Replacing humans with computers could make patients better control their sugar levels and suffer less complications in the long term. The French company Cellnovo has already shown that just a partially automated system, where blood sugar levels can be monitored wirelessly but patients still select insulin amounts, can reduce the chances of reaching life-threatening low sugar levels up to 39%. The company is now working towards developing a fully automated artificial pancreas in collaboration with Imperial College, the Diabeloop consortium and the Horizon2020 program.
Q. I have Type 2 diabetes, and I currently take 1,000 milligrams (mg) of metformin twice a day, 5 mg of Onglyza (saxagliptin) once a day, and 5 mg of glipizide once a day. Does it matter when I take the Onglyza and the glipizide? I used to take them both at breakfast, but I thought I might get better blood-glucose-lowering coverage if I took one of them with lunch and one with dinner.
The bottom line is that diabetes can be bad news—but this doesn’t have to be the case. Interventions can prevent or delay the disease in people with prediabetes. The Diabetes Prevention Program (DPP), a large study of people at high risk of diabetes, has established a prevention plan that’s both feasible and cost-effective. The DPP showed that weight loss and increased physical activity reduced the development of type 2 diabetes by 58% during a three-year period.
The core problem is insulin. Most people naturally secrete that substance when they eat something with carbohydrates, such as bread, potatoes and candy bars. Insulin acts like a concierge that escorts the sugar from the bloodstream into the cells, providing the cells with the energy to function. In most people, the body is continually monitoring blood sugar and producing insulin as needed.
The most commonly prescribed oral medication for type 2 diabetes is metformin. “Usually it’s the first line of treatment for all people with type 2 diabetes if their kidney function is normal,” Dr. Gupta says. In fact, a survey published in November 2015 in the journal JAMA found that metformin was one of the most commonly used drugs in the United States.
The fact these improvements can happen independently of weight loss should also signify a shift in how we conceptualize both obesity and diabetes, according to Peter Billings, the Seattle bariatric surgeon who operated on Benari. Billings, a nearly 20-year veteran in the field, has started to perform surgery on other lower-BMI patients similar to Benari, though they often pay out of pocket.
Pramlintide is only appropriate for certain people with diabetes who use insulin and are having problems maintaining their blood sugar levels. Because of the potential for severe hypoglycemia with the use of pramlintide is with insulin, adjustments to insulin dosage and more frequent glucose monitoring may be necessary. Insulin and pramlintide should not be mixed in the same syringe.
There are major barriers for widespread use of islet also-transplantation that can help people with type 1 diabetes. The shortage of islets from donors is a huge obstacle. The other obstacle is that this is still considered an experimental procedure and until the procedure is considered successful enough to be labeled therapeutic by the FDA instead of experimental, the costs of these transplants come from limited research funds.
Vanadium is a compound found in tiny amounts in plants and animals. Early studies showed that vanadium normalized blood sugar levels in animals with type 1 and type 2 diabetes. When people with diabetes were given vanadium, they had a modest increase in insulin sensitivity and were able to lower their need for insulin. Researchers want to understand how vanadium works in the body, find potential side effects, and set safe dosages.
Dr. May currently works as a fulltime endocrinologist and has been in private practice since 2004. He has a variety of interests, predominantly obesity and diabetes, but also sees patients with osteoporosis, thyroid disorders, men's health disorders, pituitary and adrenal disorders, polycystic ovaries, and disorders of growth. He is a leading member of several obesity and diabetes societies and runs a trial centre for new drugs.
You should have no more than three of these “feeding times” per day. The reason limiting the number and duration of your meal times is so important has to do with staying out of the vicious cycle of increasing insulin resistance. To get smart on insulin resistance — the cause of both type 2 diabetes and obesity — read Dr. Jason Fung’s book, The Obesity Code: Unlocking the Secrets of Weight Loss, or watch his free lecture on YouTube.