Medical researchers have a good understanding of type 1 diabetes — how it begins, how it harms the body and how to treat it. But getting people with type 1 diabetes to manage their disease can pose a challenge.
Type 1 diabetes develops when the body’s immune system mistakenly attacks pancreatic beta cells, which make insulin — the vital hormone that converts sugars and starches into energy and keeps sugar levels in their blood within a certain range. Because people with type 1 diabetes can no longer make insulin, they must measure their blood sugar frequently and take daily insulin — usually injections — to keep their blood sugar at healthy levels.
Properly managing the disease is crucial because high blood sugar levels are toxic to cells and eventually cause complications such as eye, nerve and kidney damage; poor circulation; and heart disease. Rubina A. Heptulla, M.D., the new chief of the division of pediatric endocrinology at Einstein and at Montefiore, the University Hospital and Academic Medical Center for Einstein, knows how dangerous those complications can be: four years ago, she lost her father to complications from type 1 diabetes. Recruited to Einstein in 2010 from Baylor College of Medicine in Houston, Dr. Heptulla is working on several fronts to spare children from a similar fate.
An Artificial Pancreas
Dr. Heptulla and scientists at Medtronic, a California medical technology company, are developing an artificial pancreas that would reduce the need for insulin injections. "An artificial pancreas could allow patients to maintain proper blood glucose concentrations while continuing daily activities," she says. "It would be a fully automated device that would mimic what pancreatic cells do in the body."
Dr. Heptulla and her collaborators have received a grant from the National Institute of Diabetes and Digestive and Kidney Diseases to support their artificial pancreas work. They've completed studies in dogs showing that the device is effective; next will come studies involving adults at Montefiore Medical Center's Jack D. Weiler Hospital Division, and younger patients at The Children's Hospital at Montefiore. "Once we've completed the studies, we'd like to make the device smaller for ease of wear and to optimize it for exercise, eating and stress, which would further expand the benefits," she says.
"My goal is always to improve adherence, and fewer injections may mean more adherence," says Dr. Heptulla, who is also professor of pediatrics (endocrinology) and of medicine at Einstein. To reduce the number of injections for children needing several each day, Dr. Heptulla is searching for ways to combine differing doses (of long- and short-acting insulin, for example) in a single syringe. The challenge of compatibly combining different insulin versions is as much political as it is pharmacological, since the medications are made by different drug companies.
Mastering the Math
Diabetes is managed "by the numbers" — a particular problem when people lack basic math skills. While at Baylor's Texas Children's Hospital in Houston, Dr. Heptulla found that some parents couldn't reduce a medication dose by 10 percent or use nutrition labels to calculate the carbohydrates in a serving. Her solution: a caregiver literacy project. Once she and her staff identified a proficiency gap, they made sure parents left the office prepared to manage their young charges' type 1 diabetes effectively. Dr. Heptulla has submitted a grant proposal to help her continue her educational efforts here in the Bronx.
Sooner Is Better
"When you intervene at a young age, you can set a course that helps the patient avoid complications down the line," she says. "We haven’t yet found the cure for type 1 diabetes, but we can make life easier for young patients and improve glucose control at the same time."
To learn more about the Diabetes Research Center, please visit its website