Treatments for Type 1 Diabetes

Type 1 Diabetes, which normally called as juvenile onset or Insulin-Dependent Diabetes Mellitus (IDDM) are usually appear during childhood, teenage years, or early adulthood(7,8).

In the Islet cell of pancreas, Beta makes insulin. It is an autoimmune disease meaning that immune system will destroys beta cell, hence insulin cannot be produced. As a result the cells in our bodies will not be able to process the glucose and therefore have no energy for movement (21) . Moreover, the glucose is unable to be transferred from bloodstream to the cells and the glucose level will increase in the blood compared to normal. Main symptoms include blurred vision, passing urine more often than usual and unusual thirst(8).

The problem

Diabetes was the seventh leading cause of death listed on U.S. death certificates in 2006. This ranking is based on the 72,507 death certificates in 2006 in which diabetes was listed as the underlying cause of death (11). Moreover, IDDM cannot be prevented as it mostly inherited by the parent cell as the research said if you have a family member with Type 1 Diabetes, your risk is about five to six percent, compared to the risk in general population which is 0.4%(2). Hence what are possible treatments to replace the insulin to minimise the rise of glucose level in the blood?

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A POSSIBLE SOLUTION

Insulin pump therapy

Insulin pump is a small mechanical device, a little larger than a pager that is worn outside the body, often on a belt or in a pocket (13). It will deliver insulin through cannula on the infusion site and the patients have to decide how much insulin will be given as it is not automatic.

Nipro Diabetes Systems Amigo OmniPod Insulin Management System

The goal of insulin pump therapy is to imitate the insulin secretion pattern which can be seen in people without diabetes. Two patterns released by insulin are:

Basal insulin is insulin that is delivered continuously in small amounts.

Bolus insulin, which is extra dosed insulin released for controlling the glucose level after taking meals (2).

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“Standard” bolus indicates insulin is pumped completely and diffuses at the onset of bolus. “Spike” shape was pumped which expected to act the fastest possible for that kind of insulin. Hence, they must take meals which contain high carb and low protein and fat in order to lowers the blood sugar levels quickly.

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“Extended” bolus represents the spreading of insulin over time by slow infusion. By pumping “square wave” shape, the bolus is avoiding a high initial dose of insulin entering the blood causing low blood sugar level before digestion. Therefore, they should take more high fat high protein meals such as steak, which will be raising blood sugar for many hours past onset of the shape.

Figure is a “combination” bolus of “spike” shape and “square wave” shape (12).Combo bolus.JPG

This will give larger dose of insulin at first and extent the tails of insulin action. As a result, those who have combination bolus are appropriate for high fat meals such as pizza and chocolate cake.

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This method can increase the “spike” bolus action and extend the action for several hours. Thus, “super” bolus people must take certain foods (like sugary breakfast cereals) which cause a large post-prandial peak of blood sugar. It attacks the blood sugar peak with the fastest delivery of insulin that can be practically achieved by pumping.

In the year 2009, about 1119 pumpers are recorded in United State and this is the one of the solution for mimicking the production of insulin in the body. The age group ranging from 0 to 20 shows the highest user of insulin pump; hence it is proven that diabetes type 1 usually appear in childhood and teenage years.

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Over the years, a number of different types and brands of insulin have been developed to meet different needs.

SOCIAL AND ECONOMICAL IMPLICATIONS

Katherine G who was diagnosed with diabetes and keep asking what had I done wrong? And wanted to smack every overweight person she saw. From Gretchen Becker – ‘The First Year Type 2 Diabetes’ copyright 2001(1).

First and foremost, after being diagnosed as diabetic, some of them cannot accept the fact and take some time to mourn their loss. Some of them might fell depressed for example:

In 2007, the world is estimated to spend at least USD 232 billion to treat and prevent diabetes and its complications. By 2025, this lower-bound estimate will exceed USD 302.5 billion. Source: http://www.worlddiabetesday.org/files/docs/Economic_aspects.pdf(15)They also worried about the next generation as Type 1 Diabetes is inherited and get stress thinking about the complication of diabetes which cause them to use wheelchair because has no feet and also being wheeled in order to use the dialysis machine(1,5). They may lose their self esteem to face the world. Some might be under pressure as they have to be strict on their food intake and must follow the diet for diabetic. Moreover, they need to take a lot of medicine and also insertion.

From this statement, I can concluded that diabetes is a highly cost disease. First and foremost, the insulin pump therapy itself is a very expensive and a lot of money spends for buying the insulin needed for pumping. Secondly, diabetes has long term complications which are dangerous for instance retinopathy, neuropathy and also kidney failure. They must use a lot of money in order to prevent these complications from spreading at their body. As we all know, not all diabetic people are wealth and they only depend on only one income source, hence can we imagine how they would survive with this disease especially those from the poorest countries and family. (15)

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BENEFIT AND RISK

Advantages

BEST hbA1c’s before the pump

The level of hbA1C decreases with an average of 6.3 after using the insulin pump compared to 7.2 – before using the pump. The pumper users also show decreasing pattern from 725 to 713. So, the percentage of getting long-term complication for instance stroke, heart disease, blindness, kidney failure and also amputation can be lowered.

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Pumpers have been shown to experience lesser episodes of severe hypoglycaemia compared to people who take injections. Clinical studies shown that using fast acting insulin, the glucose control can be improved with less risk of hypoglycaemia (3,22). Moreover, the pumper can keep up-to-date with their daily schedule. They are flexible to move and free to do what they want for example they can keep on the pump during exercising in the evening. Insulin pumpers must change the infusion site about three times a week, and using about only 156 insertion a year but the injection can achieved mean more than 1,400 injection per year. (3,22)

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Disadvantages

An episode of diabetic ketoacidosis – state of inadequate insulin levels resulting in high blood pressure and accumulation of organic acids and ketones in the blood may take place if the pumpers do not receive sufficient amount of fast acting insulin for many hours. There is high risk of infection if the catheter site of cannula has not been changed every three days and also skin reactions such as rashes may appear at the site of cannula. This therapy is very expensive as pumps are high prices. By using insulin therapy, the society might know that you have diabetes since this is one of the popular ways to cure it (19) . Some of diabetic might develop blurring vision soon after starting insulin due to a change of lens refraction and it will correct itself within two to three weeks (3) .

The picture 2 shows the process of forming of diabetic ketoacidosis. Source: http://www.deo.ucsf.edu/type2/diabetes-treatment/complications/diabetic-ketoacidosis.html

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ALTERNATIVE SOLUTIONS

Exercising

People, who exercise regularly, when compared to those who do not exercise, decrease their chance of developing diabetes by 30 to 50%. Exercise help by improving the body’s to use insulin and causes cholesterol level and blood pressure to drop (4). Aerobic exercise burns calories to help in managing the weight, strengthen the heart and lungs and gives endurance. In other word, it improves the body’s ability to use insulin and prevent diabetes. We must do warm up and cool down before and after exercising. Take at least 20 minutes and three times a week to exercise. Furthermore exercise can increase the uptake of glucose by muscles thus increase in carbohydrate intake. We must take enough carbohydrate before exercising but overdose of carbohydrate will results in hyperglycaemia. As diabetes, insulin must be sufficient before and after exercise because strenuous exercise and insufficient insulin will worsen diabetic control (5).

Supplement vitamin and herbs

Vitamin E helps dissolve fresh clot in veins and reduce the oxygen requirement of tissue and cell. Moreover, it also helps to from new skin (in healing the ulcer and burns) and increases the blood supply to tissue, thus reduces diabetes gangrene and amputations. Vitamin E reduces the need for insulin in 30% of diabetes (6).

Biotin is B vitamin that functions in manufacture and use of carbohydrate, fat and amino acids. It enhances insulin sensitivity and increase the activity of enzyme glucokinase, enzyme responsible for the first step in the use of glucose in liver as this enzyme is low in diabetic. It also helps in the treatment of diabetic neuropathy (7).

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EVALUATIONS

Through the years, we have introduced valuable solutions for patients and healthcare professionals-including continuous glucose monitoring (CGM), CareLinkâ„¢ Therapy Management Software and the MiniMed Paradigm® REAL-Time System, the world’s first integrated insulin pump and CGM System. Source: http://www.minimed.com/about/index.html (22)

From the book of ‘Diabetes Demystified’ written by Masharani, M.D – copyright 2008(2); provide us a brief about diabetes. It helps us to know well about diabetes and why they have this disease. Moreover, ways of taking care for diabetic people also included and it provides me with the chart and also graphs for better understanding. The information are also available in the other books (1,4,5,6,7,8).Hence the facts are reliable. However, the publishing date was 2008 and the information might not be updated.

I believe this website; has given me reliable and factual data. This is because it is owned by Medtronic Minimed, Incoporation and has been updated the info this year, 2010. Furthermore, they had led the technology about insulin pump therapy for 25 years and pioneered it since 1983. It helps pumpers to understand better about good control, insulin pump therapy and why pump therapy rather than the other.

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