Entries in diabetes (2)



Making insulin at Eli LillyWho am I to disagree? – Well I like sweet things but being a type I diabetic for 20 years, I remember times when technology wasn’t quite where it is today. March 5, 1997, southern Germany, a little kid drinks roughly 20 bottles of soda and feels dizzy at night. That was the day I was diagnosed with type I diabetes. I went to the hospital and was put on the top notch therapy available at the time. To test my blood sugar, I had to squeeze a huge drop of blood onto a little strip. After a minute, I wiped it down, checked the color indicating a rough estimate how my blood sugar was doing, and then inserted the strip into a little machine that would count down from 120, one count per second, to zero, when I would then learn that my sugar was out of range, or roughly 7-8 times the amount a healthy person has in their blood. I got insulin – the fancy kind that the founders of Genentech (a big pharma company!) developed in E.coli and made some of their riches with- not the old fashioned insulin that was isolated from pigs’ pancreases at the slaughterhouse. You know, it was way better than just staying alive, I would have a normal life, so I was told. That being said, my mum got up every night to check my blood sugar at midnight, 3 am, 6 am and then throughout the day of course. I had to inject two different insulins with syringes – one every time I ate, the other one every 4-6 hours. Yet it seemed so much better than the stories I heard from other people about not knowing their sugar levels most of the time, except the one time a week you got to see the doctor who had a meter. It also seemed better than the life of the child I was in a room with, who had 3 hours of dialysis every day because he had no working kidneys. And it was of course all free, because Germany has a working healthcare system.

I traveled the world and the seven seas… Fast forward 20 years to 2017. I live in the US and diabetes care has undergone quite a revolution. I test my blood sugar now with a barely visible drop of blood and get a result within five seconds – no wiping, no color codes. The meter directly sends the results to my insulin pump, which I carry 24/7. I only use one type of insulin, which basically works instantaneously, and I don’t need to worry about injecting it regularly because the pump is programmed to do that. My pump does basically everything for me, it actually learns how my blood sugar reacts to things I eat and does all the insulin dosing for me. I just tell it what I’m eating and hope I make good estimates. I’m in a priority access program for this “artificial pancreas” and can’t quite believe how we far we have come to get to this point. It comes with a price tag (since we’re in the US, where we haven’t figured out health insurance yet) but it is closer to a “normal” life than I’ve ever had. It is an amazing feeling to look back at how treatment has progressed for a condition that killed people mercilessly until the middle of the last century and still does in many parts of the world.

Everybody’s looking for something. I’ve also been looking at news articles about how we’ll be able to cure diabetes entirely for about as long as I have had the condition. Of course, it’s always only preclinical work and some mouse was successfully injected with an insulin producing cell or something along those lines, and to me the whole topic goes right along the lines of the many talks on science ethics I’ve been to, where misrepresentation or over-representation of results to the general public is always a topic. I’ve been called by many excited aunts who read in the newspaper that I was going to be cured but, I still think I’ll see a cure in my lifetime.

Some of them want to use you. I’m also sure that Big Pharma won’t be too excited when a cure is found. Diabetes is essentially a dream of any pharma company. Your life depends on their product, and it keeps you alive and paying for a long time. I sometimes wonder if that is part of why we’re still excited about a pump that manages your diabetes for you. It is time to push forward… we have come a very long way for sure from where we were 20 years ago, but I’m also a lot more cynical about it now.

- MGS -

image source: http://americanhistory.si.edu/blog/2013/11/two-tons-of-pig-parts-making-insulin-in-the-1920s.html


A Primer on Hormonal Hunting on World Diabetes Day! 


As a diabetic, I dread the feeling of hypoglycemia. It happens when I spend hours in the lab and forget to eat, when I overestimate my appetite and give too much insulin or when I exercise without making sure to give my body some extra sugar. Non-diabetic colleagues of mine claim to know the feeling of just craving sweets, feeling week and being unable to focus. I don’t know if they fully understand how it feels though when you break into cold sweat, you feel like you can’t hold yourself upright and certainly can’t keep your thoughts organized. It’s awful. So awful, evolution decided that it would be a great way to weaken prey and make it easier to hunt!
Snails aren’t exactly fast enough to catch fish under normal circumstances, but cone snails use venom to disorient small schools of fish and use their extended mouth like a net to catch their prey. Conus geographus and Conus tulipa, two cone snail species, have been found to use a very remarkable strategy to disorient their prey – they target their energy metabolism to induce hypoglycemic shock. The component of their toxin that is responsible for that reaction in fish is a modified version of insulin. Interestingly, the peptide is much more similar to fish insulin than the mollusk’s own, yet bears the typical posttranslational modification signature of the snail’s usual toxins. 
While I certainly empathize with the poor fish who die in this dreadful manner, I would very much die without insulin and am therefore very thankful to the founders of Genentech, who enabled humanized insulin production through their recombinant DNA technology which is now used by Eli Lilly to keep millions of diabetics healthy and happy. For humans insulin isn’t exactly a great weapon: A review from 2009 stated that only 66 cases of homicide by insulin have been reported, in which 11 needed an additional weapon. As I said… It’s slow and painful, but definitely gives you enough time for a 911 call. 
1) PNAS 2015 112(6), 1743-8
2) Drug Test Anal 2009 1(4), 162-76