I don't mind high sugars as much as I loathe lows. Personally I'm not so ruffled by shots either (but my liver begs to differ). However, in a message posted on The Islet Foundation, Pfizer reported that insulin-dependent diabetics declared they most hate taking shots. Was this the warm-up for the Exubera campaign? Here's a fact I support! A close second to this hatred is the hypos. Any diabetic will confess -- hypos are unforgiving. So what if you could catch two birds with one capsule?

I must reiterate the scientific genius behind the Oramed gel caps. The encapsulated insulin bypasses destruction in the stomach cavity. It reaches an entry point in the intestines where it reports for duty to the liver. This allows the liver to resume command of the glucose metabolism, just like Mother Nature intended. Whey you inject insulin - you are overriding the livers ability to monitor blood sugar and putting yourself in the line of fire for the dangerous lows. We all know this state of derangement too well. You won't find my lows picture on a milk carton if I happen to lose it, either.

Frequent episodes of hypoglycemia (even mild ones) force the brain to become accustomed to the low glucose. Unfortunately this also causes suppressed signaling of adrenaline, the livers last resort before dangerous lows. More specifically, the glucose transporters located in the brain cells are damaged from frequent episodes of hypoglycemia. So what was once the hypo threshold for the brain to signal adrenalin release becomes lower. Clinically, the result is hypoglycemic unawareness. Down with the shots, down with the lows and big ups with the future of diabetes control! Now we're getting somewhere.

The results are looking good for the first-round of human testing for Oral-lyn, Generex's flagship product. The oral insulin, delivered into the body through the oral cavity (with no deposit in the lungs), is as effective as injected insulin.

The efficacy of Oral-lyn for controlling blood sugar was decidedly as good as multiple insulin injections. The research found that regular insulin and Generex Oral-lyn had similar effects on lowering blood sugar in subjects with type 1 diabetes. The subjects received twice-daily insulin analogue for basal coverage. So this might rewind some of us old timers to the days long-gone where we could get by with two shots. Period. If Oral-lyn makes it to the local pharmacies - maybe mealtime corrections could be easy to swallow. Praise patient compliance!

On an even more impressive note - it looks like the mucosal membrane in the lungs is giving Exubera negative challenges to overcome. Perhaps Oral-lyn will come out looking a little more pristine in this capacity, since it doesn't go anywhere near the lung membranes. I'm not in favor of diabusiness - but for crying out loud - I'd like to see some companies start working for their money. Generex is one of those companies with the Big Idea!

Pfizer's bandwagon might be busted! Turns-out a study says inhaled human insulin, whether formulated as a powder or liquid, is more immunogenic than injected insulin.

Adverse effects of antibody formation have not been thoroughly investigated. But it was shown, comparatively, that inhaled insulin provokes more of an immune response than injections. Spitting is a dirty habit - but it's not good for nothing. The mucosal defense system is the body's primary line of defense against inhaled foreign matter - kind of like the MARINES of the human body. It is uniquely able to discern self from non-self bodies. So far - it looks like Pfizer's toker is a no go.

As I said before - the adverse events have not been thoroughly investigated. Until we know exactly what kind of mucosal revenge or pulmonary punishment lies ahead - I'd stick to the tried and true...subQ, for now. However the Generex Oral-lyn human trials are looking pretty promising. Stay tuned.

Imagine taking insulin was as easy as applying skin cream. Guess what - it's not so far fetched an idea, thanks to Phosphagenics and it may be coming soon!

Phosphagenics' has patented a transdermal carrier technology (TPM) that rapidly transports insulin across the skin without disrupting or damaging its surface. The company has recently announced successful results from clinical trials in Australia. This confirmes the TPM technology is safe and effective at delivering insulin into the bloodstream, without adverse events. The trial showed that the insulin safely penetrated through the human skin and delivered insulin into the bloodstream over a sustained period of time. Could this be the next generation of basal insulin? Adios Lantus. Arrivederci Levemir! Almost -- TPM/Insulin, applied topically, delivered insulin through the skin and into the bloodstream for up to 8 hours. So like sunblock -- you'll probably have to reapply.

Weep not, fellow Americans. Although Phosphagenics is based in Australia, they are in the process of applying for Phase 2 clinical trials in the U.S. Big ups to the Muffin Man for keeping me abreast of his leading-edge news from the diabetes-friendly forefront!

A year ago, competitors were out to produce their own versions of Pfizer's Exubera, the inhalable insulin. However, now it's clear that Exubera is a bomb. Yes, a slick new ad campaign might revive its fortunes, so don't count Exubera out of the race quite yet. But it's not likely to be the blockbuster product many thought it could be.

Now the fallout is hurting those companies that were scrambling to compete/cash in by producing their own inhalable insulins. According to a report in Forbes, those same companies are ready to beat a smart retreat. Meanwhile, they're trying to reassure nervous investors. Case in point: MannKind Corp. shares fell nearly ten percent on Monday after it was announced the company could take longer to line up a partner for its inhalable insulin, the Technosphere Insulin System.

Not only that, MannKind postponed the release of its second quarter financial report. Wall Street analysts downgraded the stock, saying its short-term outlook is "challenged" and cited disappointing sales of Exubera as a factor. The outlook could be even worse if it looks like insulin caps will make it to market. As I said in a previous blog on that topic, who wants to tote a bulky inhaler around if you can pop some capsules instead?

Remember back in 2006 all the buzz surrounding Exubera, Pfizer's inhalable insulin product? It was much-hyped by Pfizer and, let's face, the media happily joined in too, spreading the word that (as Pfizer would have it) Exubera would be wildly successful and make squillions of dollars for investors.

It didn't work out that way at all. Sales so far have topped out at around four million dollars per quarter, far short of the two billion projected before the product was released. Now, in a bid to lift lackluster sales, Pfizer is launching a major ad campaign for Exubera. Yes, the inhaler device is extremely indiscreet. Yes, long-term use of the drug itself could cause lung damage. Oh, and health insurers may not cover prescriptions for Exubera for those diabetics who want to try it. But I guess where there's a slick selling strategy there's a way...into the pockets of consumers, that is.

Which is not to say I blame Pfizer. The company has poured so much money into this product, does it really have a choice at this point? No. Also, it's entirely possible Pfizer could turn things around. This article by Arlene Weintraub for Business Week reminds readers that the drug giant had enormous success with its clever ad campaigns for Viagra and for the incontinence drug Detrol. Writes Weintraub, this new campaign will probably cost Pfizer big-time: we're talking tens of millions of dollars, but it will be worth it for Pfizer if it can reproduce that kind of success.

You will soon have role playing cards available for your doctor's visits. The conversation is scripted with four questions and the answers as to whether or not you should be on a statin. Two can play, but millions will have a chance of their very own!

The pocket cards are intended to empower patients to determine whether they should or should not take a statin. Statins are cholesterol lowering drugs that supposedly reduce the risk of heart attack. Diabetics are typically at a higher risk for heart attack. The card includes answers to four questions: (1) What is your risk of having a heart attack in 10 years? (2) What are the benefits of taking statins as compared to not taking statins? (3) What side effects can you expect from statins? (4) What do you want to do now?

If the risk of having a heart attack is very small, a pill that reduces that risk may not be worth it, but if the risk is really high, lifestyle changes (or a pill) might sound compelling. Once a patient has a sense of the potential dangers and benefits they can make an informed choice. I hope the cards come equipped with the source of the funding for this study: Mayo Clinic and the American Diabetes Association. I wonder if that's the underhanded way to say this study was funded by Merck, Pfizer, and GSK?

When blood sugar is falling, the stopper built into the body is the release of glucagon from the alpha cells of the pancreas which stimulates the release of glucose from the liver (but only if your adrenaline is flowing). However, when hypoglycemia is due to injected insulin - the stopper isn't entirely in place. Scientists explain how epinephrine (adrenaline) plays a major role in regulating glucose in times of low blood sugar and how this response could be adversely affected by the use of beta-blockers.

During insulin-induced hypoglycemia in dogs, the roles of adrenaline and glucagon were evaluated. The dogs fasted overnight to remove excess glucose from the blood. The dogs also had their adrenal glands removed. The adrenal glands are the source of adrenaline. Adrenaline is released into the bloodstream in response to physical or mental stress,to initiate the stimulation of glucose, among many other functions. Adrenaline and insulin were released at two different rates: a basal rate or a variable rate to simulate an adrenaline response. When the blood sugar fell to 42 mg/dL, the dogs in the basal rate group failed to release glucagon, but the simulated adrenaline response group increased normally. The liver response to releasing glucose fell in the basal group but increased in the simulated adrenaline response group. The researchers conclude that adrenaline must be responsible for this critical response to insulin-induced hypoglycemia.

Beta blockers are a common class of prescription drugs that counteract the stimulatory effects of adrenaline. Diabetics who inject insulin and take beta-blockers should be extra cautious of hypoglycemia. Hypoglycemic unawareness is already established for diabetics injecting GM insulin (genetically modified human insulin). Given the side effects of beta blockers, there is greater reason to be more aware of hypoglycemis unawareness -- yes, oxymoron. Those individuals who are on the brink of diabetes should avoid beta-blockers at all costs, according to a study in The Lancet (January 2007) beta-blockers used for hypertension increase a patient's risk of developing diabetes.

Last time I checked -drugs weren't cool, but according to a recent study, within the last 3 years, the number of teens using type 2 diabetes drugs has soared.

Medco, the largest US drug benefits manager, found the number of children taking medicine for type 2 diabetes more than doubled between 2001 and 2005. An analysis of prescription data found a 146% increase over four years in young people aged 10-19 taking type 2 diabetes drugs, and 115 % increase in all children in the survey. Children on diabetes medicines also faced other serious problems. About 17% of the boys and 13% of the girls were on drugs for high blood pressure; 5% of both were taking cholesterol-reducing drugs; and nearly 20% were taking narcotic pain relievers, drugs for respiratory conditions and antidepressants. Medco reviewed over 500,000 children each year. Of those aged 10-19, about 1.47 per 1,000 were taking type 2 diabetes drugs with a clear rising trend.

I'm so glad I'm not a teenager any more. These days it's not about abstaining from drugs. It's about the type of drugs you use. Just because your doctor is the one prescribing it doesn't mean you have to succumb to the peer pressure of drug use. I found an appropriate Chinese proverb for this blog: it is easy to get a thousand prescriptions but hard to get one single remedy. Put that in your pipe and smoke it.

Researchers defined a link between high insulin levels and defective lipid metabolism but the cause may not be exactly what you think. According to a study published in June, 2005 -- this could be due to their choice in blood sugar lowering medication.

The conclusion of the study identified obese insulin-resistant subjects taking metformin (brand names Glucophage, Diabex, Diaformin, Fortamet, Riomet, Glumetza) and rosiglitazone both improve insulin sensitivity (increase insulin production) but DO NOT improve lipid metabolism. Rosiglitazone (brand name Avandia) may have a detrimental effect on chylomicron metabolism

Blood vessels of insulin-resistant rats build up a substance called chylomicron cholesterol following a high fat meal. Because the rats are insulin-resistant, more insulin (in the form of an anti-diabetes pill) is required to clear sugars and fats from their bloodstream. Higher insulin levels reduced the rate of chylomicron removal from the blood stream following a meal. This slower clearing rate increased the chylomicron particles sticking around the blood vessels, leading to arterial plaque build up and heart disease.

Knowing that high levels of insulin are associated with elevated levels of chylomicron cholesterol, researchers will use this information to try to figure out how this happens.

Why would they do that? The answer was already explained in June, 2005. Oh it must be because arterial plaque builds differently in Australian's on anti-diabetic pills than it does in American's on anti-diabetic pills. We should all thank the good folks at GlaxoSmithKline, Bristol-Myers Squibb, Pfizer and Merck. Without their medicine -- how would anybody ever know about this stuff? First you're on an anti-diabetic pill, then you're on cholesterol lowing pill, what's next? Of course -- the blood pressure!!

How many people are Gold Star type 2 diabetic patients?

Remember the A-Game suggestions I dangled for Eli Lilly to tap for performance enhancement? Well here it comes. I called Eli Lilly headquarters to speak with the Chairman and CEO, Mr. Sidney Taurel but I was directed to their idea submission form (which consequently didn't work). Oh boy, Sid. I'm a little disappointed. So here goes - my idea is going free for all when you could've had it, first. Let's call this new and improved product Beta Juice. It delivers the essential functions of a fully operational beta cell. It produces: insulin, amylin and c-peptide. Here's why insulin should always come equipped with the other two...

Insulin brings sugar to the cells to keep our energy levels sufficient for life, homeostasis and (if we're lucky) some energy for the gym. Amylin is a controlling agent for appetite, gastric emptying and tells the liver to dispatch glucose. It is also shown to have an impact on lipolysis --- the metabolism of stored fat. Until recently C-peptide was nothing more than a number used to decipher if you were a type 1 or a type 2 diabetic. However, recent scientific studies have shown C-peptide protects small vessels from the complications associated with diabetes. The Reuters Health article is titled C-Peptide Replacement Improves Early Diabetic Neuropathy.

The American Diabetes Association promotes the ABC's of Diabetes Care in an effort to educate diabetics on controlling their disease. The ABC's of diabetes care refer to a patient's Hemoglobin A1c, blood pressure, and cholesterol. A diabetic must maintain a hemoglobin A1c less than 7%, their blood pressure must remain below 130/80 and their good and bad cholesterol must be kept in range. The ABCs of Diabetes Care were established in order to reduces the chances of developing diabetic complications like neuropathy (nerve damage), nephropathy (kidney damage) and retinopathy (eye damage).

Here comes the perfect Insulin (code name Beta Juice) -a laboratory engineered balance of insulin, amylin, and C-peptide. Insulin to balance the blood sugar level, amylin to regulate fat and cholesterol levels and C-peptide to control the damage inflicted upon the micro vessels throughout the body. This is a GREAT IDEA!! Not just because it is MY idea, but because this is a huge opportunity to mitigate the complications that insulin by itself can impose, without the checks and balances of the other beta cell hormones. What do you say, Eli Lilly? You're halfway there!! You've already partnered with Amylin Pharmaceuticals. They have one third of this patent pie. Now hop on the horn and join forces with the C-peptide patent holder and ride your stock price to the moon. The diabetic girl has spoken. I know you care, Eli Lilly. Now put your money where your mouth is and make this new and improved insulin a light at the end of the diabetes tunnel.

If at first you don't succeed - go straight to the patient's home. After a lackluster attempt to sell doctor's on prescribing Phizer's inhalable insulin, Exubera, the company has decided to begin running television and print campaigns to advertise directly to patients.

The ads will start appearing the second half of 2007. However the main contention from Congress and medical groups is that mass marketing to patients encourages excessive use of costly therapies. Exubera gained a reputation for being an over priced and not-so-discreet way to administer insulin. Doctors say the inhaler is unwieldy. Depending on a patient's health care plan, they can pay about $600 a year more for Exubera than injectable forms of insulin. Clinical trials have found the product can reduce lung function for some patients. Pfizer says the condition is reversible and is conducting a five-year study among users to monitor it.

Why the push, Pfizer? You seem hell-bent on making this one stick. The president of Pfizer's worldwide pharmaceutical operations says the television ads will target newly diagnosed diabetics who may not want to inject themselves daily. Patients who develop diabetes later in life may put off using insulin because of needle phobia. Fair tradeoff: I see your fear of needles and raise you $600 a year, a license to toke (in public), and maybe a little bruising on your alveoli. Puff, puff...give it a shot.

So the price of drugs just seems to keep on climbing. And sometimes I wonder if the sky really is the limit in terms of the prices we are expected to pay. I, for example, just filled a prescription and received a tiny bottle the size of a purse-pack-sized bottle of eye drops. And how much did I pay? $25. Yes, and that's with insurance. It's insane. But it's not happening everywhere. In western Europe, where publicly-owned, government-run health care systems are the norm, people are putting the squeeze on the big pharmaceutical companies.

Let's look at insulin. A while ago there was a kerfuffle in the UK when government advisers overseeing the National Health Service basically said "no, thanks" to Pfizer's inhalable insulin, Exubera. Too expensive, they said. Now, Germany. This week, the biggies - Eli Lilly, Novo Nordisk and Sanofi-Aventis - decided to slash the cost of their insulin products in Germany. Why? Officials from Germany's health ministry say the new fast-acting versions of insulin just aren't worth the money. That left Big Pharma with little option but to play ball anyway, by cutting prices by up to thirty percent. For Novo Nordisk, this means a projected loss of $14.5 million in sales this year, reports Bloomberg.com. According to this article, the German government is, in this regard, following in the footsteps of the UK and the US. In effect, this means trying to cut spending by carefully weighing the costs of specific drugs against their benefits, rather than just picking up the tab willy-nilly.

Bottom line? Market expert Mark Belsey says the big drug producers will have to adapt as the tide turns, spending a lot more time and money justifying the worth of their products. This new strategy, he says, will come at the expense of what used to be their main focus: creating and marketing fancy new mega-drugs.

A brilliant doctor, a motivational mission, and the biggest names of the industry -- success is the only option. Taking Control Of Your Diabetes is a diabetic conference designed to educate and motivate people about diabetes.

Through informative expos, packed with field experts, enlightening workshops and crowds swarming with curiosity -- taking a more proactive role in your diabetes is as easy as showing up. A few hours at a TCOYD expo will cover a lot of territory. Whether you're interested in the latest developments in research, new medications, fresh ideas on diet and exercise, or legal and insurance guidance-- you're bound to find somebody who has an answer. TCOYD health fairs give you the chance to personally engage major manufacturers, doctors, entrepreneurs and innovators looking to help diabetics live a healthier life. Ask your questions. Try their products. They are there to help you. Tell them what you think. Tell them what you need.

Medical advances in diabetes care continue to out-pace improvements in patient care. Share something new with your doctor next visit. TCOYD delivers the information to the people who need it most. The mission of TCOYD is motivating, educating, and empowering diabetics and their loved ones. The success of this mission is defined by what you make of it.

Think that big old Exubera inhaler (pictured) is sorta comical? You're definitely not alone. I was surfing around trying to get a clearer sense of how Pfizer's much-hyped inhalable insulin device is doing. Are users liking it? Is it really easy to use? Etcetera. But I got sidetracked into reading about that inhaler. It's big, it's plastic, it's bulky. The insulin bong. Come on, admit it. You were thinking the same thing! Here are some of the choicest comments I came across:

Spotted on one message board: "As a pharmacist, my biggest problem with Exubera is that the delivery system looks not entirely dissimilar to a bong. I just don't see the conversation starter 'excuse me, I need to take a hit off of my insulin bong' to be a great opener."

On another board, one wag lists off what he/she considers Exubera's shortcomings. In addition to the fact that, yes, it looks like a bong, this reader also observes that diabetics "have to carry around enough bulky s**t as it is." Plus there's the fact that "Type II's can't afford it...unless they cut back on their food budget...but then they will lose weight...and they wouldn't need insulin."

On Diabetes Mine: the device "really is as bad as it looks in pictures. Worse, because the bulky 'white' plastic portions are not white at all, but that hospital-grade beige that reminds you of walkers and bedpans. An aesthetic nightmare, in the age of cool gadgetry...The funny thing was that the happy Exubera user in Pfizer's video must live in a city as tolerant or as jaded as San Francisco or New York, because not one patron even glanced over as he cocked and sucked on his medicinal bong."

Medical humor site QFever pokes fun at the device's arguably limited appeal with a satirical article describing how Exubera will be a practical alternative for "several diabetics." They missed a golden opportunity here by not zooming in on the inhaler for comedic mileage. What were they thinking?!

The final word goes to Drug Nazi (who I believe has now changed his moniker to Drug Monkey), who finds the Exubera inhaler reminds him of, er, something else entirely: "Oh Yeah...gimmie some of that sweet insulin lovin' baby..." (Oh, PS, if you visit this site, you have to read "Why does my prescription take so damn long to fill?) Happy inhaling.