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World Diabetes Day is celebrated on 14th November, the birthday of Sir Frederick Banting who co-discovered insulin and used it on humans for the first time. Diabetes is a chronic disease that occurs when the pancreas is not able to produce enough insulin (hormone released by pancreas) or use the insulin for regulation of blood sugar levels in the body.
Type 1 Diabetes – It is also known as insulin dependent, juvenile or childhood onset diabetes. In addition to the above, another type of diabetes known as Gestational Diabetes occurs in some women at the time of their pregnancy. According to World Health Organization (WHO), there are 347 million people in the world living with diabetes. Every year, about 4 million people die due to diabetes or related causes throughout the world. Diabetes is not restricted only to developed nations and is increasingly affecting the developing nations as well. About 90-95 percent of diabetes patients suffer from Type 2 or maturity onset type of diabetes that commonly affects the adults. Breastfeeding may be a cost-effective intervention aimed at reducing the long-term risk of developing type 2 diabetes among women with gestational diabetes, scientists have found. Researchers at the Helmholtz Zentrum Munchen in Germany studied the metabolism of women with gestational diabetes after giving birth.Along with partners at the Technical University of Munich (TUM) and the German Centre for Diabetes Research (DZD), they were able to show that breastfeeding for more than three months brings about long-term metabolic changes. Four per cent of all pregnant women in Germany develop gestational diabetes before the birth of their child, researchers said.Although their blood sugar levels initially return to normal after delivery, one in two of the mothers affected develops type 2 diabetes within the next ten years. While it has been shown that lactation can lower this risk by 40 per cent, the reasons for this are not yet understood.In an earlier study, researchers led by Professor Anette-Gabriele Ziegler, Director of the Institute of Diabetes Research (IDF) at the Helmholtz Zentrum Munchen, showed that breastfeeding for more than three months postpartum has a protective effect, which lasts for up to 15 years after gestational diabetes.
In the recent study, they examined whether the metabolism could be responsible for this.For their analyses, scientists examined almost 200 patients who had developed gestational diabetes. About three months into Lauren’s diagnosis, a well-intentioned friend brought me a book on diabetes complications. I hate that Anne and her family joined us in this world, but – and I feel guilty for thinking and saying this – it has given me the strongest bond I could possibly have with a friend.
The Diabetes Media Foundation is a 501(c)(3) tax-exempt nonprofit media organization devoted to informing, educating, and generating community around living a healthy life with diabetes. But before we jump to the question of why glucagon, we should start with what glucagon is [1].
In a normal, non-diabetic person, increased sugar intake causes the beta cells to release insulin.
In people with type 1 diabetes, the beta cells are gone, but the alpha cells still produce glucagon. Several companies, including Enject and, more recently, Biodel, are trying to create devices that make it easy to mix the powder and saline on-demand. In anticipation of stable, liquid glucagon, one of the newest entrants into the insulin pump space, Tandem Diabetes Care has jumped ahead of the crowd and created a two-chamber infusion pump capable of holding and injecting both insulin and a secondary hormone, which they expect will be glucagon.
As a result of this foundation in control system engineering, Medtronic is actively researching alternative ways of improving closed loop control algorithms that don’t rely on glucagon. This day is celebrated every year to spread the awareness about increasing number of people being affected by diabetes across the world. It is caused due to deficiency of insulin production in the body and occurs in the childhood. It is a condition in which the pancreatic cells are not able to use the insulin produced in the body. As per current estimates, about 40 million people are suffering from diabetes in India and the number is estimated to increase to 70 million by 2025. But Type 2 diabetes can be prevented by lifestyle modification especially dietary modification.


The participants in the study received a standardised glucose solution and gave a fasting blood sample beforehand, and during the test.The scientists then compared the samples on the basis of 156 different, known metabolites. From that first call when Lauren was six, until today, almost 20 years later, Anne has done all the right things.
Until that moment I’d been so focused on figuring out the moment-to-moment way of life with diabetes, I’d not even considered anything long term.
I knew that I was right in doing that – only a fellow D mom can make that hospital call without asking first.
If it had to happen to our children, at least we had each other to lean on and pull ourselves through the days. Thanks for being my friend from the start, Anne, and for always caring about Lauren in a real and meaningful way. From the talks to the exhibit hall to the after-parties, the buzz went glucagon glucagon glucagon. Isn’t glucagon just a powder in a kit used to rescue diabetics passed out from hypoglycemia? The blood vessels supplying the beta cells carry that insulin as they pass the alpha cells. It is not precisely clear what happens to glucagon production in type 1 diabetics, but some studies imply that overall glucagon levels are higher, and further that the alpha cells are no longer signal responsive — that is, hypoglycemia does not induce an increase in glucagon production as it does in non-diabetics. In the world of type 1 diabetes, glucagon is like non-caloric glucose tablets, or the magical insulin-eraser we all wish we had.
I don’t know about most diabetics, but I, for one, end up eating half my daily calories in corrective carbohydrates as I try to carefully titrate my insulin doses, and it sucks. The glucagon in rescue kits is a powder, because glucagon does not stay dissolved in saline. This solves the problem of the hard-to-use rescue kits, but does not solve the glucagon problem for pumps or frequently used, glucose-tab-sized micro-doses of glucagon. I thought I knew most of what was important about glucagon, but I learned a good deal here. This day creates awareness regarding the risk factors of diabetes and emphasizes upon the importance of prevention and treatment of diabetes. We were on the phone linked to Children’s Hospital again, needing one another, but this time the roles were reversed. I am thankful for the many who let me pick their brains and who gave and continue to give me and my child guidance and support. Up until recently, glucagon was only discussed as a rarely used rescue treatment for diabetics. The alpha cells interpret signals passed from the upstream beta cells, and repress their glucagon production while the beta cells are working to lower blood sugar levels.
What if instead of taking in sugar every time I were going low, I could use glucagon to release stored glycogen in my liver, just like a non-diabetic would?
In order to have glucagon to use in daily treatment or pump systems, we need it in liquid form. However, all the excitement around glucagon in the artificial pancreas has led the JDRF to enter into partnerships with two new companies trying to make soluble glucagon.
The post-meal glucose peaks were still far higher than a typical non-diabetic’s, and while glucagon helped dampen lows, it did not remove them entirely. John Mastrototaro, the head of Research and Technology at Medtronic Diabetes about Medtronic’s view on glucagon.
Thus, while Medtronic is actively looking into how glucagon fits into their closed loop equation, they are also engaging in partnerships to find faster insulins, which they hope will reduce the stacking and mistiming of boluses that can result in hypoglycemia. However, glucagon is now gaining attention as the yin to insulin’s yang, and a hormone that could be beneficial for daily glucose management, and that may be necessary for a closed-loop artificial pancreas system.


Whereas insulin’s net effect is to allow cells of the body to take glucose out of the blood, lowering blood glucose levels, glucagon has the opposite effect.
However, as blood sugar levels drop, and the beta cells stop releasing insulin, the alpha cells are free to produce glucagon. Or, better yet, what if my artificial pancreas were able to use glucagon in concert with insulin, alternating between the two, to mimic what the natural pancreas does to control glucose levels? Up until now, no one has been able to create a stable, soluble glucagon — arguably because there is no reason for pharmaceutical companies or academics to invest so much time and effort into solubilizing a hormone that is only used in rescue kits. Xeris Pharmaceuticals is trying to create a liquid glucagon by suspending the peptide in a low-concentration solvent called dimethyl sulfoxide (DMSO), and LATITUDE Pharmaceuticals is trying to create an emulsion to stabilize glucagon. Plus, even assuming a stable liquid glucagon, there are downsides to a two hormone pump — more medication to buy and manage, extra tubing, and a second infusion set. Glucagon’s main site of activity is the liver, as it induces the liver to convert stored glycogen into glucose and release the glucose into the bloodstream, thereby increasing blood glucose levels.
The same blood vessels carry that glucagon directly into the portal vein and into the liver, where glucose is eventually released.
Damiano and his team in Boston presented data at the Scientific Sessions demonstrating the relative success of their approach to the bionic pancreas. Damiano, Medtronic does not think glucagon is a critical component of the artificial pancreas. However, the system would be very inefficient — heating, cooling, heating, cooling, over and over. Only time will tell, but in the meantime, I suggest getting to know glucagon a bit better– we’ll be hearing a lot about it in coming year!
She studied the old insulin regime NPH and R, and could be with Lauren for hours at a time. This cycle allows the body to maintain blood glucose levels within a tight range — insulin drives levels down, and glucagon keeps them up, alternating activity to maintain consistent blood glucose levels.
In imitation of the real pancreas, the bionic pancreas used the Tandem platform to deliver small doses of insulin and glucagon, alternating in response to the movement of the patient’s blood sugar as measured by the Dexcom G4 continuous glucose monitor (CGM). When the dosing curves were plotted, you could see insulin in, then later glucagon to correct if the insulin was too much. Mastrototaro, suspending insulin delivery will not be enough to prevent all lows in a closed-loop system, but that doesn’t mean that the on-again, off-again glucagon delivery of Dr. The glucagon was mixed and swapped out frequently during the trial, making it impractical for real-life use at this stage, and the base dose was 40 micrograms, which is 4% of the one milligram dose contained in a typical glucagon rescue kit. Damiano’s bionic pancreas, or a natural pancreas, is the best way to achieve control.
It is preferable, he believes, to instead engineer a more stable solution, perhaps with a slightly wider temperature range, but with less thrash overall. Instead of hitting the gas (insulin), then the brake (glucagon), then the gas, and so on to keep blood glucose values in range, Medtronic is taking the approach of being much slower on the gas — that is, being more conservative initially with insulin boluses, aiming to avoid the need for correction with glucagon.
Damiano’s approach mimics the natural pancreas, which is very robust but also very inefficient, creating and destroying proteins constantly so that it can respond to even minor changes in conditions. The Medtronic approach does not aim to mimic a pancreas; the ideal solution is not necessarily the most biologically accurate one.



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Comments

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    09.11.2014

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