The Sacamento Bee // July 11, 2005 04:45 PM
The obesity epidemic appears to be fueling a hybrid type of diabetes that afflicts adults and children and, some believe, may increase the devastating complications of the disease.
Dubbed "double diabetes" by some and "diabetes one-and-a-half" by others, the combination of types 1 and 2 diabetes symptoms confounds doctors attempting to accurately diagnose patients and find the best medicines to treat them.
"We don't really know how prevalent this is," said Dr. Francine Kaufman, head of the Center for Diabetes and Endocrinology at Childrens Hospital Los Angeles. "We are just at the vista of realizing it's out there and trying to determine how do we get an understanding of it."
Even Kaufman, former president of the American Diabetes Association and author of the book "Diabesity" -- about the obesity epidemic and related rise in type 2 diabetes -- does not always recognize the double diabetes cases.
Her patient, Cameron Stark, had classic symptoms of type 2 diabetes. Then 14, the girl's thirst was unquenchable. She was losing weight rapidly because her body wasn't absorbing necessary nutrients. She was vomiting. She felt tired all the time, one day falling sound asleep on the marble floor of her home.
At just a little under 5 feet tall, about 200 pounds and with a family history of the disease, Stark appeared a prime candidate for the diagnosis.
A blood sugar test confirmed it. She was given insulin to control the high sugar levels in her blood, and the Sherman Oaks teen joined the growing cadre of children diagnosed with what used to be called "adult onset" and is now known as type 2 diabetes.
One month later, another test on Stark revealed telltale signs of the far more rare variation of the disease known as "juvenile diabetes" and more commonly called type 1 diabetes.
"It was a whole different ballgame from that day forward," said Cameron's mother, Shelley Stark.
Now 15, Stark's daughter appears to be part of an emerging population with a complex set of symptoms that may require multiple medications as well as strict adherence to a healthy diet and regular exercise.
Obesity long has been associated with type 2 diabetes, a condition in which the body doesn't use insulin efficiently. Increasingly, people with type 1 diabetes -- in which the body does not produce sufficient insulin -- are becoming obese and showing signs of type 2.T
o understand how the two types of diabetes may overlap, it helps to look at the diseases separately.
Type 1 diabetes is defined as an autoimmune disorder in which the body starts attacking the "beta" cells in the pancreas that produce insulin, the hormone that escorts sugar into the body's cells for energy production. When the cells stop working, they no longer produce insulin and glucose builds up in the blood, starving the body's organs of fuel.
The causes of type 1 are not entirely understood, although genetics, viral infections and trauma to the pancreas can affect development of the disease. Type 1 diabetics must be treated with insulin shots.
In type 2 diabetes, the body produces insufficient insulin to meet increased needs for the hormones that occur because of insulin resistance, a condition in which the cells don't make efficient use of insulin.
Research has proven that, in many cases, type 2 diabetes can be controlled with a healthy diet and regular exercise. Many type 2 diabetics, however, require drugs, including insulin, to maintain healthy blood sugar levels.
For each type of diabetes, complications can vary in severity but are generally the same, ranging from heart disease, stroke and kidney disease to blindness, nerve damage, foot problems and skin disorders.
Although they don't agree on how the process works or which name to use to describe it, clinicians and researchers are finding evidence of both diseases simultaneously in the same patients. The rise in obesity is seen as a leading culprit.
In one study, for example, researchers at the University of Washington found that a majority of children with type 2 diabetes also had signs of type 1 diabetes in the form of antibodies and T-cells, immune system markers that respond to cell damage.
"There is some indication that obesity, by putting more stress on the beta cells, may in fact make the cells more susceptible to immune attack," said Dr. Jerry P. Palmer, who is head of endocrinology and metabolism at the VA Puget Sound Health Care System.
For her part, Stark gets four to six injections of insulin every day, in amounts that have dropped gradually in recent weeks.
Her mother said she now shops for low-carb, sugar-free foods. "I am learning to read labels," she said. "I check everything now.
Regular exercise also has become part of the teen's daily routine.
"I work out with a trainer two days a week," she said. "We do kickboxing, tae kwon do, yoga and core work. I learned very quickly what I had to do with my life and to take care of myself to stay healthy."
Tuesday, July 12, 2005
UCSF sets pace on stem cells
>>Related story on Diabetes work here>>
Contra Costa Times // Tues, July 12, 2005
By Betsy Mason // CONTRA COSTA TIMES
SAN FRANCISCO - In 1981, UC San Francisco biologist Gail Martin isolated some remarkable cells from a mouse embryo. She named them "stem cells" because nearly every type of cell seemed to stem from them.
The discovery laid the groundwork for a whole new area of research. Nearly two decades later, a University of Wisconsin scientist adapted Martin's technique to human embryos.
The jump to human cells stoked a growing ethical controversy that led the Bush administration in 2001 to back away from funding work involving human embryonic stem cells, save for a few pre-existing stem cell lines. That decision threatened to hobble U.S. research and give the rest of the world an edge.
UCSF took matters into its own hands and has raised $13 million in private funds, including $5 million from Intel Corp. chairman Andy Grove, to establish a stem cell biology program and a separate facility to derive new embryonic stem cell lines. Today, UCSF is still a world leader and pioneer in stem cell research.
More than 60 scientists at UCSF are exploring the cells' potential to treat diseases and conditions such as diabetes and stroke. This work is supported by continued dedication to nuts-and-bolts basic cell science critical to enabling new discoveries.
"We cover quite a bit of the territory that is going to be required to bring cell-based therapies to our patients," said Arnold Kriegstein, head of UCSF's stem cell program.
Now with the help of Prop. 71, California's 10-year, $3-billion stem cell initiative, UC's premier medical research institution is poised to capitalize on its assets in a huge way.
One of UCSF's greatest strengths, and one that sets it apart from most research institutions, is its human embryonic stem cell program, co-directed by Susan Fisher and Renee Reijo Pera. One of just two centers in the country that derived federally approved embryonic stem cell lines, UCSF has distributed these cells worldwide.
Now, UCSF scientists are deriving new human embryonic stem cell lines that could be critical to research and future therapies. These lines cannot be used in studies supported by federal funding, but Prop. 71 may help scientists bring the new lines into their labs.
Reijo Pera is also interested in understanding how human embryos develop with an eye toward understanding birth defects. Her work could benefit women who use in vitro fertilization by reducing problematic multiple births.
"If you can understand what a good embryo is, that's a huge battle that's been won," said Reijo Pera. "We don't have to then put two or three embryos back in a woman; we can put one good embryo."
Much has been made of stem cells' potential to treat brain disorders such as Parkinson's disease. Realizing that potential is likely to be more than a decade away, said Kriegstein, but a recent discovery is a major step forward.
Not long ago, scientists believed adult brains couldn't make new neurons. Fortunately, that idea was wrong. Last year, UCSF neuroscientist Arturo Alvarez-Buylla led a team that discovered newborn neurons in the fluid-filled cavity of adult brains called the subventricular zone.
The team also found a sheet of common, star-shaped brain cells known as astrocytes in the same zone. These cells were traditionally thought to simply support neurons, the brain cells that do the actual work of thinking, feeling and directing movement. But when grown in a petri dish, the astrocytes produced neurons and are the likely source of the new neurons the team discovered. One day, the discovery could help restore brain function to people with diseases like Parkinson's.
Other studies have shown that stem cells found in bone marrow and the bloodstream can help hearts function better after a heart attack. UCSF cardiologist Yerem Yeghiazarians is trying to find out how this works.
"Getting from the stem cells all the way to how we improve heart muscle, there's a huge step in between," he said. "Nobody really knows exactly how this happens."
He hopes understanding the process could lead to better treatments for millions of Americans who suffer from heart disease or heart failure.
UCSF scientists are also studying adult stem cells in other areas of the body such as the pancreas. Michael German hopes to be able to harness these cells to help people with diabetes. And Rik Derynck is studying the possibility of convincing adult stem cells on their way to becoming fat cells to grow into bone or muscle cells instead, which could help conditions like osteoporosis.
Readily available therapies are years and maybe decades away, said Kriegstein. "But we are hopeful that the Prop. 71 funds will help accelerate all of this progress and make some of these hopes a reality."
Betsy Mason covers science. Reach her at 925-847-2158 or bmason@cctimes.com.
Contra Costa Times // Tues, July 12, 2005
By Betsy Mason // CONTRA COSTA TIMES
SAN FRANCISCO - In 1981, UC San Francisco biologist Gail Martin isolated some remarkable cells from a mouse embryo. She named them "stem cells" because nearly every type of cell seemed to stem from them.
The discovery laid the groundwork for a whole new area of research. Nearly two decades later, a University of Wisconsin scientist adapted Martin's technique to human embryos.
The jump to human cells stoked a growing ethical controversy that led the Bush administration in 2001 to back away from funding work involving human embryonic stem cells, save for a few pre-existing stem cell lines. That decision threatened to hobble U.S. research and give the rest of the world an edge.
UCSF took matters into its own hands and has raised $13 million in private funds, including $5 million from Intel Corp. chairman Andy Grove, to establish a stem cell biology program and a separate facility to derive new embryonic stem cell lines. Today, UCSF is still a world leader and pioneer in stem cell research.
More than 60 scientists at UCSF are exploring the cells' potential to treat diseases and conditions such as diabetes and stroke. This work is supported by continued dedication to nuts-and-bolts basic cell science critical to enabling new discoveries.
"We cover quite a bit of the territory that is going to be required to bring cell-based therapies to our patients," said Arnold Kriegstein, head of UCSF's stem cell program.
Now with the help of Prop. 71, California's 10-year, $3-billion stem cell initiative, UC's premier medical research institution is poised to capitalize on its assets in a huge way.
One of UCSF's greatest strengths, and one that sets it apart from most research institutions, is its human embryonic stem cell program, co-directed by Susan Fisher and Renee Reijo Pera. One of just two centers in the country that derived federally approved embryonic stem cell lines, UCSF has distributed these cells worldwide.
Now, UCSF scientists are deriving new human embryonic stem cell lines that could be critical to research and future therapies. These lines cannot be used in studies supported by federal funding, but Prop. 71 may help scientists bring the new lines into their labs.
Reijo Pera is also interested in understanding how human embryos develop with an eye toward understanding birth defects. Her work could benefit women who use in vitro fertilization by reducing problematic multiple births.
"If you can understand what a good embryo is, that's a huge battle that's been won," said Reijo Pera. "We don't have to then put two or three embryos back in a woman; we can put one good embryo."
Much has been made of stem cells' potential to treat brain disorders such as Parkinson's disease. Realizing that potential is likely to be more than a decade away, said Kriegstein, but a recent discovery is a major step forward.
Not long ago, scientists believed adult brains couldn't make new neurons. Fortunately, that idea was wrong. Last year, UCSF neuroscientist Arturo Alvarez-Buylla led a team that discovered newborn neurons in the fluid-filled cavity of adult brains called the subventricular zone.
The team also found a sheet of common, star-shaped brain cells known as astrocytes in the same zone. These cells were traditionally thought to simply support neurons, the brain cells that do the actual work of thinking, feeling and directing movement. But when grown in a petri dish, the astrocytes produced neurons and are the likely source of the new neurons the team discovered. One day, the discovery could help restore brain function to people with diseases like Parkinson's.
Other studies have shown that stem cells found in bone marrow and the bloodstream can help hearts function better after a heart attack. UCSF cardiologist Yerem Yeghiazarians is trying to find out how this works.
"Getting from the stem cells all the way to how we improve heart muscle, there's a huge step in between," he said. "Nobody really knows exactly how this happens."
He hopes understanding the process could lead to better treatments for millions of Americans who suffer from heart disease or heart failure.
UCSF scientists are also studying adult stem cells in other areas of the body such as the pancreas. Michael German hopes to be able to harness these cells to help people with diabetes. And Rik Derynck is studying the possibility of convincing adult stem cells on their way to becoming fat cells to grow into bone or muscle cells instead, which could help conditions like osteoporosis.
Readily available therapies are years and maybe decades away, said Kriegstein. "But we are hopeful that the Prop. 71 funds will help accelerate all of this progress and make some of these hopes a reality."
Betsy Mason covers science. Reach her at 925-847-2158 or bmason@cctimes.com.
Envisioning a cure for diabetes
Contra Costa Times // Tue, July 12, 2005
By Betsy Mason
Diabetes is one of the most promising targets of stem cell research. People with this disease have problems with insulin, a hormone in the pancreas that regulates blood sugar levels. Patients have poorly functioning or too few insulin-producing cells, known as beta cells.
"We think that ultimately the way to cure people with diabetes, or at least many patients with diabetes, is to replace those cells," said Michael German of the UC San Francisco Diabetes Center.
Several clinics worldwide, including UCSF, already do this by transplanting beta cells from cadavers into diabetes patients.
"The problem is, at present we don't have nearly enough cells to do this," German said.
There are more than 150 million people with diabetes and more than a half million new cases each year in the United States alone. But fewer than 5,000 pancreases are available for donation yearly, he said.
"If we had an unlimited supply of these cells, we could treat everybody with diabetes," German said.
He hopes stem cells can help generate that supply.
In normal human development, some stem cells eventually become beta cells. The cells face a series of decisions that lead them down the path to becoming insulin-producing cells or another cell type. To become a beta cell, they must first decide to become part of the gastrointestinal tract, and eventually part of the pancreas, and then part of the pancreas area that contains specialized cells, including beta cells. Finally they must decide to become a beta cell.
German is working on how to coax embryonic stem cells along this path.
"The programs by which those decisions are controlled at a molecular level is what my laboratory has been focused on," he said. "The idea is that if we knew the genes and the signaling pathways that control each of these decisions that we could in fact take embryonic stem cells and drive them specifically to make these decisions and end up as beta cells."
He and other scientists have already identified some genes along the pathway in mice, and there is good evidence that the same pathway exists in humans.
By Betsy Mason
Diabetes is one of the most promising targets of stem cell research. People with this disease have problems with insulin, a hormone in the pancreas that regulates blood sugar levels. Patients have poorly functioning or too few insulin-producing cells, known as beta cells.
"We think that ultimately the way to cure people with diabetes, or at least many patients with diabetes, is to replace those cells," said Michael German of the UC San Francisco Diabetes Center.
Several clinics worldwide, including UCSF, already do this by transplanting beta cells from cadavers into diabetes patients.
"The problem is, at present we don't have nearly enough cells to do this," German said.
There are more than 150 million people with diabetes and more than a half million new cases each year in the United States alone. But fewer than 5,000 pancreases are available for donation yearly, he said.
"If we had an unlimited supply of these cells, we could treat everybody with diabetes," German said.
He hopes stem cells can help generate that supply.
In normal human development, some stem cells eventually become beta cells. The cells face a series of decisions that lead them down the path to becoming insulin-producing cells or another cell type. To become a beta cell, they must first decide to become part of the gastrointestinal tract, and eventually part of the pancreas, and then part of the pancreas area that contains specialized cells, including beta cells. Finally they must decide to become a beta cell.
German is working on how to coax embryonic stem cells along this path.
"The programs by which those decisions are controlled at a molecular level is what my laboratory has been focused on," he said. "The idea is that if we knew the genes and the signaling pathways that control each of these decisions that we could in fact take embryonic stem cells and drive them specifically to make these decisions and end up as beta cells."
He and other scientists have already identified some genes along the pathway in mice, and there is good evidence that the same pathway exists in humans.
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