The Future of Diabetes Part Two

the doctor, so medicine. And then we're talking about diabetes again in this episode, and that's why. So, guys, this is part two of our our series about the future of diabetes. In our first episode we talked about what the diseases and it's history. It's a long, long, long history, the history that dates back more than years. So we talked all about that in the last and includes drinking. We should, yes, yes, So if you if you missed

that episode, you clearly want to check it out. Let me revise drinking is probably not fair tasting, like a wine taste where you're not supposed to swallow us the urine. Yes, absolutely true, because diabetes is all about glucose level management in the blood but also comes through in the urine, and UH, water tasters would be able to detect the presence of sugar in patient's urine and thus diagnose them

with diabetes. Now, of course, our diagnostic and research methods have improved significantly since the dark ages with sipping urine UH, and in fact, we're learning a lot about diabetes just in recent years that really could lead to significant changes in understanding what the disease is at its core and how to treat it. Now, one thing should say before we even go any further is that that there are two major types of diabetes. There's type one and type two.

And as Lauren pointed out in our last episode, type one is a type of autoimmune disorder. Type two is different, UM it is UH developed in a different way, And so some of the stuff we're going to talk about is largely focused on on type two. I mean, the treatment levels can be for both UH, but there will be some stuff on type one as well, right, and so, but but just keep that in mind that when we

talk about diabetes, it's not always universal across both types. Okay, well, I thought we we should look at some studies that have come out mostly this year here in that have detailed interesting developments in diabetes research, a lot of which you might not have predicted if you just went a few years back. And here here's a really interesting one to start with. Now, I would not have expected that you would ever disc cover any link between a metabolic

metabolic disorder like diabetes and air pollution. Yeah, this is a very strange correlation that has been found. That that is odd. Like, you know, air pollutions one of those things where certain conditions you could easily imagine like asthma, other you know, respiratory illnesses, um complications and things like bronchitis or possibly pneumonia. All of that I could easily

even heart disease I can think of. But when you if you had told me a couple of years ago that there was a link between air pollution and diabetes, I well, I mean, I'm like, well, small gets into your pancreas and then what Yeah, I'm still confused. Specifically, what we're looking at here is not not fully diabetes,

but insulin resistance. So it's a you know, a pre precursor related issue here so to diabetes type two, yes, yes, So in August, there was a study published in the journal Diabetes that looked at the link between long term exposure to air pollution and signs of insulin resistance. And insulin resistance, of course, it's a condition that often precedes type two diabetes. It's influenced by inherited and lifestyle factors as well as environmental factors, as we're about to see.

So the study had a sample size of two thousand, nine hundred forty four people in southern Germany between two thousand six and two thousand eight, and these people had previously they've been participants of a project known as the Cooperative Health Research in the region Augsburg and they so the researchers looked for links in the data on these people between exposure to air pollution at their place of residence and the presence of biomarkers that give you a

sign that the person is probably experiencing insulin resistance, and

they found a correlation. So, they found a correlation between the level of airborne pollutant concentrations at residence sites and some biomarkers, particularly those associated with pre diabetes, more so than than full diabetes, and so from the press release, the lead author Dr Catherine Wolfe said, quote, the results revealed that people who already have an impaired glucose metabolism, so called pre diabetic individuals, are particularly vulnerable to the

effects of air pollution. In these individuals, the association between increases in their blood marker levels and the increases in air pollutant concentrations is particularly significant. Thus, over the long term, especially for people with impaired glucose metabolism, air pollution is a risk factor for type two diabetes. And that's interesting. I mean, I didn't come across any information about what

the what the link is? Well, and maybe, I mean, there are times where one we don't fully understand the mechanism, and sometimes it ends up just being that they are correlated, but there's not necessarily causal relationship up right. It may be that there may be some underlying link that that connects the two exactly right. There might be you go further back and you realize, oh, well, this one thing

is affecting both branches. The branches themselves are independent and are not necessarily affecting one another, but are both a result of this prime source. We don't know, at least not based upon the research that we came across for this podcast, But it is an interesting thing to look at and obviously would be something that if if in fact, there is causation there, would guide us to know about or or to to look into the possibility of increase rates of diabetes in parts of the world where this

type of air pollution is particularly prevalent. Or it could also lead to uh to you know, prevention measures even if you recognize this, even without necessarily understanding what the cause is yet. Uh. Let's say you develop pre diabetes.

You know a doctor who if this research is validated, if it's replicated and shown multiple times, the doctor might want to say, if you want to avoid progression into full type two diabetes, you you know, depending on where you live, you might want to move right And for some people that might be a possibility. Some people, of course, that may not be an option. UM. You could also argue that this is one more reason out of the thousands that we have often listed on this show too

clean that stuff up man of our carbon emissions. We've got plenty of reasons for that already, but adding another one is yet another argument to say, look like, if you add up all the even from an economic standpoint, if you just add up all the negative impact from pollution and you assigned a dollar amount, it makes financial sense to get to to make a transition, not just you know, yeah, it's gonna be hard. It's not. It's

not an easy thing. It's not a convenient thing, but it ultimately is the best thing, not just for people's health, for the environment, but for the wallet and so and thus we can excuse Ferngully to capitalism, and and it will be a terrific movie that is beloved by future generations of children. Um, there was a fern gully too, wasn't there? Oh? I'm pretty sure there was. Was there? Really? I think there was? And I is there a rapping bat in it? I don't know that there's a rapping

Probably not. I was about to say, Bruce Willis, where did that come from, Robert Williams. Yeah, you're turning into me Lauren where I just will take names and then if there's a name that is even remotely similar, I'm like, Nope, that's the name I wanted. You know what. There was a lot of infern gully Flora, there was oh and that's a great transition to our next one. This is actually my favorite one because gut flora is my new

favorite topic. I love. I love how much the bacteria that overpopulate um or don't don't overpopulate, but but but massively overwhelmed the amount of cells of you that there are in your body have so much to do also all of your health. Gut Flora is also a great name for a future Bruce Willis movie. I'm just going to throw that out there before we get too far away from Bruce Willis. We're never too far away from Bruce Willis, but do continue well, So so let's talk

about this. So what is the influence of gut flora on diabetes? Well, this one is perhaps a little more intuitive than than a possible correlation between air pollution and diabetes. So this was based on a sixteen study in the American Journal of Pathology that reported on effects of a type of gastric bypass surgery on mice with a with a model condition designed to sort of replicate the effects

of type two diabetes. And it has been observed that gastric bypass surgery, so a surgery that that sort of reroutes part of the digestive process can cause remission of type two diabetes in humans and in mice. So you think that this might be because gastric bypass leads to weight loss. Right, that's probably good, and weight gain is is one of the comorbidities, what one of the co

signs of diabetes. Right but right, But medical researchers conclude that the remission can't be explained by weight loss alone. There's something else going on here. And so after the surgery, subjects show improvements in both insulin sensitivity and glucose tolerance.

So what's going on here And what they found in this study was there was an examination of gut micro organisms before and after the bypass surgery that showed a decrease in pathogenic bacteria and an increase in other micro organisms in the gut that are considered beneficial old for gut health. And these changes seem to coincide with improvements

in metabolic and glycemic regulation. So the researchers, again, this is one of these things where they've just found an early interesting result and they're recommending more direct research into the subject. But essentially, what we need to figure out is how changes in gut micro biota influenced diabetes and metabolism in general. Mm hmm, that is really I mean, the more I learn about gut flora, the more I am pretty convinced that I'm not in charge of myself. Yeah,

you're you're a you're a hybrid organism. Well, you know, I like to think of myself as an involved being. There's a book out about that that I've actually been meaning to read. I haven't read it yet, but it's by the science writer Ed Young, who I like. In the book is called I Contain Multitudes, and it's about that title. It's about microbiota. It came out either this year of the year before, and keep meaning to read it.

I've heard it's very good. Wow. Cool. All right. So uh again, more understanding of that could lead to a greater understanding of how to to manage diabetes. But the picture is about to get even more complicated. So yet another study came out this year in and Diabete a logica diabeto logica, however you pronounced. That study found that people who have an abundance of healthy fat stem cells in their body were more resistant to developing diabetes, even

in equally obese patients. Um, so people with obesity that have the presence of the certain adipose cells fat stem cells makes their organs more more better, more efficient at storing fat in a way that is not ultimately detrimental to the body and leading to conditions that are associated

with obesity, like cardiovascular disease and diabetes. And so they the researchers concluded that understanding the molecular mechanisms that underlie this difference between obese patients with healthy fat stem cells and obese patients without them could help us develop new therapies to prevent insulin resistance in type two diabetes. But man, we're starting to get a really complicated picture of all the different influences that might work themselves out in the body.

To me, this is a continuation of that story that we explored in the first episode about the history of our understanding of diabetes, which not a big surprise, but over time becomes more complex and involved. Uh. I mean, obviously, anytime you're looking at a really complicated subject, that progression is going to go in that direction. Right. We're not gonna suddenly have a huge understanding and then go backward

unless we have another dark ages. But I'm just sure, but yeah, no, it's just interesting to think that, like the same way that people in the nine twenties might have been looking back at previous centuries and millennia of researchers going like, you thought it had to do with the kidneys, you idiots, But now we're like, oh, it

has to do with the bacteria and stem cells. And yeah, one really more brief note to complicate it even more, there was also there was also a study this year in the journal psycho neuro into Chronology that essentially identified a pathway from psychological state two diabetes, and the pathway was from a type of executive function known as low inhibition.

Essentially that is correlated with the state that's known as anxious arousal emotional anxiety, and then correlated to inflammation, which is then correlated to diabetes, which is that actually also correlated to gut bacteria, the so so all of these things so so anyway, but this becomes a self fulfilling prophecy because knowing this is making me anxious, which is therefore eat a yogurt you'll be fine. So yeah, this

is even possible. I mean, this is one of these things that's making me think that there have got to be a lot of false trails here. I mean, I'm sure all these different areas of research or turning up some things that are going to turn out to not really be primary causes. Right. They may be may be a factor that influences but perhaps not is is you know, definitive in causing, or or it could be an indicator that this other thing is happening and not not a

cause of right. Right, But anyway, I mean, I feel like, nevertheless, our picture of the cause and effect relationship with whole body state versus metabolic regulation is getting very complicated. Yeah, seems likely based upon the last few stories you've shared with us, Joe. But then, of course there is another one. This one has more to do with type one diabetes. Okay, this is uh. There was a study that came out in called hotspot Autoimmune T cell receptor binding underlies pathogen

and insulin peptide cross reactivity explicable. Let's let's let's break that one down just a little bit. This was in the Journal of Clinical Investigation. All these have been sixteen studies. This one is um Uh. It found something pretty interesting the presence of pathogens germs maybe the cause or a cause of type one diabetes. So how how would you

figure that? Well, here's how it goes. There are these insulin producing cells that we talked about in the previous episode, known as pancreatic beta cells, and in type one diabetes, immune system cells known as T cells. White blood cells attack these beta cells and destroy the body's ability to produce insulin. But what causes the autoimmune response? Like, why do the T cells attack the beta cell? They didn't like the cut of their jib because they're dumb as

a bag of hammers. They are pretty dumb. They don't

even have brains. You wouldn't believe it. I well, as someone who suffers massive all allergic reactions, I am not a big fan of the way my my body's immune system will misidentify certain allergens and then go into yeah, you know exactly then, Jonathan, how how strange, how poorly understood states within the body at the cell level of cell function um can cause complex systemic reactions that are not necessarily what your body intended intended in quotes, you know,

as we said, the cells don't have brains, but they do have a sort of programmatic function. They're supposed to be attacking pathogens to keep them out. But the study here found that these T cells were cross reactive in a particular way, and that means they react to a complex set of conditions that determine their behavior. And these conditions, the study found, could be brought on by the presence

of particular pathogens. Uh. A quote from the study abstract is T cell cross reactivity with pathogen derived antigens might break self tolerance, which that that's a great term self tolerance. I assume that means the immune system not attacking your body. I've got very low self tolerance. But that's something else, yeah, yeah,

in the end to induce autoimmune disease. So it demonstrates the value in looking at the various ways external influences such as germs and other pressures might alter T cell function to cause autoimmunity. Autoimmunity being not a good thing when the immune system attacks you, and that would include type one diabetes. So there can be certain there can probably be certain germs present in your body in certain ways that can trigger this chain reaction of autoimmune response

against your betas holes. So that's heavy stuff you've laid down on us. Joe, it's really fascinating learning more about this disease that we keep thinking we've got, like or at least the indication I always felt this was that we had a pretty good handle on it, but it turns out that it's far more complicated than I had anticipated. Well, I think we do understand a lot of the basics.

Sure well, sure, yeah, but it's just that our pictures becoming and you know, the broader picture is becoming more and more complicated, right, right, But we also have a lot of research into the practical means of how we could uh improve the treatment for diabetes. And I've got one more little bit of of research that I found that that that could potentially help lead to better understanding

and better therapies in the future. Um. There was a recent study that was published in the Journal of Clinical Investigation that looked into those early stages of type two diabetes that you were talking about a minute ago, UM that that that insulin resistance. UM. The authors of this study were investigating whether there's a link between the processes processes that lead to accumulated fat in muscle tissue, which again obesity being a common alongside to insulin resistance. Um

the others of this one. We're looking specifically at UM whether there's a link between accumulated accumulated fat and muscle tissue that that that obesity kind of issue that we were talking about earlier, and the decreased glucose uptake that is one of those early indicators of insulin resistance and therefore of type two diabetes. And there is UM. There's this protein that's called mondo A that is a link between accumulated fat and muscle tissue and decreased glucose uptake UM.

And this protein, the single protein appears to regulate genes that control both fat synthesis and insulin signals. They think that this protein might be what's telling your cells to stop taking in glucose and instead convert it into fact um. But they think that when the protein is activated too often, when there's just so much glucose in your blood, that that that this protein is being triggered constantly, it could make your cells permanently resistant to insulin instead of just

temporarily resistant to glucose UM. So, you know, but potentially in the future, this this could lead to treatments that could target and inhibit mondo A. Maybe hopefully, um. I mean, the researchers think that it could even help people manage their overall metabolism and body weight by managing the function

of the single protein. That's cool. And so it's important to also uh reiterate that a lot of these areas of research may ultimately not uh not result in a useful treatment, but there's a lot of potential out there, and there's so many different avenues of exploration that there's a lot of hope that we can find much more effective ways of either preventing type two diabetes from forming, or even type one in the case of the possibility that germs play an important role in the development of

that type of diabetes, or the management making management more less of a pain, both literally and figuratively. Uh. And to that end, there's a lot of different approaches that people have been looking into on one aspect of diabetes management, and that is monitoring your glucose levels in the first place, because we mentioned like the original tests were all about testing the sugar levels and urine, which are not necessarily as precise as you would want as reading of your

blood glucose levels. That's more of a relevant measurement. But blood glucose. The way you measure that typically is that you have to prick a finger or some other part of your body and uh get a blood sample and then use a device to analyze it. So it's invasive by definition, right, you have to get at the blood. So there's been a lot of look into the possibility of developing non invasive means of measuring blood glue close levels,

which would remove at least one of those barriers. And one of those frustrations that people UM encounter when it comes to diabetes, could you do a breath a wizer, one would hope, And that was not one of the ones that I read about. There was a paper published in the National Institutes of Health back in two thousand twelve that was sort of a review of various processes

that had been UM experimented with. In some cases even products were brought to market, but ultimately uh spoiler alert did not perform very well, and uh they wanted to. It was specifically looking at these noninvasive appre which is like, are there any that are on a level that is promising, if not as good as monitoring glucose levels through actually analyzing blood directly. So here's some of the ones that they looked at, they looked at UH bio impedence spectroscopy.

So this is measuring the resistance to electric current flowing through tissue impedence UM. So this is not that different from things that use like capacitis touch screens, that kind of stuff. I mean, our bodies we've talked about many times. UH, we conduct electricity. We also have stuff in us that impedes the conductance of electricity, and that changes depending on

our body chemistry. So the key here is that there are variations in glucose concentrations that change the number of sodium id ions and potassium ion concentrations in our blood. So typically sodium ion concentration goes down, potassium ion concentration goes up. This changes our resistance to electricity. UM. So if you were able to measure that in a meaningful way, you would be able to make some UH, you would be able to to figure out what the gluecoast levels

of blood were. However, all of these different approaches I'm going to talk about have different drawbacks. The one for this one is that it's not as reliable as other methods of checking blood glucost levels, and at the time the paper was written in two thousand twelve. It also required the diabetic person to rest for sixty minutes before taking any measurements. So yeah, you have to be at

rest for an hour before you could take a measurement. Obviously, that's not practical for a lot of people, particularly people who are suffering type two diabetes. And it maybe it's not a very severe case, but it's enough for them to have to monitor their glucose levels. Uh, they might have a fairly active lifestyle, which is part of the way to help treat or manage diabetes. Um. So yeah,

that is a little bit. That's it's not ideal, right, so are other ones to electromagnetic sensing similar It's also reliant upon the dielectric properties of tissue, but in this case you're talking about electromagnetic frequencies, not passing an electric current through tissue. They use two different inductors to sense any variation of dielectric parameters of the body and glucose

levels would affect those parameters. Also, this approach has drawbacks. Uh, it's very sensitive to temperature for one thing, so there are optimal frequencies you would want to use based upon the temperature and that means that if you haven't set

your inductors properly, then you're gonna get erroneous readings. And since those depend upon temperature and it's very sensitive, that is a level of ambiguity that is problematic when it comes especially when it comes to something that you would want in a home uh kit, write something that a diabetic person could use on their own without having to

go to a professional to have this. I mean, if you if you're gonna have to go to a professional, I think most people just a like I hate having to prick my finger, but it's better than having to go multiple times a day to somebody else. Um, then you have reverse ion toe fesis. I was about to say, do you have anything in the in the electrical end that's more difficult to pronounce? I to foresis is probably up there, and I'm certain I am mispronouncing it. Uh.

That's a fancy way of saying. You measure the flow of low electrical current between an anode and a cathode that would both be placed on a on the skin's surface. Now this one, I'm gonna be straight up with you, guys. I do not fully understand the mechanism here because I read the I read the whole paper, and I read the section, and even after I read it three times, I was like, I'm still not sure what's going on here.

But the way they described it was that you would put the electrodes on the skin and it would rely on quote a physiologically relevant fluid sample end quote. Don't know what that means. Physiologically relevant would obviously means something that would also have glucose in it and would be relevant to the blood glucose levels. But since it's not invasive, it's not the blood itself, because you're not putting the electrodes in you, You're just putting them on the skin surface.

Do you have to cry to use this? You do? For another one? You do for another one. You get in ahead of me because that's next. Um. But the product there wasn't Probably that was actually brought to market using this particular approach, but it was discontinued after numerous issues became apparent, largely that well, one thing, the electrodes would tend to irritate the skin, and also you had to have them in place for an hour before you could take a reading similar to the previous one. I

talked about. So not only do they irritate the skin, you had to wear them for a long time before you could even get your blood glucose level reading. Also, sweating would throw off the accuracy of the measurements. So, uh, if you started sweating during that hour while you're waiting to get your blood glucose level measurement, you would throw things off. So not ideal. But now we're getting into tears and crying. Yeah, fluorescence technology. Fluorescence is exactly what

you think it is. It's using an enzyme of some sort that would cause, uh, in this case, your tears to fluoresce when exposed to a particular type of light, and you measure that fluorescence, and uh, the level of fluorescence and the type of fluorescence would depend upon the levels of glucose found in your tears, which according to a study, uh that this particular paper cited. I am sorry, I didn't write down the name of the other paper, but they cited a study that suggested that glucose levels

and the tears correlate with glucose levels in the blood. Um. Not exactly like on a you know, it's not saying that the level that you find in your tears is the same as in your blood. But yes, and that if you know one, you can you can uh, exactly, thank you. How many times a day do you have to watch the end of Homeward Bound? Uh? Well, the pends you can. You can change it up, right, like you can watch Brian's game, or you can rouge. Yeah.

I cry whenever anyone suggest turning on Mulan Rouge. Um. Not not the actual movie, just the thought of having to watch it again. Okay, look I'm not saying it is no fern Gully to the Magical Rescue? Is that the actual name of fair Gully too? It is. I looked it up while you guys were talking. Um. So, so this this method would involve using this enzyme in your tears and then analyzing the tears to find the

blood glucose level. So it's not invasive. However, the enzymes have a short lifespan, and there's some questions about biocompatibility, which is obviously something you want any kind of medical process. You don't want to find out it's non compatible with your biology. Yeah, that's what we call bad. Yeah, toxic is probably one of those things you want to stay far away from, right so then you had infrared spectroscopy. Both mid infrared and near infrared uses of this technology.

Obviously they're using different frequencies on the infrared spectrum. UH. This would involve measuring absorption rates, really the reflective rates, UH, the the amount of light that comes back after you would expose an area where you're you know it's tissue area to get an idea of blood glucose levels. Right, and this is this is a method that they're using to to certainly take pulses, not invasively and mechanically right

and so electronically. Rather you're looking at reflection because uh, infrared does not penetrate very far into tissue, so you're not gonna like shine and infrared light through It's not like an X ray, it's not going through your body. So you're looking at the reflective reflection of those um, those infrared rays, those that infrared light, and then you're being able to to extrapolate from that what the glucose

levels and the blood are. But these also have issues. UM. For one thing, there are other elements that can affect the absorption of the infrared rays, like water content in your blood, so you might get a false reading because of the water content, not the glucose levels in your bloodstream. Obviously, if you're looking at medicating, that is a problem if you're going on a false reading. Also, with near infrared spectroscopy, you have to exert a great deal of scanning pressure.

In other words, you have to really dig in there. Yeah, you can't just you can't just lay the device against your skin in that case, there's other methods ultrasonic approaches. In the report that I was reading, the researcher actually noted that very little research had gone into using ultrasound itself, but a variation on ultrasound called photoacoustic spectroscopy had been experimented with, and it's kind of a funky approach. So

here's here's how it works. And when I read this, I was like, wow, now we're getting into some who thought of this. At what point did someone say, hey, I got an idea again. So you use a laser to excite fluid within tissue. So you're using the laser to essentially heat stuff up essentially, and then you listen to that tissue. You actually listen to the excitement of the tissue. Yeah, you you put a microphone up to

that tissue and you're like, go crazy, guys. And then you analyze the sound that comes from the tissue from thermal expansion and you measure, you analyze it, measuring it peak to peak, and this will give you enough information to figure out the blood glucose levels tissue. I think they were watching the scene and Ghostbusters too with the Pink Goo where they play the music for it and it starts dancing when you play your love is Yeah, it's lifted to hire. Yeah. Uh so, yeah, it's um maybe.

But apparently they can analyze the peak to peak value of the acoustic signal and determine the glucose levels from that. But like the other methods I've mentioned, this one also has limitations. Changes in temperature and pressure in particular or cause problems with precision and accuracy using this methodology, as well as proximity to Vigo the Carpathian Yes, yeah, and those giant portraits. Uh so. They also looked at a lot of other different scanning technologies, similar to some of

the spectroscopy I had mentioned already. I didn't want to go into all of them, but they across the board. The conclusion was that the demand for non invasive glucose monitoring is very high for multiple reasons, right as a quality of life issue, as a means to to remove that barrier from people who are afraid of getting UH diagnosed because they don't want to deal with that reality. And some people are very UH do have phobios of of of skin pricks and absolutely so being able to

remove that, there's obviously a demand for it. However, according to the research, there's we're just not there yet. None of these technologies had reached a level of maturity where it could be as dependable as the accepted methodology. So without that, it's you can't really recommend people switch over. Sure, speaking of technology that isn't quite there yet, Um, yeah, there's one in development. Yeah, yeah, I found I found

I found a food sensor. Yeah, I looked into this, So you're you found a company called tell Spec T E L L S P e C. And it's a sensor that you used to and to find out what ingredients are in the food at a molecular level. You like pointed at a food and it tells you the entire nutritional content. I think we've actually talked about this device on the podcast before. We may have. I think we have. It sounds really familiar, well, and there are

forgotten way more than I've said. There's some related topics as well, Like there was a Kickstarter campaign for a type of mug that was supposed to give you a readoubt of the specific stuff that was in the mug um and then ultimately I think what the Kickstarter campaign delivered was just a mug like like like they downgraded their their promise from this will tell you the ingredients of the stuff that's in here in this too. This will hold liquid um, a fluid will take the shape

of the mug itself, just like any other container. Uh But the idea was I just thought of a great idea. You could sell something that will guarantee that whatever liquid you put in it has a ten percent increase in lead content. Not not something I'm gonna market anytime soon, Joe, But I appreciate your MOXI. Uh so. So tell Spec is working on a product that, as far as I can tell, is not yet at UM brought to market.

It's still in the prototyping stage where it will use near infrared spectroscopy and bioinformatics to measure the ingredients of food on a molecular level. And uh, what you would do is you'd use the small device. It would pair with a small art phone. You scan the food you want to eat with the device. The device would send the data collects up to the cloud for analysis. That analysis would then be beamed down to your smartphone and

an easy to read format on an app. And then you would be able to see what what what is made up of the food you're about to eat. And this could help diabetics plan out their insulin dosage is right, Like if they realize, oh, there are a lot of carbohydrates in this that I didn't anticipate when I ordered it, that would impact how they would, uh manage their insulin

throughout the day. So it could allow people who have diabetes a better understanding of what they are eating and thus be able to manage their treatment on a more granular level. Yeah, and this this is a very common I mean, I'm sure that that most human people at this point in in the universe have an experience of like looking at a food label, trying to decide whether the food that you're about to eat is terrible or okay, and having no idea right in some cases, you're like, Okay,

I got it. If I'm going to eat a deep fried onion, that's bad. That's obviously not the best. But I think it's the most not the best, at least a few years ago. I think it was something like what if it's awesome? Well, so many jokes, but I'm gonna avoid I don't let me just say that. I think I read something where it was like the highest caloric intake of any regular menu. I don't. Well, first of all, if you're eating an entire awesome blossom, I'm

not sure. I'm not, but I watch your entire blooming onion. I will put that away. But they're okay, do not tell me they are the same thing. You will have words, Okay, I really don't know. The breading okay. Also the just the way they cut the onion, it's different. I didn't know you had a real opinion. I thought you were playing. I haven't add one in many, many years because I realized how bad they were for me. But there are the craving is always there, like a vampire. I always

craved the bluemen onion. Yeah, I I just lived my life denying myself that. But but point point being yes, UH nutrition is difficult, and making anything that you can do to make this kind of thing easier for people good news. Yeah. I think if they're really worry a device that gave you really solid, complex nutritional information with this sort of non invasive scan of your food, that would be cool. I'm I don't know, I'm kind of

skeptical of this device. Yeah, And we've seen we've seen, um the approach from the providers side, like from the actual like the food vendor side. We've seen that change over time, right, more and more places require UH restaurants to include nutritional information about their menu items. It's not that yeah, yeah, I would love to see a broader

adoption of that policy across all regions. It's not like it's everywhere, but you might notice that if you go to certain restaurants, like a fast even fast food restaurants, you can look up and get at least some basic idea of the nutritional value of food. And often it's not very you know, it doesn't go very deep. But then if you go to the website you might get more information. This gets a little more complicated when you're talking about like a mom and pop place, not not

a chain you know. Then you're like, well, this is that's when a little handheld device would really come in handy, because chances are you don't have like a website that gives you deep nutritional information about all those different dishes or make um easy to use mass spectrometers available to everyone and as profitable as it is to mark up drugs in the market. Yeah, yeah, well let's talk about

something else. It's a totally different So you have to atomize your food before you eat it, you know, just you know the mom and pop shop. You know, it gets gets there, they're they're kick back, atomizes a plate of that and then you know the past the nutritional data savings onto you. Yeah, definitely, Well how about alt we switched gears for a second. I want to talk about cell transplants. This was another another piece that was that we we had in our notes and then I

started research again. It's it's really fascinating and there there have been several cell transplant procedures and in different ways, and I'm going to go through some of them, but the one I really wanted to talk about was one that happened last year the Diabetes Research Institute at the University of Miami Health System developed a transplant procedure in which they took insulin producing islet cells, or those beta cells, and they implanted them into a layer of fat in

a recipient's abdomen uh, and they submit them into place using a sticky gel like substance so that that holds them so that they are able to um to to to produce insulin and move it into the bloodstream where it's needed. I think actually did use ghack, wasn't it ghack? It was not. Oh, I just remember the smell of that stuff. You guys are you guys are killing me here with your young references. I know what gag is, but that's after my time. It smells like petroleum in

my head. Now. Well. They they performed this procedure on a diabetic patient named Windy Peacock who uh said that within a month, actually the doctor said that within a month, Uh, those cells were producing insulin the way a healthy pancreas went, and they were responding to glucose levels. Naturally, they would produce more insulin if the glucose levels increased, and produced

less when they went down. She was still taking doses of insulin as a supplement in order really in order to not put too hard a strain on these cells immediately out of the gate, right to have kind of an onboarding process where the cells could get up to speed. Uh. And it seemed to be working. Uh. There had been other cell transplant procedures before this, most of them involved

transplanting islet cells onto the liver. Now this works, but it also was somewhat limited uh and and slightly less successful than this other approach, which was less invasive as well, uh than the liver surgery. But the long term effects are still being studied. So with the liveral approach, typically you see a five year lifespan for those cells and then you would need another procedure after that. Uh. They tend to produce insulin properly for about five years before

they die off. They don't know as much about the experimental process where they did it in the layer of fat on the abdomen because it was only last year when the procedure was done, So we don't know if the cells will last longer or if they won't last as long. Uh. That remains to be seen. So that's part that's part of the ongoing study. AH. But there is a massive trade off to the cell trans approach.

It's not something that is automatically a cure that is going to make people feel better for the rest of their lives. UH. That massive trade off is that you have to take um immune suppressing medications for the rest of your life because because you are taking some something else that sells into your body. Yeah, yeah, you've got you've got essentially foreign cells. And if you want to make sure that your body does not identify those cells

as hostile and thus go into attack mode. Similar to what we talked about with the type one diabetes, you have to take immune suppressing medications, and that of course has its own suite of risks. Obviously, you have a higher risk of infection, particularly UH the month or so after you've undergone a surgical procedure. UH. For this reason, the procedures for cell transplants are typically reserved just for people with type one diabetes and and those who have

severe hypoglycemia that low blood sugar. UH. If they have episodes that are really severe and come with little to no warning, then they are candidates for this kind of cell transplant surgery because the trade off of having to go on immune suppressing drugs for the rest of your life.

Is still better than having to deal with type one diabetes where you're constantly having to to administer insulin in some form, either you're doing shots or you've got an insulin and that even on your very best days when you're keeping up with it, you still you still have a pretty high risk for form going into seizure comma. Yeah, yeah, exactly, not the good times. But there's some research that I was looking into that might might help mitigate this autoimmune

response to transplant itself. Um because like like kind of in this case, all you have to do is figure out a way to protect the cells. All that's all you have to do is simple. Um, So enter some fun materials science. Um. There was a team headed up by researchers out of m I T and the Boston Children's Hospital, and they were working with materials that have

been derived from brown algae. Uh. These alginate, yes, alginate gels can encapsulate the beta cells and you know, protect them while still allowing materials some molecules like like sugar and proteins to to go in and out, so allowing the cells to remain living. If you encapsulate cells so that they're perfectly safe. But they all die, then you're

not really doing much good. Um. So, so when you implant cells that are encapsulated with these alginate gels in primates and humans, they tend to cause scar tissue to develop, however, which is bad news. You know. It indicates that another,

although slightly less troublesome, immune response is happening. So so they created like eight hundred chemical derivatives of these alginate gels um each with like we little molecular changes to see if they could get one of them to just slip under the immune systems, right, and uh, and they did so far it works in mice um and there that their next step is planning a non human primate trials.

So it's moving along and uh, you know it might be it might be a while before they get it right, but it could give it could give this this transplant of cells concept of a new breath of life. Yeah, that'd be great to see a reduction in that necessity. Right, and also too because if that happens, if in fact you can reduce the risk of essentially the body's rejection of those cells, you open up the potential of applying

that strategy to a broader range of diabetic patients. First, you would assume that you would apply it to more type ones, but who have less or fewer hypoglycemic episodes or or they tend to come with enough of a warning so that you can you can preemptively avoid it. Uh. And then possibly, if it's an effective enough treatment, you could start discussing the idea of looking at type two.

I think that would be far less likely. Yeah, yeah, you'd have to you have to figure out whether or not the you know, what type of therapies are more effective for for type two diabetes, and whether it really whether you could just start replacing those insulin creating cells in the pancreas, or whether it would be more effective to to look at the sugar the glucose re uptake right right, because remember with type two you are still producing insulin, you're just not doing it necessarily as well.

And yeah, so it's it's a different different beasts than type one. So one other interesting study that came out this year that I thought was worth looking at was about a new research approach for the understanding the function of beta cells, which could actually lead to the creation of regenerative medicine therapies for diabetes. So of course regenerative medicine, what is that that that's dealing with the cell level, being able to re engineer, regrow, or replace cells that

that are having problems within the body. They're dysfunctional or they've been damaged or destroyed. And so what did this study in Nature find, Well, they identified a protein known as f l t P or flat top, that's really what they called it, flat top, and it's a marker that helps divide pancreatic beta cells into groups. So you've got these two different types of beta cells. One group does the work there the workhorses of the beta cell brigade.

They regulate glucose metabolism, and the other group is marked as immature cells that undergo accelerated cell division, meaning they multiply more frequently. And how can you tell the difference. Well, when the protein flat top is present, the cells assumed their mature cell function, meaning that that is the mark the mark of a mature beta cell that's doing the jaw but that it's meant to do regulating glucose in the surroundings and releasing insulin. But beta cells without flat

top that they're the breeding cells the rabbit cells. Basically they proliferated four times as much as cells without flat

top and UH. And the question one of the questions the researchers were wondering about, as well, can we be sure that these rapidly proliferating cells in the pancreas or pancreatic cells eventually do turn into mature beta cells that are going to be doing the work that that a diabetic would need done, you know, releasing, or that anyone would need done, especially that you have lost function of

if you have diabetes. And the researchers found yes, they use this technique that's known as lineage tracing, so they made all the cells go on too ancestry dot com. No, they use color coded genes. That these genes have different color signals that activate when a gene is being expressed, and you can use that to trace the life cycle

of an individual cell. And all this means that hopefully through research based on these new findings about the division of cells of pancreatic beta cells, we might be able to better understand how to regenerate beta cells to replace the ones that have been damaged to destroyed through diabetes. Now that we know this about these about the relationship between these immature proliferating rabbit cells and the mature cells that do the work. Oh, that's fascinating. And then we

have the concept of the artificial pancreas. There are three essentially three main approaches to this, UH, one of which is actually called the artificial pancreas so UH. In two thousand and six there was a project launch called Artificial Pancreas. This was essentially the technological approach to creating a device that does a lot of the functions of the pancreas um at least as far as monitoring and responding to lucost levels is concerned. It couldn't actually produce insulin. You

would have to ah feed it insulin essentially. But what it boils down to is what I talked about in that last episode with the wireless insulin pumps. It's a more sophisticated approach to that, where you have a glucose monitor that is connected to a wireless pump that is automamatically responding to changes in the blood glucose level as indicated by the monitor, so that people can live, you know, relatively unimpeded lives. They don't have to put thought into it.

They don't have to actually monitor the pump or make any modifications to it. It all has taken care of and can increase a person's quality of life dramatically as a result. Ah. So it's kind of a wireless pump on overdrive. At least that's the the the goal, and it's a project that's still going on today. Are people who have had the basic level of technology. UM, They've been part of pilot programs and they the reports I've seen have said that it is a very positive experience

compared to what they were coming from. UH. But ultimately, again, this is a technology that will really monitor and glucose levels and deliver insulin. It doesn't it doesn't replace a pancreas. It's not like a robo pancreas that you have in your body that does the work of producing insulin and distributing it properly. That being said, there are other alternatives that also fall into the artificial pancreas category, one of

which is the bioengineering approach. This is essentially that cell transplant UH strategy I was talking about earlier, where you would create a bio artificial pancreas using the cells that produce insulin. But as we mentioned in that previous section, this can have pretty drastic consequences. It's not meant for every person who suffers from diabetes, at least not in the implementation that we have right now. And then there's

the gene therapy approach. There are some researchers who are looking into using gene therapy to transform cells within the digestive tract essentially within the intestines themselves, into insulin producing cells, so that you would uh repurpose some cells in the body to take on the job of producing an insulin and releasing it into the bloodstream in in response to glucose levels in the blood. So these are all possibilities

that we could see. Where it's not so much I don't know so that's so much a cure as it is an automated management system for diabetes. It's hard to mention it be like it's not like you no longer have the disease, but rather that you have systems within your body that can manage the disease. So it is almost as if you do not have it. Um it's a little you know, It's not the same thing as saying, Wow, I used to have diabetes, but now I know I'm

diabetes free, right right? Well, and and really, I mean, I I love I love doing these episodes where we look into something that I think that I know things about, and then by the end of it, I'm like, oh, not only do I have no idea how it works, but literally no one has any idea how it works. Like there's like, like, we we know the basic mechanisms by which diabetes works, and we've been talking about a lot of the new research that's that's gone into it.

But um but but really, like like on a inter cellular molecular level, we're still not sure what's going on. And so it's it's so great that all of this, all of this is being done and under and within so many different avenues to to look for potential, if not cures, at least um much more effective and less invasive treatment options. Yeah. And uh, I mean the incentive to do so is clear that we covered that in

our first episode really extensively. The millions of people that this would benefit, not to mention the financial impact it would have. Um, there there is every incentive to continue this kind of of line of of of research and experimentation and uh advances in various forms of management and treatment and diagnosis as well. So I feel like I learned a ton um Like, I didn't know about anything from three thousand years ago with a relation to diabetes until we did this episode, and now I feel like

pub trivia, I'm ready for it. So assuming that they have just an entire section on diabetes, who knows that is a very very popular pub trivia night. Yeah nothing, nothing, Nothing gets the party going like talking about a terrible disease that millions of people have. Um. That being said, I know some pub trivia masters who probably would have done at least a question, if not around on the subject because of their their particular sensibilities. I'm not passing judgment.

I'm merely making an observation. Guys, if you have any suggestions for future episodes of Forward Thinking, Maybe it's a big broad topic that you want us to do a deep dive on, or maybe it's just something you know that you're just curious about. Maybe there's a technology or or scientific development that you've heard about and you want to you want to learn more about. Send it our way.

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