As a species, humans are remarkably resilient to many of nature’s deadliest things. It’s astonishing for the fact that humans may not have as powerful as a lion-decapitating kick that a giraffe has 1, or the bite of a cockroach (which is 5 times stronger than a human’s, proportional to its body weight).2
(Fred Jackson, 2011)1
You see, a lot of organisms may claim the throne to being the biggest, fastest or strongest animal, but not a single organism can hold a candle to the human history of medical endeavours. Whether it is to harness cancer-killing agents from algae3, or to breach the blood-brain barrier with microbubbles containing chemotherapeutic drugs4, we have come a long way in fending off nasty diseases to stare down death in the face itself.
(IFLScience, 2015) 3 (IFLScience, 2015) 4
Likewise for type 1 diabetes, the road to recovery and treatment lies ever closer still, with promises of inhalable insulin or artificial pancreases. However, let’s look at a brief history of how humans have duelled with diabetes, how these efforts have culminated into many of the conventional treatments we see today and paved the way to bigger, better cures.
A BRIEF HISTORY OF TYPE 1 DIABETES
Before the discovery of insulin in 1921, children suffering from type 1 diabetes had little to hope for. The only treatment that best helped postpone death, was one that made whatever that was left of life even less tolerable.5 These were extremely strict diets with very low carbohydrate intake, and sometimes, even drove patients to die of starvation. A common life-threatening condition was diabetic ketoacidosis (DKA). This is when body cells started chomping away at energy reserves in the form of fat and muscles, producing ketones and fatty acids that are released into the bloodstream. 6
(Hearing Health Matters, 2013)7
Then, came along Oskar Minkowsi and Joseph von Mering, two German researchers. In 1889, their experiments on dogs revealed that the pancreas was the organ withholding insulin, the treatment to diabetes. 33 years later, in 1921, Frederick Banting and his assistant, Charles Best, found a way to extract insulin from a dog’s pancreas. With this extract, they managed to prolong the life of a dog with severe diabetes by 70 days after which, the concoction had been depleted.8
(National Geography Kids, 2015) 9
(Modern Farmer, 2014)10
This success was not one without setbacks: the insulin extract that was first made available were all manufactured from antiquated methods of processing bovine (cow) or porcine (pig) pancreases.8 The first issue was that these extracts often contained impurities and varied in their potencies between batches. In addition, only crude tests existed for the purpose of measuring blood glucose levels, like the Benedict’s solution that had to be mixed with urine and heated over boiling water. The first setback from these techniques was that inappropriate doses of insulin were administered, leading to other adverse effects like low blood sugar levels (hypoglycemia) when there were more insulin molecules than necessary. Secondly, allergic reactions to insulin extracts from pigs or cows were common, and occasionally resulted in anaphylaxis (a severe and acute allergic reaction).
This is why genetic engineering is particularly important. “Human” insulin was successfully created using helpful E.coli bacterial cells in 1978. Genetic engineering is basically DNA from humans being used by bacteria cells to make the very same proteins.8 In that sense, people suffering from diabetes needn’t worry about allergic reactions should they use insulin derived from pigs or cows, which may contain different antigens that are recognized as dangerous things by your human immune system. Antigens are small, tiny parts of the insulin molecule that can be sensed by your immune system as something bad, basically.
In addition to insulin molecules being commercially available and consistent in their potency levels, methods of measuring glucose levels in blood improved periodically. In 1953, urine test strips appeared. Thank goodness too, because it wasn’t until the 11th century when people stopped hiring “water tasters”.11These water tasters tasted the urine of people thought to have diabetes, to see if the urine tasted like honey. Awkward.
So, anyway! Now, we have methods of measuring glycosylated hemoglobin (A1C), which has became the gold standard for measuring long-term diabetes control. Glycosylated hemoglobin basically means, glucose being attached to hemoglobin, and hemoglobin is a funky little protein found in your red blood cells.12
Things are beginning to look up for diabetics! Or, are they?
There are two main things every person suffering from type 1 diabetes has to deal with, on a daily basis. Measuring blood glucose levels, and administering insulin. Firstly, doctors recommend type 1 diabetics to carry out these measurements four to eight times a day. This includes testing before meals, snacks and exercise, before bed, and even sometimes during the night. You may even need to check it more frequently in cases where you are ill, begin a new medication regimen or change your daily routine.
Insulin injections are no breeze either. These syringes or pens may get the job done, but at what cost? Needle-stick injuries are all the more likely when one recaps, bends or breaks the fine, thin needles.13 Proper care must be taken to ensure safe disposal of these non-reusable needles. This is because of an inability of manufacturers everywhere to guarantee the lasting sterility of these needles. Most of these insulin preparations come with bacteriostatic additives as a safety net against the common kinds of bacteria found on human skin, and it is advised that alcohol swabs should be done before every injection. Nevertheless, needles have to be kept non-reusable because some individuals may have other risk factors of contracting infections. These factors include poor personal hygiene, decreased resistance to infection for any reason or an acute concurrent illness.
A great level of attention, detail and care are basic demands from diabetics, in every aspect of their lives. A whole list of dos and don’ts would be exhausting to enumerate, but each one of them are absolutely crucial in keeping diabetics healthy. They must inject insulin at room temperature, else, cold insulin would provoke irritation at the site of injections. No air bubbles should remain in the syringe before injections, because they would alter the injected dosage and increase the risk of hyperglycemia. Hands should be kept steady throughout the injection, because needle tips can bend to form hooks or break to leave needle fragments in the skin. The injection devide should be stored with the needle pointing upward, else you could get the suspended insulin particles clogging up the needle. Not even injection site can remain constant, because otherwise, lumps of fat may appear at the usual site of injection. This should be avoided because these areas also show slower absorption rates of insulin, which can be dangerous when one needs a quick dose of insulin to counter the effects of a spike in blood glucose levels.13
Not to mention, the peak age of diagnosis for type 1 diabetes is in the mid-teens, like 13-year old children.14 If you got tired and frustrated just from reading the above paragraph, just imagine how it would feel like to have received that diagnosis, weeks after an acute onset of the classical symptoms of diabetes. Watch Nick Jonas talk about his experience with type 1 diabetes as a kid, and his experiences of wanting to just feel normal, like the rest of his friends whom didn’t have to prick their finger for at least 3 times a day.
(American Diabetes Association, 2011)16
Of course, what if a machine could deliver insulin without injections?
Like, an insulin pump? Watch this video to see what this handy little machine looks like, how people use it and what the advantages or disadvantages are.
(NPS Medicine Wise, 2012)17
If you don’t want to watch the video, fret not. What this gadget basically does is that it offers a clear advantage over conventional insulin injections, especially for children whom are not comfortable enough with injections in order to administer their insulin safely. It works by delivering short-acting insulin throughout the day, through a catheter placed under the skin. One can choose whether they want to disconnect from the pump, in instances where it may be inconvenient, in the event of a swim, a shower or intense physical activity. The insulin pump brings on additional benefits too, because the dosages are already calculated and recommended for individual patients, making it a whole lot easier to just approve the doses for administration and skipping the calculation of insulin amounts.15
The insulin doses are separated into basal rates, bolus doses and correctional doses.
Basal insulin is delivered into the body in a continuous fashion that’s very much like how a healthy pancreas would. This helps keep blood glucose levels within normal range between meals and overnight, without needing to wake up every now and then for an insulin injection. Insulin pumps are programmed to deliver different amounts of insulin at different parts of the day, to keep in sync with each individual’s unique metabolism, lifestyle and energy demands. As you can see with most diet-related diseases, cases of diabetes vary widely between patients whom demand different levels of care to different aspects to their lives. This means that there is a lot of cooperation from both the medical healthcare team, family or loved ones and the patients, in order to ensure the best possible care for the patients.
However, sometimes when you eat, you might make later changes to your diet that weren’t accounted for when you were calculating the required insulin amount. This is when a bolus comes in handy. You can easily program a larger bolus of insulin to cover additional carbohydrates in each meal or snack, or whenever you suffer from hyperglycemia (high blood glucose levels).
Also, if you still have high blood glucose levels before meals, you can still program correctional doses of insulin so as to bring blood glucose levels back into a healthy target range that your insulin pump was programmed for.
Now that we’ve covered a brief history of previous and conventional treatments to diabetes, we’ll be looking at what actually causes type 1 diabetes at a deeper, molecular level. We’ll also be understanding how it feels like to live with type 1 diabetes, whether it is as an affected individual or as a caretaker, and the hopes of new treatments or cures coming in the near future.
See you soon!
- Giraffe kills lion. Giraffe attacks lion pride and kicks one of them to death – Fred Jackson 2011, 10 November, viewed 15 November 2015, <https://www.youtube.com/watch?v=VhMU_F3arSA>
- Gizmodo. 2015. A Cockroach Can Bite Five Times Stronger Than a Human. [ONLINE] Available at:http://gizmodo.com/a-cockroach-can-bite-five-times-stronger-than-a-human-1741825320. [Accessed 15 November 2015]
- IFLScience. 2015. Scientists Transform Algae Into Cancer-Killing Drug Delivery Systems. [ONLINE] Available at: http://www.iflscience.com/health-and-medicine/scientists-transform-algae-cancer-killing-drug-delivery-systems. [Accessed 15 November 2015]
- IFLScience. 2015. Scientists Have Breached The Blood-Brain Barrier For The First Time And Treated A Brain Tumor Using An “Ultrasonic Screwdriver”. [ONLINE] Available at: http://www.iflscience.com/brain/ultrasonic-screwdriver-used-open-blood-brain-barrier-treat-tumor-first-time. [Accessed 15 November 2015]
- Diabetes in Control. 2011. History of Type 1 Diabetes Treatments. [ONLINE] Available at:http://www.diabetesincontrol.com/history-of-type-1-diabetes-treatments/. [Accessed 15 November 2015]
- MedScape. 2015. Diabetic Ketoacidosis. [ONLINE] Available at:http://emedicine.medscape.com/article/118361-overview. [Accessed 15 November 2015]
- Hearing Health And Technology Matters. 2013. Diabetes and Hearing Loss – Part I. [ONLINE] Available at: http://hearinghealthmatters.org/hearinginternational/2013/diabetes-hearing-loss-part/. [Accessed 15 November 2015]
- Diabetes Stops Here. 2012. The History of a Wonderful Thing We Call Insulin. [ONLINE] Available at: http://diabetesstopshere.org/2012/08/21/the-history-of-a-wonderful-thing-we-call-insulin/. [Accessed 15 November 2015]
- National Geographic Kids, Young Pig, n.d. photograph, viewed 15 November 2015 <http://kids.nationalgeographic.com/animals/pig/>
- Modern Farmer, Cow, 2014. photograph, viewed 15 November 2015 <http://modernfarmer.com/2014/09/inner-life-cows/>
- Empower Your Health. n.d., A Tale for the Ages: How the Mystery of Diabetes Was Unraveled. [ONLINE] Available at: http://www.empoweryourhealth.org/magazine/vol6_issue2/a_tale_for_the_ages. [Accessed 15 November 2015]
- MedScape. n.d., A1C versus Glucose Testing: A Comparison. [ONLINE] Available at:http://www.medscape.com/viewarticle/736512. [Accessed 15 November 2015]
- American Diabetes Association (2003) ‘Insulin administration’, Diabetes Care, 27(Supplement 1), pp. S106–S107. doi: 10.2337/diacare.27.2007.s106.
- Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, 2014. Atlanta, GA: U.S. Department of Health and Human Services; 2014. [Accessed 15 November 15]
- American Diabetes Association (2015) How do insulin pumps work? [ONLINE] Available at: http://www.diabetes.org/living-with-diabetes/treatment-and-care/medication/insulin/how-do-insulin-pumps-work.html. [Accessed 15 November
- Nick Jonas & Larry King: Living with Diabetes. – American Diabetes Association 2011, 21 November, viewed 15 November 2015, <https://www.youtube.com/watch?v=uWOzpwiZuHc&feature=youtu.be&t=4m36s>
- Living with type 1 diabetes: Using an insulin pump. – NPS Medicine Wise 2012, 26 November, viewed 15 November 2015, <https://www.youtube.com/watch?v=Q72l_Sktezk&feature=youtu.be>