Questions and Answers
Q: I just finished reading the November 1998 issue of DIABETES HEALTH regarding the Juvenile Diabetes Foundation (JDF) islet transplantation $20 million advance. I didn't see anything about the cloning of islets, however, which I had read about in a previous issue of DIABETES HEALTH. I am curious to know how realistic the cloning process is, and when we might see it actually take place.
Royal Oak, Michigan
A: Islet or beta cell cloning as a potential source of new islet tissue has been suggested in both the scientific and lay press. It is based on an emerging technique of growing unspecialized cells that are formed after several early divisions of a fertilized egg. These cells are called embryonic stem (ES) cells, and they have the potential to form any cells in the body. These cells are then manipulated to activate master genes that control a waterfall of other genes that result in a given cell type.
Unfortunately, as of now, those genes that control the formation of insulin-producing beta cells are not known, but investigators in the JDF Center (as well as other scientists) are working on identifying genes involved in both the formation and subsequent growth of the beta cells. We are hopeful that this approach will work in the future.
Susan Bonner-Weir, PhD
Senior Investigator, Joslin Diabetes Center,
Associate Professor, Harvard Medical School
A: Glucose in excess of 400 mg/dl requires immediate treatment, both to address the glucose itself and to determine the cause. One of the most difficult and important judgments that a physician makes is to distinguish between cause and effect regarding high blood sugars. High blood sugars alone can cause dizziness, however, so can infections, strokes, cardiac disease and stress, which all lead to high blood sugars.
I recommend a comprehensive medical evaluation. The high glucose may turn out to be the tip of the iceberg. If the individual previously had stable and normal blood glucose, a significant rise in glucose could possibly represent another illness rather than a change in the diabetes. If there is no such history or prior normal blood glucose, it may be that the glucose levels have been out of control for a long time, and finally reached a critical level where it produced symptoms. People vary widely in what symptoms they have with high blood sugars.
Daniel Einhorn, MD, FACP, FACE
San Diego, California
Q: I have attempted to do some reading on diabetes, and the one issue that jumps out at me is carbohydrates. From what I have read, any carbohydrate, regardless of its complexity, will be metabolized by the human body into blood glucose. Why then do so many diabetes educators, doctors and books recommend eating something like a 40-percent-carbohydrate diet. If somebody with diabetes has a problem in metabolizing sugar, why feed it the very thing it has a problem with? I'm sure this is not a new question, but it is to me. If you have any suggested reading source for me, I would appreciate hearing from you.
A: It took me 25 years to finally learn how dangerous a high-carbohydrate diet could be. I was one of its first victims back in 1946. The following recollection of its genesis is excerpted from page 16 of the preface of my recent book, Diabetes Solution:
"Back then [in 1946], the medical community had just learned about the relationship between high blood cholesterol and vascular (blood vessel and heart) disease. It was then widely believed that the cause of high blood cholesterol was consumption of large amounts of fat. Since many people with diabetes, even children, have high cholesterol levels, physicians were beginning to assume that the vascular complications of diabetes-heart disease, kidney failure, blindness, et cetera-were caused by the fat that people with diabetes were eating. As a result, I was put on a low-fat, high-carbohydrate diet (45 percent of calories were to be carbohydrates) because such diets were advocated by the American Diabetes Association and the American Heart Association. Because carbohydrate raises blood sugar, I had to compensate with very large doses of beef-pork insulin, which I injected with a 10 cc 'horse' syringe. These injections were slow and painful, and eventually they destroyed all the fatty tissue under the skin of my thighs. In spite of the low-fat diet, my blood cholesterol remained very high. I developed visible signs of this state-fatty growth on my eyelids and gray deposits around the iris of each eye."
Read Diabetes Solution, published by Little Brown and Company, 1997, and learn how blood sugar self-monitoring leads to the truth.
Richard K. Bernstein, MD, FACE, FACN, CWS
Mamaroneck, New York
Q: When you open a new bottle of insulin, is it okay to fill all prescribed syringe doses that you can get from the bottle, and keep them in your refrigerator? This way, you don't have to fill the syringes each day. I have been doing this for years.
A: The following answer was sent to us from Eli Lilly and Company on February 5, 1999. We note that Humulin and Humalog are registered trademarks of Eli Lilly and Company.
We recommend that prefilled syringes of either single formulation or mixtures of Humulin be kept refrigerated and used within 21 days.
If using prefilled syringes containing a suspension (e.g., Humulin NPH, Humulin Lente and Humulin Ultralente), patients must be educated to insure that they adequately resuspend the insulin preparation by rolling or gently agitating the syringe prior to administration. Prefilled syringes should never be stored vertically with the needle down because insulin crystals settling out of suspension could clog the needle.
It is also important to check your blood glucose levels frequently and discuss possible dose changes with your health care team. Your insulin dose may need to be adjusted when you experience a change in lifestyle. Any change of insulin should be made cautiously and only under medical supervision.
Eli Lilly and Company