what should be the goal when we talk of sugar control ?

when I saw this quote of the day in google,I was struck by how apt it is for diabetics .
few weeks ago suddenly my wifes blood sugars were high and widely fkuctuating and her PCp started her on actos ( I have my own reservations about this drug )
her Hba1c which used to be between 6 and 6.2 % went up to 6.9 %.
when I was trying to reassure her saying that it is still under acceptable limits she wouldnt take it and wanted to get back to her previous numbers.

so it is important to aim at the stars .

"It is a paradoxical but profoundly true and important principle of life that the most likely way to reach a goal is to be aiming not at that goal itself but at some more ambitious goal beyond it. " - Arnold Toynbee

something in Hindi on Dm for now in PDF

a simle PDf document regarding Dm in Hindi
http://www.protegediabetes.org/language/hindi.pdf



http://www.ndep.nih.gov/diabetes/pubs/TCH_AsAm_flyer_Hin.pdf

new experimental trial for type 1 Diabetes cure

A study from Children's Hospital of Pittsburg and Pittsburgh Medical Center, has shown that type 1 diabetes can be reversed in a mouse model. The scientists extracted the mouse's dendritic cells from the blood and enhanced them with specific molecule blockers. They then reinjected them into the mouse. This procedure stopped the process that kills beta cells, by blocking the T cells which attack them.
A series of injections over the course of several weeks interrupted the T cell attack on the beta cells of the pancreas and allowed the beta cells to regenerate. This resulted in the pancreas of the mice producing insulin again.
Now, the researchers at the Children's Hospital are moving on to human trials. Phase I of the trials was set to start this this past March, to determine the safety of the procedure. Scientists are hopeful that the trials will be successful.
the details are available here
href="http://www.clinicaltrials.gov/ct2/show/NCT00445913?term=type+1+diabetes+dendritic+cells+AND+pittsburgh&rank=1">http://www.clinicaltrials.gov/ct2/show/NCT00445913?term=type+1+diabetes+dendritic+cells+AND+pittsburgh&rank=1

Total quality management

Today as I was reading a book about total quality management. I came across the following paragraph.
what is said here largely reflects what ails diabetes education.


A philosopher, Moshe Hayyim Luzzato (1707-1747) wrote:
"I have not composed this work to teach people what they do not already know, but to remind them of what is known to them. For the most of what I have to say is nothing more than what most people do know. But what is said in the following pages is constantly ignored most often forgotten, because it is common knowledge and obvious. That is why no profit will be derived from a single reading of this book, for quite likely after such a reading the intelligent reader will, find little that is new. Only constant reading and rereading will prove beneficial."

WHAT HAppened to this artificial pancreas ?

it is being touted as the solution from 1995!
and we are no where near implementation.

Focusing on an Artificial Pancreas

For decades, medical scientists have dreamed of a technology that would end insulin-dependent diabetics’ daily need for needles to inject insulin and the endless pinpricks to draw blood for glucose monitoring. That dream took hold of Tejal Desai when she was a Whitaker Graduate Fellow at the University of California, Berkeley. Despite warnings that it was too difficult and she might not graduate, Desai set out to create an artificial pancreas, a small, implantable device containing live pancreas cells.
Scientists have tried to develop an artificial pancreas, among other organs, since the 1970s. One challenge to this approach is keeping the insulin-producing pancreas cells, or islets of Langerhans, alive while protecting them from the body’s natural immune system. At the same time, the islet cells must respond to changing glucose levels and release the needed insulin.

Desai saw that many of the challenges could be overcome with the right container, one that allows only nutrients, waste products, and insulin to pass through while barring harmful antibodies from entering. She built a small capsule employing micromachining techniques, similar to the technology used to make silicon computer chips, which allowed her to etch each pore merely a billionth of a meter wide in a paper-thin silicon membrane. That gave her control over pore number, location and size—enough to allow the small-sized glucose, insulin and oxygen to pass through while blocking immune components, which are larger. After filling a capsule with islet cells, she demonstrated its short-term effectiveness in diabetic rats.

“There are far-reaching applications of microtechnology and nanotechnology that seem sort of distant,” says Desai, “but this is something that has a real application in diabetes or other diseases. It’s a nice example of the convergence of cell science and material science and true biomedical engineering technology.”

Desai not only surprised the doubters; in 1999 she became the first Whitaker Graduate Fellow to earn a Whitaker Research Grant. The support helped her refine the device before handing the idea to a private company, iMEDD, in Columbus, Ohio, which was granted a license to the technology.

“We’re improving it toward more of a pharmaceutical product,” says Carl Grove, president of iMEDD. The company has enhanced the initial design—two silicon wafers glued together with islet cells between—with such improvements as a port to replenish the cells and a more reliable titanium housing. The new device, about the size of a half-dollar, is being tested in rats.

While iMEDD performs most of the scale-up work, Desai continues to do the basic science. One area of special focus aims at inducing capillaries to grow around the device, or vascularization. Improved vascularization gets insulin to the rest of the body faster and increases the transport of nutrients, especially oxygen. “You want a blood supply to be as close as possible to the isolated device,” says Desai, now an associate professor of biomedical engineering at Boston University. But there is a trade-off, she warns; too many capillaries could induce an inflammatory response.

Increasing the oxygen available to cells is one of the main hurdles, not only to an artificial pancreas, but to all artificial organs. “I think success is still going to rely on getting enough oxygen into the device, whether through vascularization or some other means. That is truly going to be a stumbling block.”

A block, she says, not a barrier. “I think we can do it short term, but the question is, how long can it really go? A permanent implant, of course, would be ideal, the Holy Grail. But I think even a two-year viability would be great.”

Desai received a Whitaker Foundation Biomedical Engineering Research Grant in 1999 for research toward a bioartificial pancreas and a Graduate Fellowship in 1995.


Annual Report 2003
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Disposable Insulin Nanopump For Diabetics



Swiss firm Debiotech is teaming up with French/Italian manufacturer STMicroelectronics to bring to market a miniaturized insulin pump, bound to change the lives of countless diabetics, provided it makes through the regulatory process.

The Nanopump, which relies on microfluidic MEMS (Micro-Electro-Mechanical System) technology, is a breakthrough concept that allows a tiny pump to be mounted on a disposable skin patch to provide continuous insulin infusion. The Nanopump will enable substantial advancements in the availability, treatment efficiency and the quality of life of diabetes patients. The original technology was awarded the Swiss Technology Award in 2006 and this agreement brings it closer to the market.

Insulin pump therapy, or Continuous Subcutaneous Insulin Infusion (CSII), is an increasingly attractive alternative to individual insulin injections that must be administered several times a day. With CSII, the patient is connected to a programmable pump attached to a storage reservoir, from which insulin is infused into the tissue under the skin. Continuous delivery throughout the day, more closely mimics the natural secretion of insulin from the pancreas.

The highly miniaturized disposable insulin pump combines Debiotech's expertise in insulin delivery with ST's strengths in manufacturing high-volume silicon-based microfluidic devices. Microfluidic technology allows the flow of very small amounts of fluids to be electronically controlled. This pump represents a significant step in the development and adoption of CSII therapy and the leading-edge technology will also find applications in many other biomedical applications.

Today, existing insulin pumps are about the size of a pager. The new ST-enabled Debiotech miniaturized MEMS device is about one quarter the size of these existing pumps and can be worn as a nearly invisible patch on the skin. The small size frees the patient from concerns with holding the pump in place and concealing it under clothing.

The MEMS-based Nanopump also provides better control of the administered insulin doses. Dosing precision is a critical factor in treatment efficacy and contributes to reducing adverse long-term consequences. The Nanopump is able to control delivery at the nanoliter level, very close to the physiological delivery of insulin. The device prevents over-dosing and detects under-delivery, occlusion, air bubbles and other potential malfunctions in the pump to further protect patients. As a disposable device, manufactured using high-volume semiconductor processing technologies, the MEMS-based Nanopump will also be much more affordable, allowing the patient or the health system to avoid the typical up-front investment associated with current pump solutions.

Read Also:
Disposable Insulin Nanopump from Debiotech and STMicroelectronics Marks Major Breakthrough in Diabetes Treatment (STMicroElectronics News)
Debiotech's Insulin Nanopump (Medgadget)