Need Diabetes Proposal Ideas for a Paper


#21

All of this is true Holger, but my original comment was only to point out that it is not sensor technology holding up the development of the BP or AP or closed loop automatic insulin delivery system choose your name. In just a few years we have seen sensor technology improve dramatically and I anticipate this will continue. What we haven't seen is work on making glucagon itself more stable and useable as a therapeutic agent. This is where the hold up lies. I can only speak for myself, but I would prefer a tiny shot of glucagon to a handful of glucose tablets any day. Fewer calories and faster acting.


#22

Let us assume for a moment that sensors are always reporting accurate results. So the number always represents the glucose level in the upper layer of the skin.

Now the problem is that the glucose diffusion to the upper layers is always 15-20 min behind - in both directions. It measures 140 mg/dL at the site but the glucose level in the portal vein might be very different from that: higher or lower. Thus the trend has to be taken into account too. Insulin is that slow that it needs to be injected before the trend shows in the upper layers. It will be on board for a longer time. For this the glucagon is very important to work against the insulin in case of a low. You are absolutely right that the system can not work without it. I just have doubts that this laggy and unharmonic interaction of sensor, long acting insulin and glucagon is really something to look forward too.

Like you I would prefer to have glucagon at hand - preferably as a glucagon pen. This solution would have much more impact on my life than that wait-another-4-years-AP. I think it is the fear of false hopes that ticks me off here. My excuse to Roger for hijacking his discussion.


#23

No problem Holger, as long as it all stays friendly and professional it's all good.

I was curious about your background based on the answers you have been giving so I looked at your profile and the glucosurfer website. I am a lifelong techie and I commend you on your work. I hope to one day spend my waking hours working on putting technology to work to benefit other PWD.

Thanks, Roger


#24

Stuart,
I wish to defend you on your questioning these things. I see that quite a few of your concerns were answered below. I might have asked similar questions and I think Holger gives some good feedback.

I have one general answer for you and to all who read this it's just IMHO, but we all know that companies are making billions off of treating diabetes. Since most companies are in business to make money then it stands to reason that they are after the goal of improving our "quality of life" not "curing our disease". Now before anyone protests this, I do aknowledge that there are a lot of good people out there who are in fact working for a "cure", but not everyone.

The area I agree with you emphatically is your later comments that said:

1) "Why is the AADE (American Association of Diabetes Educators) not have a "civilian" advisory? Peer mentors, etc."

2) "Why is there NO professional organization which has a specifically DIABETIC component which advises them directly?! Our diabetes experience MATTERS yet is openly demeaned".

I have often wondered this myself. I have had many in the medical profession (Doctors and nurses) tell me i should be a Certified Diabetes Educator (CDE) because of my knowledge and experience. Here's the problem with that. The "Medical" industry has a lock on that at least in the USA. Most people are not aware of how much of a lock on treating and managing "disease" that they have. For instance do you know that the AMA (american med assoc) actually has trademarked certain words in the industry which is why no non-medical person is legally allowed to be able to "treat", "cure", "prescribe", or for that matter wear a white lab coat and go around acting like a doctor. I know all of this for a fact as I was both an EMT and a degreed alternative medicine practitioner. In other words if you play their game, pay for th eproper degree and get the right title they will listen to you. Otherwise forget it.

I have toyed with the idea of presenting the argument that for a CDE, like many jobs out in the businesss world, that there should be more allowance for trading a degree or education with a certain amount of "Experience". Perhaps they could give an apptitude test that ensures a person has aquired the necessary knowledge and skills to be a CDE. Makes sense to me.

There Holgar, I hijacked my own discussion! :)
Roger


#25

Hello Holger:

Have any topic ideas for Roger... refuting some of my questions while kind did nothing for Roger or his thread.

(We can debate your counters another time...)


#26

Old thread, but I couldn’t resist this quip. I would hope that in 100 years we’d either be able to grow a pancreas in a vat, or grow/construct a “proto-organ” that could be implanted and connected to the some vasculature as the “normal” pancreas, and would then continue to develop into a “full” organ.

Then either surgically remove the original organ, or maybe figure out a way to induce programmed cell death. Maybe treat the patient with an engineered virus that would label the cells of the original organ - but not harm it any more than it already is. Then implant and grow the new organ (which would not be labeled). Finally, apply another virus to induce PCD in the previously labeled cells.

That would also have the “advantage” that it would be three “procedures”. Insurance companies might prefer paying for 3 $5,000 procedures might than a single $15000 one… (Well, more like $2000 for the “labeling drug”, 12K for the proto-organ creation and implantation, and $1000 for the PCD-induction drug. The labeling drug is marginally more because it might have to be made specifically to the patient’s MHC.)

After all, fetal pancreases do not grow in vats - they grow in connection to the rest of the fetus, and also in connection to the mother’s blood supply.