Diabetes cured... through surgery?

[richa]

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Richa

Edited September 5, 2008 by Pangloss

[lucaspa]

The literature I've seen regarding Type I is new methods of treatment and not really ways to cure it.

 

All the literature looking into the underlying cause of Type I are attempts to find ways to cure it. We can't cure Type I untill we find out why and how the original islet cells were destroyed.

 

One thing that could be researched and might be the best option is to find a way to monitor blood glucose levels without the need for actual blood.

 

Honestly, I can't think of a possible way to do that. Glucose simply doesn't have any distinguishing characteristics when measured at a distance: no distant absorption in the IR, UV, or any other wavelength. Not even fluorescent under UV. To include such a measurment system with the pump is going to make a very large device. Also, if you tie that in with a blood vessel, as you would have to do, you would always face the side effect of stenosis of the blood vessel.

 

I think your best hope lies not with pumps but with islet cells in cylinders as I discussed above. Let the cells themselves decide how much insulin to produce. Better than machinery.

[iNow]

Honestly, I can't think of a possible way to do that. Glucose simply doesn't have any distinguishing characteristics when measured at a distance: no distant absorption in the IR, UV, or any other wavelength. Not even fluorescent under UV. To include such a measurment system with the pump is going to make a very large device.

Not necessarily. There are a lot of technologies under development (but, as I understand them, they still need to be close):

 

 

http://en.wikipedia.org/wiki/Blood_glucose_monitoring

Some new technologies to monitor blood glucose levels will not require access to blood to read the glucose level. Non-invasive technologies include near IR detection, ultrasound and dielectric spectroscopy. These will free the person with diabetes from finger sticks to supply the drop of blood for blood glucose analysis.

 

Most of the non-invasive methods under development are continuous glucose monitoring methods and offer the advantage of providing additional information to the subject between the conventional finger stick, blood glucose measurements and over time periods where no finger stick measurements are available (i.e. while the subject is sleeping).

 

 

That link also discusses bio-implants and other continuous glucose monitoring systems (CGMS), with links to some of the specific systems under development.

[lucaspa]

Not necessarily. There are a lot of technologies under development (but, as I understand them, they still need to be close):

 

Again, I can't think of anything that could be transdermal or even trans-capillary that would work. Glucose, by itself, doesn't have any unique property that can be detected thru such a barrier.

 

There are lots of other chemicals in the blood (such as fructose and OH bonds in amino acids) that will absorb in the near IR. Ultrasound is not sensitive enough

 

The pump can just dump the insulin into the extracellular space and it will diffuse into capillaries and thus, thru the whole body.

 

I've looked at the references to the Wiki article and they seem to be fluff and hype. For instance, the one using near IR detection -- http://www.veralight.com/products.html -- only says that it is trying to detect "the presence of advanced glycation endproducts (AGEs) biomarkers found in skin". AGEs are glycation of proteins. However, if you keep digging in the website, you find that these AGEs won't give you the current level of glucose in the blood. Instead, all they can do is detect a departure from normal glycemia after the fact. The company thinks skin AGEs will detect this early. But notice the caveat: "Thus, given sufficient assay sensitivity, an AGE measurement offers the promise to detect early departure from normal glycemia." http://www.veralight.com/technology_2.html Not only won't measure blood glucose, but if the sensitivity gets too high, variation between individuals is going to be greater than the levels it measures and make the whole system useless.

 

The other references have similar problems.

 

This is one reason why you must check out the Wiki sources and you can't depend on Wiki as a primary source in a serious discussion. As we can see, actual reading of the sources refutes the statement in the Wiki article: "Some new technologies to monitor blood glucose levels will not require access to blood to read the glucose level."

 

Glucose level in the blood is not being monitored!

 

I have a feeling that those students who have been focussing on epigenetics during the past decade may have some insights in this matter.

 

Epigenetics is something different. Epigenetics deals with changes to proteins after translation. So they are out of the picture. What you need are developmental biologists. They are the ones that work with morphogenetic proteins. These are the proteins that, during embryonic development, are made by one cell but bind to different cells to cause the second cell to differentiate to a phenotype.

 

The most famous morphogenetic proteins are the bone morphogenetic proteins (there are 18 or so of them) and the other members of the TGF-beta superfamily. BMPs 2 and 7, for instance, direct adult stem cells to differentiate to osteoblasts (bone forming cells).

 

Unfortunately, right now the people working in tissue engineering are more focussed on genetic engineering than finding out what the original signals from outside the cells are. They want to turn on the genes that are the eventual target of the morphogenetic proteins, The morphogenetic proteins don't enter the cell, but bind to the cell membrane. This initiates a signal transduction cascade (the SMAD cascade in the case of BMP) that eventually ends up activating dormant transcription factor proteins that, in turn, cause transcription of genes. Genetic engineering tries to shortcut that cascade and just put in new copies of the target genes tied to a promoter that is always "on", causing continued transcription of the gene. And that, in turn, causes the cell to differentiate or continually to produce the protein that is the gene product, i.e. insulin.

 

But, of course, in diabetes you don't want insulin to always be produced. You want a system that responds to high glucose by more insulin and low glucose by less insulin.

[jdurg]

Well I wasn't really referring to measurement of the glucose. I was hoping that there would be some research to find if there were other chemicals produced by the body in response to glucose levels that could be detected. E.g. when the BGL is high, there's more of this chemical in the body, and when low there is less/none. I don't know if research into that has ever been thought of.

[Pradeepkumar]

to jryan

They might have used artificial insulin(stem cell culture technic)

they would have cultured beta cells to produce insulin artificially

[sdasanayake]

there are situations that surgery might help in curing diabetes such as chronic pancreatitis where you can have a pancreatic transplant. but surgery is not the fisrt line treatment option for any kind of diabetes.

[iNow]

Unless, as stated in the OP, it's Type II diabetes and the surgery is a gastric bypass.