RENE MONTAGE, host:
This is MORNING EDITION from NPR News. I'm Rene Montagne.
People with diabetes are expected to get access to a new type of insulin, this month. Instead of being injected, it's administered through a nasal spray. It's just one way treatment is changing for the 21 million Americans with diabetes.
In your health, NPR's Richard Knox takes us to the Joslin Diabetes Center in Boston. Experts there say the new treatments should help more people avoid the disabling and life-shortening complications of the disease.
RICHARD KNOX: Dr. Martin Abrahamson is Joslin's chief doctor. He says he's excited about the advent of inhalable insulin.
DR. MARTIN ABRAHAMSON (Chief Doctor, Joslin Diabetes Center): For some people, this is going to represent the removal of yet another barrier towards improving their glucose control.
KNOX: Glucose control. It's the name of the game for diabetics, keeping blood sugar as close to normal as possible. It means patients have to prick their finger several times a day to monitor blood sugar levels, watch their diet, exercise, take pills, and, ultimately for most, use insulin. That's why inhalable insulin is such a big deal.
DR. ABRAHAMSON: In fact, in some people, it might even spare them the use of injections.
KNOX: If they can afford it or their health plans will pay. Inhalable insulin is expected to cost 30 percent more. But insulin spritzes aren't the only new thing in diabetes care, more and more patients with type II diabetes, the most common kind, are using an injected drug called Exenatide, brand name Byetta. It's the first new type of diabetes drug in years.
DR. ABRAHAMSON: Exenatide's been a new drug that people have embraced because it's a new mechanism of action and because it can help get more people to goal.
KNOX: Exenatide stimulates natural insulin release in a different way from older drugs. It's a long-acting version of a natural hormone released in the stomach. The hormone basically primes the insulin pump. It tells the pancreas to start releasing insulin as soon as food enters the stomach. Oddly enough, Exenatide is derived from the saliva of a big lizard called a Gila Monster.
Exenatide also comes with a very attractive bonus.
DR. ABRAHAMSON: One of the side effects of Exenatide is weight loss.
KNOX: Studies show patients lose 10 to 12 pounds on average in the first year or two of using the drug. That's apparently because it makes people feel full after eating less. That's how it works for a patient of Abrahamson's called Barry Kittredge.
Mr. BARRY KITTREDGE (Patient, Joslin Diabetes Center): It's definitely had an impact on my eating. I don't eat anywhere near what I used to eat. I eat so much and I just say that's enough. And I never said that before.
KNOX: Since he began taking Exenatide in April, Kittredge says he's lost 18 pounds, after failing every previous diet. Kittredge likes nice clothes, so he's got a deal going with his adult son, Tim. Tim will buy him a new wardrobe when his father breaks 225 pounds.
Mr. KITTREDGE: I'm at about 232 right now, so I'm shooting for the--to get under the 225 and go shopping with my son.
KNOX: Taking the new drug has also dropped Kittredge's cumulative blood sugar readings, a test called hemoglobin A1C, into the normal range. That's pretty important for a man whose diabetes has already cost him the sight of one eye, not to mention the amputation of seven toes and serious circulation problems.
Companies are working on new versions of Exenatide that don't need to be injected and some day there may be a once-a-week form of the drug. But it would be a big mistake to think that new drugs are all that diabetes patients need.
After years of taking diabetes pills and injecting insulin and suffering complications anyway, Barry Kittredge has got religion, as his doctor puts it. He now believes in pills, and diet, and exercise.
Ms. JACQUIE SHAHAR (Exercise Specialist, Joslin Diabetes Center): The beauty of this machine is really using your arms to get your arms stronger, to get your legs stronger ...
KNOX: Jacquie Shahar is Kittredge's exercise specialist at Joslin.
Ms. SHAHAR: When all those muscles get stronger, it helps with increasing your metabolism and it helps with burning calories, burning glucose and that's really the goal of being here, today. How do you feel?
KNOX: After coaching Kittredge through his routine, Shahar says she wants to check his blood sugar again.
Ms. SHAHAR: So here's your meter, here are the strips ...
Mr. KITTREDGE: Mm hmm.
Ms. SHAHAR: ... go ahead and ...
Mr. KITTREDGE: See how good I can do?
Ms. SHAHAR: Yes.
KNOX: Kittredge's blood sugar was a little high when he came in this morning, but the glucose meter has good news.
Ms. SHAHAR: Wow.
Mr. KITTREDGE: So it dropped ...
Ms. SHAHAR: This is great.
Mr. KITTREDGE: That's pretty good, huh?
Ms. SHAHAR: Yep.
Mr. KITTREDGE: Yeah.
Ms. SHAHAR: This is wonderful to see how the exercise can affect your blood sugar.
Mr. KITTREDGE: Yep, very good.
Ms. SHAHAR: It dropped more than 40 points.
Mr. KITTREDGE: More than 40 points.
Ms. SHAHAR: And, and that's probably an excellent motivator to people - that they check their blood sugar before and after exercise and they see their results.
KNOX: The idea is not just to get a gold star, Shahar tells Kittredge that if he can stay motivated to exercise every day, he'll be able to cut back on those drugs. As wonderful as they are, everybody agrees that would be a good thing.
Richard Knox, NPR News, Boston.
MONTAGNE: Send your questions about diabetes to Dr. Abrahamson at npr.org/yourhealth. You can also read more about the new type of insulin, inhaled through your mouth, that should be available this month.
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