Living with sugar

Treatments now offer promise to control blood sugar fluctuations without the painful and frequent needle-pricks. Sanchita Sharma writes. Global prevalence: facts & figures | Travelling with diabetes

Diabetes cannot be treated but is managed, at times with as many as four insulin injections a day. New drugs and treatments offer promise of long-lasting insulin analogues that control blood sugar fluctuations without the painful frequent needle-pricks.

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On Thursday, pharma giant MSD announced the phase-2 trial of a new oral gliptin to be taken just once a week. “It’s from the sitagliptin (Januvia) stable, which was the first in a new class of oral, once daily diabetes drugs used to treat people whose type-2 diabetes cannot be controlled with conventional drugs such as metformin or glitazone,” says Dr Ambrish Mithal, chairman of the division of endocrinology and diabetes at Medanta.

Drugmakers Eli Lilly’s drug Bydureon allows for a once-weekly dosing.

Bydureon contains the same ingredient as Lilly's Byetta, the blockbuster twice-daily injection that was launched in 2005 and generated US $710.2 million in global sales in 2010.

“The developmental push is towards drugs that lower frequency of administration to make compliance better. Too much insulin, for example, can cause hypoglycemia, where the brain is not getting enough glucose,” says Dr Mithal. Early data from Novo Nordisk’s ultra-long acting insulin Degludec shows it may be effective for 48 hours.

In India, National Institute of Immunology director Dr Avadhesha Surolia and his team are working on very long-lasting insulin which successfully maintained near-normal blood glucose levels in animal models for as much as 120 days.

With over 50 million diabetics, the diabetes medication is the fastest growing pharmaceutical segment in India, worth R3,188 crore a year in August 2011, doubling from 1,695 crore in August 2008, shows ORG-IMS data .

The market for insulin, being taken by 2 million people in the country, is worth another R890 crore.

Since the 1920s, people with diabetes have depended on insulin— which prepares cells to admit glucose from the blood — when their insulin-producing pancreatic cells either self-destruct (type-1 diabetes) or stop producing insulin over time (type-2 diabetes).

“Insulin pumps have already replaced more painful injections to deliver insulin continuously through a little plastic catheter under the skin. The pump can be programmed to suit different diets and exercise profile and leads to better blood-sugar control,” says Dr Anoop Misra, director, department of diabetes and metabolic diseases, Fortis Hospitals.

“Discovery that incretin hormones produced in intestine decrease blood sugar has revolutionised diabetes treatment as these drugs do not cause as much hypoglycemia (low sugar) as sulphonylureas. Injectable drugs also lead to significant weight loss and have been in use in India for three to five years,” says Dr Misra.

Living healthy with diabetes

Rachit Arora, 14, diagnosed with type-1 diabetes
Jaya Shroff Bhalla
jaya.shroff@hindustantimes.com
New Delhi: A year ago, Noida-resident Rachit Arora (name changed on request), 14, started losing weight rapidly. Despite eating twice the amount of food, he was losing close to one kilogram every day. He turned cranky and listless. His mother Pranita did not take it seriously and just asked him to eat healthy food instead of snacking on junk food.

On the 11th day, the Rachit, who goes to Delhi Public School, Noida, could not move out of bed. He felt weak, complaining of abdominal pain and his breath smelt sweet.

In a panic, his concerned mother rushed him to the hospital, where a urine test showed 4+ sugar and large amount of ketones – which indicated that the insulin in his body was zero.

A blood sugar test using a glucometre showed blood glucose levels of 550mg/dl. He diagnosed with type1 diabetes with keto-acidosis. By now he was dehydrated, drowsy, with very low BP. “This is a life threatening emergency. He was immediately administered insulin infusion and repeatedly his blood sugar and ketone levels were checked for the next 24 hours.

He regained strength after 24 hours and his urine frequency decreased and BP came up and ketones in urine started disappearing. The next day, his insulin dose was re-adjusted, infusion was stopped and he started eating normally. Rachit was discharged after 10 days with multiple doses of insulin.

“We were completely taken aback when we learnt of his diabetes. We could not come to terms with the fact that a young healthy boy, could be diagnosed with a life long disease, especially as we don’t have any history of diabetes in the family,” said Pranita, his mother. But Rachit, who wears a pump to get a regular dose of insulin, leads a normal life. He loves to play basketball and lawn tennis.

Nitasha Malik, 34, diagnosed with gestational diabetes
Rhythma Kaul
rhythma.kaul@hindustantimes.com
New Delhi: Though Nitasha Malik, 34, has had a healthy son Arihant on September 15, she remembers the fear when she was told she had gestational diabetes in the fourth month of her pregnancy.

When Glucose Challenging Test (GCT) showed above-normal glucose levels, her doctor instantly immediately asked her to follow a strict diet and exercise routine. “No one has diabetes in my family. My first pregnancy had been very smooth, so this diagnosis was sort of scary. My doctor, however, assured me that if I followed a healthy lifestyle, there was nothing to worry about,” she said.

Malik initially had a really hard time controlling her cravings for chocolates and colas, but the thought that it was good for her baby gave her the motivation to stay away. “I do not have a sweet tooth. On a regular day, I would never crave for all that sugary stuff, but because it was prohibited, I could not resist it,” said Malik, a resident of Dwarka. She was told that if she did not eat right and exercise, she and her child could end up with diabetes. “No rice, potatoes, sweets etc, my diet underwent a complete change. I did not like it but went ahead as I did not want to take medicines or insulin injections,” she said.

“I also brisk walked for an hour in the morning and evening regularly. A month later I was relieved to find my glucose level had dropped to the normal. The effort had paid off,” she said.

In her eighth month, an emergency caesarean surgery had to be performed as the baby’s heart rate had dropped. “Fortunately, my sugar level was well under controlled so the doctors did not have a problem in going for an emergency surgery. My son is as healthy as other babies his age,” she said.

Shobha Malick, 46, diagnosed with type-1 diabetes at age 15
Rhythma Kaul
rhythma.kaul@hindustantimes.com
New Delhi: Life seemingly took turn for worse for Shobha Malick, 46, who was diagnosed with the insulin-dependent, type-I diabetes at the age of 15. Today, when you see her playing with her 11-year-old son, Raunak, she shows all the signs of a woman who has won the battle against diabetes.

“Excessively thirst, sweating and frequent urination were the first symptoms of diabetes, but I didn’t know it then. I was in Class 10 then, and no one in my family or close friend circle had heard of the disease. Only when I read a chapter in biology about diabetes and it symptoms that I told my father,” Malick said.

Tests showed her blood glucose reports to be 400 mg/dl — the normal is 140 mg/dl — and she was immediately referred to the AIIMS, where she was admitted for 10 days.

She doesn’t remember worrying when told she would have to be on insulin for the rest of her life. “I wasn’t scared because I thought I would not let the disease dampen my spirit. I had kind of promised to myself that I would try and live as far as possible a normal life. I learnt how to take the injection on apples and oranges,” she said. “It’s been 31 years, and I have been taking insulin injections daily. It has become a way of life for me, like we brush, take bath etc.,” she added.

Malick talked about her disease to only a very close few. Malick was disheartened to see that even some of the most educated people were discriminating against diabetics.

“I was selected for the nursing degree course at AIIMS, but was refused admission as some in the committee held my diabetes against me,” she said. But Malick managed to convince them. Not only did she complete the course, she stood second in her batch.

Global prevalence: facts & figures | Travelling with diabetes