Children with Diabetes Friends for Life Conference and Expo (Orlando, July 11-15, 2007)

Friends for Life, the national Children with Diabetes (CWD) conference, took place in Orlando, Florida, from July 11 to July 15. The conference exercised both mind and body – while experts discussed the latest treatments in diabetes, professional athletes ran sports camps. The exciting exhibit hall featured the latest continuous glucose monitors, insulin pumps, and tasty sugar-free products. In the midst of it all, we had our diaTribe stand. See our Dialogue with founder Jeff Hitchcock for more on how the conference began!

There is often a gap between the advice from health care providers and what patients actually understand.This dearth of health literacy was the focus of US Surgeon General Ken Moritsugu’s keynote speech. We thought long about his message: to close the gap, both parties need to work toward better communication. It is challenging because much of the time, healthcare providers are pressed for time – if your doctor is not, you are among the lucky! We do strongly encourage working with a diabetes educator no matter how good your diabetes management is. They can help you figure out how to improve your management and can probably even give some communication advice – not only with your doctor but also with your friends and family. Moritsugu also encouraged patients to make a point to stay informed about the goings-on in the world of diabetes. We at diaTribe urge you to check out diabetes resource dLife where you can find nutrition information, recipes, and even MSNBC Hardball’s Chris Matthews talking about his experience with diabetes. We would absolutely agree with Moritsugu that you should work to close the communication gap by using your knowledge and experience to help others. For more on what Moritsugu shared, see this month’s Logbook.

Ready, set, pump! Dr. Henry Anhalt, a noted pediatric endocrinologist and CDE spoke extensively about “Why we pump.”

He said his type 1 patients would insist that they were accurately delivering fractional insulin doses with a regular syringe but would fail miserably in a reproducibility test. As many readers know, and as Dr. Anhalt stressed, insulin pump therapy allows you to deliver exactly how much you need, and leads to better glycemic control. Better control of course means lower risk of both micro and macrovascular complications. Dr. Anhalt discussed pumping for children in particular; since school nurses are not allowed to give insulin shots, some parents find it difficult putting their children on an optimal MDI schedule, and pumping is one solution that many parents find helpful.

The artificial pancreas, a device-based “cure,” is on everybody’s mind.

Dr. Aaron Kowalski, who is leading the effort toward the artificial pancreas by the JDRF, talked about the current state of the art. The ultimate iteration of the artificial pancreas will be a “closed loop,” fully automated insulin delivery system based on continuous glucose monitoring. In this context, a closed loop refers to the device system’s capacity to work effectively to maintain healthy glucose levels without any input from the wearer – it would be like having an electronic pancreas. Earlier versions will be a “hybrid” closed loop, requiring at least some input from the wearer; a closed loop is extremely difficult to achieve for many reasons. For example, in non-diabetic patients, simply thinking about or smelling food starts the pancreas producing insulin. The device system, at least with current monitoring technology, cannot replicate this. It must be reactive to changing glucose levels, rather than proactive like the non-diabetic human body, resulting in imperfect timing of insulin delivery and a perpetual game of catch-up. On the other hand, a hybrid closed loop allows wearers the option of manual bolusing before meals to eliminate the catch-up factor. Other barriers to a true closed loop from our perspective include the availability of a top-notch sensor – the current ones are getting much better but still have issues with accuracy (especially at low levels), the availability of very good algorithms (in development), and timing – there is still a lag between the time that insulin goes into the system and the time it begins working and with a perfect artificial pancreas there wouldn’t be a lag, just as there isn’t in non-diabetics. But here’s to progress – we do feel like there is much more of it in the last year or two and we’re excited about the research on this front, since most patients have been hearing this is “about five years away” for decades!

People with type 1 diabetes do not need more insulins; they need smarter insulin.

The current insulin therapies can require over 30 minutes to reach their peak activity. That means ideally when you see a movie, you take your insulin, watch the first 30 minutes of the movie, and then start eating your popcorn. Dr. Irl Hirsch, insulin expert at University of Washington commented on Biodel’s Viaject, a new subcutaneously injected formulation of insulin, noting that this insulin may be absorbed much more quickly – it is in phase 3 tests and is expected to be available by 2009. We’ll be looking out for this.

And on a related (or not) note… what is the weirdest injection site you can think of?

According to Dr. Irl Hirsch, there is research being done to find alternative routes for insulin administration. These include ocular, rectal, intra-vaginal and per lingual (through the tongue) routes. Current insulins are not fast enough, but they act faster or slower depending upon the injection site due to differing rates of absorption per site. There is even some research to suggest the scrotum is one of the more optimal places to inject! Do not try this at home.