Our brains are obviously hard-wired to love food.  For many years, scientists have been trying to unravel the mystery of why we go all ga-ga over fresh-baked chocolate chip cookies, for example.  If we could figure out — and even control — the neuroscience of appetite, just imagine what that would do for combating obesity, and for living with diabetes!

I bring this up because it’s been on my mind since last month’s annual ADA Conference, where I unfortunately missed three talks on the topic: “Imaging Flavors,” “Brain Representation of Taste and Other Food Perceptions,” and “Imaging the ‘Food-Seeking’ Brain.”  I wasn’t able to review the material either, since the ADA doesn’t allow cost-free press access to Webcasts after the fact. Dern.  But from what I can tell, researchers are still pussy-footing around questions like, “What exactly happens to the levels of blood flow in the brain where neurons are active when you smell or taste a food?”

And now, there’s some great new popular science to help us all make sense of it: a new book by former FDA Commissioner Dr. David A. Kessler called “The End of Overeating: Taking Control of the Insatiable American Appetite,” which takes on the American food industry and their exploitation of our natural food preferences.

The author began by experimenting on himself, trying to understand why a chocolate chip cookie should have such power over him.

According to the NY Times, Kessler comes to the conclusion that we’re all generally suffering from “conditioned hypereating” — not a lack of willpower, but rather a “chronic biological challenge” made more difficult by the overstimulating food environment that surrounds us.

Sounds convincing. Certainly we are tempted by an onslaught of glitzy advertising and mega-sized portions in this country. Interestingly:

“Dr. Kessler isn’t convinced that food makers fully understand the neuroscience of the forces they have unleashed, but food companies certainly understand human behavior, taste preferences and desire… He offers descriptions of how restaurants and food makers manipulate ingredients to reach the aptly named ‘bliss point’…  (foods that) reach the precise point at which we derive the greatest pleasure from fat, sugar and salt.”

So what can we do about it?  This is where the willpower comes in.

“Planned and structured eating and understanding your personal food triggers are essential. In addition, educating yourself about food can help alter your perceptions about what types of food are desirable. Just as many of us now find cigarettes repulsive, Dr. Kessler argues that we can also undergo similar ‘perceptual shifts’ about large portion sizes and processed foods.”

He’s essentially asking Americans to re-teach themselves about food, become cognizant of every morsel that goes into their mouths, and learn enough about unhealthy foods to start finding them repulsive. In other words, act like you’ve been diagnosed with diabetes, even if you haven’t!

More easily said than done, I’d say. Statistics tell us that even millions who already know they have diabetes aren’t on the “structured eating” bandwagon yet. Because clearly, their brains are hardwired to go ga-ga over chocolate chip cookies too.  So don’t tell me it doesn’t take willpower to combat those impulses. Those of us working diligently to control our blood sugar use it over and over again every day.

I’m sure this book is interesting, but honestly, I was hoping for some kind of breakthrough in the neuroscience of food, like a way to severe the pull of that chocolate chip cookie, for instance — or perhaps a method for installing an automatic carb-counter that scans each bit of food and does the math for us?

Meanwhile, we’ll just have to keep using our conscious brains to combat the unconscious desire for all the “wrong foods.” Viva la Willpower…

I’m taking a cue from my buddy Scott Johnson and other bloggers, and enjoying a look back at what I was on about here a few years ago, via the WayBack Machine.  Here’s what DiabetesMine roughly looked like back in 2005. Wow!

In the process, I stumbled on the following post, from April 2005, that seemed worth re-hashing: It’s still a double-whammy pain in the ass, every day of my life!!

Free Gifts with Diabetes

What did you get? Let’s see, mine came with a thyroid disorder and severe allergic reactions that turned out to be gluten intolerance. So now on top of the carb-counting and the shots, I’m limited to wheat-free foods, which is a whole other world of complexity, since so much “normal” food is glutinous. Are we having fun yet?!

I’m finding out how common it is for us folks with one organ-specific autoimmune disease to develop other autoimmune disorders. The body’s immune system, already going haywire, attacks other organs, like the thyroid gland.

Apparently upwards of 30% of Type 1’s also get Celiac Disease, an inability to digest gluten, a protein found in wheat, barley, and rye. Sheesh! If it’s so common, why did it take so many allergy-specialist-visits and so much bloodletting on my part to discover that my reactions were caused by gluten?! They tell me mine is a “straightforward wheat allergy” as opposed to full-on celiac sprue, but the imposition’s the same: no normal pasta, bread, or baked goods of any kind. Analyze that!!

So is it becoming more common for new diabetics to suddenly show up with all sorts of add-on disorders? Probably not. My Endo says it’s partly due to the doctors getting more and more proactive in looking for these things before symptoms arise: Type 1’s get tested for thyroid disorder, rheumatoid arthritis, and (maybe, if suspicion arises) gluten problems. Type 2’s for cholesterol, high blood pressure, sleep apnea, and a host of other things if they’re severely overweight.

My doc recommended I search the official Endocrinologists Association web site for “polyendocrine autoimmunity” to research this issue further. Um, NOT really a site for patients. Too much medical mumbo-jumbo we’d rather not decipher. But I did like the Patients First campaign and the Patient-Physician Contract. If you tend to slack off, this is worth printing out and pasting on your fridge, I’d say.

Back to reality, though: Diabetes and gluten intolerance is otherwise known as the DOUBLE-WHAMMY PAIN IN THE ASS. Those of you who’ve got them know just what I mean!! So here’s what I do: I order lots of gluten-free (GF) crackers, cookies, and baking mixes ahead of time from my favorite online stores, www.glutenfreemall.com and www.glutenfreetradingco.com. Then I bake breads and prepare GF pancakes and such ahead of time and freeze them. So when I’m at home, no problemo. Going out in the restaurant world’s another story. But that’s a posting for another day…

Funny how the more things change, the more they stay the same.

When I was a guest on cancer-patients podcast last week, the hosts asked me if we PWDs don’t get frustrated: cancer seems to have all the big celebrities behind it, and make all the big headlines. Does it ever bother your community that diabetes doesn’t get that level of attention? I was a bit dumbfounded. But then I thought of the Children’s Congress. Today, a close look at what some (big AND little) folks are doing to advocate for diabetes…

Ten years ago, 8-year-old Tommy Solo asked his mother why children couldn’t lobby on behalf of themselves for a cure for diabetes.  He didn’t understand why only the adults could do this.  Tommy’s mother brought that idea to JDRF and, eventually, Children’s Congress was born, with Tommy serving as one of its first delegates in 1999.

Last week, a 150 children, ages 4 to 17, and their parents descended on Washington DC for the fifth biannual Children’s Congress.  Among the delegates were several children from five of JDRF’s affiliate international chapters, including England, Australia, Israel, Denmark and Canada. The lobbying event, which usually occurs over the course of four days, was shortened to three this year and was packed with legislative and lobbying experiences for the young delegates.

Pam Ryder, mom of 11-year-old Hannah, was one of the delegates who testified at the Senate Hearing.  She explained why she and her daughter wanted to attend: “We had talked to a delegate and his Mom who were at the 2007 Children’s Congress. It sounded like an amazing, empowering experience. For Hannah I was hoping that being around so many other children experiencing the same thing would be helpful – before this experience, she only knew a handful of kids dealing with diabetes. Also, the opportunity to be part of the solution was what convinced me that we needed to do this.”

After arriving on Monday to a Welcome Dinner, JDRF wasted no time getting the delegates to the White House, where they had the opportunity to meet President Barack Obama! Cool! President Obama grinned brightly as he greeted the delegates, and JDRF staff in front of the White House for a photo opp (you can watch video of their meet-and-greet on the Children’s Congress website). After the exciting White House visit, the delegates and their parents had an educational afternoon with a Town Hall event, featuring opening remarks from JDRF International Chairman Mary Tyler Moore. The panel featured Alisa Weilerstein, a professional cellist; Kalilah Allen-Harris, Miss Black USA 2007; Dr. Aaron Kowlaski, JDRF Research Program Director; and Jared Allen, defensive end of the Minnesota Vikings; and was emceed by ESPN sportscaster Brian Kenny. The panelists shared their experiences with diabetes, such as how Alisa and Kalilah handle obstacles while on stage.  The Q&A saw Dr. Kowalski answering questions like whether or not a CGM makes one “bionic.”

On Wednesday morning, the delegates and their parents convened for the Senate Hearing titled “Type 1 Diabetes Research: Real Progress and Real Hope for a Cure,” led by Senators Collins and Lieberman. Also on hand were Senators Burris, Akaka, Lautenberg (NJ), Shaheen and Spectar (PA).

The first panel of witnesses testifying were JDRF’s big names: Mary Tyler Moore, Dr. Griffin Rogers, Director of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); Sugar Ray Leonard, an Olympic gold medalist boxer whose father has diabetes; and the one and only pop sensation Nick Jonas.

In his testimony, Nick described his diagnosis while on tour in 2005, after his brothers started noticing his 15-pound weight loss. When he finally saw the doctor, his blood sugar was over 700 mg/dl. Nick recited a verse from his diabetes-inspired song, A Little Bit Longer: “Waitin’ on a cure/But none of them are sure/A little bit longer/And I’ll be fine.”

“Diabetes has changed my life, but I know that I’ve benefited from the government’s investment in diabetes research. With the help of Congress, I’ll only have to wait a little bit longer for a cure,” Nick said. Nick also emphasized that until then, he wanted to be a positive force for diabetes. “I want to show kids with type 1 diabetes – like all the kids sitting with me today – that they can live with diabetes and still make their dreams come true.”

Following that were delegate testimonies from the kids and their parents: Hannah Ryder of Maine, Patrick Lacher of Connecticut, Asa Kelly of North Carolina, and Ellen Gould, mother of four of the delegates, interviewed here last week.

Ellen tugged on the heartstrings of the audience as she described the challenges of caring for four children with diabetes.

“On many occasions, we carefully measure blood sugars, count carbs and inject what we think is the right amount of insulin. It is so discouraging when we measure just a few hours later and their blood sugar is way above normal range. Sometimes we have to deal with the low blood sugars. Like the Saturday morning several months ago when we were awakened by Sam, collapsed in his room, incoherent, because of a dangerously low blood sugar. It took us 20 minutes to get him back to normal – but what happens the next time if we don’t hear him? As their mother, I want to reach out and make it better – but I can’t. I can’t cure this disease. I can’t make it better for my kids. I need help.”

Hannah, the youngest delegate to testify, shared her personal frustrations with diabetes: “Before I could go to school or join a club, we had to have meetings. Sometimes I don’t like all the attention. But I know it is the attention that is going to keep me safe and it is attention like this that is going to help find a cure.”

Pam, Hannah’s mom, wrapped up by describing how Children’s Congress impacted them: “The entire experience will be with us as we continue to fight for a cure.  It certainly made us realize that we are not in this alone and that we have some heavy hitters, a great organization, and many determined people fighting with us!”

Thanks to all the delegates, their parents and JDRF for putting on another great event and showing Congress that we are out here and still fighting!

Considering what I am about to write, I feel a little guilty about the post headline here. But these sensational headlines are just the point: the media is abuzz the last few days with the possibility that Lantus insulin “may be linked” to cancer.

The rumors started late last week, when the media got wind that a prominent diabetes researcher forecasted that an “earthquake” event was about to hit that would compromise the safety profile of Lantus.  This leak came nearly two weeks before the data was actually published in the European journal Diabetologia.

For both academia and the pharma industry, a leak like this is just so irresponsible!  Why? Because it kicks off just the kind of anti-Avandia media frenzy that frightens patients off their meds, without real substantiation of the potential danger.  In this case, the research data wasn’t even out yet, and already headlines like mine, above, using the “C-word” (cause) were appearing far and wide.

Now that the data is actually out, there are a few
Important Things to Know About This Story:

1) No cause was shown! “There was no evidence that Lantus actually causes cancer, but it might possibly cause any existing cancer cells to grow and divide more rapidly,” according to Ulf Smith, president of the European Association for the Study of Diabetes (EASD).

2) Backing up for a moment, the study conducted here was not your usual kind, where one group takes the drug and another gets a placebo (unethical in a case like this, of course). Rather, researchers took recorded data (housed in databases) from 127,031 patients in the UK, Germany, Sweden and Scotland and “crunched the numbers” to look for associations with instances of cancer.

Given that it’s just a bunch of numbers correlating insulin use with a handful of different types of cancer, the data is pretty inconclusive.  Even the American Diabetes Association has come out with a statement that “the data within these studies and between these studies are conflicting and confusing.”

3) The official recommendation to patients using Lantus now by the ADA and other expert groups is not to stop using insulin, and also to “consult your doctor” if you have concerns.  I have to agree with the much-quoted diabetes analyst David Kliff that this approach is a bit lame.

That is, while I agree that it’s important for PWDs not to toss aside their insulin, I’d also like to know how the many physicians across this country are supposed to be prepared to consult with their diabetes patients when they’ve had no time to analyze the data?  And how, after reading these confusing studies, can they effectively tell their patients anything other than “there might be a link between Lantus and cancer?”

4) As eloquently pointed out by Jenny over at Diabetes Update, the population studied was most likely a very high-risk group for cancer due to a number of other factors, leading with running consistently high blood sugars for many years — most likely long before being prescribed Lantus.  Many had probably also been taking “cocktails of powerful oral drugs for years before starting Lantus.”  Therefore, to pin the cancer correlation solely on Lantus insulin is probably misleading at best.

Nevertheless, Jenny concludes that “this latest alarm… is probably GOOD news, because it will trigger some serious research into the cancer profile of all the analog insulins and perhaps, even, of the oral diabetic drugs.”

Personally, my prediction is a bit different: I’m betting that after a lot of bantering about by various researchers and industry experts, we’ll end up with data illustrating a TINY risk in people who already had or are already very high-risk for cancer.  Meanwhile, the damage has been done in the sense that people who really need it are afraid to take their insulin.

I say this even with the knowledge of new, more conclusive evidence that the oral drug Januvia may indeed spur pancreatic cancer.

When it comes to insulin, as long as the risk of side effects is tiny, which I’m assuming it will be, we patients will have to weigh the pros and cons: the consequences of not taking insulin when you need it are more immediately damaging, are they not?

Whether the cancer risk with Lantus proves significant or not, the scare is surely hurting drugmaker Sanofi-Aventis, which is not good for us either, in terms of rising price-points and possible curtailing of drug development.

*Sigh* In the end, it’s always the patients who suffer most.

A final run-through of our 150+ amazing submissions in this year’s DiabetesMine Design Challenge reveals some of the “prettiest” entries — those that obviously come from the world of artful design rather than medical utility. And why shouldn’t more medical devices be more aesthetic?!

PicoSulin mini insulin pump

- weighs just 2 oz. and uses and insulin penfill cartridge, plus it looks a heck of lot like an iPod Nano -

(click on the image below to see the full entry)

Flexy Pump

- an armband pump only 1.5cm wide at its thickest point -

(click on the image to see the details; yes, I realize the actual mechanism of insulin delivery is a bit unclear)

Flex Insulin Pump

- “light, discreet, flexible and comfortable” -

This one was featured in an ADA Conference talk about futuristic patient-friendly pump designs, although honestly, I think it looks a bit like wearing a banana slug.

Sleep-O

- not sure why this comfortable hypo-detection device should only be worn at night? -

Kardia

- VERY pretty, but where do you keep your lancet and test strips? -

Well, no matter how you slice it, new healthcare designs with a “consumer bent” is a H-O-T topic. Have a look at this new Ning network called Designing for Care, and the ensuing book in the works.