I’m in Chicago for the annual American Diabetes Association (ADA) Scientific Sessions, and this is the biggest city-city I think I have ever visited. Los Angeles, where I grew up, has oodles of people, but they’re so spread out that you don’t notice it’s even a city unless you’re downtown. Further, the downtown skyline is tiny– there’s the one library tower that shows up in umpteenfinity movies, but other than that, there’s lots of spare sky to go around. In downtown San Diego, where I live now, there are a handful of tall buildings, but lots of short ones, so you can catch glimpses of the ocean between every few streets.
Flying over Chicago is citycitycity. I’m staying somewhere in the centerish (my knowledge of Chicago geography is poor– my apologies), near the Michigan Ave set of walkways and stores, and it’s building after building after building, all abutted. To see sky, I have to actually look up, and not just between buildings. A bit of a shock at first, but I imagine I would get used to it; I do like all the people and the thrilling sense that so much is going on all the time all around me.
My blood sugar so far has been atrocious. Starting the morning of my flight, it’s been doing this thing where it jumps up– a fast meteoric rise that I can’t bolus to keep up with. On day 1, I was able to keep it below 200, but only by pumping in way too much insulin at the first sign of trouble and then correcting with carbs on the other end. Up and down, up and down– ugh. (The geek in me says: like an elevator in a Chicago high-rise! Boom!)
It doesn’t help that my Dexcom Continuous Glucose Monitor (CGM) is going through one of what I call its extrema phases. It catches the highs and lows, certainly, and even overestimates them– showing me at 200 when I’m 150 and at 40 when I’m 60. I prefer that to the opposite, when it goes through a faux steady phase, but psychologically the exaggerated up and down makes me more jumpy when I bolus, and I end up imitating the trend line the Dexcom is showing me.
But tomorrow is another day! Tomorrow will be better! Such is the mantra that every diabetic must live with, or else we would stop caring and just give up pretty early on in this game.
More precisely, today is another day. For those of you counting, it’s 2:30 AM my time, and 4:30 AM Chicago time. Not good. Why am I awake? I never sleep well on the first night of a hotel stay. If I’m lucky, I sleep well thereafter– wish me luck!
And tomorrow the fun begins with the ADA Scientific Sessions. It is a giant conference as far as scientific conferences go, which means few people present science they haven’t already published. But it’s a great opportunity to hear a smattering of everything, and to catch up on the areas of diabetes research and care I don’t follow day-in-day-out. The basic science talks are generally light on the immunology, heavy on the beta cells if you consider the two-part problem of diabetes (stopping the immune attack and replacing beta cell function). Perhaps the more interesting sessions, though, are the ones that report recent results from trials, treatments, and new drugs. I’m looking forward to hearing more from Kevan Herold on the ABATE trial and the other immunomodulatory treatments that clinics around the world are trying.
And some of the big themes I predict we’ll hear buzzing about in the talks and the halls that I’m interested in? I’m going with two. The first is pulled from every industry right now, where we hear “We need more data! We need more data!” In diabetes, this could apply to treatment data (When are you bolusing? What are you eating?); genetics (Why is person A diabetes-prone while person B is not?); drug reactions (We should be at the minimum SNP-chipping all these clinical trial patients!); and so on. More data always helps, though I argue with every alleged Big Data problem: the bottleneck is rarely data acquisition. How will we interpret all the data once it comes in? We don’t need more data so much as more information. (Hey, you should hire some bioinformaticists and data analysts! I’m not biased, I swear!)
The second is more diabetes-specific, and that is “Metformin is magic.” Metformin! The wonder drug! Cheap, and can be used to treat diabetes, cancer, and metabolic syndrome! Unlike many drugs, the side effects of metformin seem to trend positive– doctors are seeing a reduction in cancer rates, and the it’s looking promising for type 1 diabetics as well. I recently saw a talk by James Watson, who has always been ..outside the norm.., in which he rambled on about how he is taking metformin to prevent cancer, and how everybody should. The funny thing is, the scientific community seems to be arriving at the same conclusion (see, for example, a recent review in Cell Trends in Endocrinology). The evidence has been piling up for years (ask the Google), but I think we’re reaching a critical mass. I think we’ll hear a lot about from doctors and scientists this year, and in a few years, we’ll all be taking metformin like baby aspirin. Of course, the drug companies don’t make much on it, so we’ll be hearing a lot more about GLP-1 analogues and the like from them, but my money’s on metformin for the drug I’ll most likely be supplementing with in five years’ time.
And now it’s even later (earlier?) than when I began. I better sleep if I intend to pay attention to any of the talks! With that– over and out from Chicago!
Ah, I’m sorry, Catherine– I wanted to see the ABATE results, too, but I had to miss that session in the end. When I have heard Dr. Herold speak in the last few months though, he expresses positivity among a group of “responders”– and it looks like the evidence they find of that is mounting: http://www.healio.com/endocrinology/diabetes/news/print/endocrine-today/%7BE83EA259-9EDE-4C57-A9AF-484C968F63B4%7D/Studies-suggest-teplizumab-may-be-beneficial-treatment-for-type-1diabetes . I think we are getting closer to being able to delay full progression for longer, which is exciting!
thank you so much for the updates, Karmel. Keep them coming! (And please do write about Herold’s ABATE trial — that’s the drug I got when I was diagnosed and I’m fascinated to hear how his trial is going.) Have fun!