Two new treatments for diabetes have led to great excitement among those who might benefit. Inhalable insulin, which should be available this month, could mean less pain for diabetics who inject the hormone daily. And the drug exenatide, which helps promote insulin production, can lead to weight loss for some. Dr. Martin Abrahamson, medical director of the Joslin Diabetes Center in Boston, answers questions from the NPR audience, submitted after our story on the two treatments.
Can people with Type 1 diabetes (formerly called juvenile or insulin-dependent diabetes) benefit from exenatide, the new injected drug that uses a natural hormone to stimulate insulin release? — submitted by several listeners
Type 1 diabetes is caused by destruction of the cells of the pancreas that make insulin — the beta cells. It is what we call an autoimmune disease: the immune system thinks the beta cells are “foreign cells” and destroys them. For exenatide to work, some beta cells must be functioning. Thus, exenatide would not work in people with Type 1 diabetes and is not approved for their use.
I've been an insulin-dependent diabetic for 31 years with good control and no complications. Could I benefit from inhalable insulin? — J.S. Orlando, Fla.
Inhaled insulin is approved for use in patients with either type 1 or type 2 diabetes. You may be a candidate, provided you do not smoke, have not smoked for 6 months and do not have any active lung disease.
Could inhalable insulin lead to weight loss? —submitted by several listeners
No. Insulin therapy, whether injected or inhaled, usually leads to some weight gain.
Are there any negative side effects to inhalable insulin? What about lung problems? — Nancy Williams, Cincinnati, Ohio
At this stage, we know of no long-term negative pulmonary side effects of inhaled insulin.
Are there homeopathic, naturopathic or herbal equivalents to this new inhalable insulin? Or is it even possible to treat diabetes with these alternative techniques? — submitted by several listeners
I know of no alternative or complementary medications that can be used instead of insulin, either injected or inhaled.
Can a person with Type 2 diabetes control diabetes solely through nutrition and exercise?— submitted by several listeners
Yes. In some cases, strict dietary control and exercise can control the diabetes.
What exercises do you recommend to assist in fighting diabetes? — Brian Paradise, Jacksonville, Fla.
The Diabetes Prevention Program study showed that regular moderate aerobic exercise (walking at a reasonably brisk pace for 30 minutes a day, 6 days a week) and some weight loss (about 5 percent of body weight) reduced the risk for the development of Type 2 diabetes. There is no effective way to prevent Type 1 diabetes. For someone who has diabetes of either type, the same level of exercise and some weight loss would help control the disease.
What can be done to avoid nerve damage related to diabetes? Can problems related to nerve damage be reversed? — submitted by several listeners
We know that good control of diabetes can prevent or delay the progression of many of the complications of diabetes. For the most part, we cannot completely reverse the changes once they have occurred, but with good diabetes control and blood glucose levels as close to normal as possible, we can delay the rate of progression of nerve damage.
Do you have any suggestions for treating the pain of neuropathy, caused by circulation problems associated with diabetes? — Judy Stearns, Gobles, Mich.
Neuropathic pain — from tingling and numbness to shooting pains in the extremities — can be tough to treat, but fortunately we have some medications that can be used. They include antidepressants or anti-seizure medications. The FDA has recently approved two medications for treatment of neuropathic pain: duloxetine (sold under the name Cymbalta) and pregabalin (sold as Lyrica).
There are implantable devices, and some wearable devices that look like a watch, that measure blood sugar throughout the day. Who would be a good candidate for such a device? — submitted by several listeners
Continuous glucose monitoring devices are available for use today by patients. For the most part, we suggest that patients on insulin with wide swings in their glucose levels may be candidates, as may those who have frequent episodes of hypoglycemia, or low blood sugar, including those diabetics who don't experience warning symptoms when their sugar goes low. You should check with your doctor if you think that you might benefit from using this device.
I am a 65-year-old male with atherosclerosis. I am beginning to suspect that my arterial plaque problems are driven by my diabetes. Is there scientific evidence to support this idea? If so, should I seek more aggressive diabetes treatment? — Mike Harris, Huntingtown, Md.
Diabetes is associated with increased risk for atherosclerosis (particularly Type 2 diabetes) — so you are probably correct! We know that good control of diabetes together with good control of cholesterol and blood pressure and smoking cessation significantly reduce cardiovascular risk in patients with Type 2 diabetes.
Are diabetics more likely to see their blood sugar drop below normal levels if they eat too much fiber? I understand that fiber inhibits the body's absorption of glucose. Is this true? What advice would you give a diabetic regarding fiber consumption? — Corinne Perez, Lubbock, Texas
Fiber consumption is recommended for all people, including those with diabetes. Fiber per se should not increase the risk of developing hypoglycemia. Maintaining a balance between food, exercise and medications, as well as adjusting medications if food intake or exercise changes in any way, will help avoid hypoglycemia.
My 57-year-old father was recently diagnosed with diabetes, and was placed on insulin to control it. I've been told that once on insulin, most diabetics are never able to live without it — that controlling their diabetes through nutritional and lifestyle changes alone is no longer an option. Is this correct? — Tiffany Tooley, Athens, Ga.
People with Type 1 diabetes have to remain on insulin for life. But some patients with Type 2 diabetes who are overweight and start on insulin may be able to come off the insulin if they get their weight down and exercise regularly. These are the minority of patients, but some people with Type 2 diabetes have managed to do this.
The most important thing, however, is to control the blood-sugar levels. If insulin is needed to do this, one should remain on insulin.
We recommend lifestyle changes even in patients who require insulin to control their diabetes, because managing diabetes is not just about giving medications or insulin. The dose of insulin is determined to some degree by your level of activity and what you eat. The more active you are, the better the insulin works, so you might need less insulin.