Scientists are trying to figure out how to transplant islet cells and then protect them from the patient’s immune system so that long-term immunosuppressive medications aren’t required. Micro encapsulation is an approach scientists are testing to find out if a special coating to the transplanted islets can help the patient avoid rejection of those islets. These coatings let in nutrients to nourish the cells but prevent your body’s immune system from attacking them.
It is also known as insulin-dependent diabetes mellitus (IDDM) and results from body's inability to produce insulin. Usually, it occurs in childhood or adolescence, but can surface up at any age. In this, the patient needs to take insulin injections on regular intervals (generally daily) in order to absorb glucose in the body. Type 1 diabetes mellitus is also referred to as juvenile diabetes, at times.
A randomized, sham-controlled, crossover study of 50 adults with type 2 diabetes evaluated the effectiveness of Percutaneous Nerve Stimulation (PENS) therapy in the treatment of neuropathic pain. PENS is a modern adaptation of acupuncture that uses percutaneously placed acupuncture needles to stimulate peripheral sensory and motor nerves innervating the region of neuropathic pain. The results showed that active PENS treatment improved neuropathic pain symptoms in all patients. In addition to reducing pain, the treatment improved physical activity levels, sense of well-being, and quality of sleep and reduced oral non-opioid analgesic medication requirements.2
“These findings are very exciting. They could revolutionize the way type 2 diabetes is treated. This builds on the work into the underlying cause of the condition, so that we can target management effectively,” lead researcher Roy Taylor, from the Newcastle University, told The Guardian. Interesting, indeed, as many of the current treatments for type 2 diabetes involve medication and even surgery to restrict stomach capacity.
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings through its clearinghouses and education programs to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
Metformin: The DPP study found that metformin, the safest first-line therapy for type 2 diabetes, may help delay the onset of type 2 diabetes in people with prediabetes. Participants who took the low-cost generic drug had a 31% reduced risk of developing type 2 diabetes compared to the control group (those not on metformin or intensive lifestyle intervention). Again, 15-year follow up data showed that 17% of those on metformin continued to have a significant reduction in type 2 progression. At this time, metformin (or any other medication, for that matter) is not currently FDA approved for prediabetes, and it is sometimes prescribed “off-label” by a healthcare provider. Your healthcare provider can give you more information and determine whether metformin is a good option for you.
The advice above is therefore not only illogical, but also works poorly. It completely lacks scientific support according to a Swedish expert investigation. On the contrary, in recent years similar carbohydrate-rich dietary advice has been shown to increase the risk of getting diabetes and worsen blood sugar levels long-term in people who are already diabetic. The advice doesn’t improve diabetics’ health in any other way either.
Currently, people with diabetes who receive a transplanted pancreas (typically not possible unless you are also having a kidney transplant) or who receive islet-cell transplants as part of a research study in the US must take these drugs so that their own body won’t attack the new cells. The drugs work, but raise risk for bacterial and viral infections as well as for mouth sores, nausea, diarrhea, high cholesterol, high blood pressure, fatigue and even some cancers.
Diabetes is one of the most prevalent chronic diseases in the United States. The morbidity and mortality associated with the disease is significant and derives primarily from complications of persistent hyperglycemia. Longstanding hyperglycemia has been shown to lead to vascular complications involving large and small blood vessels, such as arteriosclerosis, glomerulosclerosis, and retinopathy. Diabetic neuropathy, characterized by pain and paresthesias, is among the most frequent complications of longstanding, poorly controlled diabetes and is often associated with a reduction in physical activity and with sleep disturbances.1,2
Metformin is a type of biguanide and it is currently the only biguanide available in the United States. It is often the first oral medicine prescribed for someone newly diagnosed with diabetes. It has the advantage of not causing low blood sugar. Metformin does not cause your pancreas to make insulin, but it helps your body use insulin better. Metformin can cause side effects such as nausea or diarrhea in some people. Your doctor may prescribe metformin in combination with another oral diabetes medicine.
Glucose in the bloodstream passes through the kidneys, where it can either be excreted or reabsorbed. Sodium-glucose transporter 2 (SGLT2) works in the kidney to reabsorb glucose, and a new class of medication, SGLT2 inhibitors, block this action, causing excess glucose to be eliminated in the urine. Canagliflozin (Invokana), dapagliflozin (Farxiga), and empagliflozin (Jardiance) are SGLT2 inhibitors that have been approved by the FDA to treat type 2 diabetes. Because they increase glucose levels in the urine, side effects can include urinary tract and yeast infections.
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Even as things stand now, there are a lot of people left out in the cold. A 2016 study, for instance, found that only 41,000 people with diabetes annually get bariatric surgery in the US—fewer than 5 percent of the total new cases diagnosed every year. And the longer someone has diabetes, studies have suggested, the less likely they are to go into remission if they eventually get surgery. Getting those numbers up will not only require changing the minds of insurers, but public opinion, too.
Because the drugs listed above act in different ways to lower blood glucose levels, they may be used together. For example, a biguanide and a sulfonylurea may be used together. Many combinations can be used. Though taking more than one drug can be more costly and can increase the risk of side effects, combining oral medications can improve blood glucose control when taking only a single pill does not have the desired effects. Switching from one single pill to another is not as effective as adding another type of diabetes medicine.
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Sulfonylureasmay increase the risk of death from cardiovascular disease. Prolonged exercise and alcohol intake increase the risk for hypoglycemia. Patients undergoing surgery or who have had recent trauma, stress, or infection may need to switch from a sulfonylurea to insulin to manage blood sugar levels. People with kidney or liver disease need to take precaution.
In another study, albeit including only 30 people, those who were recently diagnosed and went on a very low-calorie diet for eight weeks experienced remission. That remission continued more than six months after their low-calorie diet ended. In people who have had type 2 diabetes for a long time, unfortunately, weight loss has a much more limited impact.
The chart above gives averages. Follow your doctor’s advice on when and how to take your insulin. Your doctor might also recommend premixed insulin, which is a mix of two types of insulin. Some types of insulin cost more than others, so talk with your doctor about your options if you're concerned about cost. Read about financial help for diabetes care.
Can prediabetes be “cured”? In the early stages of prediabetes (and type 2 diabetes), diligent attention to food choices and activity, and most importantly weight loss, can improve blood sugar numbers, effectively “reversing” the disease and reducing the odds of developing type 2 diabetes. However, some people may have underlying factors (such as family history and genetics) that put them at a greater risk of type 2 diabetes, meaning they will always require careful attention to blood sugar levels and lifestyle choices. Returning to old habits will likely put someone back on the road to prediabetes, and eventually, type 2 diabetes.
Another study published in the same journal, however, examined the effect of chromium on glycemic control in insulin-dependent people with type 2 diabetes. People were given either 500 or 1,000 mcg a day of chromium or a placebo for six months. There was no significant difference in glycosylated hemoglobin, body mass index, blood pressure, or insulin requirements across the three groups.
Curcumin is a bright yellow chemical produced by the spice turmeric, among other plants. Curcumin seems to have multiple benefits for diabetes symptoms. It has been shown to be a marked inhibitor of reactive oxygen species that promote oxidation damage in cells. Curcumin lowers inflammatory chemicals like tumor necrosis factor-alpha, and that’s good because TNF-a causes insulin resistance and irritates fatty livers. Curcumin can reduce another pro-inflammatory chemical called NF-KB. The above-mentioned actions provide a benefit in diabetes protection and reduce the risk of developing diabetes symptoms and complications. Curcumin has also been shown to enhance pancreatic beta cell functioning and reduce fatty liver deposition. It reduces high blood sugar, A1C, and insulin resistance. It was also shown to reduce the onset of Alzheimer’s disease, and that is a higher risk in diabetic patients than in nondiabetic patients. A good dose is 200 to 3,000 mg a day.
You might hear of alternative or complementary treatments, such as herbal remedies and vitamin or mineral supplements. Although research continues into their possible benefits, studies thus far haven't proved their effectiveness. They also could be dangerous for kids and teens with type 1 diabetes, especially if used to replace medically recommended treatments. Talk to the diabetes health care team if you have questions.
If you have gestational diabetes, you should first try to control your blood glucose level by making healthy food choices and getting regular physical activity. If you can’t reach your blood glucose target, your health care team will talk with you about diabetes medicines, such as insulin or the diabetes pill metformin, that may be safe for you to take during pregnancy. Your health care team may start you on diabetes medicines right away if your blood glucose is very high.
A number of companies are attempting to be the first to produce an artificial pancreas system. An artificial pancreas is likely to be worn outside of the body and would continuously measure blood glucose and deliver an appropriate amount of insulin. It would not necessarily be a cure, but would represent a way of treating type 1 diabetes without injections and without the continual dosing decisions.
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Kelly Prinkey-Krupinski, 48 and an avid dog lover, has been struggling with adult onset Type 1 diabetes for 12 years. She said the disease runs her life. “It is a constant struggle,” she said. “My mind is always aware that every bite of food that I eat, every medicine I take, every illness and emotion I experience will affect my blood sugar. There is never a vacation from the constant balancing act to stay alive. It scares me to think of a time when I can't obtain the insulin that I must take 24-7. I would pray that there will be a cure in my lifetime. I just hate to think of the kids that struggle with Type 1 diabetes. This research with dogs sounds promising. As a dog lover myself, I would love to see if our canine friends can be cured. I'm excited to see the results.”
Big pharma are in the early stages of developing their own cell therapy approaches for diabetes. Novo Nordisk, one of the largest providers of diabetes treatments, is bidding for stem cells and an encapsulation device, stating that the first clinical trial could take place in the “next few years.” Sanofi, also a big name in diabetes, is working with the German Evotec in a beta cell replacement therapy for diabetics.