Class 2, Group 1: Diabetes & Technology

Uploaded by WafeekWahby on 23.04.2012

>> Ralph Kuchenbrod: Thank you all for coming.
Our presentation today is about diabetes.
And as we go through our presentation we will
understand some very personal topics such as for Justin.
It has meant a lot to all of us.
As for research, this is a fascinating topic.
Diabetes is a disease, a human disease that affects the body's
metabolism and it occurs when the pancreas, a gland inside
your body, fails to produce a hormone called insulin.
Insulin is in your blood stream and it helps the blood transfer
sugar, called glucose to the various cells in your body;
muscle cells, liver cells, and your fat cells.
And if the cells cannot absorb the glucose, the sugar stays in
your blood and you'll get what is referred to as
high blood sugar.
And what happens with high blood sugar is--
the symptoms are excessive urination, you're hungry,
or you're always thirsty.
And they can test this by looking for elevated
blood sugar levels in your blood and they can look for
sugar in your urine.
These are all medical test that doctors can perform.
There are two types of diabetes and type 1 is what they prefer
to often is juvenile onset diabetes and it occurs in
children and young adults.
Almost always if they are younger than 25 years of age.
They don't know what causes it and currently there is no cure.
It is incurable and 3 to 5% of all diabetics are all type 1.
Type 2 is a little different than type 1.
Type 2 can occur at any age and it can be
caused by stress, pregnancy, obesity, and an injury.
Often you will hear women who are pregnant become diabetic
and they refer to that as gestational diabetes.
It comprises 93-95% of all diabetics, so it's a huge number
of diabetics out there in the world that have type 2.
But its becoming more frequent in younger people because of
obesity--kids aren't as active as they used to be or should be
and their finding that some people are getting diabetes
when it used to be older who were out of shape
or obese people getting it.
Failure to recognize the symptoms, the onset starts when
you get nauseated, headaches, vomiting, ultimately going into
a coma or even death.
If you know you got diabetes and you don't treat it,
you stand a very good chance of getting an infection.
And it affects the capillaries in like your feet and in your
fingers and toes and you cannot fight off infections.
People who have diabetes have to be serious about foot care.
The least nick at the toenail makes your skin get infected
and your body won't be able to fight the infection
and it leads to a lot of gangrene and amputations.
You can also have an increased risk for stroke
and heart disease.
There are medical test involved drawing blood and looking for a
glucose and hemoglobin levels in the blood and fortunately
type 2's can often control their disease through diet
and exercise.
And often can prevent type 2 diabetes by maintaining a proper
diet and an active lifestyle.
>> Rebecca: I'm going to talk to you
a little bit about some history of diabetes.
Diabetes is one of the oldest known diseases and its official
name is diabetes mellitus--I guess that's how you say it.
>> male voice: Mel-lee-tus.
>> Rebecca: Mel-lee-tus, okay.
And so diabetes, that word comes from the Greek word
that means "siphon", which means used to use to drain liquids.
And then later on they added the word, mellitus because that
words means honey in Latin and that described the sweetness
that was found in it.
Today diabetics have a lot of options.
It wasn't so easy to control the disease
and manage it in the past.
In the olden days it was just hard to be able to really even
know what it was.
As mentioned, one of the main signs was frequent urination
and so actually, the Indians, the way they used to test
for this was that they used ants, and so if ants were
attracted to the urine that showed that it contained
high sugar levels in that.
Since there was very little knowledge and technology
available during this time, people just tried to fight the
disease the best way that they knew how, and prior to 1922,
one of the diets was an Allen diet.
This was extremely low carbohydrates and low calorie
diet, however, that just lest people live only a few weeks
or months longer.
And it wasn't until the 20th Century that a lot of the
treatments changed.
A man by the name of Frederick Banting, I'm sorry we didn't get
his picture on there, he was Canadian man and in the 1920s
he later won the Nobel Peace Prize for his discoveries.
He began by experimenting with dogs and one of the quotes
I found was this: "Dog's blood glucose levels were brought
under control by one of the fluids he called insulin."
And so not long after that they decided to test it in humans and
there was an 11-year-old Canadian boy who was given
a first shot of insulin from a cow, actually.
And so the results were successful and he became
healthier and the glucose levels became normal.
But in the beginning insulin did not cause problems,
people did become sick and they had an allergic reactions.
The only way they could get insulation into the body was by
using the glass syringe and using sterilized needles.
And sometimes they were injured in the process
of preparing stuff---things were becoming contaminated,
that's what made people sick.
It also took a lot of carefully planning out and measuring this
and you would only have to take it on an as needed basis.
The diabetic population, they really pushed for a more of a
once a day type of treatment and they did finally develop
something like that, but what happened was, they said
it was the wrong type of insulation that was developed.
The patients taking these had higher rates of blindness,
kidney failure, and nerve damage and those individuals had to be;
there were individuals that had to be treated
by multiple injections.
So in 1950 they developed some oral medications that people
could start taking and by the 1960s people could begin
doing their own testings with different samples
they can do at home.
And in the 1970s, tests were invented to measure
the glucose levels in one's blood.
And so over time there's been development that progressively
gets better and Justin is now going to talk about what the
current developments are.
>> Justin Hayes: This is definitely a subject
that is near and dear to my heart.
My wife has been diabetic since she was 8 years old, as juvenile
diabetic and I can tell you now that the technology has greatly
changed her lifestyle in a better quality way.
Insulin, there are many different types of insulin.
How you take your insulin really depends on your diet,
your activity levels.
There are many professional athletes
that are actually diabetic.
Jay Cutler is, the quarterback for the Chicago Bears
is diabetic.
Your genetics, your lifestyle, all that plays into the type of
insulin that you need; your diet, all that.
There's many different, over 40 different types of insulin.
There's fast acting, short acting, intermediate acting,
long acting, and pre-mixed.
For that pre-mixed, which actually mixes
[unclear dialogue] one's together.
The reason that there are so many types is based on the
lifestyle and diet.
If you're an athlete, before you go you bed you're not active,
you need long acting insulin.
They came out with a new one called Lantus about 5 years ago.
My wife was on pro pump and she would actually
take that before bed.
What it would do it would release insulin in through her
bloodstream through the night, instead of taking the shot
and it all hits her just at once, it's slow acting.
So that's why there are so many different kinds.
Blood Glucose meters have changed a lot over the years.
There's the traditional meter where you take the dose at home,
where you just prick your finger,
put it in the machine and that will give you your blood sugar.
There are meters that test alternative sites, so not only
do you have to prick your finger, you can prick your arm,
you can prick your leg, others areas of your body.
They now have lasers that can check your blood sugar.
It actually penetrates the first layer of your skin
and can actually read the actual liquid under your skin
to see how much sugars in it.
One of the most important one's that has come out in my opinion
is MiniMed, that's the name of the company [unclear dialogue]
a continuous glucose monitoring system.
And what makes this so important is that the insulin pump
actually communicates with that.
So you actually have two tubes that go into you, one to inject
the insulin and then one to actually read the blood sugar.
The tubes look very similar to this and I'll pass those around.
This one actually travels through this little tube;
it can be 3,4, 2 feet long depending on where you
want to place your pump.
So basically these two things, this pump communicates together
with the injection of the insulin and
reads what your sugar is and determines what you need.
There is also a glucose watch, its made by Glucowatch.
You can wear a watch that measures your sweat
and your oil on your skin but the actual accuracy
of that is still kind of under interpretation.
The insulin pump is very important and that's the one
my wife went on a couple of years ago.
Now what makes it so important is that you can set it
to inject insulin at certain times during the day.
So basically, what the technology has done is how to
take in some of the functions of the pancreas, instead of that
being inside of your body, and placing it outside your body.
So basically you have this pump, it kind of looks like a pager,
it has controls, a processing monitor, and batteries.
It has as disposable reservoir, which is like a cylinder,
which is what the insulin goes into.
It has an infusion set, which is;
partially this is like 15% of it.
How it works is, there is actually a needle that goes
inside your stomach, or your quadricep and it has the needle
inside of it and around it is a clear plastic tube.
So you inject it with the needle, pull the needle out,
and the tube stays in and that stays in you for three days
and that is how you get insulin injected into you.
It's got a cannula for subcutaneous insertion
under the skin, that's that clear plastic tube
and tubing system like what I showed you right there.
I'm going to show a YouTube video.
I am going to show this video because it really shows
a young gentleman, a youth, a boy, a juvenile diabetic.
It shows the family interaction, like how serious this is and
really how technology is really increasing the life expectancy
of people.
>> Dr. Wafeek Wahby: Can we see one minute of it?
>> Justin: Yeah, I try to do this.
[video playing].
[no dialogue].
>> woman: I'm priming the pump.
Priming the pump gets out the air out of the insulin,
out of the tubing.
You just hold down the button until you start to see the drip.
After you've seen the drip, you push escape,
get back to the main menu.
>> older male voice in video: What do you think about
the pump, Brent?
>> male in the video: I like it.
>> older male voice in video: You like it better than
doing the shots everyday?
>> young male: Yup.
>> older male: How many shots were you doing
before the pump, each day.
It was little bit more than that.
You were doing about six.
>> Young male: Four to five.
>> woman: Before you put,
before you put the needle into this thing,
do not pull out the blue--this blue right here,
do not pull it out because it's inside of the tubing.
Only pull this out after it's on the site.
[no dialogue]
Have you primed your stomach?
Take your shirt off.
>> young male: I do it right there
where I put the pen.
That's where I took it out.
>> woman: Where did you put it?
Don't forget how you're going to fix the tubing.
>> older male: Make sure you show them
how you're going to do the tube so it comes out the bottom.
>> young male: Make sure you have the tube
pointing like that way so it goes to your...
>> women voice: your pocket.
[no dialogue].
>> Justin: So that actually stays in you
for three days.
After three days you switch out and so now he can adjust
his meter to get insulin to go through the system.
My wife does that exact same thing.
The reason why this technology is so important--research,
according to a study, presented by the
American Diabetes Association--
the life expectancy for the groups diagnosed between 1950
thorough 1964 was 53.4 years, compared with a life expectancy
of almost 70 years for the groups diagnosed between
1965 and 1980, and that is just comparing old technology,
that's not even comparing the newer stuff
that has just come out.
So basically this technology is extending the life of people
with diabetes, it is making it easier for young gentleman like
this is able to have a more functional life, anticipating
sports, sleep better at night, not having to worry about
[unclear dialogue].
And they can have more control over their insulin intake.
And Mark's going to talk about some future technology.
>> Mark Brink: Well, as we talked here,
it's a very serious condition, diabetes, whether it is type 1
or type 2 and the Holy Grail obviously is a cure.
So unfortunately, since there are two different avenues of
diabetes that means that the research money is split in
two areas as well.
So a cure isn't as quick to come as it might be as if
it was just one single disease.
As Ralph said, type one, they think it's basically an
autoimmune disease where your body is actually attacking the
pancreas creating the cells.
I'm sorry, the insulin creating cells in the pancreas.
Whereas type 2 also can be genetic and there are certain
ethnic groups that is predisposed to it,
but the vast majority of type 2 diabetes is caused
by a sedentary lifestyle and obesity.
So for the research they're doing for type 1, they're
looking into what's called, T-regulatory cells and what
they're basically trying to do is manipulate these cells to
make them stop the destruction of the insulin creating cells.
So we introduce this new cell in the body that basically
suppresses your body's immune system that is currently
attacking your good cells and it lets the body heal itself.
They're also looking into gene therapy.
Again, one of the ideas is that your immune system is attacking
these pancreas cells, so what they're trying to do is disguise
or create a cell, that isn't a pancreas cell that can still
create insulin and then put that into the body with
the hopes that the body won't recognize it as a pancreas cell
and it can go on and do its duty to create insulin for you.
For type 2, again it's a different avenue of research.
The triggering mechanism for it [unclear dialogue] is obesity
and sedentary lifestyle and for most people simple weight loss
and exercise will essentially cure diabetes, type 2.
For some people though, they're past that point and for people
who they feel, or who have what they call morbid obesity,
which is a body mass index of 40 or greater.
They're actually doing, researching a type of gastric
bypass surgery, not the type you hear about
with the Lap ban surgery.
This is actually where there're going in
and calling it abilio pancreatic resection and they're actually
removing part of you intestines and rerouting your insides
to reduce the ability for your body to absorb all of the fat.
Unfortunately that also sometimes causes severe
malnutrition but for these people they are doing it for,
it's a matter of life or death, essentially.
For those who aren't so morbidly obese, another thing that they
are researching is called vanadium salts
and this is something that can normalize the glucose levels
and because of that, it can help both people
with type 1 and type 2 diabetes.
So that is our paper.
We each have our own conclusions.
Ralph, you want to start us off?
>> Ralph: Type 1,
I have a personal connection to it.
Years ago when my youngest son had a playmate that lived just
down the street from us and one day I got a phone call
that my son Ben and his friend Jeffery got arrested
or had gotten in trouble for shoplifting.
They had stolen candy from a candy store
and I was really upset about that.
And I was like, "Why, why steal the candy?"
Well, I didn't know that Jeffery was a type 1 diabetic and he was
not allowed to have candy at home and I was stunned that
here's a young man, I can't imagine a kid without candy and
you just couldn't imagine a life without it, all his friends did.
And Jeffery died when he was 8-years-old so it hit home
very early for me of how bad it was and how blessed
I was to have children that didn't have diabetes.
>> Justin: I would just like to
conclude that I am personally thankful for the technology
that is available in this day and age.
Not only does [unclear dialogue]
help the individual but it also helps them have
a better quality of life, if they want to start a family.
It helps out with pregnancy.
We just had our first child in June and you know 20 years ago
they might have said that it wouldn't be a good idea for you
guys to attempt to have a child due to birth defects
and now its much more common [unclear dialogue],
give you the green light like [unclear dialogue].
So I am just very fortunate to live in this day and age with
this technology and I only see us moving forward with
new discoveries as Mark said, on a genetic level
and cell level as well as the electronic level
and the materials that are being used.
I just hope that this technology can also be given to people who
may not be able to afford it.
The health care system can provide those like the one in
the video, because what this does,
it will enable them to live a normal life.
Insulin comes from pigs, almost all of it, it comes
bottled like this and there is an event in town in Champaign--
I haven't been able to go in a couple of years,
it's called "Kiss a Pig"-- it's good if you guys know anyone
with diabetes, it supports them,
it supports the ADA, they pass out some
pamphlets if you guys want to read into more on that.
[unclear dialogue] for the technology, the research
and moving forward in this [unclear dialogue].
They're going to be providing my wife and my family
a better quality of living.
That's all I have.
>> Mark: And my conclusion is
basically that the use of technology is tremendous
for those with type 1 diabetes.
They are born with it, they didn't do anything to get it,
it just happened to them.
So it's wonderful that there are efforts to help cure them.
Type 2 diabetes, as we talked kind of last week,
its think it's kind of a doubled-edged sword.
I'm up here, I'm overweight, I'm sedentary, I am living
a possible future of diabetes if I continue
down the path that I am on.
And I think Rebecca said in one of our discussions about this
paper is that it has been eye opening to me,
to really bring this home.
You know, there's basically the technology, sorry,
the double-edged sword, is again, the technology that
we've got to control it also brought us here.
You know, with our sedentary lifestyle, we're not hunting and
gathering for our food, we're using washing machines, cars,
etc. for labor savings and that's why there's such a huge
growth in the United States in particular for type 2 diabetes.
And there's a search for a cure, but for most of us exercise and
weight loss and maintenance of a healthy weight would
get us there without any further research.
You guys have any questions for us?
>> Dr. Wahby: Let us first give them
a hand for this work.
Now for questions.
>> student #1: For your wife, how long,
kind of of like, after she picks an injection site to move
on to the next one like, I don't know, kind of, what's it like?
Does it hurt, like, how can she go back to that site later,
like how long does that, just kind of like, I don't know.
>> Justin: It's really interesting,
my wife is a really active person.
She is always on the go.
My wife is not overweight by any means, so that does not
play a part in it, she just got it.
It's not hereditary, when it comes to the site it really
depends a lot on her lifestyle.
When we going on vacation or if she has a work presentation to
do, because the pump can be placed so many different
apparatuses where you can place the pump at different locations.
You know how like in James Bond with the gun on your thigh,
you can put your pump on your thigh and you can put your pump
in your pocket like the little boy did.
You can get bras with the overage, you can put the pump
there and so she, and she really picks her site location
based on what the bodies telling her.
So if she is using this side, you can feel the tissue,
it's a little different, she'll pick the other side,
or she'll pick her thigh and now you can go below the waist,
I know he said above the waist, but you can go below the waist,
like the quadricep area.
She pretty much loses her stomach area and then her upper
leg areas and she does that with what is comfortable with her.
>> Dr. Wahby: Other questions?
>> student #2: Does insurance cover,
like the pumps?
Is that a standard coverage thing?
>> Justin: Yeah, insurance is different
of course among companies.
Mark: [unclear dialogue].
Mark: I had them once.
Thank God I got a job at the U of I.
But before I used to work at Walmart and my wife used to work
at a different bank from the one she's at now [unclear dialogue].
And uh, I think we paid for the pump like $3,000
under that insurance plan.
Like he works at [unclear dialogue].
Hey, every insurance company is different.
The better insurance you have the more opportunity
you have to better take care of yourself.
And it's not just, "Hey I need to get a pump,"
there's so much supplies.
There's test strips, there's insulin, there's alcohol swabs,
there's just so much stuff you have to use on a daily bases,
so many materials and if you had to pay for it all out of pocket,
you'd be bankrupt its so expensive.
[unclear dialogue] so insurance pays a big part, yes.
>> Justin: What I've learned from insurance
in general, if insurance pays for it that means it works.
It better manages you, it makes you healthier long term so that
there aren't further costs down the road.
>> Dr. Wahby: More questions here.
>> student #4: If you didn't have insurance,
if you knew someone that does not have insurance
how would you afford that?
Are there any places that you can go and get treatments?
>> Justin: I'm not exactly sure.
From a juvenile standpoint I'm sure there's a lot of camps,
there are a lot of organizations,
there are a lot of fundraisers.
The ADA, the American Diabetes Association
provides a lot of that.
They will get families the best care they possibly can.
Unfortunately in some cases, like the pump is probably is the
most expensive, these tubes and these tubes and reservoirs
and all these supplies are very expensive.
So a lot of the times they go back to a bottle and a needle,
so if you don't have the insurance, this is what you can
afford, so you may not get the cutting edge technology.
There are even adults that I know who still use this
and I'm like, "why?"
I used to know a guy at Allstate who was in his 40s who was
diabetic and we actually, me and my wife took [unclear dialogue]
and introduced him to the pump and within a couple months
he was on it and he has done so much better.
So I can't tell you much about people I don't know,
it's insurance and money.
>> Dr. Wahby: Another question please.
>> student #5: You said the pump
performs the same functions as the pancreas, right?
>> Mark: It does not
perform the same function.
Do not think that it performs the same functions as that
of the pancreas, but it will perform similar functions.
It's more close to how the how the actual Pancreas works
because your body doesn't know what it's eating until
you put it in and your body reacts to that based on the
carbohydrates you take in that are going to turn to glucose.
So basically what it boils down to do is carb count and on this
meter, when you do a food intake, you still have to pay
attention to you nutrition and count your carbs and you adjust
that basal rate on your pump.
And that adjusts.
You can put, enter, all you have to do is put in you carbs.
If you have 15 carbs, you put in 15 and the machine will adjust
that basal rate for the insulin to go into you.
>> Dr. Wahby: Any other questions?
I have a question about diabetes, too.
Why is it taken from fingers?
Is the blood in the fingers different from any other place?
>> Mark: Because it's at one of your
extremities so it is one of the most important
places to test because with diabetes, the health effects--
once they start to decline--
affects your vision, affect your fingers, affect your feet,
and just like Ralph was saying,
my grandma was a type 1 diabetic and she lived to be
55 years old.
My mom was adopted so there is no hereditary line with her in
particular but she got a sore on her heel, it turned to gangrene,
and she had to eventually have both her legs amputated
above the knee.
And she died in the early 1990s.
This was horrific to see this happen and luckily this
technology has really changed that, increases the life
expectancy and like feet care is very important.
I was at the doctor today and it said on the wall,
if you're diabetic, go get [unclear dialogue] socks now,
you know doctors think that's very important, that care, so.
>> Dr. Wahby: Well, I think we can give them
a round of applause, again.