Diabetes Wellness News

August 2022 Volume 28 Number 8 $3.00 ISSN 1539-5294

DIABETES WELLNESS NETWORK® YOUR INTERACTIVE DIABETES SUPPORT SYSTEM

DRWF Research NEWS

THE BETA CELL BACK IN THE SPOTLIGHT The latest research on the vital role played by beta cells examined by DRWF Research Manager, Dr. Eleanor Kennedy

Introduction

Can the pancreas heal itself?

The hallmark of diabetes is the destruction or exhaustion of the beta cells in the pancreas, with their resulting failure to produce insulin. They can be replaced by islet transplantation, of course, but this technology has not really entered the mainstream of diabetes care. However, findings from recent diabetes conferences offer new hope. First, it seems that non-beta cells in the pancreas can re-program themselves to produce insulin. Second, the diabetes drugs that work best in the long term may be those that protect the beta cells.

According to Dr. Pedro Herrera of the University of Geneva, speaking at this year’s EASD (European Association for the Study of Diabetes) conference, it may one day be possible to treat diabetes by inducing the pancreas to produce insulin again. Dr. Herrera, who has used ground-breaking genetics technology to explore this possibility, said: “When I started this project in 1999, the most successful study was one where we removed 99% of the beta cells.” The study model was kept alive with Continued on page 3

THE INFLATION REDUCTION ACT: Congress Acts on Drug Price Reform A few months ago, Diabetes Wellness News, discussed insulin affordability and the high cost of medications. Americans pay way more on prescription drugs than people in other countries. This angers voters and for a long time, lawmakers had vowed to do something about it. Recently, the US Congress passed the Inflation Reduction Act—hashed out by Senate Majority Leader, Chuck Schumer, D-NY and Senator Joe Minchin, D-WV, which includes several provisions around drug prices and health insurance. This will relieve the burden that patients face in paying Continued on page 2

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IN THIS ISSUE: DRWF Research News: The Beta Cell Back in the Spotlight ................................................ 1 The Inflation Reduction Act: Congress Acts on Drug Price Reform ............. 1 Curbing Those Sugar Cravings When You Have Diabetes...................................................... 4 Managing Diabetes in the Heat, by CDC....... 6

The Inflation Reduction Act: Congress Acts on Drug Price Reform...Continued from Page 1

inflated cost on their prescriptions for those who are on Medicare. “The proposal to limit out-of-pocket expenses would make a huge difference in my life,” said a Type 1 diabetic Medicare recipient who pays almost $5000 out of pocket cost for insulin each year. The bill will reduce Medicare’s drug costs in several ways. The federal health secretary would be able to directly negotiate with manufacturers to obtain lower prices for several high-cost drugs, require drug companies to pay rebates to Medicare if their prices rise faster than overall inflation. To qualify for negotiation, the drugs would have to be on the market for years. The bill will also improve Medicare’s drug benefit by placing a $2,000 annual limit on out-ofpocket drug spending, capping out-of-pocket insulin expenses at $35 a month, eliminating cost sharing for vaccines, and expanding eligibility for the low-income drug subsidy. Currently there is no limit on total out-ofpocket on insulin spending. People on Medicare will not have to pay more than $2,000 a year in out--of–pocket cost for prescription drugs, which will make an enormous difference for seniors with certain conditions such as diabetes and other serious illnesses. Starting next year, if a drug company raises their drug prices faster than inflation, the company would have to pay a rebate to Medicare. According to the Kaiser Family Foundation (https:// www.kff.org/) a healthcare policy analysis, stated that half of all prescriptions covered by Medicare increased in prices faster than the cost of inflation. This provision could help discourage pharmaceutical companies from hiking prices. Please click on link for more information (https://www.kff.org/medicare/event/august-11-webevent-understanding-health-care-provisions-inflationreduction-act/ ).

So, what is true and what is not? The argument made by drug makers as an opposing view that if these changes are made, then it will lead to few new drugs. According to Open Secrets, a non-profit nation’s premier research group tracking money in U.S. politics and its effect on elections and public policy, the pharmaceutical and health product industry had spent more on lobbying in Congress this year than any other industry fighting against changes because this bill would cut into their profit. (https:// www.opensecrets.org/federal-lobbying/industries/ summary?cycle=2022&id=H04). An analysis report by the Congressional Budget Office (https://www.cbo.gov/cost-estimates) estimated that the effect on drug development would be exceedingly small. Only fifteen out of over a thousand new developed drugs comes to market in a 30 years’ time span, which is about 1% of new drugs. Most large drug companies spend more money on marketing than on research and development. This bill will not cut Medicare benefits. There are Ads in the media that are misleading about what will happen if the bill passed—that it will take away from the Medicare budget. But in fact, the amount of money is what the government is expecting to save because Medicare will not have to pay as much for expensive drugs; there would be a cap on cost, such as insulin. So most importantly, seniors’ benefits would not be cut. So, what about insulin, which is the focus. The US prices are four times higher than other countries and about 1 in 4 diabetes patients has reported taking less insulin than prescribed because they cannot afford it, which can be life threatening. On August 16, 2022, the bill was just sign into law by President Biden. The bill limits insulin copays to $35 per month for Medicare Part D beneficiaries starting in 2023. Seniors covered by Medicare also have a $2,000 annual out-of-pocket cap on Part D prescription drugs starting in 2025. Medicare will also now negotiate the costs of certain prescription drugs. “We’re very excited that seniors are going to see these cost savings,” said Dr. Robert Gabbay, chief scientific and medical officer at the American Diabetes Association (ADA). “For patients aged 65 and up who rely on insulin, the Inflation Reduction Act is a “game changer!” This bill is a victory for Medicare recipients; however, it Continued from Page 3 3 Continued on page

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falls short on many patients who are covered by private insurance. ADA plans to advocate for relief for more patients, which calls for capping monthly insulin costs for a broader patient population. “We were hoping that now is the time to go national and really have a comprehensive law that would protect all people with

diabetes in the U.S.,” Gabbay said. If you are struggling to cover your insulin, ADA resources may be able to help curb those costs at Insulinhelp.org(https://insulinhelp.org/).

The Beta Cell Back in the Spotlight ...Continued from Page 1

insulin, to see if it could regenerate insulin producing cells. Dr. Herrera said: “And the answer was “yes”. I was very surprised, but we saw that many insulin-producing cells were popping up in the islets of these mice that were completely devoid of beta cells.” This was the start of many years of experiments which revealed that alpha cells, which normally make glucagon, and delta cells, which produce somatostatin, can reprogram themselves to produce insulin instead. Dr. Herrera’s hypothesis was that local deprivation of insulin could switch on insulin production in a non-beta cell. Further experiments have also shown proof of concept of this plasticity in human islet non-beta cells. Dr. Herrera’s team then obtained islet cells from people with type 2 diabetes or healthy donors, and isolated very pure alpha cell populations and produced pseudo islets from them. They were able to get these to produce insulin, and to make them do this in the presence of high glucose—rather like a healthy pancreas. The team is now involved in a number of investigations, paving the way to human trials. Dr. Herrera said: “Promoting the body’s own cell therapy is already an area of active research.”

Preserving beta cells with medication Glucose-lowering drugs do not always address beta cell dysfunction in type 2 diabetes, according to findings presented at the 19th World Congress on Insulin Resistance, Diabetes and Cardiovascular Disease recently. Professor Ralph DeFronzo, Chief of the Diabetes Division, University of Texas Health Science Center at San Antonio, said: “Once type 2 diabetes is diagnosed, 90% of the insulin-producing beta cells in the pancreas have stopped functioning.” There are sophisticated measures of beta cell function, but there is also a very simple one—the HbA1c. Professor DeFronzo said: “If HbA1c is rising, you’ve got the patient on a drug that is not preserving beta cell function.” The UK Prospective Diabetes Study (UKPDS), which was the first trial to show that a decrease in HbA1c decreases the risk of complications, compared the effect of lifestyle change, metformin or glibenclamide, Vol. 28 No. 8

sulphonylurea. HbA1c decreased in all groups at the start of the study; however, over the course of 15 years, it crept back up again and six years into the study, it was back where it started, at around 7%. By 15 years, HbA1c had increased even further. As the study went on, therapy had to be intensified in response to the rise in HbA1c, so that by the 15-year mark, many participants were also on insulin. Professor DeFronzo said: “UKPDS taught us about complications but also that sulphonylureas and metformin don’t work long-term, because they don’t have an effect on the beta cell.” Other trials have shown a similar trend. Professor DeFronzo added: “These findings are all because of ongoing beta cell failure.” However, durability of glycaemic control can be found with the thiazolidinediones, according to findings from eight different trials, which showed a sustained decrease in HbA1c of up to 2%. Professor DeFronzo said: “With the thiazolidinediones, whatever the initial drop in HbA1c was, it stayed down and there’s only one reason that can happen. These drugs have an effect on the beta cell.” Similar results were seen with a trial of the GLP-1 receptor agonist exenatide, while another study showed that even a single dose of liraglutide restores beta cell response to hyperglycaemia. Further evidence comes from a study comparing C-peptide secretion on exenatide and insulin glargine. Levels were around three times higher on exenatide after three years. Professor DeFronzo concluded: “There are only two drugs that are going to preserve your beta cells on a long-term basis—pioglitazone and GLP-1 receptor agonists. These should be first line therapy.

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Curbing Those Sugar Cravings When You Have Diabetes By Amy Campbell, MS, RD, LDN, CDE

Whether you’ve had diabetes for 20 years or 20 days, you’ve probably been told to say goodbye to sugar and anything that contains sugar. While the old adage that people with diabetes shouldn’t eat sugar is (thankfully) pretty much a thing of the past, the reality is that downing a can of Coca Cola or grabbing a handful of cookies isn’t going to do your blood sugars—let alone your waistline—any favors. Yet, someone apparently forgot to tell your brain and your stomach, because you’re craving for sugar or anything remotely sweet is still going strong. You might even notice that you crave sugar more than ever since being diagnosed with diabetes. Why? And what can you do about it?

Anatomy of a Craving Google the definition of a craving, and some pretty strong terminology pops up. The Merriam-Webster dictionary defines a craving as “an intense, urgent, or abnormal desire or longing.” Food cravings can stem from a number of factors, including: • Emotions • An imbalance of hormones, specifically, leptin

and serotonin • A release of endorphins, or “feel-good” chemicals • A lack of sleep • A nutrient deficiency, such as iron deficiency

anemia Even being dehydrated can trick your brain into thinking that you’re hungry, when what you really need is a tall glass or two of water. It’s important to

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realize that cravings are not the same as being hungry. Yes, you may crave a specific food when you haven’t eaten for a while (meaning, you’re hungry), but hunger and craving are very different. Hunger occurs when you haven’t eaten for a few hours. Your stomach may growl, you may have a headache, and you might even feel weak. Once you eat something, your symptoms go away. And eating pretty much any food satisfies that hunger. A craving, on the other hand, is usually for a specific type of food—sweet, fatty, salty. It can occur due to emotions, such as feeling sad, depressed or bored, or to hormonal fluctuations. In addition, cravings can happen at any time, even if you’ve recently eaten. And if you wait long enough, the craving often subsides. If your cravings are of the sweet sort, it may be that you’re a regular sugar-eater; the more sugar you eat, the more endorphins your brain releases, setting up a vicious cycle of constantly wanting more. Why? Endorphins help to calm and relax you; you might even say that they provide a “natural high.” Plus, for many people, sugar tastes good, and it’s associated with childhood memories, so the more you eat, the more you feel comforted.

Diabetes and Cravings: Is There a Link? If you have diabetes, you may notice that a craving for something sweet can pop out of nowhere, especially when your blood sugar is dropping or goes low. This can happen even if you usually don’t eat sugary foods. In some regards, this makes sense: low blood sugar Continued on page 5



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inconsistent times can set you up for fluctuating blood sugars and feeling hungry, which can lead to cravings. • Kick off your day with a protein-packed breakfast.

Eating protein in the morning lessens the chances of sugar cravings later in the day. Try Greek yogurt, nut butter or an egg. • Take stock of your sweet tooth, and set a goal to

cut back. The more you eat sugar and sweets, the more you’ll want them. Don’t forget that sugar lurks in many foods, including salad dressings, pasta sauce and cereals. Read labels and go for low or no-sugar foods whenever possible (hypoglycemia) means that not only are glucose levels in the blood too low, the cells in your body aren’t getting any fuel. This lack of energy triggers a host of side effects ranging from feeling shaky or lightheaded, to feeling grumpy, to feeling ravenous. In fact, plummeting low blood sugars activate an area of the brain that causes a desire to eat. For the most part, the foods you’ll reach for tend to be high in carbohydrates, and not necessarily the healthy kind, either. End result? Your blood sugar soars sky high, leaving you feeling lethargic and now having to deal with hyperglycemia.

Curbing Those Cravings If you’re ready to get off the blood sugar rollercoaster and kick those cravings to the curb, try these steps: • Get back on track with eating regular meals

and snacks. Skipping meals or eating meals at

• Eat mindfully, meaning, pay attention to what and

how much you eat, as well as your surroundings. Avoid multitasking when you’re eating—put down that smartphone and turn off the TV! • Be aware of emotional eating. It happens to

everyone, but if you’re always reaching for sweet treats when you’re sad/bored/lonely/depressed, it’s time to deal with your emotions in other, more helpful ways. • Move more! Exercise can reduce cravings and it’s

not too bad for your blood sugars, either. • Get the sleep that you need to balance out your

hormones and banish the urge to eat sweets. • Check your blood sugar regularly. If they’re not

within your target, or if you’re trying to deal with constant blood sugar highs or lows, talk with your healthcare team about making a change to your treatment plan.

Drug Discount Card: Up to 75% Savings Individuals with Medicare often reach their doughnut hole at this time of year. If you are one of those individuals, the Diabetes Research & Wellness Foundation drug discount card may be of benefit to you. The card provides individuals with the opportunity to save up to 75 percent off the regular price of prescription medications. The card is accepted at over 54,000 pharmacies nationwide; there is no fee for the card, and registration is not necessary. Anyone can use this card regardless of income, insurance state, age, residency, or diagnosis. Call or send an email for your free card today at 1-866-293-3155 or [email protected]

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The CDC has Tips on Managing Diabetes in the Heat There are still many hot and humid days during the month of August. How to keep your cool during the hottest time of year. Remember to take steps to stay cool when the weather heats up.

– SUMMER CHECKLIST – Drink plenty of water.

Did you know that people who have diabetes—both type 1 and type 2—feel the heat more than people who don’t have diabetes? Some reasons why:

Test your blood sugar often.

• Certain diabetes complications, such as damage

Stay inside in air-conditioning when it’s hottest.

Keep medicines, supplies, and equipment out of the heat.

to blood vessels and nerves, can affect your sweat glands so your body can’t cool as effectively. That can lead to heat exhaustion and heat stroke, which is a medical emergency.

Wear loose, light clothing. Get medical attention for heat-related illness. Make a plan in case you lose power. Have a go-bag ready for emergencies.

It’s the Heat and the Humidity Even when it doesn’t seem very hot outside, the combination of heat and humidity (moisture in the air) can be dangerous. When sweat evaporates (dries) on your skin, it removes heat and cools you. It’s harder to stay cool in high humidity because sweat can’t evaporate as well.

• People with diabetes get dehydrated (lose too

much water from their bodies) more quickly. Not drinking enough liquids can raise blood sugar, and high blood sugar can make you urinate more, causing dehydration. Some commonly used medicines like diuretics (“water pills” to treat high blood pressure) can dehydrate you, too.

Whether you’re working out or just hanging out, it’s a good idea to check the heat index—a measurement that combines temperature and humidity. Take steps to stay cool when it reaches 80°F in the shade with 40% humidity or above. Important to know: The heat index can be up to 15°F higher in full sunlight, so stick to the shade when the weather warms up.

• High temperatures can change how your body uses

insulin. You may need to test your blood sugar more often and adjust your insulin dose and what you eat and drink.

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Physical activity is key to managing diabetes, but don’t Continued on page 7



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get active outdoors during the hottest part of the day or when the heat index is high. Get out early in the morning or in the evening when temperatures are lower, or go to an air-conditioned mall or gym to get active.

Your Blood Sugar Knows Best Some kids are out of school while others are returning, vacations, get-togethers, family reunions. This end of summer season can throw off your routine, and possibly your diabetes management plan. Check your blood sugar more often to make sure it’s in your target range no matter what comes your way. It’s especially important to recognize what low blood sugar feels like and treat it as soon as possible. Play it safe in the sun with a hat and sunglasses.

Wear loose-fitting, lightweight, light-colored clothing. Wear sunscreen and a hat when you’re outside. Sunburn can raise your blood sugar levels. Don’t go barefoot, even on the beach or at the pool. Use your air conditioner or go to an air-conditioned building or mall to stay cool. In very high heat, a room fan won’t cool you enough.

Too Hot to Handle Know what else feels the heat? Diabetes medicines, supplies, and equipment: Don’t store insulin or oral diabetes medicine in direct sunlight or in a hot car. Check package information about how high temperatures can affect insulin and other medicines. If you’re traveling, keep insulin and other medicines in a cooler. Don’t put insulin directly on ice or on a gel pack. Heat can damage your blood sugar monitor, insulin pump, and other diabetes equipment. Don’t leave them in a hot car, by a pool, in direct sunlight, or on the beach. The same goes for supplies such as test strips. You’ll need to be able to test your blood sugar and take steps if it’s too high or too low. Just make sure to protect your diabetes gear from the heat.

Stormy Weather

Warm-weather Wisdom: Drink plenty of water—even if you’re not thirsty—so you don’t get dehydrated. Avoid alcohol and drinks with caffeine, like coffee and energy or sports drinks. They can lead to water loss and spike your blood sugar levels. Check your blood sugar before, during, and after you’re active. You may need to change how much insulin you use. Ask your doctor if you would like help in adjusting your dosage.

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Hurricane season is upon us. Severe thunderstorms with hail, high winds, and tornadoes are more likely in warm weather, too. People with diabetes face extra challenges if a strong storm knocks out the power or they have to seek shelter away from home. Plan how you’ll handle medicine that needs refrigeration, such as insulin. And be prepared by packing an emergency go-bag—a supply kit you can grab quickly if you need to leave your home. Here’s to staying cool, staying safe, and enjoying the long end of summer days! https://www.cdc.gov/diabetes/ library/features/manage-diabetesheat.html

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Start your own Fundraiser for Diabetes Research • Start a Facebook Fundraiser You’re invited to start a Facebook Fundraiser: DRWF would love if you could help us, and encourage others to start a fundraiser on Facebook. In just a few clicks, you can start a fundraiser and invite your friends. You can also add a donate button any time you post by selecting “More Options” (the three dots) below the status box, and then selecting “Support Nonprofit”. Search for and select “Diabetes Research & Wellness Foundation — Washington, DC location” and 100% of the money you raise will be sent to us. Every dollar counts! Click on :http://ow.ly/7MCP30mnlyS

• Go Fund Me Campaign Help DRWF provide insulin to those in need. DRWF’s latest campaign is to help offset the cost of insulin for those who simply cannot afford it. You can make a difference, please click on to: https://fundly.com/

• eBay for Charity eBay for Charity— Select DRWF as your charity and you can sell and donate.

eBay for Charity has partnered with the PayPal Giving Fund to make it easy for sellers to donate 10% to 100% (or as low as 1% for eBay Motors vehicles) of your item’s final sale price to a certified charity. It’s as easy as 1 – 2 – 3! Currently, there is over 270 items that DRWF can benefit from. https://charity.ebay.com/charity/Diabetes-Research--Wellness-Foundation/2012087

Did you know you can support DRWF by donating your car? It’s fast and easy to do. The service provides quick and easy pick up of your car. Now is a great time to donate your car. The foundation greatly appreciates your donation to continue our mission. Find out more: https://careasy.org/nonprofit/diabetes-research-and-wellnessfoundation

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