Simply understanding Type 2 diabetes
Most concerning with diabetes is the risk of complications with any vital organ associated with blood flow away from the heart to the tissues. The organs most often affected are the eyes, heart, kidney, brain, limbs and nervous system, as well as the small and large intestines. These complications can be prevented by detecting diabetes early and keeping blood sugar levels within "normal range."
Blood sugars can be tracked fairly closely with a number of devices as well as blood markers. Unfortunately there are currently no non-invasive devices that can accurately measure blood sugar readings. We are able to determine a patient's average blood sugar level by following Hemaglobin A1C test results over 3-4 months or by following Fructosamine test results over 2 weeks. These averages can be confirmed with real time checks or with monitors that record blood sugar levels over long periods of time.
The following factors can further contribute to the complications of type 2 diabetes and therefore need to be taken into consideration when developing a treatment plan:
(a) weight with underlying genetic background;
(b) insensitivity to insulin, as well as, a deficiency of insulin;
(c) actions of various 'gut' hormones (the incretins); and
(d) liver function
Current treatments for type 2 diabetics include pills, insulin injections and modification of lifestyle. The delivery of insulin has been simplified from using 'needles' to using 'pens' with ultrafine tips which are already drawn up for the patient, and by using insulin pumps for individuals who are having trouble controlling their diabetes. One challenge discovered with the use of insulin 'pens' is that long and short acting insulins cannot be mixed into one pen; therefore, requiring the patient to make multiple injections.
I have participated in more than 100 sponsor developed diabetic trials over the past 12 years. These trials have led to a number of new therapeutic treatments that improve the quality of life for diabetics. We should continue to see new developments in the near future which address some of the challenges that diabetic patients encounter. Studies are now being conducted to solve the issue of not being able to mix long and short acting insulins into one pen. Along the same lines, with the discovery of another physiologic mechanism of glucose control via the 'gut' hormones (the incretins), some by injection, studies are now underway to mix these two solutions into one injection. At the same time there are numerous studies attempting to prolong the effectiveness of these incretins so that injections rather than being done once or twice daily, will be simply be done once a week. As more studies are performed at investigative sites like ours, advances in the treatment of type 2 diabetes are becoming a reality.
Dr. Joseph Soufer has served Greater Waterbury as an endocrinologist/internist for more than 30 years. He is conducting clinical research in diabetes/metabolism and other medical therapeutic areas at Chase Medical Research at 500 Chase Parkway in Waterbury.
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