Frequently Asked Questions About Diabetes
Will I always have to prick my child’s finger to test his blood sugar?
The technology for non-invasive blood sugar monitoring is there, but at this time there are very few monitoring systems that have been approved by the FDA and are on the market.
Cygnus has developed the Glucowatch® Biographer. The Glucowatch works by using a low level of electric current to extract glucose into a pad that sits under the watch-size monitor. The Glucowatch measures glucose at approximately 26 readings during a 12-hour period. The Glucowatch does not completely eliminate the need for finger testing. You must use a finger stick test to calibrate the watch. Also, blood sugar tests performed on a meter are suggested to compare readings. The Glucowatch is currently on the market and has been approved by the FDA for use in children. For more information about the Glucowatch, go to http://www.glucowatch.com/
Continuous Blood Glucose Monitoring Systems are another semi-invasive method of measuring glucose without using a finger stick. Medtronic MiniMed's Continuous Blood Glucose Monitoring System™ (CGMS) measures glucose using a sensor that pulls glucose from interstitial fluid. At this time, it is not available for consumers, but is available for use through your diabetes doctor. For more information about CGMS, go to www.minimed.com.There are many methods on the horizon, such as using infrared light to measure glucose. These new technologies hold a lot of promise for less invasive ways to monitor blood glucose.
For more information about these and other technologies, visit www.childrenwithdiabetes.com.
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Can my child ever eat sweets again?
Yes, he can! Until recent years, people with diabetes were told not to eat foods high in sugar, such as desserts and candy. We now know that it is not simply the sugar in foods that raise a person's blood glucose but the total amount of carbohydrates. You can include occasional sweet treats in your child’s meal plan by substituting them for another food with the same amount of carbohydrates.
As long as you either exchange carbohydrates to make sweets fit into the meal plan or take the correct amount of extra insulin, you will be able to work simple sugars into your child’s meals and snacks. It is important to remember that when your child eats sweets, he is usually giving up healthier foods that are higher in valuable nutrients. Foods high in simple sugars should be an occasional treat, not everyday foods.
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Will my child have to take insulin forever?
People with Type 1 diabetes are deficient in insulin. In the early stages of diabetes, the pancreas produces a small amount of insulin. Sometimes, enough insulin is made to allow someone to greatly reduce the amount of insulin they take by injection, or even stop shots altogether. This usually lasts only for a short time and patients will need to continue with insulin shots. The injury to the pancreas is a permanent condition.
Unfortunately, there is no "cure" for diabetes at this time. Taking insulin is the only treatment available currently. New research is being done at universities, which tries to restore the body's ability to make insulin on its own. Wider use of these procedures, especially in children, is years away.
If your child has Type 2 diabetes, you may not need to take insulin, but an oral medication may be necessary instead.
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Will my child’s diabetes go away?
No, it will not. Although people with diabetes and their families often wish and think that the diabetes has gone away, once you have diabetes, it is always there.
For people with Type 1 diabetes - often called juvenile diabetes - the diabetes seems to go away during the "honeymoon" period when the blood sugars are almost always within normal range. This happens because the person's own insulin-making cells (beta cells) start working more, and the pancreas starts regulating the blood sugar more than it did before the person started taking insulin. As a parent, you may think that the doctors have made a mistake and that your child does not really have diabetes. This honeymoon period does end after a time, however, and your child's body will not make any more insulin.
For people with Type 2 diabetes, most often referred to as adult onset diabetes, the diabetes seems to disappear if blood sugars are controlled through diet, exercise and/or medication. But the diabetes actually is being controlled - it is not truly gone. To keep the diabetes under control, the person must still monitor their blood sugar levels, watch their diet, exercise and take their medicine.
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When will we have a cure for Type 1 diabetes?
There are several ways to try to cure Type 1 diabetes. One method is to give the person with diabetes islet cells, which make insulin. This is being done in a study in many centers throughout the U.S. and Canada after success was reported in Canada in 2001.
Transplanting islet cells does not require major surgery but rather is an injection of the purified islet cells into a major blood vessel so they can settle in the liver and continue to work. The cells are able to survive and decrease or eliminate the requirement for insulin injections. Because these cells come from cadavers, the body’s immune system may still reject them. To prevent the rejection of the cells, the patients need to take many immune-suppressive medications every day.
Emory University is a site for the islet cell transplants in people over age 18. Chris Larson, M.D., the lead physician and surgeon, estimates that there will be answers about the success and safety of this procedure within two to three years. The long-term safety of the immune rejection medications will continue to be a concern because they increase the risk of infections and cancer. Islet cell transplantation may be available to some high-risk patients with diabetes in about 10 years but likely not to children.
Dr. Larson and many others are researching medicine that interrupts the rejection of the islet cells and could be given for shorter periods with fewer side effects, but these have not yet been studied widely in humans. Concern remains about the short supply of human pancreases and islet cells since one or more pancreases are needed for each procedure.
Another approach to a cure is to stimulate the new growth of islet cells. Studies using this approach were started in 2002 using a special protein that makes islet cells grow from the cells forming the ducts of the pancreas. Studies of safety and effectiveness usually take four to five years and another one to two years for approval from the FDA if studies are successful. This approach would still have the risk of rejection.
Additional studies use genetic engineering to change other kinds of cells to turn on insulin production and to recognize blood glucose levels, which is very important. These studies are probably 10 to 15 years from human use.
A mechanical pancreas – an insulin-delivery system that responds to blood sugar levels –could also be an alternative to insulin injections, although it is not precisely a cure. A model has been used successfully in dogs. In France, it has been used in humans for 48 hours. Many companies are working on glucose responsive insulin systems; several have implantable pumps. These may be available sooner than the other potential cures but would still need widespread studies with FDA approval. They are not likely to be available for another six to eight years.
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