December 8, 2009

Dr. Alberto Pugliese of DRI

by



Dr. Alberto Pugliese says to (16:58):Hello

Jon says (16:58):Hi Dr. Pugliese

Jon says (16:59):Hopefully we will get a few more people rolling in here in a minute

Dr. Alberto Pugliese says to (16:59):Hello Jon

Dr. Alberto Pugliese says to (17:02):Not a problem, we can start anytime even with a few people

AllieB2 says to (17:03):oh good I have a few questions, whenever you’re ready to take them, Dr. Pugliese. {smile_smiley}

Dr. Alberto Pugliese says to (17:03):ready

AllieB2 says to (17:03):Hi, I’m Allie Beatty, by the way {smile_smiley}

Dr. Alberto Pugliese says to (17:03):nice to chat with you Beatty

Dr. Alberto Pugliese says to (17:03):sorry, I meant Allie

AllieB2 says to (17:03):lol

AllieB2 says to (17:04):
no problem.

AllieB2 says to (17:04):
my question has to do with the antigen and thymus relationship, regarding the insulin producing cells…

Dr. Alberto Pugliese says to (17:04):
OK, what is the question?

AllieB2 says to (17:04):
is it true that islets are not the ONLY insulin-producing cells in the body?

Dr. Alberto Pugliese says to (17:06):
yes that is true. other cells, including cells in the thymus and neurons can produce insulin. However, that insulin is not produced in a way that it has effects on sugar levels

AllieB2 says to (17:06):
is it more homeostasis functions?

Dr. Alberto Pugliese says to (17:07):
the insulin produced by neurons has mostly local effects, the insulin produced in the thymus helps educating the immune system to prevent unwanted reactions against insulin-producing cells – we call that self-tolerance

Jon says (17:09):
I attended a diabetes symposium at UCSF a couple of weeks ago, and they were studying Omega 3 fish oil to prevent diabetes. Is this something you have heard of, and do you think there is a possibility there?

Dr. Alberto Pugliese says to (17:10):
yes. there is a clinical trial that has just started to explore the feasibility of this approach and later whether it prevents the development of diabetes
Jon says (17:10):
What would you say is the most promising research you have seen?

Dr. Alberto Pugliese says to (17:10):
the idea is the omega 3 fatty acids stimulate an appropriate regulation of the immune system

AllieB2 says to (17:11):
Is this at all similar to the effects of Vitamin D3?

Dr. Alberto Pugliese says to (17:12):
this would work like a dietary supplementation and it would be given to children who are at risk of diabetes (genetically) at birth or during pregnancy, continuing on after birth

Dr. Alberto Pugliese says to (17:13):
the effects would be complementary with that of vitamin D, but because vitamin supplemetation has been increased already this is an effect that is hard to study

Dr. Alberto Pugliese says to (17:14):
There is a lot of promising research, I am excited about new ideas about using people own’s cells to treat autoimmunity

AllieB2 says to (17:14):
that would be incredible!

Jon says (17:14):
are you talking about stem cells?

AllieB2 says to (17:14):
do you think it is possible to “retrain” the attacking T-cells to NOT attack our islets?

Dr. Alberto Pugliese says to (17:16):
There is a lot of data already, from many laboratories, so it is actually pretty credible. I am talking about certain types of immune cells, in particular dendritic cells, which can eliminate bad T cells or promote the formation of regulatory T cells that

Dr. Alberto Pugliese says to (17:16):
would control the bad T cells

AllieB2 says to (17:17):
😀

AllieB2 says to (17:17):
as a scientist, who is aware of other scientists’s work — what is your opinion of Dr. Faustman’s research?

Dr. Alberto Pugliese says to (17:19):
it has been hotly debated, as you know. I am more of the opinion that much of her original claims were not confirmed. Also, I fail to see the rationale to do another trial with BCG, which has been done already and shown not to be effective.

Dr. Alberto Pugliese says to (17:19):
Also, such a trial would not be a translation of the protocol she used in the mice

Jon says (17:20):
Do you think Diabetes is Genetic?

AllieB2 says to (17:20):
yes, i had heard the original “cocktail” was much stronger (if that’s the right word to describe it)

Dr. Alberto Pugliese says to (17:21):
sure. there are several genes involved, we have identified several, and more are going to be discovered in the future. Remember that genes do not cause diabetes in every person, but make it more likely for the disease to develop

Julie says to (17:21):
Similarly I fail to see why Dr. Skyler needs to repeat the oral insulin trials which have proven ineffective for the most part – yet he continues to tie up trial-net funds

Jon says (17:22):
so where are you in the regulatory t-cell research? What is the next step?

Dr. Alberto Pugliese says to (17:22):
the oral insulin trial did show that there was a protective effect in those patients that had insulin autoantibodies. The data were statistically significant, with statistical analysis performed blindly by independent teams of statisticians

Dr. Alberto Pugliese says to (17:23):
if you think about it the results are telling us that those who had an immune response to insulin (antibodies) were those who benefited from the treatment – it makes a lot of sense

Julie says to (17:23):
Respectfully, isn’t presence of anti-GAD more predictive of onset of type 1 than insulin autoantibodies?

Julie says to (17:25):
I’m much more interested in your research Dr. Pugliese

Dr. Alberto Pugliese says to (17:25):
Julie, you are correct, but it depends on age groups too. In young children insulin autoantibodies are strong predictors too. Also remember that autoantibodies are just one aspect of the immune response, and we need to improve our ability to study T cells

Dr. Alberto Pugliese says to (17:26):
also, there is a lot of research from humans and mice that shows that insulin is a required antigen for the development of diabetes, while GAD is not. having said that, GAD is an important autoantigen too

Dr. Alberto Pugliese says to (17:26):
HI to the people who just joined, please shoot questions

Jon says (17:27):
Tonights topic is REVERSING AUTOIMMUNITY

renee says to (17:27):
hello this is my first time here

Julie says to (17:27):
What is being done to look at reversing autoimmunity without the use of immunosuppressants?

Jon says (17:28):
Hi Renee. Do you have any questions about Diabetes research for Dr. Pugliese?

renee says to (17:28):
not right now..I came on to learn more

Dr. Alberto Pugliese says to (17:29):
a lot. for one, the trials with specific antigens such as insulin and GAD. then, we are strating to use short term immunosuppressive drugs together with antigen to kill off the bad T cells and reeducate the new ones

Jon says (17:30):
What would you say is your biggest obstacle in your research?

Dr. Alberto Pugliese says to (17:30):
plus there is a lot of research on the dendritic cells and regulatory T cells, as mentioned before

AllieB2 says to (17:30):
is the use of “short-term” immunosuppressant drugs safer in terms of developing cancer (or not) in the long-term?

Tracey says to (17:30):
Do you have any thought on rituxibab to stop the ongoing destruction of beta cells in the body. Even if rituximab works, it will still be necessary to take insulin shots.

Dr. Alberto Pugliese says to (17:31):
there are many obstacles, but possibly the biggest one is the difficulties in obtaining funding, since the NIH budget has not been increased appropriately

Julia says to (17:32):
In your opinion…The big question… will there be a cure BEFORE a vaccine?

Dr. Alberto Pugliese says to (17:32):
yes, short term immnusuppression should be safer. also it changes the approach from chronic suppression to short term suppression followed by the stimulation of regulatory responses and proper immune function

Julie says to (17:32):
I question why the rituximab studies are done in otherwise healthy children with new onset type 1 – I think the first trials should be done in adults. Children can’t make the decision for themselves whether or not to be subjected to the unknown.

Dr. Alberto Pugliese says to (17:33):
re Rituximab: if it works, if we break the circle, there is a chance that enough beta cells may survive that one may not need to take insulin

Dr. Alberto Pugliese says to (17:34):
also, even if one takes insulin proper metabolic control will be easier to obtain, and there should be fewer hypoglycemias

Julie says to (17:34):
The potential toxic effects are far too heavy in my opinion to outweigh the possible benefits

Dr. Alberto Pugliese says to (17:35):
finally, if we correct autoimmunity maybe we can start seeing some regeneration or stimulate it

Julie says to (17:35):
Why do you think there is such an increase in type 1 – especially in populations that have newly immigrated to a new country? Yesterday I read that Somali residents of Minnesota are presenting with type 1

Dr. Alberto Pugliese says to (17:36):
as regards the study in children, arguments can be made that the disease is primarily a disease of children, and thus a treatment should be tested in them. also, rituximab has been used in other conditions. In the end there was a decision that involved

Dr. Alberto Pugliese says to (17:36):
many people, taking into account ethics and safety

Dr. Alberto Pugliese says to (17:38):
We don’t know why diabetes is becoming more frequent. there could be both environmental factors and the effects of genetic admixture of populations that emigrate

Dr. Alberto Pugliese says to (17:39):
the idea is that mixing genes from different populations may bring together gene combinations that favor diabetes

Julie says to (17:40):
Dr. Pugliese, in a person who has not yet presented with type 1 diabetes but has a sibling with it, what A1C would you think is telling that onset will occur?

rob6465 says to (17:40):
What is a good range for a person’s A1C ?

Dr. Alberto Pugliese says to (17:41):
any level above the normal range, usually normal range is between 4-6, depending on the assay used

Jon says (17:41):
How is the thymus involved?

renee says to (17:42):
Is there such a thing as autoimmune screening?

Dr. Alberto Pugliese says to (17:42):
the thymus, early in life, controls the shaping of the immune system

Dr. Alberto Pugliese says to (17:42):
the thymus is the place where autoreactive T cells are eliminated

AllieB2 says to (17:42):

Dr. Pugliese — is DRI working on a way to externally develop dendritic cells for individuals (based on their own existing dendritic cells) that could be used to *retrain* their immune system to tolerate insulin-producing cells?

Dr. Alberto Pugliese says to (17:43):
sometimes, this process is imperfect and some auto reactive T cells may survive – these may later cause disease

rob6465 says to (17:43):
Is there any relation with diabetics and Rest Leg Syndrome ? I’m diabetic since 2001 and i’m 40 and started developing RLS about 1 yr ago.

Dr. Alberto Pugliese says to (17:43):
allie: yes, this is what we are trying to do

Dr. Alberto Pugliese says to (17:44):

we are using a particular type of dendritic cells that we have discovered in the thymus and later found to exist also in blood

AllieB2 says to (17:44):
are you currently taking samples from people of their dendritic cells? or are you using animals to research?

Dr. Alberto Pugliese says to (17:44):
these cells express insulin on their surface, we think they use it to interact with the T cells to control their reactivity and prevent that they attack the beta cells

Jon says (17:45):
Do you think that consumption of omega 3 in the mother can prevent diabetes in their offspring?

Dr. Alberto Pugliese says to (17:45):
Allie: we are studying both patients and mice

AllieB2 says to (17:46):
I’d like to volunteer my dendritic cells for you to study {smile_smiley}

AllieB2 says to (17:46):
21 years type 1, under the belt

Dr. Alberto Pugliese says to (17:46):
Jon: this is what the trial will eventually answer, I think it is possible that we will see an effect

Dr. Alberto Pugliese says to (17:46):
thank you Allie

Julie says to (17:47):
Would the same hold true for siblings of children with type 1 – should they increase their consumption of omega 3 to reduce inflammation and perhaps delay insulitis?

Jon says (17:47):
How will you select patients to study?

Dr. Alberto Pugliese says to (17:47):
Julie: yes, it might, but only a trial can prove that
*** (17:48):Welcome to Dr. Alberto Pugliese Chat , Cyndee !

Dr. Alberto Pugliese says to (17:48):
Jon, which study?

Jon says (17:48):
the dendritic cell study

Dr. Alberto Pugliese says to (17:49):
We have been studying patients and their family members, including those with autoantibodies. There is no restriction on age or duration of diabetes.
*** (17:50):Tracey quit the room

Julie says to (17:50):
In what areas of research is genetic therapy being tried on humans today? Do you anticipate FDA will ever approve gene therapy for human trials in type 1 diabetes?

Dr. Alberto Pugliese says to (17:52):
Julie: one disease where gene therapy has shown promise is ADA deficiency. There are possible applications for gene therapy also in type 1 diabetes, but we are not at the point of FDA approval yet.

Julie says to (17:53):
I sincerely appreciate your dedication to understanding type 1 diabetes and how complex it is….it just seems difficult to envision it will ever be “cured”

Jon says (17:53):
we have about 5 minutes left, if anybody has any more questions.

Dr. Alberto Pugliese says to (17:54):
it is difficult, but there are lots of good people working on it, so I am hopeful

Julie says to (17:54):
I believe the DRI people are tops…absolutely focused and dedicated

Jon says (17:54):
Thanks a lot for taking time out of your busy schedule to be here tonight Dr. Pugliese

Dr. Alberto Pugliese says to (17:54):
thank you Julie, we do our best

Dr. Alberto Pugliese says to (17:55):
Thank Jon, it has been a pleasure

Julie says to (17:55):
Any opinion on potential for encapsulated porcine islets to restore euglycemia?

Jon says (17:55):
I hope we can chat with you again in the near future

Dr. Alberto Pugliese says to (17:55):
surely

AllieB2 says to (17:56):
Thank you Dr. Pugliese!

Dr. Alberto Pugliese says to (17:56):
there is progress in the field of encapsulation too, we have to wait and see

Jon says (17:56):
As always, we will post a transcript of this chat in case anybody missed any part of it

Julie says to (17:56):
What about using one’s own stem cells ?

Dr. Alberto Pugliese says to (17:57):
that is something that we and other people are pursuing. but also remember that even if you are able to make new beta cells you still need to prevent the immune system from destroying them again.

AllieB2 says to (17:58):
do you believe it *is possible* to retrain the immune system to NOT attack islets?

Julie says to (17:58):
I always think when you and your colleagues together come up with something safe enough to use in Dr. Kenyon’s daughter, then I’ll try it {laugh_smiley}

Dr. Alberto Pugliese says to (17:58):
yes, this is our goal

Dr. Alberto Pugliese says to (17:59):
I agree, safety is paramount.

AllieB2 says to (18:00):
I’m confident with the technological and scientific advances these days — you’re research will pioneer the cure for autoimmune diabetes.

Julie says to (18:00):
If you care to answer, what made you interested in type 1 diabetes in particular?

Jon says (18:00):
if anybody should have more questions, do you have an email where they can get in touch with you?

Dr. Alberto Pugliese says to (18:00):
when i was a young physician I was involved with the care of newly diagnosed children

Dr. Alberto Pugliese says to (18:01):
often, i was sad when their siblings would later developed diabetes and frustrated because I could not cure them

Dr. Alberto Pugliese says to (18:01):
my e-mail is [email protected]

Dr. Alberto Pugliese says to (18:02):
thank you for the confidence, Allie

Julie says to (18:02):
You’re a treasure Dr. P…we’re lucky to have you on our side.

Gina says to (18:02):
Hi everyone sorry i am late

AllieB2 says to (18:02):
Thank you, Dr. Pugliese. You and your work is remarkable!

Gina says to (18:02):
sorry DR. P

grace says to (18:03):
Hello Dr. P, where is your practice?

Dr. Alberto Pugliese says to (18:04):
I don’t practice anymore, I just do research. I work at the Diabetes Research Institute in Miami
*** (18:06):Welcome to Dr. Alberto Pugliese Chat , reese !

Gina says to (18:06):
Dr. P: I know I am late and im not sure if anyone asked this but, do you know why people get type 1 in their 20’s

grace says to (18:07):
What is your opinion of the insulin pump & do you have a brand preference?

Dr. Alberto Pugliese says to (18:07):
some people do. many others get diabetes much younger, and some when they are older.

Gina says to (18:07):
i got type 1 6 yrs ago at age 25

Dr. Alberto Pugliese says to (18:08):
I am removed from the clinic so I am not current on pumps, but I think they work well for a lot of people. Hopefully there will be soon some pumps with integrated glucose monitoring

Gina says to (18:08):
that would be nice

Gina says to (18:08):
like what the jdrf is doing with the artificial pancreas project

Dr. Alberto Pugliese says to (18:08):
there are already continuous monitoring systemts, so integration should be possible

AllieB2 says to (18:08):
Dr. P — do you know if certain viruses (like chicken pox) might alter the body’s immune response that would *trigger* an attack on islets?

Dr. Alberto Pugliese says to (18:09):
Gina: yes, that is related to what JDRF is doing

Dr. Alberto Pugliese says to (18:09):
there are a number of viruses that have been linked to diabetes, especially coxcackie and rotavirus

renee says to (18:10):
is there such a thing as autoimmune screening with people with type 1?

Dr. Alberto Pugliese says to (18:10):
Renee: sorry I did not get to you before. Yes, we can screen for autoantibodies, which are highly specific for type 1 diabetes

Dr. Alberto Pugliese says to (18:11):
you can also screen for other autoimmune diseases

Gina says to (18:11):
i am really interested in why i got diabetes so late. i mean does something trigger it off?

Gina says to (18:12):
could i have prevented getting it?

renee says to (18:12):
That is ok dr.P my son was dx’d with kawawaski disease at age 2 we often wondered if there was a link to him now having type 1

Dr. Alberto Pugliese says to (18:12):
at some point the immune system is triggered to attack the beta cells. we do not know what the trigger or trigger may be. Also, the destructive process may proceed at different speed in different individuals

Dr. Alberto Pugliese says to (18:12):
nobody knows how to prevent it yet

Gina says to (18:13):
maybe not prevent, prolong

Gina says to (18:13):
if i ate better or something

Jon says to Dr. Alberto Pugliese (18:13):
If Gina had locked herself in a sterile room for 25 years, would she still have diabetes?

grace says to (18:13):
what would be the reason for screening for autoantibodies?

Dr. Alberto Pugliese says to (18:14):
probably. experimental mice get more diabetes in sterile conditions that if exposed to germs

Gina says to (18:15):
Dr. P: how are you guys trying to reverse autoimmunity>

Dr. Alberto Pugliese says to (18:15):
you would screen to identify a person that is likely to develop diabetes. knowing that can help you have an early diagnosis, reducing the risk of complications at onet, and it also empowers you to consider participating in a prevention trial

Dr. Alberto Pugliese says to (18:15):
jon: I meant probably not

bjphilly says to (18:16):
how would you know who to screen?

Gina says to (18:16):
are there any trials going on right now that you think anyone here could qualify for?

Dr. Alberto Pugliese says to (18:16):
gina, i don’t think you could have done anything. most times diabetes develops in families with no history
*** (18:16):pookas quit the room

DFC says to (18:16):
I have no history of it in my family and I have it

Dr. Alberto Pugliese says to (18:17):
usually it is appropriate to screen first degree relatives, they have a higher risk

bjphilly says to (18:17):
I was adopted and did not know the history of family.

Gina says to (18:17):
DR. P: its funny in my family, (on my mothers side) my grandmothers brother got type 1 at age 21, my moms sister got type 1 at age 30 and i got type 1 at age 25, 1 each generation

Dr. Alberto Pugliese says to (18:18):
current trials usually enroll individuals with autoantibodies but no diabetes and patients with recent onset

DFC says to (18:18):
DR P what is the likely hood of my kids having diabetes if I were to have them?

bjphilly says to (18:18):
who are 1st degree relatives?

Dr. Alberto Pugliese says to (18:18):
Gina: that sometimes happens, and it tells you that there are genetic factors involved

Gina says to (18:19):
so my kids, my sisters kids and my first cousins kids can be at risk right?

Dr. Alberto Pugliese says to (18:20):
first degree relatives are parents or siblings of a patient. The risk to children of a patient is probably 4-7%

DFC says to (18:20):
that is not bad

DFC says to (18:20):
thank Dr for answering my questions

grace says to (18:20):
my son adam is type 1 and has the following question…Why do I always feel low after eating cookies to bring my blood sugar back up when I know I’m high enough?

Dr. Alberto Pugliese says to (18:20):
yes, relatives have a higher risk, but the risk is low, so that odds are in favor that they will not develop diabetes

BetterCell says to (18:21):
Hello, sorry I am late.

Gina says to (18:21):
Dr. P, even though at least one person each generation in my family has developed type 1 over the age of 20?

Gina says to (18:22):
the risk is low?

Dr. Alberto Pugliese says to (18:22):
Grace: to bring the sugar up after it is low it is better to eat food with complex sugars, like bread. Cookies have more sugar but it burns fast, so blood sugar levels may drop again

Gina says to (18:22):
ah thats good to know

Gina says to (18:22):
is that why they say chocolate is not a good option for bringing up a low?

bjphilly says to (18:22):
I use pretzels and crackers sometimes Grace

Gina says to (18:23):
they say pretzels are the fastest

Dr. Alberto Pugliese says to (18:23):
Gina: I was referring in general. There are families in which 2, 3 sometimes even more siblings get diabetes and even other autoimmune diseases.

grace says to (18:23):
When I test and I’m high, how come I don’t feel any symptons?

BetterCell says to (18:23):
is there any information available on how to prevent as well as treat Hypoglycemia Unawareness?

bjphilly says to (18:23):
they are gina

renee says to (18:23):
another words my son is type so I am at risk of developing diabetes

Dr. Alberto Pugliese says to (18:24):
Grace: high sugars do not cause much symptoms, unless very high for prolonged times

Dr. Alberto Pugliese says to (18:25):
BetterCell: yes, there is information, I can’t summarize for you here but you should be able to find it on the internet, I think. If not e-mail me.

Dr. Alberto Pugliese says to (18:25):
Renee: technically yes, but probably at very low risk

Gina says to (18:25):
better cell: Linda Gonder-Frederick, Ph.D. actually did a chat about hypo unawareness last year, here is the transcript link if you want to read it <a href=”http://diabetestalkfest.com/chattranscripts/2006/lindagonder.php”>http://diabetestalkfest.com/chattranscripts/2006/lindagonder.php</a>

renee says to (18:26):
My son walks around for days with high blood sugars he is a teen now and recently has had a lot of sick days

BetterCell says to (18:26):
Thank you Dr. Pugliese. However, I do not have your Email Address.

grace says to (18:26):
you are being such a help, how often do you do these chats? My son adam is 10 and he has a lot of questions but needs to go to bed now?

Dr. Alberto Pugliese says to (18:26):
I posted the e-mail address earlier on this chat. I am sure we can do another chat.

BetterCell says to (18:27):
Thank you Gina

Jon says to (18:27):
Dr. Puglieses e-mail is [email protected] It will also be on the transcript.

Gina says to (18:27):
better cell: here is a list of other chats we have done <a href=”http://diabetestalkfest.com/transcripts.html”>http://diabetestalkfest.com/transcripts.html</a>

bjphilly says to (18:28):
Grace <a href=”http://www.childrenwithdiabetes.com”>www.childrenwithdiabetes.com</a> is a good website for you and your son

DFC says to (18:28):
This is good information {smile_smiley}

rickst29 says to (18:29):
hypo unawareness CAN be treated with bio-feedback awareness training… but my preferred treatment is a continuous glucose monitor (I’m pt., not MD or RN)

BetterCell says to AllieB2 (18:30):
Since I came in late this might have already been discussed, my feeling about transplantation is that it is not very successful and the risks of being on Life-Long Immunosuppressive therapy is not very good. Is there anything more viable available for those

BetterCell says to AllieB2 (18:31):
of us w/T1DM?

Dr. Alberto Pugliese says to (18:32):
I agree, transplantation needs to improve and what we need is to be able to prevent rejection and autoimmunity without immunosuppression. That is difficult to do. However, because that is so critical for many diseases, there is a lot of people trying to

Dr. Alberto Pugliese says to (18:33):
solve these problems.

grace says to (18:33):
thanks for your help dr. p, we need to leave the chat room for now,

Dr. Alberto Pugliese says to (18:33):
my pleasure

Dr. Alberto Pugliese says to (18:35):
If it’s OK with you I will retire, if there are no more questions

DFC says to (18:35):
I have to go as well. Thank you Dr. P

Gina says to (18:35):
Dr. P thank you so much for coming

BetterCell says to (18:35):
Grace, Could I have that site Address again, I cannot retrieve it. Thanks.

renee says to (18:35):
Thankyou Dr.P

Dr. Alberto Pugliese says to (18:35):
Thanks for hosting me, Gina

BetterCell says to (18:36):
Thanks Dr. Pugliese

Gina says to Dr. Alberto Pugliese (18:36):
I hope you will be able to chat again!

bjphilly says to (18:36):
thank you for your time Dr. Pugliese

AllieB2 says to (18:36):
Thank you, Dr. P!!

BetterCell says to (18:36):
Hello Allie

BetterCell says to (18:38):
So,…..What is available for T1DM at this time besides the taking of Insulin?

bjphilly says to (18:38):
Insulin is the elixir of life for us.

Dr. Alberto Pugliese says to (18:39):
Nice chatting with everybody, good night

bjphilly says to (18:39):
there is also Symlin which we could use with insulin to help those spikes

BetterCell says to (18:39):
Yes, I know….However T1DM continues to be a Disease that involves more than Insulin. It is a Multi-factor Illness rather than singular.

renee says to (18:40):
so true bettercell

bjphilly says to (18:40):
I’m well aware having lived with it for almost 50 years

renee says to (18:41):
How about your teen years … did you always comply philly?

BetterCell says to (18:41):
If a person w/T1DM has Gastro paresis….then it does exactly the same as Symlin and is in fact contraindicated for those w/gastroparesis.

renee says to (18:42):
can symlin be given through a pump?

Girl23dk says to (18:42):
I’m having such a hard time “getting used” to living with 1DM. Does it get any easier bj?

bjphilly says to (18:42):
my educator uses it through a pump

bjphilly says to (18:43):
NO

BetterCell says to (18:43):
Symlin basically slows down the digestion and Gastro paresis does it as well. There is a belief in the Gastro Community that most T1DM will develop gastro paresis because of Neuropathy related to T1DM

Girl23dk says to (18:43):
to bad {flush_smiley}

renee says to (18:43):
I thought so philly someone told me different

bjphilly says to (18:44):
research has helped us to manage better then years ago, I must say. no more boiling of glass syringes and purer insulin and of our pumping

Girl23dk says to (18:45):
thats a good thing. In that way it’s easier…..

BetterCell says to (18:45):
Yes, that is All True bjphily,,,,,,,,the management is better, but the Complications REMAIN!!

bjphilly says to (18:45):
yes it is 23

bjphilly says to (18:46):
I must say that things have improved except there is no cure

bjphilly says to (18:46):
yes there are still complications

bjphilly says to (18:47):
but with better education those complications can be delayed

Girl23dk says to (18:47):
you have to have a lifelong friendship with your Diabetes

bjphilly says to (18:47):
yes we do

BetterCell says to (18:47):
In my opinion, things have not improved that much over time. Things HAVE improved for IRD(aka Type 2 Diabetes) but not for T1DM!!

bjphilly says to (18:48):
but using information that is available it helps

bjphilly says to (18:48):
Bettercell how long have you had Diabetes

BetterCell says to (18:49):
I am still aware of Physicians here in NYC that appear more comfortable and better able to interact w/IRD than T1DM

renee says to (18:49):
it was nice chatting with all of you have a great night and good numbers

bjphilly says to (18:49):
having seen 50 years of improvement I can’t agree with you

bjphilly says to (18:50):
nite Renee

BetterCell says to (18:50):
I have had T1DM since I was six…….so that would be over 25 years.

bjphilly says to (18:51):
when you were 6 do you remember in order to find out where your bgs were you had to pee in a test tube and parents dropped in a pill or used a tape to meaire sugar

bjphilly says to (18:51):
meaire=measure

BetterCell says to (18:52):
The only “Improvement” is that of ACE Inhibitors and Cholesterol Lowering Drugs….In Reality there has not been much of an “Improvement” despite all the HYPE that you seem to be involved with.

Gina says to (18:52):
whoa

bjphilly says to (18:53):
that’s because I was a teen and was responsible for taking care of my D. That’s why I appreciate what we have today.

BetterCell says to (18:53):
Good Management Techniques are just that……However the problems associated with T1DM as being a “permanent “Member of your Family” remain

bjphilly says to (18:54):
it was like being in the “dark ages” no information as it is today

Gina says to (18:54):
bettercell do you have a blog

BetterCell says to (18:55):
Yes my Blog Site devoted to T1DM is: bettercell.blogspot.com It is entertaining as well as filled w/Wisdom and Personal Stories.

Gina says to (18:55):
oh yeaaaaaaaaaa

Gina says to (18:56):
i knew i knew you

Gina says to (18:56):
lol

BetterCell says to (18:56):
How do you know me?

Gina says to (18:56):
from your blog

BetterCell says to (18:56):
I have not seen you there.

Gina says to (18:56):
i dont comment

Gina says to (18:56):
just read

BetterCell says to (18:56):
Oh..

Gina says to (18:56):
i lurk

BetterCell says to (18:56):
That’s OK

Gina says to (18:56):
i lurk everyone

Gina says to (18:57):
i used t o try to comment on everyone’s but its just too many now

Gina says to (18:57):
i cant keep up

BetterCell says to (18:59):
Getting back to the “Dark Ages”….Physicians (Endocrinologists) that are out there, still appear to be more available for IRD than T1DM. The reason, is that it is easier to treat and that there is more$$ made available. To treat T1DM well, a Physician mus

bjphilly says to (19:00):
I’m aware of what you are saying

BetterCell says to (19:00):
must be Intelligent, focused and not look at their Watches as often as they do. I feel that the BEST PHYSICIAN for T1DM is YOURSELF!!