I have just read a report in a Journal called Nature Chemical Biology (Journal Link). Not your typical bedtime reading, or daytime reading for that matter, but this article caught my eye, not so much for the catchy title:
as for the content:
What this means, is that this technology could eventually lead to a cure for diabetes – this is huge!
But before we get into that let’s take a step back and go over what we are actually talking about here
What you need to know about Diabetes
Diabetes, or diabetes mellitus to be more precise, is a metabolic disorder characterized by abnormally high blood glucose levels
There are two main types, creatively named Type 1 and Type 2
- Type 1 is caused by the pancreas not producing enough insulin, and comprises about 10% of cases
- Type 2 is caused by the cells of the body failing to respond properly to insulin, and comprises about 90% of cases
There is a third type – gestational diabetes – seen in pregnant women, but this is small in comparison – although no less significant should you suffer from it
Diabetes is a major Global Health problem...
A World Health Organization Global Report on Diabetes reported the 2016 Global prevalence of diabetes at 422 million. This is a huge number – to put it in perspective it is more than the entire combined populations of the US and Germany
... And it is becoming more significant every year
Prevalence has increased from 382 million in 2013, an annual growth rate of about 5% per year. The International Diabetes Federation estimated Global Worldwide economic cost of diabetes in 2014 to be over $600 billion – that could buy you a lot of STEEM (especially at current prices)
So what’s this insulin stuff that causes diabetes then?
Let’s talk for a minute about glucose and glucose homeostasis (the means by which the body maintains it at appropriate levels)
Glucose is a sugar which circulates in our bloodstream and is the body’s key source of energy. When you hear people talking about blood sugar levels, they are talking about blood glucose levels. Glucose is produced in three different ways
- Absorption into the body from consumption of food
- Breakdown of glycogen, the form in which glucose is stored in the liver
- The generation of glucose from the breakdown of substances such as proteins and lipids – a process known as gluconeogenesis
To understand how the body maintains appropriate levels of glucose (homeostasis) you need to know about two hormones – insulin and glucagon:
You need Insulin to lower your blood glucose levels – produced by Beta cells of the Islets of Langerhans (the pancreas is all you need to know), this hormone is released into the bloodstream in response to rising glucose levels, when it causes absorption of glucose into fat, liver and skeletal cells, and reduces glucose production and secretion by the liver
You need Glucagon to increase your blood glucose levels – produced by Alpha cells of the Islets of Langerhans (the pancreas is all you need to know), this hormone is released into the bloodstream in response to reducing glucose levels, when it causes increased glucose secretion by the liver (gluconeogenesis)
When you have diabetes, as I mentioned right at the start, you either don’t produce enough insulin, or the cells of the body don’t react appropriately to it, and so you can’t reduce your blood sugar level as it starts to rise after a meal. This is dangerous
How do I know if I have diabetes?
Well, typically a patient with diabetes will present with weight loss, polyuria (increased urination) and polydipsia (increased thirst). But symptoms can also be very non-specific. A classic presentation would be a patient with non-specific symptoms who casually mentions in passing to their physician that they are drinking litres of water every day
Once a diagnosis of diabetes is suspected, it is a simple matter to diagnose it via blood tests
Type 1 diabetes typically presents in patients who are otherwise healthy and of normal weight, and in most cases is autoimmune in nature
Type 2 diabetes is closely related to lifestyle, and typically presents in patients who are obese with poor diet and a lack of physical activity
It is not the symptoms of diabetes that cause the real problem, it is the complications that arise from long-term abnormal glucose homeostasis – more deaths are attributed to complications than to diabetes itself. Complications typically develop much later than the initial diagnosis, and can be thought of according to the organ/system affected
- Vascular disease – increased risk of cardiovascular disease, stroke and peripheral artery disease
- Diabetic retinopathy – visual impairment due to damage to blood vessels supplying the eye
- Diabetic nephropathy – chronic kidney disease due to damage to blood vessels supplying the kidney
- Diabetic neuropathy – nerve damage, including numbness, tingling and changes in sensation
Damn, this sounds bad, how do we treat it?
As always, prevention is better than cure
Type 1 cannot be prevented – as it is primarily autoimmune in nature, if you get it and your Beta cells are damaged or destroyed, you are just unlucky, but there was nothing you could have done (that we know of currently)
Type 2 can be prevented, or at least delayed, by eating well, exercising and keeping your body weight within normal limits
Once diagnosed, management is focused on maintaining a normal blood glucose concentration, through
- Lifestyle measures - diet, exercise and weight loss
- Medication – insulin injections for type 1, oral medications in type 2
And of course there is a huge daily burden to the patient, in terms of continually monitoring their blood glucose via fingerprick testing, and then calculating doses of drug that needs to be given
At the moment there is no cure, and so a diagnosis means a lifetime of treatment, however long that may be. The World Health Organization estimates that diabetes at least doubles a person’s risk of an early death
So - if you avoid this:
You increase your chances of avoiding this:
Ok, so now I get why it’s a problem – what’s the deal with this new research paper?
If you’re feeling particularly masochistic and if you have access to the journal’s website, you can read to the entire paper here:
If you don’t have enough time, here’s the short answer
These researchers have created synthetic cells that mimic the actions of our natural Beta cells – remember, these are the ones that produce the insulin we need to reduce blood glucose. The synthetic cells sense blood sugar concentration and secrete just the right amount of insulin
The technology behind this is amazing – what these guys have done is to generate artificial Beta cells containing ‘packets’ full of insulin that fuse with the cell’s outer membrane and release insulin into the bloodstream when blood sugar levels are too high. As the insulin goes to work and the blood sugar level drops, the packets then unfuse from the membrane and the supply of insulin is cut off
How they have done it I have no idea, but it works, at least so far - experiments with mice show that the cells can regulate blood glucose for up to five days
The synthetic cells are not as good as the real thing, as they run out of insulin after a period of time and then have to be replenished, but they are clearly a potential advance over current treatments
Next steps are to see if these results can be translated into humans. Of course, it is entirely possible that the results are not seen inhuman trials – the history of medical research is littered with drug failures that showed huge promise in animal testing and even early human testing, but which then failed to demonstrate efficacy in large scale pre-registration studies
But if they can show that this works in humans, then we move into a place whereby diabetic patients could inject these artificial beta cells and automatically regulate their blood sugar levels for days at a time. The ability to deliver real time accurate automated blood glucose regulation is a huge step forward when compared to current regimens that typically involve blood glucose measurements and injections several times per day
There is a long way to go – this technology has never been tested in humans – but diabetes is one of the biggest health problems the world faces – moving a step nearer to a cure is a great thing!!