Speaker 1: Brought to you by Toyota Let's go Places. Welcome to
Speaker 1: Forward Thinking. He there and welcomed up Forward Thinking, the
Speaker 1: podcast that looks at the future and says, I like
Speaker 1: to play the drums. I think I'm getting good, but
Speaker 1: I can handle criticism. I'm Jonathan Strickling, I'm Lauren Volga,
Speaker 1: and I'm Joe McCormick in. Today is going to be
Speaker 1: the first part of a two part series we're doing
Speaker 1: about the future of diabetes and diabetes treatment. And Lauren,
Speaker 1: this is a topic you have been hankering to do
Speaker 1: for a while. I've I've been suggesting it for kind
Speaker 1: of ever because I keep I keep running into all
Speaker 1: of these new research articles about amazing things that have
Speaker 1: been done in the in the treatment and diagnosis of diabetes,
Speaker 1: and and it's a really big issue. I mean, this
Speaker 1: isn't a thing that, like, you know, seven people are
Speaker 1: are dealing with. This is this is a little bit
Speaker 1: larger than that. Not not at things that only seven
Speaker 1: people are dealing with are not worth looking into me
Speaker 1: for those seven people, it could be it could be huge,
Speaker 1: But no, that is exactly the point that why we
Speaker 1: wanted to tackle this. Diabetes is something that affects millions
Speaker 1: of people, It's going to affect millions more in the future. Obviously,
Speaker 1: It's one of those topics that we should look at
Speaker 1: and say, what's the forward thinking approach to dealing with
Speaker 1: managing uh, diagnosing, perhaps in some distant future, curing diabetes. Yeah,
Speaker 1: I would say with diabetes, it's not exactly like all
Speaker 1: other diseases, not not just because it affects so many,
Speaker 1: but because it is one where I would say, at
Speaker 1: least from from where i'm you know, I'm no expert,
Speaker 1: but just in what I read the end does sort
Speaker 1: of seem to be in sight with diabetes more so
Speaker 1: than with many other chronic diseases. At the very least,
Speaker 1: the facility with which we can manage diabetes today has
Speaker 1: has increased exponentially over the last several decades. And there's
Speaker 1: just a lot of research progress. Yes, their entire organizations
Speaker 1: that have been UH in in existence for since like
Speaker 1: the nineteen forties, that have been dedicated to researching and
Speaker 1: treating and diagnosing diabetes. So ah, yeah, and before we
Speaker 1: got into this research, I didn't realize how long ago
Speaker 1: people knew about this. Wow. Yeah, we've got a timeline
Speaker 1: to go through. Yeah, I went a little crazy, y'all
Speaker 1: when I was researching the history of diabetes and our
Speaker 1: understanding of it, and uh, we should all know better
Speaker 1: than to put a history section in there. I kept
Speaker 1: thinking I should skip some stuff, but I kept finding
Speaker 1: things that were so fascinating. But first, let's let's talk
Speaker 1: about some numbers about why this is such a big deal. Yeah. Yeah,
Speaker 1: because he said millions of people. So I mean, so,
Speaker 1: so what's what's what's millions of people? We've got like
Speaker 1: like trillions of people on the planet. Not quite trillions yet,
Speaker 1: but sometimes it feels that way when you're on a
Speaker 1: crowded Marta train. But according to Center for Disease Control
Speaker 1: report in UH two thousand fourteen, there are twenty nine
Speaker 1: point one million people in the United States who have diabetes,
Speaker 1: and eight point one million of those people are undiagnosed.
Speaker 1: So there's only like three hundred and something million people
Speaker 1: in the United States. That's like significant percentage, nine point
Speaker 1: three percent of the population in two thousand fourteen, so
Speaker 1: not almost ten percent of the population having diabetes, and
Speaker 1: out of that group, twenty seven point eight percent of
Speaker 1: them don't have it as a diagnosed condition. They may
Speaker 1: be aware that something is wrong, especially if they're suffering
Speaker 1: some of the more severe symptoms of diabetes, but they
Speaker 1: haven't been formally diagnosed with the disease. Um percentage wise,
Speaker 1: the group that has the highest incidents rate of diabetes
Speaker 1: is the sixty five and older group. That's twenty five
Speaker 1: point nine percent of the population, more than a quarter
Speaker 1: of all people over the age of sixty five the
Speaker 1: United States have diabetes. As with many diseases, this is
Speaker 1: a disease where risk factor tends to increase with age. Yes, yes,
Speaker 1: and then uh, the actual largest as far as sheer
Speaker 1: numbers go, Like the largest number of people that would
Speaker 1: be in the forty five to sixty four year old
Speaker 1: age range with the thirteen point four million diabetics, but
Speaker 1: that only accounts for sixteen point two percent of people
Speaker 1: in that age range, So percentage wise it's fewer, but
Speaker 1: in sheer numbers it's the largest population. So uh, one
Speaker 1: of those fun things that you start to think about
Speaker 1: when you start, you know, grouping people into percentages. Uh.
Speaker 1: More men than women are diabetic in the United States.
Speaker 1: They're fifteen and a half million men with diabetes versus
Speaker 1: thirteen point four million women, and that same CDC report
Speaker 1: estimated that the total cost of diabetes in the United
Speaker 1: States in two thousand twelve was two hundred forty five
Speaker 1: billion with a B dollars two d forty five almost
Speaker 1: two hundred fifty billion dollars. Uh. So that includes both
Speaker 1: direct and indirect costs. So if you look at just
Speaker 1: the direct costs of diabetes, this being the diagnosis and
Speaker 1: treatment and management of the disease, that's seventy six billion.
Speaker 1: So still I mean enormous number uh, indirect costs in
Speaker 1: case you're wondering, well, what what the heck is that entail?
Speaker 1: According to the CDC, they were lumping in things like disability,
Speaker 1: loss of productivity due to the fact that people are
Speaker 1: missing work uh, and premature death as contributors to indirect costs. Globally,
Speaker 1: it's been estimated that about twelve percent of all health
Speaker 1: expenditure is going to diabetes treatment. So yeah, this is
Speaker 1: where the word trillion can be the start can start
Speaker 1: to get thrown around, because when you're looking on a
Speaker 1: global scale, uh, it is it is an enormous issue,
Speaker 1: both financially and obviously as a quality of life and
Speaker 1: and just health and survivability issues around the world, which
Speaker 1: is why we're really tackling it. It doesn't look like
Speaker 1: things are getting particularly better right now. The diabetes UH
Speaker 1: prognosis is that it's going to be on the increase
Speaker 1: over the next few years. Yeah, despite the optimistic news
Speaker 1: that we're going to have it lit like like like
Speaker 1: kind of the warning signs are out there. Researchers are
Speaker 1: sort of going like, hey guys. Yeah, According to one
Speaker 1: paper I was reading, by twenty thirty, there's an expectation
Speaker 1: that there will be five hundred fifty two million people
Speaker 1: with diabetes worldwide. And and it's difficult to make global
Speaker 1: estimates about this kind of thing because some researchers think
Speaker 1: that many more cases go undiagnosed and underestimated. Even in
Speaker 1: those undiagnosed cases in other parts of the world, the
Speaker 1: number of cases right now could be of what we
Speaker 1: currently think there are a k A about five hundred
Speaker 1: and twenty million cases worldwide, which would mean that you
Speaker 1: would guess that number for would be even higher because
Speaker 1: that was based upon sort of what we are pretty
Speaker 1: sure or what we know so far. Right right in
Speaker 1: the US alone, rates and expenses of diabetes are expected
Speaker 1: to very nearly double during that time period. Yeah, that's
Speaker 1: something else we'll be chatting about quite a bit. In fact,
Speaker 1: let's go ahead and kind of transition into that. There's
Speaker 1: been a lot of news over the past several years
Speaker 1: about increases in the price of insulin, and we're going
Speaker 1: to talk more about diabetes and what insulin you know,
Speaker 1: what factor insulin plays in diabetes management. But the important
Speaker 1: thing to remember here is insulin dosages are are something
Speaker 1: that that people with type one or type two diabetes, uh,
Speaker 1: that's usually part of their diabetes management. People with type one,
Speaker 1: you need it. People of type two, you might not
Speaker 1: need it, but you should certainly have access to it. Yes, yes,
Speaker 1: So there are a lot of different types of insulin, uh,
Speaker 1: not just in how it interacts the body, but how
Speaker 1: it's produced. And that makes this conversation a little more complicated.
Speaker 1: It it's not like we have a single that that
Speaker 1: says insulin and you just draw off as much as
Speaker 1: you need and you're good to go. There's actually lots
Speaker 1: of different types. There's long acting, there's short acting, there's
Speaker 1: instant acting. There's all different types of ways to derive insulin.
Speaker 1: So it gets pretty complicated. But The thing you need
Speaker 1: to remember is that the pharmaceutical game is a for
Speaker 1: profit deal. So as that it means, you know, the
Speaker 1: companies are trying to make a profit selling insulin no
Speaker 1: matter what the type. Maybe there's not as much competition
Speaker 1: as it sounds based upon the fact there's so many
Speaker 1: different types of insulin. There are actually a few major
Speaker 1: companies that are They provide the vast majority of insulin,
Speaker 1: and at least in the United States um and there
Speaker 1: are a lot of other factors that are playing a
Speaker 1: role here, including drug wholesalers, pharmacies, insurance companies, all of
Speaker 1: these things of act the price of insulin, and part
Speaker 1: of the price also depends upon something that is completely
Speaker 1: independent of diabetes and the demand for insulin, and that
Speaker 1: is that the overall drug sales have been on on
Speaker 1: a decrease like they would they've been decreasing over time.
Speaker 1: So that sounds like that's pretty good except for pharmaceutical
Speaker 1: companies that want to make a profit. One way you
Speaker 1: can offset your losses in one area is to increase
Speaker 1: the prices of another drug that's still in demand in
Speaker 1: another area. And while that's not the only cause, or
Speaker 1: even necessarily the primary cause for insulin prices on the increase.
Speaker 1: It is a factor. It is a contributing factor. Um.
Speaker 1: In fact, pharmaceutical companies said as much in a two
Speaker 1: thousand eleven Reuters Health summit. They admitted to the fact
Speaker 1: that part of the reason the insulin prices were on
Speaker 1: the increases because other drugs were not selling as much.
Speaker 1: So you cover your losses in one area by increasing
Speaker 1: the price on another. It's frustrating, but that's kind of
Speaker 1: how capitalism tends to work. So um. Anyway, the drug
Speaker 1: companies are are really seeing a benefit to the strategy,
Speaker 1: as you would imagine. I mean, you've got a growing market,
Speaker 1: more people being diagnosed with diabetes who need access to
Speaker 1: these medications. You can increase the price of those medications,
Speaker 1: so more people buying stuff for more money means yea
Speaker 1: for companies that make the stuff right. So um, And
Speaker 1: I don't want to demonize anybody in this. It's not
Speaker 1: I certainly have very strong opinions. Might not want to No, no,
Speaker 1: I I I absolutely understand their their strategy behind this.
Speaker 1: But when you when you hear stories about parents of
Speaker 1: children with type one diabetes who are paying as much
Speaker 1: as their mortgage every month to to get an insulin supply.
Speaker 1: It's like, oh, that's not that's not chill. Yeah. There.
Speaker 1: I do have a lot of strong opinions, but they
Speaker 1: also range on the political scale, which is why I'm
Speaker 1: trying trying to be as objective as possible. Absolutely that
Speaker 1: that was that was an emotional aside from me, and
Speaker 1: I completely agree with it for the record. But another
Speaker 1: issue that we have here is that the United States
Speaker 1: doesn't regulate the price of prescription drugs. So this this
Speaker 1: really plays into that. Right, we don't have a regulatory
Speaker 1: body that says you can't do that. We're we're seeing
Speaker 1: stuff play out right now in the United States that
Speaker 1: is sort of related to this issue. You know, we
Speaker 1: had the Congress calling up the CEO of the company
Speaker 1: that makes EpiPens to really talk about the increase in
Speaker 1: EpiPen costs over the last you know, five or six years,
Speaker 1: and so we're starting to see that kind of take
Speaker 1: a turn here in the US. But as of right now,
Speaker 1: there is no official body that says, hey, you can't
Speaker 1: charge that much because people real people are dying or
Speaker 1: suffering or or there they're taking extreme measures to stretch
Speaker 1: their supply as much as possible in order to be
Speaker 1: able to afford to live, and so there's there's a
Speaker 1: lot of that going on right now. Also, you might
Speaker 1: remember we did an episode about biologics, and insulin falls
Speaker 1: into that category, meaning that there they aren't as easy
Speaker 1: to replicate in the lab as small molecule drugs that
Speaker 1: you would you would create a generic for. Right It's
Speaker 1: it's a relatively uncomplicated biologic, but it's still much more
Speaker 1: complicated than for example, UH aspirin. Yeah, so you know,
Speaker 1: and patents can expire on the process for creating uh
Speaker 1: biologically um derived drugs, But that doesn't necessarily mean that
Speaker 1: someone's going to come along and create a cheaper, faster,
Speaker 1: uh more efficient method of manufacturing it and thus lower
Speaker 1: the cost and pass the savings onto you. That's not
Speaker 1: necessarily going to be the case. In fact, there's only
Speaker 1: so much cost you can cut from the manufacture RNG
Speaker 1: side on the on biologics, So, uh, that doesn't necessarily
Speaker 1: mean someone couldn't come in and sell the stuff for less.
Speaker 1: But why would you when you can be making all
Speaker 1: of this lovely money. But she can make a beautiful hat. Yeah, yeah,
Speaker 1: you can. You can sit there and uh and and
Speaker 1: light your your your giant stogie with your hundred dollar bills. Um,
Speaker 1: I'm sure they're using it for for drug development and
Speaker 1: paying many of their hard workers as well, not just
Speaker 1: for money, hats but but but exactly, I mean getting
Speaker 1: into numbers, it's hard. Another thing that it's difficult to
Speaker 1: estimate is is the actual cost of a drug here
Speaker 1: in the United States because the process of obtaining obsurance, insurance,
Speaker 1: and then obtaining drugs either through that or through another program. Um.
Speaker 1: It it means that we don't have like a solid
Speaker 1: price sheet for a lot of stuff. But you looked
Speaker 1: into one of the estimates, Yeah, this is okay, So
Speaker 1: this is This again illustrates how complicated things are here
Speaker 1: in the US and then other parts of the world
Speaker 1: to UH. You could have two people in line to
Speaker 1: buy the exact same drug, and one person is going
Speaker 1: to pay one price and another person is going to
Speaker 1: pay a dramatically different price, and it could all depend
Speaker 1: upon the way that they are paying for that drug,
Speaker 1: whether it's out of pocket through insurance, through programs like medicaid. UH.
Speaker 1: These all have an impact, and it's all because of
Speaker 1: the different relationships that are going on. Behind the scenes
Speaker 1: to set prices, and it gets kind of crazy because
Speaker 1: like we're used to the idea of you go to
Speaker 1: a store and if if Lauren wants to buy like, uh,
Speaker 1: some some chocolate milk, and I want to buy some
Speaker 1: chocolate milk, We're not charge different prices for that chocolate milk.
Speaker 1: I mean it might be it might be like twenty
Speaker 1: cents more expensive at like your favorite big box store,
Speaker 1: us my favorite, but if we're going to the same store, yeah,
Speaker 1: I mean, I mean, okay, let's be fair. Some stores
Speaker 1: they have a picture of me and they say, charge
Speaker 1: an extra dollar for chocolate milk. He is a chocolate
Speaker 1: milk fiend and he doesn't pay attuch the price tags.
Speaker 1: But in a fair world that doesn't happen. But in
Speaker 1: the drug world, that's it's totally different. So there was
Speaker 1: a research fellow, Dr Jing Lao, who was worked in
Speaker 1: the division of pharmacoepa, demiology and pharmaco economics. Wow, I
Speaker 1: didn't think I was going to get through either of
Speaker 1: those at Brigham and Women's Hospital in Boston. It wrote
Speaker 1: an article in two thousand and fifteen for JAMMA in
Speaker 1: Internal Medicine. I always like to go Jamma for this,
Speaker 1: you know, getting jam out. So he found that between
Speaker 1: two thousand and fourteen, medicaid costs per unit of insulin
Speaker 1: increased between six dollars and eighty six per unit to
Speaker 1: fifteen dollars and thirty eight cents per unit, depending upon
Speaker 1: the type of insulin. Now this was just through Medicaid,
Speaker 1: but but the same is true across the board. And
Speaker 1: he said, no matter how he cut or analyzed the data,
Speaker 1: there was always a price increase. It didn't matter how
Speaker 1: he was, like, you couldn't massage the data so that
Speaker 1: there wasn't a price hike, right to clarify, Yeah, like
Speaker 1: like like increasing by six dollars and eighty six cents
Speaker 1: was the lowest of the price increases that occurred. And
Speaker 1: and it went all the way up to that fifteen
Speaker 1: per unit per unit, and and that was and again
Speaker 1: it depended upon the type of insulin. Like we mentioned earlier,
Speaker 1: there were tons of different types of insulin um and
Speaker 1: some types of insulin, like long acting insulin, were affected
Speaker 1: more than others, largely because fewer diabetic patients were using
Speaker 1: long acting insulin and companies still had to produce it.
Speaker 1: There's still a demand for it, but to offset that
Speaker 1: manufacturing costs of producing something. When you know, if you're
Speaker 1: a company and you're producing insulin and no one is
Speaker 1: using this particular type, you could shut that production down,
Speaker 1: switch that those resources to something else and make more money.
Speaker 1: But if there's still a demand for it, but it's
Speaker 1: not as big a demand as it used to be,
Speaker 1: then the way you cover those losses again as you
Speaker 1: hike the price UH. And this sends up being a
Speaker 1: burden on people who are dependent upon that specific type
Speaker 1: of insulin. UH. This is a huge problem for a
Speaker 1: growing number of people, So it's it's even more more
Speaker 1: concerned than if it were just a huge problem to
Speaker 1: start with. It's a huge problem and the number of
Speaker 1: people effects is increasing. So diabetes is an illness that
Speaker 1: disproportionately affects people in lower socioeconomic classes, largely because they
Speaker 1: may not have access to UH a good healthy diet,
Speaker 1: and or they may not have the opportunity to do
Speaker 1: any sort of exercise routines or anything. Things that have
Speaker 1: been shown to, if not prevent diabetes, often either decrease
Speaker 1: its effects or or put off when it would actually
Speaker 1: set in for a person. So sure Sure also recent
Speaker 1: studies have shown and we'll talk about this a little
Speaker 1: bit later, that stuffit like a like stress and even
Speaker 1: air quality can can be increasing risks can can increase
Speaker 1: your risks of developing type two diabetes. And not only that,
Speaker 1: but you have people in these same socioeconomic classes who
Speaker 1: will go to extreme measures to skip or ration medications
Speaker 1: to reduce that financial impact they have for purchasing medications.
Speaker 1: That can also lead to patients attempting to manage diabetes
Speaker 1: primarily through diet, like in other words, trying their best
Speaker 1: to eat a healthy diet and not have to take
Speaker 1: insulin because insulin is so expensive, which certainly helps um
Speaker 1: and can in some cases lead to effective management of
Speaker 1: the disease, but in many cases it cannot. Right there,
Speaker 1: it cannot help in type one. I mean it will not,
Speaker 1: it will not magically have you produce insulin if you
Speaker 1: have type one diabetes. Will talk more about that in
Speaker 1: a second. If you have type two diabetes and it's
Speaker 1: not severe, it might be that through managing your diet
Speaker 1: and exercising more, that's all you need and you don't
Speaker 1: have to take any insulin shots or or have any
Speaker 1: other method of having insulin doses. But for some people
Speaker 1: that's just it's just not enough. It's physically not enough.
Speaker 1: It's not that they are bad people. Is not that
Speaker 1: they aren't working hard enough. It is not that they're
Speaker 1: not eating healthy enough. They literally aren't producing enough insulin.
Speaker 1: So I want to make that clear. I don't want
Speaker 1: any sort of blaming going on here for people who
Speaker 1: actually are suffering through this. I mean, if you can,
Speaker 1: if you can get a direct facts to that, to
Speaker 1: those people's like pancreas, pancreases, pancrea, um, then maybe you
Speaker 1: can blame the pancreas. Yeah, but as far as we know,
Speaker 1: the pancreas is not one of the more sentient organs
Speaker 1: and therefore hasn't made any you know, actual decisions. It
Speaker 1: never responds to my snapchats. Yeah, weird. I wrote a
Speaker 1: song about it. Yeah, yeah, he wrote a song about
Speaker 1: the pancreas. I don't remember that. I just remember that.
Speaker 1: There is one. That's all I wait, no, are you
Speaker 1: thinking of part of like a surgeon? No? No, no,
Speaker 1: that is that that song I could do from beginning
Speaker 1: to end right now, because he finally made it through
Speaker 1: med school somehow he made it through. But no, the
Speaker 1: there is to a karaoke episode. Sometimes oh man, she
Speaker 1: knows not what she asks for. So at any rate,
Speaker 1: we need to remember that these effects aren't just devastating
Speaker 1: for the people who can no longer afford or or
Speaker 1: have are having difficulty affording insulin. It affects all of us, right,
Speaker 1: because whether it's affecting us through insurance rates or other
Speaker 1: types of economic factors, even if you have no emotional
Speaker 1: connection with somebody who's going through this, there is an impact. Yeah,
Speaker 1: that the loss of productivity in a workplace, the the
Speaker 1: overall right, the rates of insurance, the the the rates
Speaker 1: of hospital availability due to those resources being taken up
Speaker 1: by by people who have unfortunately encountered side effects with
Speaker 1: that kind of disease. Um. I mean, you know, what
Speaker 1: I'm saying is is that you don't have to be
Speaker 1: a crazy socialist in order to get to want to
Speaker 1: help solve this problem. Now, this this problem is something
Speaker 1: that everyone, regardless of your economic philosophy, should want solved
Speaker 1: because no matter what, it does have an impact, right
Speaker 1: you know. So uh and so yeah, so, what what
Speaker 1: is diabetes? We've been talking about it for like for
Speaker 1: like trillions of well, you know, like like I wanted to.
Speaker 1: I wanted to do that thing where we go like like, hey,
Speaker 1: there's this problem, you've maybe heard of it, and then
Speaker 1: we describe what it is. It might have been better
Speaker 1: to do it. This is great, all right, Yeah, diabetes,
Speaker 1: Let's let's talk about diabetes. Yeah, so diabetes. Hey, and
Speaker 1: I'm gonna take laughter wherever we can find it in
Speaker 1: these episodes, because this is something that I feel very
Speaker 1: strongly about. In the interest of full disclosure, one of
Speaker 1: my parents is type two diabetic, so this I I
Speaker 1: and I also obviously I am concerned. I'm I don't
Speaker 1: know if you guys know this, Lauren, you do because
Speaker 1: you bring it up all the time. I'm getting up
Speaker 1: there in years, so I am concerned about this sort
Speaker 1: of stuff. I think that if you go back through
Speaker 1: the record, did Joe and I have equal mocking Yeah,
Speaker 1: but you are also my co host on text for
Speaker 1: two years, so I don't think I've ever mocked your age.
Speaker 1: Usually you're the one who brings it up, That's true.
Speaker 1: I I am probably the most guilty of the three
Speaker 1: of us. So. Diabetes, also known as diabetes militis, is
Speaker 1: a disease in which the body suffers due to blood
Speaker 1: sugar levels that are too high. So glucose levels in
Speaker 1: the blood are above healthy levels. And glucose, to be fair,
Speaker 1: is important stuff. I mean, it is what our cells
Speaker 1: use as a fuel source. But to get the glucose
Speaker 1: where you need it, your body produces a hormone called insulin,
Speaker 1: and diabetes is a disease really kind of a family
Speaker 1: of diseases that impact insulin production leading to increased blood
Speaker 1: sugar levels. So you mainly have type one and type
Speaker 1: two diabetes. There are other ones as well, but those
Speaker 1: are the two big broad categories, right, and so the
Speaker 1: common distinction that is made is the type one diabetes
Speaker 1: is the diabetes that is experienced from early onset diabetes,
Speaker 1: and type two diabetes is adult onset diabetes. Yeah, that's
Speaker 1: why it used to be known as In fact, that
Speaker 1: was the official term for type two diabetes until relatively recently,
Speaker 1: when when I guess you realize you didn't have to
Speaker 1: be an adult. Yeah no. But but as as we've
Speaker 1: said earlier in this episode, in type one, your body
Speaker 1: does not produce insulin at all, um, and that is
Speaker 1: because type one diabetes is actually an autoimmune disorder. The
Speaker 1: bodies over zealous immune system is targeting and killing the
Speaker 1: cells in the in the pancreas that make your insulin
Speaker 1: for you. Yeah, those are called beta cells or some
Speaker 1: sometimes in in there. You go, yeah, yeah, no, wonder
Speaker 1: I couldn't just say that. That's very strange. I looked
Speaker 1: it up. But the yeah, the beta cells in this
Speaker 1: case are attacked by T cells immune system white blood
Speaker 1: cells right right that in the fact, there's ongoing research
Speaker 1: about why the T cells attack the beta cells and UH,
Speaker 1: and discovering the cause of this is one way that
Speaker 1: we might be able to help discover ways of curing
Speaker 1: diabetes in the future. But there is some research on
Speaker 1: that that we will get to either later in this
Speaker 1: episode or probably in the next one, actually, I think
Speaker 1: in the second episode. Yeah, And then we've got type
Speaker 1: two diabetes, right where the body might produce insulin, but
Speaker 1: it doesn't do it very well. It's not very effective
Speaker 1: at it, so glucose tends to stay in the blood
Speaker 1: stream and accumulate and get to dangerous levels. It's the
Speaker 1: It is much much more common than type one diabetes. Yeah,
Speaker 1: in the United States, about of diabetes cases are type
Speaker 1: two and UH. And what happens in type two specifically,
Speaker 1: is that for a number of reasons um that the
Speaker 1: body becomes resistant to insulin. It no longer insulin no
Speaker 1: longer prompts your body's cells to take gluc to take
Speaker 1: glucose out of the blood stream um. So, so you're
Speaker 1: glucose levels in the blood remain high, which prompts your
Speaker 1: pancreas to keep making more and more insulin um. Eventually,
Speaker 1: this leads to an overload situation where the pancreases beta
Speaker 1: cells start dying off because they just haven't had a break.
Speaker 1: And then there are other types of a big one
Speaker 1: being gestational diabetes that occurs in about seven percent of
Speaker 1: all pregnant women in the United States, has the same
Speaker 1: symptoms as type two diabetes, and generally happens the first
Speaker 1: time a woman is pregnant. It often will go away
Speaker 1: after the woman gives birth, but it can increase the
Speaker 1: risk of the woman later developing type two diabetes. So,
Speaker 1: and like we said, there are other ones as well.
Speaker 1: There's one that's actually linked to steroid usage in fact,
Speaker 1: But but but the primary ones are are really type
Speaker 1: two and then type one. Uh so, what's the big deal? What?
Speaker 1: Why are we worried? About glucose in the bloodstream. Well,
Speaker 1: in and of itself, it's not terrible, but it leads
Speaker 1: to some deterioration of different things in the body. Yeah,
Speaker 1: like your kidneys and your eyes are often to u
Speaker 1: two types of tissue that are are first affected by this.
Speaker 1: So you can suffer impairment, vision impairment, you can go blind, Actually,
Speaker 1: you can suffer really bad kidney damage. You can also
Speaker 1: cause nerve damage. It could contribute to heart disease or strokes,
Speaker 1: as well as some other related issues. It can also
Speaker 1: necessitate amputation in some cases. And the reason for that
Speaker 1: is that you could suffer nerve damage in your extremities,
Speaker 1: mostly your feet, most frequently your feet, and then not
Speaker 1: notice when you when you develop things like sores or
Speaker 1: other injuries on those on your feet, which can then
Speaker 1: get worse and worse to the point where they necessitate
Speaker 1: an amputation. Um. And so actually that's one of the
Speaker 1: things that that doctors will tell you if they diagnose
Speaker 1: you with diabetes is to frequently inspect your feet because
Speaker 1: you may have uh sores or wounds or something along
Speaker 1: those lines that you weren't aware of because you couldn't
Speaker 1: it due to the nerve damage. But if you're able
Speaker 1: to take care of your feet, then you can you
Speaker 1: can avoid the necessity of an amputation further down the road. Um,
Speaker 1: and all of this is part of why it's so
Speaker 1: important that that people have access to insulin who need it,
Speaker 1: because that helps that helps mitigate that kind of damage. Yes,
Speaker 1: uh yeah, so this is life or death was really
Speaker 1: what we're talking about, you know, it's and and to
Speaker 1: really bring home how big a problem this is and
Speaker 1: how long it's been around, we now have Jonathan's epic
Speaker 1: timeline of diabetes, not my personal one as far as
Speaker 1: I know, I'm if I do have diabetes, I am
Speaker 1: I'm currently undiagnosed. Uh, but it really is an epic
Speaker 1: timeline though, oh yeah, no, it's crazy. So the first
Speaker 1: timeline I consulted really started in nineteen ten, and it
Speaker 1: was going it was going into like the formal, academic,
Speaker 1: real deep study of diabetes. But if you want to
Speaker 1: look at how long have people been aware that something
Speaker 1: along these lines was going on and sort of the
Speaker 1: path of discovery to figuring out what was actually happening,
Speaker 1: you gotta go way back to fifteen fifty two b C.
Speaker 1: And this is by the way just the earliest known record,
Speaker 1: so it could predate like like our our knowledge of
Speaker 1: something related to diabetes could predate this. But heasy Ra,
Speaker 1: a physician, noted the symptom of frequent urination for an
Speaker 1: as yet unnamed disease at that time, which is later
Speaker 1: by by experts been identified as diabetes um In b C,
Speaker 1: there are Hindu writings that make reference to an emaciating
Speaker 1: disease that has an odd symptoms, which is that ants
Speaker 1: are attracted to the urine of people who have the disease.
Speaker 1: I imagine that's because we discovered later that the kidneys
Speaker 1: are trying to purge glucose from the body through the urine. Yes,
Speaker 1: so there's elevated levels of glucose or sugar in the
Speaker 1: urine and ants like like sugar. So uh five that
Speaker 1: are BC were the first descriptions of sugar being present
Speaker 1: in the urine of people with the disease. The disease
Speaker 1: specifically obese people. Two BC. Apollonius of Memphis coins the
Speaker 1: term diabetes, so we get the terms that's crazy, that's it.
Speaker 1: We got diabetes two BC. So the word means to
Speaker 1: go through or to siphon and it's referencing the symptom
Speaker 1: of a patient draining more fluid than they could consume,
Speaker 1: so that frequent urination. So that was the defining feature
Speaker 1: of the disease for a very long time because that
Speaker 1: was you know, obviously, early physicians had to have very
Speaker 1: limited um means to base their observations, right, They couldn't
Speaker 1: look into the human body without usually killing somebody, So
Speaker 1: that kind of made it difficult to pursue any kind
Speaker 1: of harder yes, challenging first century c e. The Greeks
Speaker 1: described diabetes as a disease that results in quote a
Speaker 1: melting down of the flesh and limbs into urine end quote.
Speaker 1: I love ideas that people have. Yeah, if you skip
Speaker 1: ahead about a hundred sixty three years to one sixty
Speaker 1: four in the Common era, Galen of Pergamum, a Greek
Speaker 1: physician diagnoses diabetes as a kidney disease. Uh, this would
Speaker 1: not be the only time people were slightly off track,
Speaker 1: you know, they you can understand mostly urine kidneys equal
Speaker 1: urine just working backward. Just turned out that they were
Speaker 1: not quite on the right track there. Then we get
Speaker 1: into the dark ages. Physicians would diagnosed diabetes with water tasters,
Speaker 1: which is exactly what you think it is. I'm guessing
Speaker 1: making water, tasting the water that you make exactly. The
Speaker 1: physicians would take a sip of the patient's urine and
Speaker 1: if they tasted sugar, if the urine had any sweetness
Speaker 1: to it, they would know that the patient had diabetes. Wow,
Speaker 1: jors really went the extra mile in the dark ages. Uh.
Speaker 1: That's also when they added the word militis to diabetes.
Speaker 1: Militis is Latin for honey, so sweetness. So you've got
Speaker 1: to siphon from diabetes and then you have honey with
Speaker 1: the militis siphoning sweetness from your body. Yeah. Yeah, So
Speaker 1: sixteenth century we get a poetic go ahead, Paracelsus, who
Speaker 1: is a Swiss German philosopher, physician, and occultist. Uh so
Speaker 1: he said that diabetes is a serious general disorder. Getting
Speaker 1: away from that specific kidney diagnosis from earlier. Uh, now
Speaker 1: we're gonna skip over to seventeen seventy six. Lot of
Speaker 1: stuff was going on that year. Don't know if you
Speaker 1: guys are familiar with it, but you know there's a
Speaker 1: whole musical about it. So I will bore you here
Speaker 1: just to say sit down, John um. An English physician
Speaker 1: by the name of Matthew Dobson made notes about diabetes
Speaker 1: and noticed that some people die in less than five weeks,
Speaker 1: while others can live with a chronic condition, and the
Speaker 1: pending upon the severity, could survive for several years, which
Speaker 1: is really the earliest record of someone making note that
Speaker 1: there seems to be two different pathways for this disease,
Speaker 1: not to the point where any kind of formal description
Speaker 1: was made of either type, but rather just a general observation.
Speaker 1: Then we get to a Scottish military surgeon named John
Speaker 1: Rollo experimented with patients by putting them on a high
Speaker 1: fat and protein diet after noticing that the sugar content
Speaker 1: in their urine would increase if they ate starchy foods.
Speaker 1: The idea was get them off the starchy foods, put
Speaker 1: them on high fat and protein diet foods, and the
Speaker 1: following year he published a work saying that there was
Speaker 1: elevated level of sugar in the blood as well as
Speaker 1: the urins. This is the first time we actually see
Speaker 1: someone say maybe there's more to this. One of these
Speaker 1: other humors could possibly be involved. Yeah, it's not not
Speaker 1: that people were still using the idea of humor. Were
Speaker 1: they They were not. People are still using it today,
Speaker 1: all right, some people misuse humor, and I call those
Speaker 1: the satire sites that don't know. Never mind, that's totally
Speaker 1: different to how sorry, I just got completely distracted. Uh
Speaker 1: skipping ahead of eighteen forty eight. By the way, there's
Speaker 1: tons of other stuff that I could have included. I
Speaker 1: finally got some self control. It began to not include
Speaker 1: every little interesting fact that was coming across. But in
Speaker 1: eighteen forty eight, a French physician Clothe Barnard we we,
Speaker 1: I'm so bad at French. I casey, where's Casey? My
Speaker 1: French is terrible. My French is terrible. So but anyway,
Speaker 1: Bernard learns that glycogen is formed by the liver and
Speaker 1: the knee hypothesizes that the same type of sugars found
Speaker 1: in the urine of diabetics um. In eighteen sixty nine,
Speaker 1: a German medical student Paul longer Hans, which is going
Speaker 1: to sound familiar to anyone who's heard of the islets
Speaker 1: of longer Hans, identified two different types of cells in
Speaker 1: the pancreas. Now one type of cell. He said, all right,
Speaker 1: I understand this. This is the stuff that secretes the
Speaker 1: pancreatic fluids that we've kind of observed in previous medical
Speaker 1: exploratory surgeries things like that would be another one of
Speaker 1: the bile let's just call it bile. But the second
Speaker 1: type of cells, which would be what we end up
Speaker 1: calling the islets of longer hans, also known as the
Speaker 1: beta cells that we've mentioned earlier, they produced something else
Speaker 1: that was kind of a mystery to him. He wasn't
Speaker 1: sure what it was that would turn out to be
Speaker 1: the hormone insulin um and so, but this was the
Speaker 1: beginning of that realm of exploration. In the eighteen seventies,
Speaker 1: you had a French pharmacist named a Pollinaire Bouchard that
Speaker 1: who made note that diabetic patients have less sugar in
Speaker 1: their urine. During a time of food rationing in Paris
Speaker 1: when the Franco Prussian War was taking place, so people
Speaker 1: were having less access to food. He noticed that his
Speaker 1: diabetic patient ended up having less sugar in their urine,
Speaker 1: and it began to give them the idea that perhaps
Speaker 1: there could be individualized diets for people who have this
Speaker 1: disease and that that could improve their condition. Um thanks
Speaker 1: Franco Prussian War yeah. Sometimes sometimes some interesting developments come
Speaker 1: out during times of conflict, and they aren't necessarily directly
Speaker 1: related to the conflict. It's just out of necessity we
Speaker 1: learned things like that, So kind of fortuitous in a
Speaker 1: weird way. Fortuitous for diabetic patients, not so much for
Speaker 1: people who were fighting in the Franco Prussian War. In
Speaker 1: eighteen eighty nine, researchers at the University of Strasbourg and
Speaker 1: France remove the pancreas of a dog to see how
Speaker 1: it would affect the dog's digestion, and they observed that
Speaker 1: the dog developed diabetes. So they said, okay, so the
Speaker 1: pancreas seems to play some role in this disease that
Speaker 1: we've been studying for for centuries now but had very
Speaker 1: little actual understanding about it. By nineteen away we get
Speaker 1: German physicist George Ludwig Zuelzer who experiments by injecting a
Speaker 1: quote pancreatic substance in the quote into diabetic patients. It
Speaker 1: seems to work a little bit. It actually does decrease
Speaker 1: the level of glucose in their blood. Yes, severe side effects.
Speaker 1: It is not a purified method of insulin dosage um.
Speaker 1: It ends up being uh, it's not an effective treatment
Speaker 1: because the side effects are so severe. In the nineteen hundreds,
Speaker 1: you have a couple of different things happening. Dr Elliott Joscelyn,
Speaker 1: By the way, this is where my notes originally started.
Speaker 1: Dr Elliott Jocelyn wrote the first edition of the Treatment
Speaker 1: of Diabetes militis in nineteen sixteen. In nineteen Sir Edward
Speaker 1: Albert Sharpie Schaffer, which is possibly the best name I
Speaker 1: have ever read, can't his name is my name too,
Speaker 1: published a study on the pancreas. Sir Edward discovered that
Speaker 1: the pancreas produces a substance that non diabetics would produce,
Speaker 1: and that would be insulin. So this builds on that
Speaker 1: that islets of Longer Hans research that was done decades before.
Speaker 1: Uh So, the name actually comes from insula, which means island,
Speaker 1: and it's called that because the islets of Longer Hans
Speaker 1: were the source of the hormone. So they just continue
Speaker 1: to use the island's motif. Um. So we've got siphoning,
Speaker 1: we've got honey, and we've got islands all all wrapped
Speaker 1: up here in this disease. Your islands aren't working. You
Speaker 1: will siphon honey yes in doctors Frederick Banting and Charles
Speaker 1: Best would experiment with dogs that had had their pancreases removed.
Speaker 1: They inject dog insulin into the experiment animals and they
Speaker 1: see that the glucose levels go down. UH. They would
Speaker 1: actually eventually get awarded the Nobel Prize for that. In fact,
Speaker 1: technically Banting was awarded it and shared it with Best.
Speaker 1: James call Up developed a means of purifying insulence so
Speaker 1: that it could be used on humans, and then by
Speaker 1: three just two years later, you get the first commercial
Speaker 1: production of insulin from Eli Lilly and Company, which is
Speaker 1: still a major producer of insulind. Over the next several years,
Speaker 1: companies would develop different approaches to producing insulin, including slow
Speaker 1: acting insulins, fast acting insulin's. You know, all these sorts
Speaker 1: of different approaches depending upon UH what you were specifically
Speaker 1: trying to manage UM. One of the things that that
Speaker 1: people who have severe diabetes wrestle with is the fact
Speaker 1: that going to bed is terrifying because you want to
Speaker 1: make sure that you take the right insulin dosage to
Speaker 1: manage your glucose levels without going hypoglycemic, meaning your glucose
Speaker 1: levels fall too low. Because that can lead to a
Speaker 1: very dangerous episode, and if you're asleep, there's no you
Speaker 1: don't have any warning signs before it happens. So the
Speaker 1: different types of insulin are absolutely necessary to to deal
Speaker 1: with UH diabetes at different stages. By ninety six, you
Speaker 1: get Sir Harold Himsworth who publishes a paper distinguishing the
Speaker 1: two types of diabetes according to insulin sensitivity. But it
Speaker 1: wouldn't be until nineteen fifty nine that these two types
Speaker 1: are formally defined in medical literature as type one and
Speaker 1: type two UH. The American Diabetes Association would form in
Speaker 1: nineteen forty in response to increase rates of diabetes and
Speaker 1: heart disease in the United States. By nineteen forty four,
Speaker 1: you get the insulin syringe. It's a standardized syringe used
Speaker 1: for insulin dosages and it actually UH It revolutionizes diabetes
Speaker 1: management at that point, so the insulin was obviously the
Speaker 1: first major development, but this syringe made it far easier
Speaker 1: to administer the insulin and UH dramatically improve the quality
Speaker 1: of life of millions of people who were suffering from diabetes.
Speaker 1: Nineteen sixty four you get the first strips to test
Speaker 1: blood glucose levels up to that point, you were testing
Speaker 1: urine not blood, which was less accurate. Also, the earliest
Speaker 1: tests were incredibly elaborate, like you had to boil stuff,
Speaker 1: and yeah, you know it was it was a very
Speaker 1: long process in order you just to get that initial
Speaker 1: read out of how much glucose was in your system. Right,
Speaker 1: And this is frequently the kind of thing that you
Speaker 1: need to be on top of in a kind of
Speaker 1: immediate sense for best best response. Yeah, yeah, if you're
Speaker 1: because if you're looking at it and you're like, well, here,
Speaker 1: these are what my glucose levels were an hour ago,
Speaker 1: it may not be the case at that point, and
Speaker 1: you know, or maybe that you've already suffered some terrible
Speaker 1: episode because of it. Uh. The first blood glucose meter
Speaker 1: would be developed in nineteen seventy, which was meant for
Speaker 1: clinical use, not home use. It was like a five
Speaker 1: dollar device in nineteen seventy and was meant, you know,
Speaker 1: that was just at the doctor's office. You weren't going
Speaker 1: to buy one and take it to your home. But
Speaker 1: nineteen seventy also saw the development of a very useful
Speaker 1: piece of technology, the insulin pump, which as of evolved
Speaker 1: quite a bit since its first invention, but an insulin
Speaker 1: pump helps remove the need to do regular insulin shots. Essentially,
Speaker 1: it's a device is a pump that can pump insulin
Speaker 1: into you and you can typically set the pump so
Speaker 1: that it puts injects a specific amount of insulin into
Speaker 1: your system and UH it was a huge help for
Speaker 1: people trying to manage diabetes. It's standard issue for anyone
Speaker 1: who has type one diabetes UH and is more frequently
Speaker 1: being used by people who have type two diabetes. It's
Speaker 1: not as common, but more type two are seeking out
Speaker 1: the possibility of using a pump um. So this is
Speaker 1: the way it works is that you typically have a
Speaker 1: little spring loaded device that has the tube through which
Speaker 1: insulin will be delivered into your body, and it's got
Speaker 1: a little needle at the end of it to puncture
Speaker 1: you and and insert a catheter under your skin. So
Speaker 1: you would typically find someplace around your abdomen. You would
Speaker 1: place the spring loaded device onto that site after you've
Speaker 1: already prepped it obviously activate it. It would then essentially
Speaker 1: inject and then place the catheter into into the place
Speaker 1: in your abdomen. You would remove the device. You would
Speaker 1: then remove the needle and then you're left with a
Speaker 1: catheter that leads into your body and the pump can
Speaker 1: pump inslin directly into your system that way, um, and
Speaker 1: it's designed at a point now where people can self
Speaker 1: administer this. Actually watched a video of a young boy,
Speaker 1: I mean maybe like twelve or thirteen years old doing this.
Speaker 1: Hard to watch for somebody like me, who one I
Speaker 1: feel a lot of empathy toward the kid, who, by
Speaker 1: the way, was like, this is so much better than
Speaker 1: having to give myself five or six in slun shots
Speaker 1: to day. But also just the idea of like you've
Speaker 1: got to do this and every and you can't just
Speaker 1: set it and forget it. You've got to replace it. Like,
Speaker 1: you can't leave it in place indefinitely. After after like
Speaker 1: maybe up to three days, you would have to move.
Speaker 1: You have to remove it and prepare a new site
Speaker 1: and inject again. So it's a constant thing. It's one
Speaker 1: of the things where you know, you're aware that this
Speaker 1: is going to be part of your routine from that
Speaker 1: point moving forward. It's one of the other things about
Speaker 1: this disease that I think is easy to forget if
Speaker 1: you have never had to deal with it. It's that
Speaker 1: you know, the treatment for it and and even just
Speaker 1: the monitoring of it can be painful. And it's something
Speaker 1: that that diabetics deal with. I mean, it's much better
Speaker 1: to deal with that than the symptoms of diabetes. Sure,
Speaker 1: but you know, like just a prick is kind of
Speaker 1: an argument that you could you could conjure up in
Speaker 1: your head, but I don't know. Just to prick several
Speaker 1: times a day every day for the rest of your
Speaker 1: entire life is certainly certainly a thing. It's it could
Speaker 1: be discourage. It can discourage people into even checking to
Speaker 1: see if they should be diagnosed, because we have this
Speaker 1: weird thing as humans we're not knowing is almost like
Speaker 1: not having it. And if we don't admit it, then
Speaker 1: we don't have to go through that that pain and
Speaker 1: that frustration and that inconvenience. But the truth of the
Speaker 1: matter is it's much better than the alternative. It's just
Speaker 1: hard to imagine that when you aren't dealing with it yet.
Speaker 1: Right moving on through the timeline, were almost done, uh
Speaker 1: in the nineteen eighties. This is when researchers start to
Speaker 1: develop the technique to synthesize insulin using bacteria, which really
Speaker 1: simplified the manufacturing process allowed you to create much greater
Speaker 1: yields of insulin um and it's still a complicated process,
Speaker 1: but less so than it used to be. It also
Speaker 1: means that there's less likelihood of having like a shortage
Speaker 1: because you can more easily manufacture it. However, as we
Speaker 1: mentioned at the top of this episode, it does not
Speaker 1: necessarily mean it brings the price down, or at least
Speaker 1: that doesn't. It's not a big enough factor for that
Speaker 1: to be, you know, to to actually decrease the price.
Speaker 1: So what was it like living with diabetes in the past.
Speaker 1: Probably not very good. A lot of medical care in
Speaker 1: the past. Yeah, Well, to be fair, if you had
Speaker 1: type one diabetes, there wasn't really any living with it
Speaker 1: at all. Anyway. You would typically have a life expectancy
Speaker 1: of about five weeks because your body wasn't producing insulin.
Speaker 1: No one knew about insulin, there was no it was.
Speaker 1: It was pretty much a death sentence. If you had
Speaker 1: type two diabetes, you might live a long life if
Speaker 1: it's not a severe case and you're not over indulging
Speaker 1: and you know, just just through happenstance um, but it
Speaker 1: would also be a life riddled with complications. But for centuries,
Speaker 1: no one knew how to treat diabetes, so your quality
Speaker 1: of life would be poor to nonexistent, depending upon the
Speaker 1: type you had. By the average life expectancy for a
Speaker 1: ten year old child diagnosed with diabetes was one year,
Speaker 1: so to eleven and that's it. If you were thirty
Speaker 1: and you then developed diabetes, doctors will give you four
Speaker 1: more years, And if you were fifty, the expected expectancy
Speaker 1: was eight more years. So actually the older you were,
Speaker 1: the longer you would survive after being diagnosed with diabetes.
Speaker 1: But still, I mean you, you didn't have any reliable
Speaker 1: treatments that could give you a better quality of life.
Speaker 1: Doctor Rolo, who I mentioned earlier, wasn't the only physician
Speaker 1: to attempt to treat diabetes with changes in diet, and
Speaker 1: not all those attempts were successful. According to the Defeat
Speaker 1: Diabetes Foundation, there was a French physician in the eighteen
Speaker 1: fifties who treated diabetics by feeding them lots of sugar.
Speaker 1: Well that makes a stupid kind of sense. If you
Speaker 1: see the body is losing lots of sugar through urine,
Speaker 1: then maybe you need to replace it. I don't know.
Speaker 1: It didn't work, uh, and it was not a treatment
Speaker 1: that was UM pursued for very long but and it's
Speaker 1: not the only time people were wildly incorrect with how
Speaker 1: they should treat diabetes, but it was one of those
Speaker 1: notable ones. And I should also mention that while this
Speaker 1: did appear on their website, I did some preliminary research
Speaker 1: to try and find like some corroboration, couldn't find anything.
Speaker 1: But that doesn't mean it it's not true. It just
Speaker 1: means that while I like I was giving myself very
Speaker 1: limited time for each of these items because I didn't wanna,
Speaker 1: I didn't wanna spend too much time on this one
Speaker 1: thing and then say like it's absolutely not true or
Speaker 1: it really is true, and I didn't contribute anything else.
Speaker 1: UM survival rates among infants born to mothers with diabetes
Speaker 1: were really low. Initially, the fatality rate was greater than
Speaker 1: fifty percent. Dr Priscilla White, who founded the Jocelyn Pregnancy
Speaker 1: Clinic in nineteen dedicated much of her career to fighting
Speaker 1: just aational diabetes, and by nineteen seventy four, Dr White
Speaker 1: had reached a nine percent survival rate among babies born
Speaker 1: to her patients, so an incredible turnaround of that that
Speaker 1: rate so uh, I felt that was absolutely needed to
Speaker 1: mention that Dr White played a great part in this.
Speaker 1: Go twentieth century and go go go that, and go
Speaker 1: that nice woman's research here. Yeah. Absolutely. By the nineteen twenties,
Speaker 1: commercial production of insulin had really transformed diabetes management. In fact,
Speaker 1: it became possible to manage diabetes beyond just trying to
Speaker 1: change your diet. That was further boosted in the nineteen
Speaker 1: fouries with the development of that syringe I talked about,
Speaker 1: and by two thousand four, life expectancy for people with
Speaker 1: diabetes was much longer, but still fifteen years lower than
Speaker 1: that for the general population. So transitioning now into some
Speaker 1: of the modern technology about how we diagnose and manage
Speaker 1: diabetes today, Well, first of all, we've got a ton
Speaker 1: of different gluecoast meters out there that are much more accurate.
Speaker 1: They typically require you to to prick your finger and
Speaker 1: put blood on a strip of paper and then analyze
Speaker 1: that that blood using some sort of meter device, But
Speaker 1: they tend to be very very accurate, which give people
Speaker 1: a good idea of what type of insulin, how much
Speaker 1: insulin they need to administer in order to manage their diabetes.
Speaker 1: We have a lot better understanding of the effects of
Speaker 1: different foods. So sometimes diabetics want to eat something that
Speaker 1: is going to you know, raise their glucose levels, and
Speaker 1: so they'll they'll sometimes at the rent fest and you're like, well,
Speaker 1: there's going to be a deep fried Snickers bar. Yeah,
Speaker 1: and so you might you might take that into account
Speaker 1: and you adjust your your insulin dose dosage for that
Speaker 1: day so that you can experience that. Like, it doesn't
Speaker 1: necessarily mean forgoing all types of foods that you might
Speaker 1: really like and then just eating things that are of
Speaker 1: that aren't starching, like avoiding carbohydrates and highly uh. There's
Speaker 1: also some improvements to technology so that insulin pump I
Speaker 1: mentioned earlier. There are now wireless pumps that are in
Speaker 1: various stages of development and deployment. And these wireless pumps,
Speaker 1: first of all, when you're wireless pump, you might think like, well,
Speaker 1: is this an internal thing? How is it wireless? It's
Speaker 1: wireless in the sense that you can have a wireless
Speaker 1: connection between the pump and a glucose meter, so that
Speaker 1: you still have a pump that you have to wear
Speaker 1: on your body somehow. Usually there's some sort of yep,
Speaker 1: but still got a tube from the pump to going
Speaker 1: underneath your skin. Uh. It clips on typically to a
Speaker 1: piece of clothing or something along those lines, but it
Speaker 1: can connect wirelessly to a glucose meter. So what you
Speaker 1: would do is you would go to test your your
Speaker 1: glucose your blood glucose level, and you'd prick your finger
Speaker 1: and do all that, and then the meter would make
Speaker 1: the measurement and then send that data to the wireless pump,
Speaker 1: which would then administer the proper amount of insulin in
Speaker 1: order to manage your eucost levels or even stop uh
Speaker 1: administering insulin to make sure you don't go hypoglycemic. Right.
Speaker 1: So what that means is is that if you're if you're, say,
Speaker 1: out to dinner and and you know that you need
Speaker 1: to you've either just finished something or you're about to eat,
Speaker 1: you know that you need to adjust your insulin levels,
Speaker 1: you don't need to uh take your pump off at
Speaker 1: the dinner table and manually punch in the button and
Speaker 1: do a whole thing and then like stick it back
Speaker 1: in your body, or you know, go to go to
Speaker 1: a restroom and do that kind of thing. You can
Speaker 1: you can do it more more discreetly right right, Yeah,
Speaker 1: so you don't. Yeah, it really means you don't have
Speaker 1: to fuss with the pump at all, and that that
Speaker 1: like that is again another quality of life issue beyond
Speaker 1: the the pain of dealing with diabetes just to manage
Speaker 1: it properly, there's also it's not so much a social stigma.
Speaker 1: But you know, you don't want to have to this
Speaker 1: embarrassing you have to take out a medical device and
Speaker 1: you're sitting around dinner with You don't want to make
Speaker 1: anyone feel self conscious. You don't want to draw attention
Speaker 1: to it. You know, you just want to be able
Speaker 1: to enjoy your time without that added frustration. Um. So yeah,
Speaker 1: that those definitely have a a big advantage over the
Speaker 1: traditional insulin pumps um and they're still in different stages
Speaker 1: of development. We'll talk more about that in our next episode.
Speaker 1: One of the things I saw I thought was really
Speaker 1: interesting is that another implementation of this approach is using
Speaker 1: smartphones and smart watches as your your way of of
Speaker 1: getting an indication about your glucose levels. So there's this
Speaker 1: one company that's offering a product that would pair with
Speaker 1: Apple's iPhone and their their watch as well, and the
Speaker 1: way it works is that you have an app, you
Speaker 1: download it to your watch and your phone, and you
Speaker 1: use a little sensor that this company provides and it
Speaker 1: has a thin wire they say, it's about the thickness
Speaker 1: of a hair, and you stick that under the skin, uh,
Speaker 1: and secure the sensor to your body. It monitors your
Speaker 1: glucose levels, sends that information to a secondary device which
Speaker 1: then takes the data, sends it to the cloud where
Speaker 1: it gets analyzed so that you get the actual proper
Speaker 1: blood glucose level. That data is sent to your iPhone,
Speaker 1: which they could be sent to your watch. There's a
Speaker 1: lot of different stops along this this route, like a
Speaker 1: lot of points here, but the point being that you
Speaker 1: can look at your watch and get a very quick
Speaker 1: accurate reading of what your blood gluecose levels are and
Speaker 1: then respond if necessary. UM. So kind of interesting to see,
Speaker 1: Like I wouldn't have necessarily thought of like the smartphone
Speaker 1: or smart watches being a device that you could convert
Speaker 1: into like a medical device in this way, but it
Speaker 1: absolutely is something that could do that and allow you
Speaker 1: to keep a really close look on that and that
Speaker 1: could be very that could be life saving and right circumstances,
Speaker 1: UM and and this is kind of wrapping up our
Speaker 1: our initial episode about diabetes, and we've we've covered yeah,
Speaker 1: all that all that good juicy history stuff. Where we
Speaker 1: are now, um, you know, in the a lot of
Speaker 1: a lot of really interesting things are coming in in
Speaker 1: the future. We're going to talk about them next time. Yes,
Speaker 1: so we'll we'll focus on a lot of research and
Speaker 1: a lot of thought that has gone into ways to
Speaker 1: manage and treat and possibly cure diabetes. And how far
Speaker 1: off are these things? Um, how realistic are they? We're
Speaker 1: going to take a look at some of those questions
Speaker 1: in our next episode. If you guys have suggestions for
Speaker 1: future episodes Beforeward Thinking, write to us. Let us know
Speaker 1: our email addresses f W Thinking at how Stuff Works
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Speaker 1: and we'd love to hear from you guys. If you
Speaker 1: will talk to you again really soon or more on
Speaker 1: this topic in the future of technology, visit Forward Thinking
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