Preventing Diabetes

"When I got the news [that he is potential candidate for Type 1 diabetes], I was devastated. I hope it doesn't come to me, and I really didn't want it to come to him [his five-year old brother living with Type 1 diabetes]."
Hayden Murphy, 13, Plainfield, Illinois 

AP Photo / Nam Y. Huh  Weston Murphy, 5, who has Type 1 diabetes, pricks his finger to test his blood at his home in Plainfield, Ill. His oldest brother is among more than 400 children and adults participating in U.S. government-funded international research

"Does it [a proposed new protocol] prevent indefinitely? Does it slow it down, does it delay diabetes? That also would be a pretty big win."
Dr. Louis Philipson, endocrinologist, University of Chicago

"We know so very little about the exact mechanisms that cause Type 1 diabetes."
"For the most part, it's really shooting an arrow into a field and hoping one of the arrows hits a target."
Dr. Desmond Schatz, medical director, University of Florida Diabetes Center

Before the discovery of injectable insulin, a hormone that is produced by the Islets of Langerhans in the pancreas, to compensate for the body's inability to produce its own insulin to turn the food we eat into energy, a diagnosis of Type 1 (once called Juvenile-Onset Diabetes) diabetes was as good as a death sentence. The afflicted person would simply waste away, his body incapable of utilizing the glucose that absent insulin could no longer turn into energy for the brain and the body to function.

When Canadian doctors F.G. Banting and C.H. Best working out of a small, ill-equipped laboratory at the University of Toronto with J.B. Collip under the supervision of J.J.R. MacLeod successfully unravelled the mystery of how insulin-dependent diabetics could learn to cope with their disease by injecting daily amounts of insulin to transform food into the energy source it is intended to be by nature, that death sentence was removed. People with diabetes, since 1921, have been able to evade death through control of their diabetes.

Clearly, there is a genetic disposition inherent in acquiring diabetes; as much for Type 1 as there is for Type 2, though  the latter type is considered a lifestyle disease, and the former a mysterious affliction whose cause is not yet quite understood. Each can be life-threatening if not kept under control, but the issue of control, again, is a difficult one. In the case of mature people with Type 2 diabetes, the requirement is to alter habits; in the instance of Type 1 diabetes, the critical requirement is to carefully follow the protocol of an imperative of careful injection measurements.

In either case, people living with diabetes face a far more complicated life than those without diabetes; they are more susceptible to heart disease, to neurological damage, to eyesight impairment in the long term. In the short term they must balance their daily requirements of blood sugar levels ascertained through constant blood-chemical readings, to determine the intake of insulin required to achieve a balance of moderation; a difficult tightrope.

Medical scientists have grappled with the mysteries surrounding diabetes and its management, and hopes for prevention, along with the possibility of finding a cure for decades. The more common of the two types of diabetes is Type 2 by far, affecting millions upon millions of people globally. Tens of millions of people live with Type 1, far fewer, but still significant numbers, and the difference is that Type 1 usually strikes young children or teens who must learn to live with diabetes, with the help of their families. It does become a family affair.

Poorly controlled blood sugar leads to either hyperglycemia or hypoglycemia; too low blood sugar counts or alternately, too high. Prolonged low blood sugar can lead to episodes of frightening seizures like grand mal attacks in people with epilepsy, and can in fact lead to death if the person is unable to be revived. Hypoglycemia means the brain is starved temporarily of glucose and cannot function well; if 'warnings' are not heeded and a source of glucose immediately taken, the condition swiftly plunges leading to increased deterioration.

In the case of 13-year-old Hayden, one of 400 children and adults taking part in a new U.S. government-funded international study, Hayden has the example of his five-yer-old brother who was previously diagnosed with diabetes. More recently Hayden received the news that results of a blood test indicate he may also develop diabetes. The decision was taken to enroll him in the study to attempt to ascertain whether an experimental new insulin capsule is capable of preventing or delaying the onset of Type 1 diabetes.

An earlier, smaller study involving a different set of researchers whose results were published in the Journal of the American Medical Association, felt that children who took insulin pills experienced immune system alterations the researchers felt might help in preventing diabetes. A newer, larger study has randomly assigned its participants for experimental insulin capsules or alternately to take placebos to compare the effects.

Typically, people in middle age who are sedentary and who gain more weight than is healthy are  targets for diabetes onset of the Type 2 variety. Medication to stimulate the body's use of insulin that their bodies still produce can help them balance their blood sugar levels; alternatively, if they can be convinced to eat moderately and more healthfully and exercise, control may be achieved in this manner.

For Type 1 diabetic children control is far more complex and for obvious reasons; there is no natural insulin production; it is hypothesized that a viral infection could be responsible for the pancreatic breakdown of insulin production; it could trigger the body's own immune system to go into action, and when it does, it erroneously targets its own organs, like the insulin-producing pancreas.

The hope is that insulin pills could be used, if the study proves them to be effective, to constrain the immune system from attacking the pancreas. Researchers feel that by taking insulin by mouth for it to be digested like food, the faulty immune system might react to the circulating insulin by not attacking the pancreas. As for a treatment for diabetes management by swallowing insulin pills; the fear is it would be digested and its properties degraded.

Research is ongoing. Life would be infinitely simpler and far more pleasant for people suffering from diabetes if a more congenial and life-assuring protocol could be found to enable them to live more comfortably with their non-functioning pancreas.