LifeAfterDx--Diabetes Uncensored

A internet journal from one of the first T1 Diabetics to use continuous glucose monitoring. Copyright 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016

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Location: New Mexico, United States

Hi! I’m William “Lee” Dubois (called either Wil or Lee, depending what part of the internet you’re on). I’m a diabetes columnist and the author of four books about diabetes that have collectively won 16 national and international book awards. (Hey, if you can’t brag about yourself on your own blog, where can you??) I have the great good fortune to pen the edgy Dear Abby-style advice column every Saturday at Diabetes Mine; write the Diabetes Simplified column for dLife; and am one of the ShareCare diabetes experts. My work also appears in Diabetic Living and Diabetes Self-Management magazines. In addition to writing, I’ve spent the last half-dozen years running the diabetes education program for a rural non-profit clinic in the mountains of New Mexico. Don’t worry, I’ll get some rest after the cure. LifeAfterDx is my personal home base, where I get to say what and how I feel about diabetes and… you know… life, free from the red pens of editors (all of whom I adore, of course!).

Monday, September 21, 2009

Angels do dance on the head of a pin, after all

Now when I think of vectors, I generally think of mosquitoes, tsetse flies, and rats. Critters who, while going about their normal businesses with no particular malice towards us, spread assorted plagues through the human population.

Controlling or preventing epidemics often involves controlling the vector.

In fact, until today, I didn’t know there was any other sort of vector. But there is. As it turns out, vector is one of those over-used words that carries very different meanings in various fields of human endeavor.

In mathematics, a vector is a number with size and direction. In design work, it is a type of graphic that changes size without loss of resolution. A vector can also be a course or direction of an aircraft. Or, in genetics, a vector is an agent that transfers genetic material from one cell to another.

Genetic scientists working in the dangerous but promising field of gene therapy are starting to use viruses as vectors the way you and I use FedEx. Virus vectors are used to intentionally deliver gene packages to the inside of human cells.

So here’s my third-grade understanding of gene therapy (I often push the envelope in my recreational reading). A significant number of diseases are caused by broken, missing, or damaged genes. Fixing the gene reverses the disease. Fixing broken genes cell-by-cell is no easy matter, but if you can place repaired genetic code into a cell, the cell will reproduce. Over time the fixed cells start doing whatever job it was the broken cells weren’t doing right and Presto Changeo! The disease is defeated by the body itself. Simple. Elegant. At least on paper. It turns out the devil is in the details.

So why use a virus as the delivery boy?

It is in the very nature of how viruses choose to invade the cells that makes them possible vectors for gene therapy. Viruses are the ultimate Trojan Horses. They have all kinds of tricks up their tiny little sleeves to get past the body’s immune system sentinels and arrive safely inside your body’s cells.

So virus vectors were chosen as the obvious way to deliver the repaired genes into the cells, as viruses like to get into cells anyway. The trick is to engineer the viruses to do what you want it to do, and not necessarily what they evolved to do. If you make the virus too weak, the immune system discovers the invader and wipes out the virus, along with its precious genetic FedEx package of repaired genes. If you make it too strong…

Early gene therapy clinical trials have had some stunning successes in curing an assortment of rare diseases. Successes have included the “Bubble Boy” disease, one sort of blindness, and a rare blood cancer. But the cutting edge trials have also killed some of the participants.

The key to success seems to be a more holistic approach that includes a greater understanding of the role of the immune system in this complex cosmic dance. You can’t just repair the damaged genes, stick them in a virus, and inject them into the human body. You need to really, really, really understand how the immune system is going to react to the vector.

As more research on viruses continued it was discovered by Dr. James Wilson (University of Pennsylvania School of Medicine) that there are at least 120 sub-types of a particular virus called AAV.

AAV viruses seem to have affinity for various organ systems, they prefer certain types of tissue and don’t really care all that much for other regions of the body. Using a AAV virus matched to the organ system for a given disease should prevent run-away infections, the prime suspect in clinical trial deaths, allowing the doctors of the future to choose the right viral delivery service for what ails you.

How amazing is that? Nature may have given us a complete tool kit to repair our damaged bodies. What are the odds?

Viruses, long regarded as the enemy, could prove instead to be angels.

Monday, September 14, 2009

Job Security

On Fridays I’m on Rio duty. It is my day to take him to school. This last Friday, as we sat at the stoplight at Hot Springs Boulevard and New Mexico Avenue, I saw a young Hispanic man come out of the Allsup’s store.

Allsup’s is the northern New Mexico equivalent of 7/11, Circle K, or Mini-Mart. Cheap gas and over-priced goodies.

This young man is very much over weight, he’s not walking so much as waddling. It is two minutes after 7:30 in the morning; the sun had only come up an hour ago. He is carrying in his hands the largest cup of soda I have ever seen. I think it was 84 ounces. And I doubt very much that it was diet.

An 84 ounce cup is the equivalent of seven full cans of soda. More than a six pack in a single cup. That works out to 980 calories, about half the recommended calorie intake for an entire day, and a carb load of 273 grams!

Now to be fair, there must be some ice in that cup, so it probably isn’t actually a full 84 ounces of liquid poison, but still…

I groaned to myself. Actually, I swore under my breath. I wanted to jump out of the car grab the kid by the ear and have a talk with him... but, he looked so happy, and I’ve got to get my kid to school, and… And, OK, I’m a total pussy who doesn’t like to just lecture people on the street. If he had walked into my clinic with that soda it would have been a different story.

So… where does our responsibility lie? Did I miss a teaching moment? Do we have the responsibility, both to society and to our fellow man, to fight the obesity epidemic where ever we encounter it; or does that tread on the rights of others?

You’d have to live under a rock not to know that smoking cigarettes destroys your health; yet for a variety of reasons young people do choose to start smoking.

Had this young man made a similar choice? Or did he have no real idea what lurked inside that cup? Maybe he already has un-diagnosed diabetes and he is feeding the ravenous thirst of hyperglycemia.

I’m thinking, in hindsight, that it would have been OK for Rio to be late to school.

I don’t know what I would have said, but I think I should have said something.

Tuesday, September 08, 2009

Another high blood pressure moment

So I’m reading the morning AP news online before going to the clinic. The article is about the President’s upcoming speech on health care reform. At the very end, almost as a side note is the following:

In one measure of the intense opposition Obama and his allies faced this summer, opponents of the Democratic effort outspent supporters on television commercials in August for the first time this year, according to a company that monitors political advertising. Foes of the Democratic drive spent $12.1 million last month, compared with $9.1 million for backers of the effort…


OK. My clinic’s entire budget is just shy of three million dollars per year. That means three million bucks bucks covers the salaries and benefits of our providers, dentists, nurses, managers, support staff, finance people, and the diabetes guy. (Not that he costs much.)

The three mil also pays for our ambulance service, buys replacement equipment, all of our medical supplies, keeps the lights and heat on, pays for hazardous waste disposal, electronic medical record software licenses, and lab tests. From band-aids to copy machine toner, three mil covers all of our bills for a year.

And the folks who want to stop health care reform just pissed away over 12 million in a single month?

That money could have run four health centers for a full year.

And that 12 mil forced the other side to piss away over nine mil, or three more clinics.

Don’t forget, that is just what was spent in the month of August. It shows just how much money there is to be made by keeping the status quo. If opponents are spending this much, you can imagine the level of investment that they are protecting. Billions are lining the pockets of the folks who want to keep things they way they are.

It is literally blood money. They are profiting on death and illness. We used to be a great county, a great society.

How did it come to this?