"Living with diabetes"

Living with diabetes
By Mona Charen
Published December 28, 2006

When he was 9 years old, our middle son began to behave oddly. Normally
talkative and happy, he seemed to have no energy and complained often
of feeling sick. We had him examined by the pediatrician but found
nothing. We took him to a therapist, who thought he seemed depressed.
A few weeks after the first meeting with the therapist, David began
to show symptoms we understood. He started to get extremely thirsty and
had to run to the bathroom frequently. This time, the pediatrician had
no trouble with the diagnosis: Type I diabetes. We went straight to the
emergency room and into a new life.
There are worse things, we reminded ourselves from the start. A
trip to Children's Hospital is pretty much guaranteed to make you count
your blessings. That much having been said, diabetes is no picnic.
There are up to 3 million Americans with Type I -- an auto-immune
disease in which the body destroys its own insulin-producing cells in
the pancreas -- and as many as 20 million with Type II, a disorder in
which cells lose the ability to absorb insulin.
Type I diabetics have to think about their condition every day, all
day. David wears an insulin pump, which replaces injections. He must
test his blood glucose (BG) with finger sticks a minimum of five times
daily and count the carbohydrates he eats so he can calculate the
proper dose of insulin he needs.
He must also (and this is a pitfall for kids) remember to give
himself insulin for every morsel he eats, and change the infusion site
of the pump (a catheter inserted under the skin with a needle) once
every three days. He must be aware that physical activity, illness,
stress and temperature can affect blood glucose levels. If BG goes too
high, his risk of long-term complications like blindness, nerve damage,
amputations, kidney failure and heart disease rises. If his blood sugar
goes too low, either because he doesn't eat or because he gives himself
too much insulin, he can lose consciousness and even die.
When I mention to people that David lives with diabetes, I often
hear cheery predictions that medical research is on the cusp of finding
a cure. Doctors, particularly those in other specialties, seem quite
confident of this. But as I've learned, medical research is not some
self-propelled machine that rolls ever forward. Drug companies invest
in research, as do governments, universities and private foundations.
But companies often require assurance that a new technology will be
covered by insurance before they invest too much. And finding a cure
for Type I diabetes, which affects only a few million people, will not
rank as high as finding a cure for more common ailments.
There has been a great deal of buzz about stem cell research and
diabetes. The theory there is that if we could grow a new pancreas
using our own stem cells, we could transplant a new organ without the
need for damaging anti-rejection drugs. Maybe. But this prospect is
distant at best.
On the other hand, we are tantalizingly close to a technology --
the artificial pancreas -- that, while not a cure, would dramatically
improve the lives of diabetics (including many with Type II).
Continuous glucose monitors (CGMs) have just begun to be marketed.
Using a subcutaneous probe, they measure BG every five minutes without
the need for finger sticks. So we now have two technologies: the CGM
and the insulin pump, one that measures blood glucose and one that
doses insulin. They are the two halves of an artificial pancreas. The
brass ring will be getting the two to speak to each other.
The Juvenile Diabetes Research Foundation (www.jdrf.org) is about
to begin a clinical trial to measure whether CGMs improve the overall
blood sugar control of diabetics. Early indications are that they do.
(Those who wear the devices are amazed at how little information they
had been receiving from finger sticks alone.) Next the challenge will
be to develop the algorithms to permit the CGM to speak to the pump --
and to do so safely. If the algorithm is not foolproof, the wrong dose
of insulin could kill the patient.
David is now 13. He owes his life to Dr. Frederick Banting of
Toronto, who discovered insulin in 1921. But his long-term prospects
are in the hands of thousands of researchers, government officials,
doctors and insurance company executives who will decide whether the
next great leap in diabetes treatment is vital or not.

Mona Charen is a nationally syndicated columnist.

.