Nov 23 2012 Update

For some reason, my pancreas is still partially working.

Up through the end of August I was doing 8 units of Lantus a day.  I would test before bed and if I was over 200, I would do 2 units of Humalog.  But, over the summer I cut out a lot of carbs so I wasn't doing too many corrections.  In the end, my A1c dropped to 5.8.  It had been about 7.1 before that.  That was a good improvement.  Although, my doctor thought it was too much and that I should cut back to 7 units a day.

So, I've been on 7 units since then and doing a few corrections.  I'm guessing my A1c will go up.

I've also gained a few pounds.  I'm up to about 159-160 now in the morning.  I would like to get back to 153-155 range.  I have started lifting weights-- doing about 18 sets of a circuit at the local Y.  I'm doing this 3x a week and have been for about 2-3 months.  I'm trying to tell myself that the extra pounds are from muscle, but don't want to kid myself.  I think I need to cut back on calories.

Possible Type 1 Cure with Tuberculosis Vacine Called "Bacillus-Calmette-Guerin"

click here for the full article.

Here is a copy of the article from the Wall Street Journal:

By RON WINSLOW

Researchers said a cheap generic drug used as a vaccine against tuberculosis showed promise in a small human study as a potential therapy for Type 1 diabetes, one of medicine's most-difficult-to-treat diseases.

The drug, called BCG, for bacillus-Calmette-Guerin, appeared to halt the process that causes the disease, in which the immune system mounts an attack on the pancreas, destroying its ability to produce insulin required to regulate blood sugar.

In addition, in four of the six treated patients, who had been living with the disease for an average of 15 years, the treatment enabled the pancreas to temporarily begin producing insulin again, researchers said.

"These were people with almost-dead pancreases," said Denise Faustman, director of the immunobiology laboratory at Massachusetts General Hospital, Boston, who led the study. "The data suggest that the pancreas can kick back in even 15 years after you get the disease. That surprised us."

Results of the new study are being unveiled in two presentations during the annual meeting of the American Diabetes Association, which began Friday in San Diego.

Dr. Faustman cautioned that the results don't amount to a cure and they need to be confirmed in a larger study, which is expected to begin enrolling patients within a year. Further research is required to determine what dose and how often injections of the drug would be necessary to maintain the benefit of the treatment. "You can't yet throw your insulin syringes away," Dr. Faustman said.

Patients in the current study were given two injections of BCG four weeks apart. Dr. Faustman said the drug costs about $15 a vial. In the larger study, Dr. Faustman said, the plan is for participants to get injections six weeks apart for as long as 18 months.

Robert Henry, president for medicine and science with the American Diabetes Association and a diabetes researcher at University of California, San Diego, said the findings are based on a small number of patients and should be considered "preliminary." But "if this is real" and is validated in larger studies, "we might have a very cheap and effective way to treat and perhaps prevent Type 1 diabetes."

About 3 million Americans have Type 1 diabetes, formerly known as juvenile diabetes because it is typically diagnosed in children. Globally, about 70,000 new cases are diagnosed each year. The more common type of diabetes is Type 2, which unlike Type 1, is driven by obesity and metabolic disorders that are typically preventable with exercise and diet.

Type 1 is caused by an immune system gone awry. Managing the disease typically requires frequent daily blood tests and insulin injections. Long-term consequences include blindness, kidney failure, heart disease and amputations. Dr. Faustman said treating the disease in the U.S. costs about $17 billion annually.

The new results come on the heels of three late-stage trials in which other medicines failed to stop or prevent the immune system's attack on the pancreas, in particular the so-called islet cells that produce the body's supply of insulin. Researchers' efforts to develop an artificial pancreas or methods for transplanting islet cells as possible treatments forge ahead but a cure has remained elusive.

The new findings "add to our knowledge of how we can potentially prevent the autoimmunue destruction of islet cells in Type 1 diabetes," said Tom Donner, acting director of the diabetes center at Johns Hopkins University Medical Center, who wasn't involved in the research.

It was especially interesting, he said, that pancreatic function was at least transiently restored in people who have had the disease for years. He and other researchers said few would expect that pancreatic function could be restored after such a long period under immune-system attack.

Most studies of drug therapies are undertaken in newly diagnosed patients whose pancreases are still producing some insulin. The hope in those cases is to prevent further damage.

Eva Mezey, an immunology expert at the National Institutes of Health who is familiar with Dr. Faustman's work, said even if such a treatment strategy allows restoration of only a small amount of a person's own insuliln production capacity, it would likely be a benefit. Instead of relying solely on insulin injections to manage blood sugar, which don't typically conform to the body's natural rhythms, "it would give the body a chance to have the normal physiological regulation of insulin levels," she said.

Dr. Faustman said she and her colleagues identified BCG as a possible therapy while screening a library of generic drugs. As a vaccine for tuberculosis, its effect is based on its ability to raise an immune modulator called tumor necrosis factor, or TNF.

In Type 1 diabetes, an abnormal version of an immune system cell called a T-cell mistakenly sees the insulin-producing cells in the pancreas as an enemy and attacks them. Earlier research in mice by Dr. Faustman showed that such cells are vulnerable to elevated levels of TNF.

The new study offers "proof of concept" that the same dynamic is at work in people.

Write to Ron Winslow at ron.winslow@wsj.com

May 2010 Update

The lower calorie diet seems to be working. My average May weight was 153.6. Down 1.2 lbs from April.

The AM blood sugar readings went from 72 to 93. Not a good sign for the next A1c reading. I'm about a 2 weeks behind on the A1c test, but was fighting a cold and wanted to wait until I was feeling good again.

April Report on Weight

With an actual diet that actually counted calories, I was able to reverse the weight gains a little bit.

My average weight in April was 154.8. This was a 1.1 pounds lighter than the March average. The month ended was a weigh-in of 153.5.

The New New Diet

Lots to report on. In the last post, I mentioned my new diet for April. I started a rough approximation of the exchange system (1 fat, 3 protein, 2 startches, etc). I must have been cheating (it was the pecans).

I started April at 156.5 lbs. I went on vacation until April 10th. After vacation, with lots of exercise and trying the exchange diet, I weighed in at 158. This was not working.

I went back to very strictly counting calories. Bye-bye pecans! I am doing 1900-2300 calories per day. Something seems to be working. My weight went from 158 to 157 to 156.5 to 156 to 154.5 to 153 to 155 (not clear why) and then 154 today. So, 4 lbs in 7 days. We'll see if I can keep this up. I'm pretty hungry.

On another note, I went back down to 8 units of Lantus a night. I started on 9 on Feb 18, 2010. Prior to that my 30-day average morning reading was 108. While on 9, my average morning reading was 87. Over the last 30 days it has been 78 with a few low 60's and high 50's.

So, with the diet and lows, I went back to 8 on April 14, 2010.

March Update-- New Diet, Blood Sugar Good

March was not a great month for keeping the weight down.

My average weight for the month was 155.9. It is time to go back on the diet. This is almost 3 lbs more than the Jan avg. It is no mystery what the problem is--- too much hummus and rice crackers after work. I can tell I was overeating, because the lingering hunger from eating the right amount is coming back.

However, the AM blood sugar readings proved to be pretty good. My average for the month was 93 with a high of 111 and a low of 69.

Using Regression Analysis to Predict A1c Measures

My wife, correctly, made fun of me for running a regression analysis using my morning AM blood sugar readings to predict my A1c readings.

I have data from every single morning to match up with my 7 A1c readings.

So, I tested to see if the A1c reading was most closely correlated with the 90-day, 60-day, or 30-day average of the morning readings.

It turned out that it was most correlated with the 90-day reading. For stats minded folks, here were the R-squared results:
90-day: 81%
60-day: 69%
30-day: 66%

I think I was expecting a much higher reading. Even 81% didn't seem that high given that both of these data points measured blood sugar.

On my last reading, the regression predicted a 6.6 and the actual reading was 6.3. It should be noted that the 95% highest and lowest bound was a prediction of 3.2 to 10.1!

Looks like we'll need more data to draw any conclusions.

Jan-Feb Weight Update

I'm posting to keep myself motivated to keep weight under control. I would like to stay in the low 150's. Feb was not a great month.

In Jan, I averaged 153.0 with the lowest morning reading of 151.5 and the highest of 155.

But, in Feb, I averaged 154.8. The lowest was 153 and the highest was 157.5.

The highest reading came today. Now, I need to motivate myself for March.

Increase in Lantis- tracking decline in pacreatic function through Lantus incresases

I wonder if the increase in the need for Lantus can help show the rate of decline in pancreatic output? I'm not really sure if the amount of Lantus I'm on is really a lot or not.

History of insulin after honeymoon period
Started with 6 units on 12/20/2008. Stayed at this level for 110 days
Went to 7 units on 4/8/2009 for 205 days
Went to 8 units on 10/29/2009 for 113 days.
Went to 9 units on 2/18/2010

I'll have to check with my doctor to see if there is a way to see how much insulin my pancreas is still producing.

Latest A1c Results

My latest A1c results went back in the right direction. Here is the history:

3/1/2008	14.4
5/30/2008	7.4
9/2/2008	7.2
11/19/2008	7.6
4/2/2009	7.1
7/10/2009	6.3
10/28/2009	6.8
2/5/2010	6.3

But, my blood sugar readings were occasionally hitting 200+ after a meal. So, I've gone up to 9 units.

Driving and keeping the A1c low is a lot of work.

2009 BG Levels

For 2009, my AM fasting numbers were probably a little higher than I would have liked. I'm still on 1 shot of insulin at night--- 8 units now. I went from 7 to 8 at some point this year.

My average morning reading was 98. A graph of the daily readings is above.

2009 Weight Results

I weighed in everyday, first thing in the morning. I found that this kept my diet on track and kept me motivated. If the weight got too high, I could eat a little less that day.

The above graph shows the results.
Min: 150.5
Max: 156
Average: 153
Jan 1: 153
Dec 31: 153

Based on my size and build, this is a pretty good range for me.

2009 Workout Results

At the start of the year, my wife got me to do the the Lazyman Triathlon at our gym. Over 6 weeks, we had to run a marathon, swim 2.5 miles, and bike 112 miles. This was a good way to do some different workouts.

Around May, I started to keep track of my work-outs- it was a combination of running, jumping jacks, basketball, push ups, the plank, and sit-ups. I tried to do so weight training, but that didn't pan out so well.

Here were my documented totals for the year:
Miles run: 164.1
Minutes of cardio: 1,768
Minutes of b-ball: 2,460
Push-ups: 3,508
Seconds of Plank: 7,902 (mostly in 60 second chunks)
Sit ups: 5,538
Seconds of the Boat: 1,620
Minutes of Weights: 20 (whew, this is bad. before May i didn't write it down, and after May, i didn't do any)

Overall, not a bad year. If you average it out every day (and lump running, cardio, and b-ball together), I averaged about 15 minutes of aerobic, 10 push-ups, 15 sit-ups, and 20 seconds of the plank per day.

Let's see if I can keep this up in 2010!

Technical Article on LADA

Technical article. Still can't find the chart that shows the rate of decline in the pancreas as a function of when diagnosed.

Target Blood Glucose Guidelines

The following are targets as reported by Diabetic Living, Fall 2009:

American Diabetic Association:
Fasting: 70-130
Before Meals: 70-130
After Meals: Less than 180 (1-2 hrs after start of meal)
A1c: Less than 7%

American Association of Clinical Endocrinologists
Fasting: less than 110
Before Meals: less than 110
After Meals: Less than 140 (2 hrs after meal)
A1c: Less than 6.5%

Reader's Digest: Hope for Cure for Type 1 in 5 Years

In Feb 2009, Reader's Digest published an article on some research for a type 1 cure.

Here is the article:

In an exciting study in mice, researchers reversed new cases of type 1 diabetes using the cancer drugs imatinib (Gleevec) and sunitinib (Sutent). The mice were bred to develop diabetes, but none of them got the condition while on either drug. In mice with early stages of the disease, 80 percent were symptom-free after two weeks of treatment-and when drugs were given for ten weeks, results lasted even after the regimen ended. Up next: years of human studies to check safety and efficacy. (The researchers say the drugs will likely work only for people with new cases of the disease.)
Available: Not for at least 5 years.

Sounds interesting. I'm always looking out to see how I can keep these Beta cells working.

Latest A1c-- Wrong Direction, More Insulin

Latest result this week was 6.8. Moving in the wrong direction after the 6.3. I now moved up to 8 units of Lantus at night. Weight and exercise regimes are OK, so it looks like the Pancreas is slowly fading on me.

3/1/2008 14.4
5/30/2008 7.4
9/2/2008 7.2
11/19/2008 7.6
4/2/2009 7.1
7/10/2009 6.3
10/28/2009 6.8

My Weight History

In an earlier post, I mentioned that I got lucky and started diligently collecting my data on Jan 1, 2007, before I was diagnosed with diabetes. This gave me some interesting data to look at.

At some point before Mar 1, 2008, my blood sugars started going though the roof (my A1c on Mar 1 was 14.4).

From this graph, it looks like I had extremely elevated blood sugars for quite some time. This is why I thought my diet was so great-- i was essentially starving to death. It didn't matter how much I ate, I kept losing weight. I was drinking a ton of water (and going to the bathroom a ton) to essentially flush all the calories out of body.

Once, I went on insulin (the little circle on the graph), you can see that my weight shot up!

Since, then, I've had to work to maintain my weight.

A1c Results-- Takes a long time to move that ship

Since diagnosis on March 1st, 2008, here are my A1c results:

3/1/2008	14.4
5/30/2008	7.4
9/2/2008	7.2
11/19/2008	7.6
4/2/2009	7.1
7/10/2009	6.3

For the newbie, these numbers should be less than 7 or 6.5 (or according to some, less than 6.0). The 14.4 was so high that most charts don't even go that high. Luckily, I wasn't showing any signs of damage to the eyes, nerves, kidney's, etc. (at least yet!).

The initial insulin really brought the numbers down to a reasonable level. But, there is still a lot of work to do. And, this is not an easy process. I was already exercising quite a bit and the diet was ok.

It is a constant reminder that it takes daily work to get these numbers where they should be.

I'm still researching how the risk levels really change from 5.5 to 6.0, or from 6.0 to 6.5 as an example. It is hard to get a good answer to where these levels should be. And, it may be that there are just too many factors to consider.

Does Byetta Save Beta Cells

As my honeymoon period wound down and my blood sugars started to rise, my doctor put me on Byetta. The idea was to use Byetta to control the post meal spikes rather than go on insulin right away.

He indicated that in some studies in mice, Byetta restored Beta cells. He stressed that in no way have these results shown to be true in humans.

But, as a diabetic newbie, I was willing to try this approach.

I was on Byetta for about 6-9 months and it did lower my post b-fast and post dinner numbers.

For me, a side effect of Byetta was that it made me mildy nauseous to certain types of foods. I compared it to my wife when she was pregnant-- there were just certain foods that I couldn't stand to look at.

Recently, I went off Byetta in favor of Lantus (insulin) because my pre- and post-meal readings were pretty low.

I hope that Byetta helped preserve some beta-cells.