Drug War '07: drug giants Novo Nordisk and Sanofi-Aventis have been sparring recently over their insulin pen designs. Novo alleges Sanofi has stolen its design ideas, basically. Check out Bev's post on this to learn more.

The reason it's such a big deal to them is money. The insulin pen could be super-lucrative for investors. Meanwhile, here's some news that's bound to get big pharma even more excited: a new study reports that insulin pens are cheaper and more effective than insulin shots.

Why so good? Fewer trips to the emergency room and fewer visits to the doctor. Insulin pens boast a pre-measured dosing system, with each dose of insulin contained in a single, disposable cartridge. This eliminates the risk of over- or under-dosing, says senior author of the study, Dr. Rajesh Balkrishnan of Ohio State University in Columbus. The researchers say that study participants who used an insulin pen instead of a regular syringe ended up reducing their annual healthcare costs by nearly $17,000. Wow.

What I'm not clear on here is whether or not they factored in the added expense of upgrading from syringes to insulin pens.

Want to know more? The study has been published in the latest issue of Clinical Therapeutics, but you can click here to read a summary.

A man en route to Sydney, Australia, collapsed mid-flight during a 25-hour trip from Norway to Australia. The man, an engineer whose home is in Sydney, has diabetes and was prevented from bringing his medical supplies on board the plane. Can you believe it? It was all due to new airline security rules requiring that people with diabetes carry documentation along with their medications. The passenger arrived at the airport with a supply of insulin, but was forced to leave it behind because he did not have the required letter from his doctor. He was very sick on arrival in Sydney and had to be rushed to hospital in an ambulance.

Don't risk your life to get from A to B. That's the moral of this story. Okay, maybe the security rules go a bit overboard. Yes, it's a shame we live in an age where such rules are deemed necessary etc etc. Bottom line: if you plan on taking anything even slightly unusual on board a flight, do yourself a favor and find out in advance if there are any applicable restrictions. Assume anything unusual could be a problem. Assume airline/airport security staff don't know about diabetes and don't particularly care about your personal well-being. If you have web access, the info you need is probably just a few clicks away. I don't know what the circumstances were, but if that were me, I would not have boarded the plane.

Works by the modernist painter Charles Demuth (1883-1935) are now on display at the Amon Carter Museum in Fort Worth, Texas. Add Demuth to the pantheon of notable Americans with diabetes. Demuth lived nearly his entire life in Lancaster, Pennsylvania. He had a hard life, being type 1 diabetic at a time before digital meters and pumps and all that good stuff. Not only that, he was diabetic at a time when insulin was only beginning to be used.

So, you may well ask: what did they do in the dark, dark pre-insulin days? Well, dear reader, the treatment was pretty unsophisticated. Starvation, basically. They got you eating as little as possible. Not surprisingly, life expectancy was not good in those days! Demuth suffered from a lack of energy and eyesight problems. Eventually, he was started on insulin and his health improved as a result.

For subject matter, Demuth frequently turned to the increasingly industrialized landscape of his hometown, Lancaster. Icons of the industrial skyline - smokestacks, water towers and the like - were often the subject of his paintings. The Amon exhibit is titled "Chimneys and Towers: Charles Demuth's Late Paintings of Lancaster." The exhibit will remain on display in Fort Worth through October, when it will relocate to the Norton Museum of Art in West Palm Beach, FL, then it's off to the Whitney Museum in New York City.

Click here to read more about Demuth and this new exhibit.

There's a story running on CNN Money about the progress of Oramed Pharmaceuticals' insulin capsule, which is currently under development. The capsule, taken orally, could provide a more convenient way for diabetics to get insulin than through shots. And popping a gel cap would, needless to say, also be more convenient than toting and blowing on one of those big old clunky Exubera inhalers.

In the quest to get its product to market, Oramed needs cash, and lots of it. Answering the call, a combination of private investors are putting up more than two million dollars in financing for the Israel-based company.

It's hoped the money will help to propel the insulin capsule through completion of Phase 1 (drug safety) trials by the middle of next year. Said Oramed CEO Nadav Kidron, "This investment marks a milestone for Oramed's stability, allowing the company to fully focus on its research and development efforts and complete its phase 1 product trials."

Stay tuned.

In the past, I've blogged about an Australian experiment using implants that could, theoretically, eliminate the need for type 1 diabetics to use insulin shots. Researchers said it's possible to implant seaweed-coated capsules containing insulin-producing cells in the abdomen. The cells produce insulin, but the tiny pores in the seaweed do not allow immune system cells to pass through and destroy the cells. Allie has also looked at a related issue: experiments that surgically attach kelp-coated islets to the liver for the same purpose.

Sounds pretty brilliant. But could it really work? The verdict looks like "Yes." According to the results of a new Johns Hopkins University study, such implants could be helpful for type 1 diabetics whose bodies otherwise reject insulin transplants. The capsules utilized in the study were coated with a substance made from alginate, which is derived from seaweed. The technology could eventually be offered to diabetics whose bodies reject insulin cell transplants, something which could became standard treatment in the future. It would likely be a safer choice than the only other option known so far: anti-rejection drugs. Talk about the power of nature!

The results of the study have been published in Nature Medicine. Next step is a larger trial that will lead to seeking FDA approval for the technique.

As a diabetic with the esteemed honor of pouring my heart and soul out for an audience as well-informed as you - I feel it is OUR job to inform our doctor's of the important discoveries being made in diabetes. The discovery I am most concerned with these days is raising awareness of C-peptide.

When I learned that all forms of synthetic human insulin these days DO NOT have C-peptide (like natural human insulin does) I asked my doctor what C-peptide does. My doctor explained, "C-peptide is nothing more than a biomarker to tell us [doctors] how much insulin your body is naturally producing."

When Chrissie in Belgium asked her doctor he told her that [C-peptide] has absolutely no importance. Uh oh...

Doctor's are convinced that C-peptide is useless for type 1 diabetics. Give the next paragraph consideration and you and your doctor might have a new perspective on the importance of C-peptide.

In a healthy, nondiabetic individual -- islets produce insulin. Insulin is made of 51 amino acids in 2 chains, with a tail of something called C-peptide (connecting peptide). Insulin grabs sugar from the blood and transports it into the cells where it becomes energy. It gets into and out of the cells through cellular pathways that are monitored by a delicate balance of sodium (Na) and potassium (K). This balance is regulated by C-peptide. The movement of insulin and glucose through these cellular membranes without C-peptide is dangerous and causes diabetic complications that develop in small vessesls of the eyes, kidneys and nerves.

Tight control of diabetes results in complications over time. If you find 500 mg of protein in a 24 hour urine collection - it's a complication (nephropathy). If your nerve conduction velocity reaction time is measured at 5.0 seconds - it's a complication (neuropathy). You take your insulin -- these complications should not occur, right? The reason for diabetic complications may not be your insulin at all. It may be the thing that your insulin is lacking.

So here's a little community service we ALL can do to enlighten our doctor's. Ask your doctor about C-peptide. Chances are you will get the same answer Chrissie in Belgium and I did. When this happens - smile, and politely hand your doctor a printout of this blog.

After all, if the Creator put receptors in our cellular membranes - He must've done it for a reason. The path to enlightenment is paved with gold.

An "incredible story of dedication and perseverance" is how dLife pitches its upcoming story on US Army Sergeant First Class Mark Thompson (pictured at right). It does sound like an awesome story and definitely worth a look. Says dLife, Thompson, who is diabetic, ended up in battle in Iraq and trying to manage his diabetes even when under fire. Talk about your tough challenges. Thompson was diagnosed with diabetes after becoming a combat arms commander and he didn't want to give all that up because of the disease. No, sir. He continued to serve and ended up joining his comrades in Iraq.

In its press release, dLife says that Thompson was told he could never be deployed to Iraq. Seems he wrangled it anyway. He found the idea of quitting "unacceptable." Says Thompson, "diabetes was not going to stop me from being who I wanted to be." He came up with a plan for managing his diabetes in the field, and successfully plugged that plan to his superiors. The caveat: that he could serve under strict guidelines and could be sent home at any moment if necessary. The first problem was discovered immediately: the more than fifty pounds of gear Thompson has to lug around crushed his automatic insulin pump. D'oh! Worse, he knew it would take over a month for a new one to arrive by mail. Even bigger d'oh! Left with no other choice, Thompson resorted to doing things the old fashioned way, with near-constant blood tests and administering up to fourteen insulin shots a day.

The dLife story on Thompson promises to dish more amazing details and has a happy ending: he served his entire year in Iraq and was awarded the Bronze Star for heroic or meritorious achievement in service. Says dLife creator Howard Steinberg, "I have a new hero. Plain and simply put, the story of Army Sergeant Mark Thompson is one of the most inspirational stories I have ever heard. This was not only a good story for the dLifeTV, it was an honor to present." Wow.

Get a load of this GREAT news quote: "We had Korn, then Harry Potter, now Laurie Jordan." Er, who the heck is Laurie Jordan?! She is, or should I say was, a teaching aide in Michigan, apparently. And the quote comes courtesy of the parent of a kid who attends Roosevelt Elementary School in Michigan. The bosses of the school, the Zeeland school district, have a reputation for toughness. First they banned Korn t-shirts. Then they banned Harry Potter readings in the classroom. And now? An employee, Laurie Jordan, was fired because she refused to learn to give insulin shots.

Jordan's excuse: a fear of needles. School administrators decided all school employees should acquire the know-how to give emergency care to diabetic students, which of course includes learning how to administer insulin shots. Jordan said no, thanks. On Monday, a big crowd turned up to a public meeting in support of Jordan. The general consensus seems to be that firing her was a tad on the excessive side. Present at the meeting were school board members, school employees and community members. "A show of support like that is overwhelming," said Jordan after the meeting.

Needle phobia is fairly common. This woman is not a nurse, she has no medical training, and she does not want to undergo this kind of training. Parents want their kids to be protected. Giving an insulin shot is a pretty straightforward procedure. On the other hand, should employers be allowed to force employees to take on this responsibility? It's tricky.

To read more, check out this article in the Grand Rapids Press.

I was somewhat surprised to see an article on the web about a college-age girl who stopped wearing her insulin pump and tried going back to the old-fashioned insulin shots. I'm surprised because the pumps seem to be the gadget for diabetics and I have assumed young college-age kids would go for the latest technology over syringes every time. "It was rough at first," says Rachel Beckner (19) of Richmond, Virginia. However, she persevered for a year without it because she was unhappy with the way the insulin pump looked. I guess she felt self-conscious about it. A year later, though, Beckner has returned to the pump. She admits her blood sugar levels were not as stable on shots as they had been with the pump. It was also a question of convenience versus aesthetics: ultimately, convenience won out!

Beckner has had diabetes since age seven. The article in which I read her story also touches on the fact that she is just one of thousands of teenagers heading off to college who also have to deal with chronic medical conditions. For the first time in their lives, away from their parents, they have to handle the responsibility of managing conditions like diabetes alone. "My parents aren't there to monitor what I eat, or ask me if I've checked my blood sugar and done my shot, and I really have to be responsible about that," says Beckner. "It was harder in the beginning," she admits, but also says "I learned that I could take care of myself on my own, and I could deal with my diabetes and not have to rely on [my parents] for everything."

Earlier today I blogged about a problem identified at the American Diabetes Association meeting, now underway in Washington. In a nutshell, researchers say that more than three-quarters of diabetics are not receiving optimal treatment. Why? Because they get diagnosed, their doctor slaps them on a once-daily insulin shot regimen and that's that.

A Washington Post report on these assertions goes into more detail. "Clinical inertia" is the phrase used to describe the problem here. Ouch. (If I were a doctor, my feelings would be hurt...) The problem is, doctors don't follow-up with more intensive treatments if they're needed. They don't act as quickly and as aggressively as they should, say researchers.

Anyway, the reason I bring this whole topic up again is because the Washington Post article also touches on what has been done in the UK to deal with this problem: The British National Health system pays doctors extra for following exact treatment guidelines laid out for them. They accumulate points for each step followed. The cash bonus comes when they have accumulated a certain number of points. It's a shame it takes cash to motivate physicians, but I guess you can't argue with success.

Pfizer Inc. renewed positive momentum (some might say, hype?) over its inhalable insulin product Exubera. The company announced two-year data on Exubera showing that the product is as effective as insulin shots.

The results show that not only does Exubera control blood sugar as well as insulin shots, but also that it results in less weight gain amongst users. The weight gain issues is an added bonus that no doubt will help many patients make up their minds whether or not to make the switch to Exubera...if they can afford it, that is, as the product won't come cheap. Co-pays as high as $50 seem likely - eek! How outrageous is that??

On the down side, the data also confirmed that Exubera has a slightly negative effect on lung function--more so than that caused by insulin shots.

Pfizer made its announcement at the American Diabetes Association's conference, now under way in Washington.

Among the presentations being given at the American Diabetes Association's annual conference, now under way, was a press briefing reporting that most Type 2 diabetics are receiving suboptimal treatment. The numbers are pretty impressive. According to researchers in the UK and Germany who have been looking at this issue, more than three-quarters of Type 2 diabetics on insulin therapy are not getting the results they should be. The cause of the problem seems to be that they are not getting enough insulin often enough. The result? Even though patients are on an insulin shot regimen, their HbA1c levels are still way too high.

This was a big study, too, by the way, involving data collected on millions of patients.

Here's some important news for parents of preschool-aged Type 1 diabetic children: according to a new study, Type 1 kids do better on insulin pumps than on daily insulin shots. According to researchers from the Loyola University Medical Center, the pumps, also known as continuous delivery devices, are "safe, effective and superior" to insulin injections. Moreover, switching a child with Type 1 diabetes to a more effective treatment such as this as a very young age decreases the likelihood of serious health complications as that child matures.

Interestingly, the researchers also note that the pumps have so far not been widely used on very young children. They speculate that one reason might be a fear on the part of doctors and parents that little ones might tamper with the devices. In fact, this was not a problem, at least with the children involved in this particular study, all of whom were aged between two and seven years. Personally, I find that surprising...

A while back, March 6 to be exact, I touched on the subject of diabetes and job discrimination in the UK, as reported by the BBC. One of the diabetic workers who claimed they had been discriminated against was a taxi driver. Well, I was interested to read another article in the BBC today on roughly the same topic: the impact of diabetes on the license-holding status of drivers. Apparently, Britain's Department of Transportation is considering easing restrictions on drivers with Type 2 diabetes. This came about following research that demonstrated Type 2 diabetics are less of a risk behind the wheel than previously thought. Currently, people who are dependent on insulin injections to control blood sugar are unable to hold a British Group 2 license, which includes trucks and buses. The reason for the ban was a fear that if a diabetic suffered a fall in blood sugar, their eyesight and speed of thought could be affected, or the person could even experience a blackout. Research now suggests, however, that at least in the short term, diabetics on insulin are no more likely to suffer problems than diabetics who use tablets to control blood sugar.

File this one under "You can't please everyone." A debate is underway in Indiana over a bill (SB 336) that would allow school staff to administer insulin to students. On the one hand, many were very happy about this bill, which would require schools to train medically unlicensed school staff in treatment for kids with diabetes. The purpose is to ensure that diabetic kids are getting full access to care at their schools, where access to school nurses is usually very limited. On the other hand, some parents worry - justifiably, I would say - that giving such power to schools could be opening a real can of worms, ethically speaking. "My son wears an insulin pump. I wouldn't want anyone other than an RN adjusting that," says the mother of one eleven year old. Indeed, most states forbid non-medical staff from giving insulin, and with good reason. "Insulin is a very dangerous drug," says Lindsey Minchella, the Indiana director for the National Association of School Nurses. "A tiny, tiny insulin increase can be a very dangerous thing." Further, when parents give permission for their diabetic kids to receive assistance from school employees, they are required to do so with the understanding that the employees are not liable for damages should something go wrong.