When Immune Systems Attack!

Bridling at Insulin’s Cost, States Push for Generics

This is what always pisses me off about big discussions about the cost of prescription drugs today- all the talking heads waste all their time talking about generics...

so talking heads-
where's my generic insulin? (two different insulin that cost $100 together in co payments)
where's my generic test strips? (that's $75 in co payments)
where's my generic pen needles? (luckily that one is only like $30 in co payments)

...oh, wait. If there is ever a generic insulin, for some reason I doubt that it will come in a pen...


*rant warning*

As terrible as this whole Type 2 epidemic is, I am really really really tired of Type 1 getting the shaft by the media, by the politicians, by the pharmaceutical companies, by everyone.

Hell, can anyone even tell me when was the last time the ADA even published a book on Type 1? I mean a whole book, not the usual paragraph or two bs we get in every "diabetes" book that is really just about Type 2. I mean, has anyone seen this book?

Know Your Numbers, Outlive Your Diabetes

The woman who co-authored it has Type 1 and runs a blog about having Type 1, and the book is about Type 2.

W. T. F.

From The Scientist

Turning Out the Pockets for Narcolepsy and Diabetes

The Scientist 2004, 18(5):36
Published 15 March 2004

Paradoxically, a single MHC class II allele, HLA-DQ0602, confers susceptibility to narcolepsy but prevents development of type I diabetes. Clinical immunologist Lars Fugger and structural biologist Yvonne Jones, both at Oxford University, have compared the crystal structure of the allele with those of two similar MHC molecules that respectively predispose to type 1 diabetes and protect against narcolepsy.[1] They have identified unique features of several pockets within the peptide-binding groove of HLA-DQ0602 that could explain the contradiction differential influences T-cell stimulation.

In particular, says Fugger, the extra large P4 pocket selectively accommodates a candidate auto-antigenic peptide that might stimulate autoreactive T cells in narcolepsy, a potential autoimmune disorder. For diabetes, the unusual stability of the P9 pocket could promote development of regulatory T cells able to actively suppress disease-causing T cells. "In many ways," he adds, "I would say that narcolepsy and diabetes could be mirrors of each other."

"It is exciting to be able to combine structure with data, ranging from the epidemiological and clinical through genetic to molecular," Jones says. Jerry Nepom, director of the Benaroya Research Institute in Seattle, Wash., writes in an E-mail that the study "clarifies the 'who' and 'what' of some interesting HLA susceptibility molecules and provides some hints, but no answers yet, about the key 'how' and 'why' questions [that] link the [HLA] structure to disease."

- A. Nicola Schweitzer

References

1. Siebold C, et al.: "Crystal structure of HLA-DQ0602 that protects against type 1 diabetes and confers strong susceptibility to narcolepsy,".
Proc Natl Acad Sci 101:1999-2004.

Here's the Abstract:

Crystal structure of HLA-DQ0602 that protects against type 1 diabetes and confers strong susceptibility to narcolepsy

And what does this all mean?

Hell if I know...

From Narcolepsy Network

Body Mass Index and Narcolepsy
De Groen J, Center for Sleep and Wake Disorders, The Netherlands
Several studies have reported an increased prevalence of obesity and increased body mass indices (BMI) in narcoleptic patients. Possible causes are decreased activity due to sleepiness, or a side effect of medications taken. Recent research on hypocretin and leptin has, however, provided growing evidence that an altered energy homeostasis in narcolepsy plays a role. This study set out to explore the association of narcolepsy and BMI. Upon examination, the study of 124 newly diagnosed patients showed that BMI is increased in unmedicated narcoleptic patients, independent of age, disease duration and amount of daytime sleepiness. This underscores the notion that obesity in narcolepsy is part of the disease process itself, and not secondary to behavioral consequences of narcolepsy or medication status.

Food Consumption Patterns in Narcolepsy
Bruck D, Victoria University, Melbourne
With the discovery of hypocretin abnormalities in narcolepsy, there is increased interest in appetite and food consumption patterns in people with this sleep disorder. This study examined the detailed food, drink and medication intake patterns of 22 people with narcolepsy/cataplexy over a three-day period. The results were compared to 20 age- and socioeconomic status-matched controls. People with narcolepsy were found to initiate sweet consumption and snacking behavior more frequently than controls but did not consume more total calories or carbohydrates through snacks. Participants with narcolepsy clearly consumed more food overall than controls, with the main difference occurring at mealtime. Amongst the author's conclusions was speculation as to whether satiety signals operate normally in those with narcolepsy. Further consideration of the mechanisms (hypocretins) may explain some of the differences found, such as: appetite control abnormalities, metabolic rate differences, stressinduced eating and blood sugar irregularities (as seen with the higher rate of diabetes in narcolepsy, which has been argued to be independent of obesity).

At the top of every page this morning is the changes in carry-on rules the FAA has made because of the terror plot in Britain.

So what's the first thing I do?

Click on the link to the FAA's website to see if it affects insulin.

Am I flying anytime soon? Or even this year?

Nope.

I keep doing this. I hear reports from Beirut about the lack of medicines and immediately think "what if I was there". Every disaster or civil unrest or potential pandemic I hear about, the first thing I think about is how I would be screwed. Bird Flu? I'm fucked. Hurricane Hugo part 2? Sucks to be me.

I never thought this way until Katrina. I can pretty much blame it on this post: The dangers for diabetes. Watching that poor woman going through a panic attack and then pass out on national television because she had had no insulin in four days...well, for better or worse that has changed how I react to world events.

I say worse because I don't like the fact that I now frame ever disaster through how much my diseases would screw my chances of surviving. I don't watch the news to think about me, I watch to learn, to know whatever I can about the world. But now, this thought about myself is always in the back of my mind and I don't like it.

Ok, I'm trying to understand this from David Mendosa's blog.

Blood sugar reaches "a peak 72 minutes after eating with a variation of 23 minutes either way."

So if we wait to take a shot at mealtimes, wouldn't the peak of the insulin and the peak of our blood sugar be different?

Then it continues:
"Knowing when we peak is especially important for people with either type 1 or type 2 diabetes who use rapid-acting insulin. If the peak is too high 74 minutes after starting a meal – 140 mg/dl (7.8 mmol/l) to 180 mgl/dl (10 mmol/l) depending on whose recommendations you follow – you can take corrective action sooner than the official recommendations."

Soooo when should I take my humalog?

Today is so useless. Or should I say was, seeing as it is now past midnight.

I did nothing today. At least I took a shower...I should have been at work. Why is it so hard to understand that change is not good for me? Now my whole week will be fucked up cause I was off and asleep today and will be at work tomorrow. But I am bothered by the fact that even though school's out I'm still really, really sleepy. Knowing my luck, the narcolepsy will be controllable right in time for the start of fall semester...oh goody.

Not only was I mentally brain-dead today, my blood sugars have sucked...another reason why change is bad. I feel like a big slug. :(

But I did find out that The Truth About Stacey comes out November 1st. This makes me very happy and giddy. I loved that book as a kid, since we had the same name, but what I'm really waiting for is seeing all the diabetes stuff in graphic form. Will they show her testing her blood sugar? Or taking a insulin shot?

Gods, I hope so. Which of course sounds weird, but I need to see someone else doing this too. In six years, I have never seen someone taking a shot at a restaurant or testing their blood sugar in class. I know it's all in my head, but never seeing anyone else doing this has made me even more self-conscious about having to do all these stuff in public.

So I have a theory on the effects of blood sugar on adderall.

Normally it has always taken two hours for me to wake up after taking my first dose of adderall in the morning.

But of course my blood sugars were always high.

Now that I think I have figured out a way to keep them in the 100's overnight, I have been waking up about an hour after taking my medicine. So my guess is with better blood sugars my body absorbs the adderall faster.

Ever since I realized my diabetes was out of wack due to the dawn phenomenon, and my endo was more interested in giving me some drug not approved for usege with insulin... well I took matters into my own hands and worked out my own dosing schedule.

And the results?

two mornings with blood sugars over 200

one morning with blood sugars over 300

and eleven mornings with blood sugars below 200
(which is probably more than I have had for the rest of the year combined)

I win.