Diabetes Innovations to Manage Diabetes!
By Julie Paff, RD, LD, CDE
Managing diabetes requires time and effort! In fact, you might think about managing diabetes as having a full-time job! The duties and responsibilities that would be listed on the job description for the diabetes manager include:
- Taking the right dose of diabetes medicines at the right time
- Eating the right amount of food at the right time in relation to medicine doses
- Testing blood sugars regularly and checking that they are in the target range
- Exercising regularly to improve blood sugar control
- Managing situations that may alter blood sugar levels (certain medicines or illness, for example)
- Getting to a healthy weight to improve blood sugar control
Healthy Bodies and Blood Sugar Management
If you do not have diabetes, you don’t even think about what your body does to keep blood sugar in a healthy range. The body is on auto-pilot in controlling blood sugar levels. If you eat (or do not eat) the body controls the level of blood sugar by releasing hormones. The brain measures blood sugar levels continuously and sends messages to release the right hormone at the right time to keep the levels of sugar in the blood in a healthy range. In healthy adults:
- If you miss a meal, the blood sugar levels drop and the brain sends a message to the alpha cells in the pancreas to release glucagon, a hormone that helps the liver release stored sugar into the blood stream.
- If you eat a large meal, the brain tells the beta cells of the pancreas to releaseinsulin into the blood stream. Insulin moves sugar from the blood stream to the muscle and fat cells where it is burned for energy or stored as body fat. When insulin levels in the blood increase, blood sugar levels drop.
- If you gain a few pounds, the extra fat cells release hormones, leptin andadinopectin, which slow down insulin in the blood, so less sugar moves to body cells.
The result is that whether you eat very little food or a large meal, the brain constantly measures blood sugar levels (like a blood glucose meter or continuous glucose monitoring system) and orders hormones be released to ensure a constant and consistent supply of sugar in the bloodstream to support our daily needs.
What Happens in Diabetes!
In diabetes, there are actually several hormone changes that result in elevated blood sugar levels:
- The body makes less insulin, so the blood sugar rises, because less sugar is moved to muscle cells by smaller amounts of insulin.
- The pancreas may release too much glucagon at certain times of the day, causing extra sugar to be released into the blood stream. The bottom line is that blood sugar is much higher than recommended for health.
- If you gain weight as abdominal fat, the extra fat tissue releases different hormones, including leptin and adiponectin. Leptin and adiponectin actually impair insulin from moving sugar from the blood to muscle and body cells where it is burned for energy. As a result, blood sugar levels go up.
With all these changes in the body, blood sugar is no longer controlled without a thought. The person with diabetes must manually take extra steps to make sure the blood sugar isn’t high or low. This means testing regularly, taking medications, eating at the right time, exercising and managing sick days and life situations that might alter blood sugar.
Innovations in diabetes medicines over the past 3 decades have made managing diabetes easier. Initially only one class of pills was available to treat blood sugar. These drugs, sulfonylureas, work to increase insulin production in the pancreas. Over time new drugs were introduced that work in different ways to improve blood sugar:
- Biguanides slow down the release of stored sugar from the liver
- DPP4 Inhibitors help the body increase insulin release in response to a meal.
- Meglinitides increase insulin production
- Thiazolinediones help the muscles take up more sugar with less insulin
- Canaglifozin increases how much blood sugar is moved out of the body in urine.
- Bile Acid Sequestrants reduce how much sugar enters the blood stream from the intestine.
- Alpha Glucosidase Inhibitors slow how fast sugar enters the blood stream from the intestinal tract.
Even the types of insulin have increased over the years-newer insulins have more predictable action peaks, allowing people to time food or activity with insulin dosing for better blood sugar control. Some insulin work quickly and others stay in the blood stream for up to 24 hours.
Doctors choose the medications based on individual needs and often multiple medications are used.
All the new medicines do not replace the need to test blood sugar, choose consistent meals and exercise regularly.
What is on the Horizon!
Diabetes is a complex disease and research findings are developing new treatment options to improve the job of managing diabetes.
- Stem cell research is looking at ways to restore the ability of the pancreas to make insulin
- Some researchers are looking at ways to change how fast food moves through the intestinal tract, changing how fast blood sugar from foods enter the bloodstream.
- The Juvenile Diabetes Research Foundation and other medical research groups are working to create a closed system that simulates normal body function, by monitoring blood sugar levels and infusing either glucagon or insulin to maintain tight continuous control of blood sugar levels. This is often referred to as the “artificial pancreas”.
While many of these innovations are not yet available to people with diabetes, there are components being added to insulin pumps, meters and glucose monitoring systems that allow for tighter control and earlier action to correct abnormal blood sugar. There are many innovations on the horizon for better control in persons with diabetes. In the ideal world, diabetes treatments will make the job description for diabetes manager easier and the results will be tighter blood sugar control and a healthier future!
If you would like to learn more about future innovations in diabetes treatment, Seton Diabetes Education Center is offering a free diabetes education seminar on insulin pumps, continuous glucose monitoring, and artificial pancreas research.The target audience for this session is persons on multiple doses of insulin each day who want better blood sugar control.