News : More options available for diabetes patients

Loretta Schnoor of Vinton has lived with diabetes for 75 of her 90 years.

Anna Reisch, right, was diagnosed with diabetes at age 5.

Good News: Future Diabetes Treatment Options Continue To Evolve

Two Women Share Their Journey

March 27 was American Diabetes Association’s Diabetes Alert Day. It is recommended that people consider taking the Risk Test found at www.diabetes.org. You can manage your risk for diabetes, but only if you become aware and know what to do. See your health care provider for a diabetes screening.

Treatment of diabetes has come a long way in recent years. Here are a few facts about the history of medications. Later we will share some of what is on the horizon. Also, two area people will share some of their journey with diabetes. Everyone’s case will be different, but hopefully these stories can be encouraging

Insulin was first isolated from a dog pancreas in 1922. When injected into a patient, their blood sugar initially improved, but the insulin supply was limited, so treatment at times could not be maintained. Because of its impurities, skin abcesses could develop. Allergic reactions were also common.

Later insulin was derived from other animal sources, like cows and pigs. Animal insulin, although it saved many lives, was not ideal.

Today insulin is made in a laboratory by injecting the human insulin gene into bacterial DNA. Large amounts can be made and it rarely causes allergic reactions. This became available in the early 1980’s and vastly improved patient lives.

Oral diabetes meds have been around since 1955. New categories are still being developed. The gut hormones, GLP-1 and GIP were found to play a role in blood sugar management. Oral meds, like Januvia came out in 2006. Injectable drugs (Byetta and now Victoza) came out as early as 2005 with good results, including the benefits of weight loss.

Diabetes was still a mystery when Loretta Schnoor, Vinton, was diagnosed. She just turned 90 years old this month and has lived with Type I diabetes for 75 years. She was diagnosed in 1937 at age 14. She stated, “There were no oral meds at this time so I took a long-acting pork insulin shot every day. Initially I was hospitalized for 10 days and was taught to weigh every gram of food and to know the carbohydrate (carb) and fat amounts. I avoided white sugar. Today they allow you to have more carbs.”

Loretta’s family was supportive and promoted detailed care of her condition, including specialists in Des Moines at that time. The whole family pitched in to give her the best possible chance to survive.

Diabetes management was more time consuming in Loretta’s day. Needles had to be boiled to sterilize and reuse them. They were sharpened on a fine stone when they felt dull. “Now the needles are so small and disposable. And yes, injections were painful back then!” she recalls.

Loretta recalls having to take a urine specimen and a special solution in a test tube and boil them over a bunsen burner to watch for a color change. This indicated her sugar level. Today she takes her blood sugar from a fingerstick with a small glucometer that gives her a reading in 5 seconds. Insulin adjustments were made slowly back then, 1 unit every other day she recalled.

Many decades ago, folks did not disclose such family issues. Loretta’s family was no different. She commented, “No one was told of my diabetes, not even the school teachers. There were no hot school lunches, so I managed my diet just like at home with a sack lunch. I kept my insulin in an ice box in my room at home. Later as a school teacher myself, I did not tell my students or their families either. There was no need to. I had no problems,” she stated.

As a young child, Loretta was taught to obey all rules. She did not question her diet or complain. “I ignored the bad things about diabetes and just went on with my work,” she said with a smile. When she experienced low blood sugar, she would eat an orange.

As a youth, Loretta did not know any other kids with diabetes. She states that emotionally, she never got discouraged about having diabetes. She just accepted the situation as it was.

Loretta chuckled as she recalled, “As a young adult, some of the guys I dated never came back again because they did not understand why I would not eat like them. Everyone went for ice cream after a movie, but I could not eat the sugar."

“I was taught to follow the medical advice. I and my family were consistent with our meals and even our sleep. We were regimented. Although I never did specific exercises, I was always active,” she said.

Loretta believes that having diabetes is one of the reasons she has lived a long and healthy life. She would encourage others to see the benefits of consistency in all areas of life, food, sleep, and physical activity.

As you can see, Loretta used her resilience and consistency to pave the way for a long and healthy life, despite having diabetes for 75 years. She has never been hospitalized for diabetes complication. It has definitely paid off for her.

Teenager's story of childhood diabetes

Anna Reisch, Garrison, is a 17 year old high school senior who was diagnosed in 1999 at age 5 with Type I diabetes. She was hospitalized for 4 days and was not allowed to come home till both parents were able to correctly give shots of insulin to their daughter..

She plans to study culinary arts in college this fall. She states, “I want to be a baker with a focus on the needs of diabetics, so I need to be responsible with my health. This goal reminds me to keep on track with diabetes.”

Anna recalls that she gave her own shots of insulin at age 5 with her mom’s help.

“When in 6thgrade while at diabetes camp, the staff decided I should consider an insulin pump. At first it was difficult,” she commented.

As with any new device, there is a learning curve. It took awhile before she became confident with the external insulin pump. “Although I like the pump, it is frustrating to always carry a vial of insulin, syringes and extra tubing as back-up in case of pump failure, but within hours I could get really high blood sugars, so I have to be prepared.”

But the bright side of a pump is that there are no daily injections. The device can let a person know when they are going high or low before the situation could become dangerous. Insulin adjustments can be made immediately when needed.

“I used to have highs and lows, especially with playing sports, but with the pump, I have better control,” she notes.

In school, Anna was sometimes seen as different from others because she was allowed to eat whenever her blood sugar was lowering. “I heard kids say, ‘I wish I was diabetic so I could eat that way.’ Now my friends see me as normal. I’ve learned to have fun with it. I let them poke my finger when I test,” she commented.

Unlike in Loretta’s day, families of diabetic youth today are more open about the disease. This is especially true in the area of sports. Anna’s mom went to school early on and spoke to the teachers and students about diabetes so they could understand what Anna was going through. There is responsibility on the part of the youth, parents and the teachers or coaches for a student’s safety.

The parent(s) have to have a plan of action agreed upon with the school personnel, the student has to keep supplies with them, and the teacher/coaches must enact the plan if the need arises.

Anna still has to take her blood sugar 4-6X/day and change her pump reservoir and tubing every 3 days. A pump alarm will sound if her sugar level is going very high or low. She checks her sugar level before driving to be safe.

Unlike Loretta, Anna can recall a tough time in her life with diabetes. In eighth grade she would neglect to check her sugar levels or adjust insulin doses. “My levels were too high and it took a toll on me. However for the last 3 years I have had good control.”

Anna would encourage others to be responsible with their blood sugar control every day, not just when they feel like it. “I became aware that having highs and lows made me

emotionally and physically fatigued. Now that I’m taking responsibility, I’m having many more good days than bad.”

She goes on, “Once you get the hang of what’s going on with you physically and emotionally, it’s easier to take care of yourself. What motivates me is knowing I really do feel better and wanting to avoid damaging my body.”

Uncontrolled blood sugars can damage nerves, blood vessels of the body, especially the eye, kidney, and extremities. Even when symptoms are undetected by patients, the damage is happening at the cellular level. With good control, damage can be delayed, minimized or even prevented.

As noted earlier, new ways of treating diabetes are constantly evolving. This usually involves the beta-cells of the pancreas, which make insulin.

One such device is an internal insulin pump which is implanted in the abdominal cavity and insulin is delivered to the liver like in a normal person’s body.

The use of stem cells and pancreatic precursor cells may someday be able to replace a Type I diabetic’s beta cells thereby reversing diabetes.

Another method would stimulate replication of actual beta-cells. Transplantation of insulin-producing pancreatic cells from cadavers is already being trialed in humans.

Others are working on an insulin patch worn on the skin, or insulin absorbed from the lining of the mouth.

Some weight loss surgeries have been reported to “reverse” Type 2 Diabetes or allow reduction in medication. Long-term effects and results are still being studied.

There are also studies being conducted to make obsolete the need to poke your finger to check glucose levels. A glucose breathalyzer might someday be used similar to the alcohol level detection devices used by police. An ear lobe sensor might also be used similar to the ones that now detect oxygenation levels at the fingertip.

All of these studies and trials unfortunately progress slowly, like baby-steps, to ensure safety and reliability of success. How soon the treatments will be available is not clear at this time.

In the mean time, keep doing all that you know to do to manage blood sugar the best you can. Remember, you are the one in charge. You are the “Chairman of the Board” of your life. Better treatment is on the horizon. So hold on. Just like Loretta and Anna, be consistent, safe and responsible with your health and may you live long and happy.

If you have any concerns about your risk of diabetes, please see your health care provider or call Vinton Family Medical Clinic 472-6300 to set up a screening. Ask for a referral to a diabetes care team for personal help with blood sugar patterns or help with an eating plan at Virginia Gay Hospital’s Diabetes Self-Management Program-319-472-6193.