 for patients with commercial insurance to obtain 2 devices for as little as $25.
Patients and healthcare professionals with questions about Baqsimi can visit www.baqsimi.com or call The Lilly Answers Center at 1-800-LillyRx (1-800-545-5979)."
Read the full press release from the FDA by clicking on the link below.

https://www.baqsimi.com/?fbclid=IwAR2NLvlgRSbpFJgm0ycjJwFwxJdYbYx80f47-ohElcx44C-Uc3tJhIODgao

Thursday, July 25, 2019

Joslin Medalists, 2019



The photo shows approximately 150 Joslin Medalists in Boston in May, 2019. There is a medalist meeting in Boston in odd numbered years. Each person in the photo has been a type 1 diabetic for at least 50 years. Some of the medalists shown have been type 1 for 75 years, and a couple of them for 80 years.


Friday, July 12, 2019

Double Diabetes

There were no diabetes "types" when I was diagnosed in 1945. All people diagnosed with diabetes were treated with insulin taken from pigs and cows. That crude form of insulin gave me back my health. In the years 1936-1939 it was discovered that there were two types of diabetes, but it was not until 1959 that the labels Type 1 and Type 2 were attached. Oral drugs for Type 2 diabetics were introduced in the years 1955-1956.
Now, in current times, we are seeing more and more people with
characteristics of both type 1 and type 2 diabetes. These individuals have "double diabetes". This occurs when:
1. A person with type 1 diabetes becomes overweight and develops the basic feature of type 2 diabetes – insulin resistance (IR). Typically, the type 1 diabetic would then use a type 2 medication to help control the IR. Insulin would still be necessary as well.
2. A person with type 2 diabetes has one of the key features of type1– the presence of antibodies in the blood against the insulin producing beta cells of the pancreas causing a decrease in the body's ability to produce insulin. The decreased insulin production can then lead to the type 2 diabetic becoming insulin dependent. These individuals still use their type 2 medication for their IR.
"The term ‘double diabetes’ was first coined in 1991 based on the observation that patients with type 1 diabetes who had a family history of type 2 diabetes were more likely to be overweight and rarely achieved adequate glycaemic control even with higher insulin doses. The more extensive, or stronger, the family history, the higher the dose the patient received."
Double diabetics may have initially been either type 1, or type 2. Once they have become double diabetics they have IR, they are using insulin, and they are using a medicine (usually metformin) for their IR. I have several type 1 friends, and type 2 friends, who are double diabetics. Some of my type 2 friends are using a pump and a CGM.
In the 1990s I stopped using animal insulins, and began using synthetic insulins. I began gaining weight, even though I was following a much healthier diet, and eating fewer carbs. The only thing that had changed was my insulin. I have read many reports that say the synthetic insulins cause our cells to store fat. Maybe that was the reason for my weight gain, but I did not know that information until much later. I had never been more than five pounds above my ideal weight (185) until the 1990s. By the year 1997 I weighed 242 pounds. That was a net gain of 57 pounds. A lower carb intake and plenty of exercise did not seem to help at that time.
Finally, in 1998, I was diagnosed with insulin resistance. I had several relatives with Type 2 diabetes, and it seems likely I was predisposed to become type 2. The predisposition and the weight gain are likely the explanation for my insulin resistance. In the early 2000s I reduced my daily carb intake, increased my amount of exercise, and lost 34 pounds. I initially used avandia for my IR, but started using metformin in early 2011. Using metformin for one year was very good for me. That medication has helped many diabetics lose weight. I lost an additional nineteen pounds, and was only four pounds above my ideal weight. Despite the weight loss, I still had IR. Metformin, eating an average of 140-150 carbs per day, and getting lots of exercise kept me in good health. My A1c's were typically below 6.0, and except for some neuropathy, I do not have any diabetes complications. Double diabetes can be controlled, and my health is just as good now as it was before I became a double diabetic.
A type 1 diabetic with IR has double diabetes, but is NOT both type 1 and type 2. That person is type 1 with a type 2 characteristic. That is not the same as having both types of diabetes.
If you are type 1, you gain a substantial amount of weight, and you have type 2 relatives, you might want to discuss your situation with your doctor. You may have insulin resistance. You may have double diabetes.

Tuesday, July 9, 2019

My Story on Diabetes Mine

In the year 2015, Mike Hoskins published a blog on Diabetes Mine about my life with type 1 diabetes. I sent the article to Mike, and he edited it, including pictures, and a reference to my book. Here is my story on DiabetesMine.com

Wednesday, July 3, 2019

Finding The Right Lady, Our Marriage


I was teaching at Bridgewater College in 1963, in Va. I had a little black book with names of coeds that I had picked from the 1962 yearbook. I showed the list to my dorm mother friend. She looked very carefully at my list and said date this one, her name is Anita, she is wonderful, and forget about the others. That was not my plan, but I agreed to give Anita a call. After a few dates with Anita I was not so interested in calling any more girls, so I just stuck with Anita and Wanda. I dated Wanda on Friday, and Anita on Saturday, Sunday, Monday,..... I guess the dorm mother had hit the nail on the head. Anita was different in a very positive way. Beautiful, so sweet, and I felt very comfortable with her, like I had with Mary Louise. I looked for that little black book one day, and it was gone. I have wondered if the dorm mother had cleaned my room one day. saw my list, and threw it away??? She really did like Anita. I DID TOO!!! I stopped dating Wanda, and Anita and I were going steady. Anita eventually told me that the girls at her dorm had helped her fix her hair, pick out the dress she wore, etc before our first date. I think the whole campus knew we were dating. At that stage I was even dating her on Fridays. Dating every day of the week. I wonder if any other couple ever did that.
I took Anita home with me for the Thanksgiving weekend. Mother loved Anita! Daddy did too! Hey, this is getting serious here!!! Anita and I had already admitted our love for each other. When the semester was over I went home for Christmas, and Anita went to Falls Church, Va to be with her family. It was agreed that I would go to Anita's house the day after Christmas so I could meet her family. Late on Christmas Day a terrific snow storm hit Roanoke. The roads were plowed late the next morning, but the driveway at our house had about 18 inches of snow. My parents insisted that I stay home, and wait to see my sweetie when the spring semester began. They were out of their minds!!! I shoveled the driveway, and packed my car while Mother was screaming at me. I started up the hill on our driveway. Too much ice, it was bitter cold. My tires were spinning, and Daddy helped me put chains on the rear wheels. I still could not make it up that hill. I was about to give up when I saw daddy coming with his tractor. He pulled my car up the hill to the road, and off I went. The roads between Roanoke and Falls Church, Va. were slick and dangerous, but nothing was going to stop me. It took me about six hours, normally it would have been four hours. I found her house, and I met her parents and her brother. Nice people!
That evening we went downstairs to the rec room where there was a fireplace, all warm and cozy. I proposed marriage that evening, and she said yes!!! HURRAY! Months later her Mother said she knew that we were engaged, she could tell by Anita's grin as we walked up the steps. We were going to keep it secret for awhile because we had been dating for less than two months. We planned our wedding for May 31, 1964. We were married after 7 months of courting. We celebrated our 55'th anniversary on May 31, 2019. We have had a wonderful marriage, still going strong!!!
*******************************************
Anita read this chapter after I finished writing it in 2010.. She proofread all my chapters. She said it was to find misspelled words and grammatical errors, but I know she had other reasons as well. She was an English major in college.
She laughed all the way through this chapter.
The first picture below shows Anita when she graduated from high school in 1962. The second shows us with our firstborn, David, 1966.