American runs on Dunkin', I'm lovin' it, and an entity that single-handedly defined tall, grande and venti as synonyms with coffee - you know who I'm talking about. Caffeine is a fix for many of us in the hectic pace of life today. Approximately 60% of America has a daily date with their liquid love. However, rumor has it coffee can innocently deteriorate beta cell function. How can we ensure our luxurious boost isn't suppressing our poor little beta cells? Chlorine has been added to the Nation's water supply in an effort to kill-off bacteria that may have adverse affects in humans. Unfortunately, this decision may have inadvertently contributed to the rising trend of people developing diabetes. The chlorinated water combined with coffee grinds produces a byproduct used in labs to cause diabetes. I called 3 large chains famous for their brews. Survey says people with (and without) diabetes can get the safest cup of coffee at establishments that filter their water.

When chlorine combines with any organic compound from plants, it can produce toxins called dioxins.

Dioxins are environmental pollutants with highly toxic effects on human health (World Health Organization). They affect a number of organs in mammals. Dioxins are prevalent throughout the food chain. Once dioxins have entered the body - their chemical stability allows them to exist for upwards of 7 to 11 years. They are absorbed and stored in fat tissue. Dioxins are created out of industrial processes but can also result from natural processes like volcanoes and forest fires.

Why does this matter? Well alloxan is a toxin that labs use to induce diabetes in research animals. It is also a dioxin. When chlorinated water (most tap water throughout the United States) combines with the plant compounds in coffee, it creates alloxan. How do you take your coffee…err…diabetes? For your protection - I suggest bottled water next time you brew a pot.

Falling in line with the aforementioned public service announcement - I asked McDonalds, Starbucks and Dunkin Donuts if they prepare their coffee with filtered water. Here's the response:

McDonalds: Louise advised me that McDonalds is 85% franchise owned and it is the decision of the franchise owner whether or not to use filtered water. FYI - I take that as the softest way of saying we have no idea what goes in the pots of 85% of McDonalds' coffee. I'm going to venture with a NO for Micky Ds.

Starbucks: Great news! A large corporation like Starbucks (NYSE: SBUX) adheres strictly to their mission of social responsibility and environmental honors. Sean assured me that every Starbucks location has in-house water filtration systems that are used in the process of brewing you every tall, grande and venti serving of their dreamy delights. Rest assured - the water is filtered!

Dunkin' Donuts: Sherry informed me that Dunkin' Donuts uses filtered water, as well. She wasn't able to give me details of filtration systems like Starbucks, but I should hope the good faith of customer service is all that it's cracked up to be.

Millions of people already have diabetes but hundreds of millions can take little steps to avoid potentially developing it. Support the companies protecting their customers' health. Please share the establishments that use filtered water to brew their coffee.

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What guarantee do you have as a person with insulin-dependent diabetes that your analogue is safe? Happy to go out and forage for answers, I called the 3 insulin analogue providers to seek knowledge on consumer protection (during business hours). I place my calls to imminent competitors: Sanofi-Aventis, Eli Lilly and Novo Nordisk. There is something to be said for good sportsmanship and great customer service (during business hours). It's another thing entirely when asking a company to own responsibility for the consequences of the product they sell. Checkout the analogue safety check and what the guardians of GMP (good manufacturing practices) are doing to protect YOU.

Sanofi-Avens (beautiful hold music, BTW) handled my call with aplomb. I spoke with Joyce who was happy to provide me with ensurance that the analogues are manufactured in FDA approved plants located in Frankfurt, Germany. None of the raw materials for the manufacturing of Apida or Lantus derive from China. In addition, she insured me that the analogues are put through rigorous evaluations throughout manufacturing that guarantee us (the consumers) that NO heparin happenings will result from the laboratory limbs of Sanofi-Aventis. Beautiful - straight forward answers, certifiable guarantee!

Eli Lilly reliably snuffed my curiosity to the tune of "All of our professionals are still assisting other customers". Counting my time on hold before I got the boot like yesterday - patience is a virtue. Third time's the charm. I'm taking a wild guess here - but Eli Lilly must have their customer support line set to hang-up after 4 minutes and 35 seconds because for the second day in a row - my call to customer support was involuntarily disconnected. At this rate I'm thinking Eli Lilly (NYSE: LLY) either doesn't have enough $$ to staff their customer support line or they don't care enough to answer. I can answer one question (partially) for Eli Lilly - it's about origin of manufacturing. Scott Strumello blogged a great informative piece about Eli Lilly outsourcing to Humera. No harm no foul. It's a great article disclosing who is really manufacturing Humulin R and Humalog and where they are doing it. You may have to subscribe to TuDiabetes to read the article -- and I must say as a member myself-- that could be a great thing!

Novo Nordisk, to me, is like that kid you always wanted to get to know but just wasn't sure how to go about it. Christine initially answered my call - perfect demeanor for customer service: great tone of voice, very helpful in handling my call. Levemir vials are manufactured in Clayton, North Carolina. NovoLog vials and FlexPen are manufactured in Clayton, North Carolinia as well. The Levemir FlexPen is manufactured in Denmark. Christine then courteously transferred me to Aman who ensured me that all Novo Nordisk insulin analogues were manufactured under sanctioned FDA good manufacturing practices. She went above-and-beyond the call to promise to get back to me with further details when I asked about batch testing and information availability to consumers. Aman was almost confident that the batch test results were stored in a database, but not entirely confident they are available to the public. (Update on 5/8/08 at 2:30pm EST) Aman called to inform me that the FDA has information regarding batch tests should there be a need to access information regarding the content analysis.

Just in case, here's the page for the FDA How to Report Problems With Products Regulated by FDA

I'm not going to complain. I'm rather pleased that Sanofi-Aventis (the name just sings - doesn't it?) and Novo Nordisk have a stellar support staff on queue to answer consumer concerns. It's a hard-knock life, this pharmaceutical business. You've got to keep a close watch on every aspect : raw materials, employee compliance, technician GMP loyalty, batch testing boo-yaa, machine operator sobriety - you name it, it's probably part of the magical process to bring you the insulin analogues to keep your motor running. Let's hope the godspeed of GMP is with us all!

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The question of Homeland Security comes into play as the heparin mystery unfolds. In case you haven't heard - 81 people have died as a result of contaminated heparin, a blood thinner. As a person with insulin-dependent diabetes and a diabetes consumer advocate, I'm taking the initiative to call upon the 3 large manufacturers of insulin analogues. I need to know, as a captive consumer, I am protected to the best of their abilities. Eli Lilly, Novo Nordisk and Sanofi-Aventis should have a small army to protect their consumers. After all - it's not like they can't afford it. Let's see what is being done to ensure each vial of insulin analogue is thoroughly protected and free of undeclared contaminants.

My questions to each analogue manufacturer will be: where are the analogues manufactured? When are the contents of each vial analyzed? In light of recent contaminants found in heparin - can you guarantee the contents are not tainted?

First up is Eli Lilly. Attempts to reach Eli Lilly at 5:30pm on a Tuesday evening are unrequited. Whatever happens - don't run into analogue difficulties after business hours because Eli Lilly can't take your call. Ironical, isn't it? They butter their bread on your dollar yet they won't cough up the cheese to roll their customer support line 24 hours. In the event of an emergency… call back tomorrow. That speaks to me about Lilly's focus on customer support.

:::crickets:::

Now for Novo: difficult site to navigate, first observation. I did find my way to a contact page with a form. I choose "USA" as my country and "diabetes care" as my topic. I submit the aforementioned questions as follows: where are the analogues manufactured? When are the contents of each vial analyzed? In light of recent contaminants found in heparin - can you guarantee the contents are not tainted? Please respond so I can inform my audience on YouTube and AlliesVoice.com regarding the safety of their insulin analogues. Thank you!

Lilly deserves the same courtesy - let me see if I can submit my questions to Lilly via email so we can get to the bottom of this uncertainty. I found the following: For medical information, call The Lilly Answers Center at: 1-800-LillyRx (1-800-545-5979) . If ever was there NOT a time to hang-up on a caller…the call, once answered and put on hold for the next available "professional", was conveniently dropped. I called back and got dropped AGAIN. At least Lilly is consistent.

This is just unfair. I'm not even sure I should post this blog because it's just not looking good for the 3 Amigos. Here I am, on the Sanofi-Aventis page for customer support at 6:04 PM Eastern Standard Time on May 6, 2008. I find this statement on the above mentioned page: if you would like to contact the Customer Information Center, please click here. So I click here only to encounter a broken link. Hopefully by the time you get to reading this blog, and checking the link - it's live again. At this point in time - this is unsurpassed customer support. That is true - unless you are Eli Lilly. Anybody who consistently drops customer calls is (without contest) the cheekiest monkey in customer support.

As it stands, uber urgent customer support is unavailable from ALL 3 insulin analogue manufacturers after hours. I wholeheartedly believe these companies will follow-through on responding to my questions. To keep you informed, as a person with insulin-dependent diabetes - please SUBSCRIBE to "Allies Voice". The answers to my questions should be arriving any day...I hope!

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Not until we're faced with a life-altering situation do we realize discrimination exists against people with diabetes. These situations can define us or derail us. Many people assume if you have diabetes - it's your fault. If an employer witnesses you experience a low blood sugar - you're uncontrolled. If your sugar happens to be too high and you need to treat yourself - you ate something you should not have eaten. The list goes on and the stifling reality is sometimes these assumptions may lead to unlawful termination or damaging allegations. Let's unite to be part of the natural solution of diabetes advocacy and avoid nurturing the problem of ignorance. Have you been subjected to diabetes discrimination? Please share your experience to enlighten the world on how to avoid careening into an abrupt career change or a socially arresting stigma.

I know what it is like to lose almost everything you've worked hard to achieve in a professional career, Being subjected to workplace diabetes discrimination can take the wind out of your sails. Diabetes is not something that belongs in the workplace. Diabetes is what it is - a discretionary daily chore to stabilize blood glucose. Not your bosses business. Not your neighbors' problem. Not an open-invite into your personal life. Diabetes is not justification for a boss to deliberately humiliate you in front of the office.

It's a catch 22, you see. Back in the founding years of the American Diabetes Association - they encouraged people with diabetes to keep it on the down-low. They knew that places of employment were less likely to hire you if they knew you had diabetes. The ADA realized this was presenting a challenge in fundraising and awareness for the growing condition of diabetes.

With great strides - the ADA began employing measures to protect people with diabetes from discrimination. Kudos! The Equal Employment Opportunity Commission (EEOC) has since devised guidelines to protect people with diabetes in the workplace. Public schools have adopted measures to protect the safety, health, and well-being of children with diabetes. The world is gradually coming to realize that in spite of diabetes - life goes on. It always did and the song remains the same. Why haven't some employers learned the lyrics?

Every now and again - some people (companies) slip through the cracks. Call this blog a sieve for ignorance. Call it a public service announcement. Discrimination against people with diabetes is a debilitating illness.

Speak on behalf of the 20+ million people living with diabetes. Protect them from discrimination. Don't be part of the problem - be part of the solution. Have you ever been subjected to discrimination as a result of diabetes? Please share your life lesson to help educate the world and protect people with diabetes from discrimination.

        

Funny how we perceive doctors to know it all until we start questioning what it is we think they know. In all fairness, I don't expect an internist to be able to explain the research of a dedicated scientist - but a comment one doctor made to me a few weeks ago launched me on an investigation.

When discussing my excitement about Dr. Faustman's research to cure Type 1 diabetes with BCG -- the doctor (who was born, raised and trained in India) said to me, "Children are vaccinated for TB in India with BCG. Type 1 diabetes exists in India. Why would you think this research will work?"

Good point, doc. So with itching curiosity -- I go straight to the source, Dr. Denise Faustman. I propose the question my faithless internist passed to me in our debate. I do not perceive these questions as brick walls. In fact, these types of questions help me deconstruct the confusion that breeds misunderstanding of the Faustman cure.

Very clever - Dr. Faustman explains that the dose used to vaccinate children from tuberculosis is equivalent to trying to treat elevated blood glucose with 1 unit of insulin, one time. It's not expected to be effective at all. However, statistically speaking - the incidence of Type 1 diabetes in the US is higher than in countries where they vaccinate for TB. Here in the US we do not vaccinate for TB. Coincidence?

Think about it: the TB vaccination is a preventative measure - a weak dose to prevent a speculative illness. The cure for chronic, long-standing diabetes is like performing a piecemeal extermination. You are segregating a specific class of T-cells and then retraining the immune system to not attack itself. It's actually more sophisticated but that's the Cliff's Notes version. If it was so simple -- it would've been done decades ago!

To follow-up from my appointment on Tuesday I would like to ensure everybody that Phase I for human trials to cure Type 1 diabetes is moving along with grace and grit. Dr. Faustman and her research team are carefully calculating every step along the way. Rest assured they are playing by the FDA rules. No harm, no foul and certainty for the pass to Phase 2.

Phase I began in December 2007. It will establish a safety threshold for dosing of BCG. Once this threshold is established -- Phase 2 will begin to trial for efficacy in ceasing the the attack on beta cells. Am I still excited? You bet! I've already booked my next date with Dr. Faustman's Lab: March 31st, 2009. Happy Birthday Allie

        

In the last 25 years, in spite of the average blood glucose level (HbA1c) improving in people with diabetes - the level of diabetes complications is on the rise. People with diabetes are taught to rely on a good A1c (i.e, good numbers) to prevent complications. It's disheartening if your A1c is getting better but the complications of diabetes are arriving on schedule (unlike your latest travel arrangements). The discrepancy between the HbA1c and the measure of glycated albumin (fructosamine) is known as the glycation gap and you may want to know a little more about it to prevent diabetes complications.

Here's a thought - wouldn't you want to know about a test that measures the level of complications? This imaginary test is actually faster than the A1c and it's more efficient in measuring how effective your diabetes treatment protocol is in preventing complications. Call it a defensive diabetes treatment. Call it a test by another name. Call it whatever you want - but definitely think about giving this test piece of mind in your diabetes control.

Complications in diabetes come from a memorizing buffet of imbalances. However, the repercussions of advanced glycated end products (AGEs) are spoken about rarely but account for a considerable portion of the blame.

AGEs form when proteins bind with sugars in the absence of water. In the absence of C-peptide, this concoction is guilty of the damage diabetes inflicts upon tissues. Glucose metabolism, without C-peptide, leaves a person with diabetes unable to protect their precious soft tissues from the aftermath of AGEs. Yet we all rely on our HbA1c to tell us if our "numbers" are sufficiently protecting us. Protecting us from what? Glucose metabolism regardless of the number - 80 or 380 - results in AGEs. It makes sense to measure the glycated proteins of our body rather than repeat a glucose check.

Measuring the albumin allows a more accurate measure of the existing glycation in our blood protein. Albumin has a turnover rate of 21 days. Hemoglobin regenerates every 120 days (17 weeks) so measuring the HbA1c is an accurate test every 3 months for blood glucose. That's a long time to wait to see if your latest treatment adjustment is effective. It is also very important to know if your AGEs are rising or falling. The name of the game in diabetes control is numbers - but what numbers should we be counting?

Hemoglobin is the protein in red blood cells that carries oxygen. Serum albumins are a group of several proteins that occur naturally in the blood. Both hemoglobin and albumins can bind to glucose. When this binding occurs, the protein is said to be glycosylated.

HbA1c and fructosamine tests measure how many proteins have been glycosylated. In other words, how many proteins have glucose connected to them. HbA1c is one of 3 hemoglobin molecules that makes up red blood cells. Glucose attaches slowly to this molecule of hemoglobin over 120 days. Glucose will attach to hemoglobin based on the amount of glucose available. Thus, a glycosolated hemoglobin lab value provides average blood glucose levels during a 1-4 month period.

Fructosamine (glycated albumin) measures short term control of blood sugar for the past 1-3 weeks. Each 75 µmol change equals a change of approximately 60 mg/dl blood sugar or 2% HbA1c.

Although fructosamine is available in the US - we tend to curry favor for the HbA1c. Why? Your guess is as good as mine. However times are a'changing and there is another test that is being developed to take fructosamine a step beyond the glycosylation gap. The test is called the G1a and the company developing it is Expinex Diagnostics.

The Epinex G1A™ Rapid Diabetes Monitoring Index Test will be a monthly test for the control of glycation, the underlying cause of the complication of diabetes. The test will consist of a disposable test cassette and a handheld reader device. A drop of blood is placed on the sample well of the cassette and the cassette is inserted into the reader device. Results will be displayed within 5 minutes. Sure beats waiting for the lab results, doesn't it? Better yet - this test can be performed with accuracy every 21 days, rather than waiting for insurance to cover a test every 3 months. You can't be that - in house testing, a simple drop of blood and a results-driven meeting with your doc. Finally!

Tomorrow is Earth Day - and the beautiful irony in the occasion is that it is my first appointment with Dr. Faustman since the start of human trials to cure Type 1 diabetes. I have no clue what'ss in store for me - it anything at all. But I will relay any and all details of my meeting with the MGH research team. In the meantime, please stay tuned for the next episode of "Allies Voice"!

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My mom has an obsession with collecting vacuum cleaners. The house is stocked with different varieties of vacuums to the extent you could choose a different one each day of the week. However, the one vacuum that she'll insist you leave a shoe (as collateral) to borrow is the Dyson. In a household with 3 women, 3 dogs, a cat and a HOG -- you're gonna accrue a healthy share of filth.

You've seen the commercials about the innovative bagless suction. The monstrous torque to pull up the ingrained dirt from the carpet fibers is no joke! Add to that a ferocious industrial-looking body equipped with heavy duty features for guaranteed cleanliness. I'm thrilled to inform you that the Dyson lives up to it's reputation and surpasses the embarrassing mediocrity of the competition!

In fact, this vacuum is so efficient -- Websters should consider adding a new word to the dictionary: vacuumore! Why? Because you will see how unimpressive other vacuums are by running a simple test: vacuum one room of your house with your current vacuum. Then grab your brand new Dyson (any model) and vacuum the same room -- same day. I hate to ask you to do twice the work -- but you'll actually see how efficient the Dyson truly is by the residual filth the Dyson picks up after the competition. You'll see other vacuums are no competition at all! Why continue using a vacuum that only covers half the job? My philosophy is this: time is precious. Don't waste it with another vacuum. Save it with a Dyson!

After proving the extraordinary efficiency of the Dyson, I hope you are as happy with your Dyson purchase as I am that you purchased it through "Allies Voice" or Shop4Cures. Thank you for your support for Dr. Faustman's research to cure diabetes!

        

WARNING: this blog is lame because I'm trying to revitalize my spirits. I spent my 30th birthday in the hospital. The insurmountable stresses of life have added a new ailment to my gripping chronicles: ocular migraines. Anyhoo - at the ripe age of 30, I'm about 23 years fed up with diabetes. I'm moving forward with copious excitement to give my blood to Dr. Faustman once again. I realize that it's still a trial and not scientific truth yet but that's exactly why the show must go on. I'm going to do all I can to ensure she advances with uninterrupted funding. It's going to be easy. It's going to be fun - two words you typically DO NOT see associated with diabetes!

And how do I plan to raise this money? The sales commissions from Amazon.com purchases on Shop4Cures. Great shopping for a great cause - who says shopping can't save the world? Curing diabetes would be a great start. It's not much to ask when you don't have to give anything - just shop. Amazon.com pays 4% of the total sale. I tried to develop a turnkey system that works for all parties: consumers, sellers and people with diabetes. Sit back, click through and enjoy your shopping online.

I've been going through "Allies Voice" withdrawal. I need to hit the ground running - literally. I have no leverage in the supine position. My April 22nd appointment with Dr. Faustman will be here before we know it!! In the last 2 weeks I've had more time for pondering aloud and annoying hospital staff than any person should squander. It's time to get some of these thoughts into the blogosphere. What exactly is GLUT? What is the fructosamine test? In countries where they vaccinate with BCG - is the incidence of Type 1 lower? Ever wonder how an injection of Avastin feels? I can go on and on. Was I bored in the hospital? You bet! Thanks for all the emails. It feels good to be back home!

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Would you use an insulin analogue that caused beta cell destruction? Depending on the age of diagnosis, and type of diabetes - certain insulin analogues may not be the most ideal for the treatment of your diabetes. A person without diabetes excretes insulin with a pH of approximately 7.2 - 7.4. A person, with or without diabetes, should have a blood pH of 7.35 - 7.45. Here's my question: does the pH of your insulin analogue catalyze beta cell destruction?

The pH of the extracellular fluid can cause interference with beta cell regeneration. For a newly diagnosed Type 1 diabetes - deviating too far off the ideal range of blood pH is potentially stifling. For Type 2 diabetes, the further away from 7.3 the intracellular fluid pH strays, the weaker the might to regenerate. In both circumstances, individuals are at a disadvantage because higher blood glucose predisposes the blood to greater acidity. Wouldn't it make sense for diabetes treatment to mandate restoring the blood pH with an insulin that has a pH of 7.3?

In the US, the majority of insulins prescribed are insulin analogues. In light of a study that evaluated glucose metabolism in "young" and "adult" islets, cultured at different pHs - I had to wonder if some insulin analogue could impair beta cell regeneration / catalyze beta cell destruction. What do you think?

The study found a reduction of insulin secretion at both the acidic and alkaline sides of pH 7.3. Glucose provoked an increase of insulin secretion in both "young" and "adult" islets, as well. Good, that means keeping the body pH as close as possible to 7.3 will help islets (green and golden) respond to glucose. Check.

The study results also demonstrated that "young" islets are more acid tolerant than "adult" islets. Both basal and glucose-stimulated insulin secretions, as well as other parameters of "young" islets were significantly higher than those of "adult" islets in response to low pH. Okay, so like a tired old person, compared to a young vigilante - it would seem logical to lay off the more acidic insulins for the treatment of Type 2 diabetes.

To me, this study alludes that in adult-onset diabetes the administration of an insulin-analogue with an acidic pH lower than 7.3 is detrimental to the preservation and recovery for islets. So why on Earth is Lantus - with a pH of 4.0 (i.e., acid WASHED analogue) - the hottest selling analogue for the treatment of Type 2 diabetes? (Hint: checkout the Sale of the Century blog).

And for the sake of "young" islet preservation, considering the diagnosing event is typically diabetes ketoacidosis (acidic blood + elevated glucose + ketones) -- the choice of insulin to restore blood glucose should be an insulin as close to 7.3 as possible. I'd say go with a combo of NPH and Regular but I hesitate to confirm anything due to the extraordinary "range" accepted for pH in these formulas - clocking in at anywhere from a pH of 6.9 to 7.8!! Talk about a crapshoot!

To summarize:

What does pH have to do with beta cell survival? A lot. Balancing your blood pH has been shown to lend protection to your beta cells as they attempt to recover. For Type 2s this should matter a great deal. For Type 1s this should matter even more. If you have a squirt of insulin (and C-peptide) left in the life of your beta cells - wouldn't you protect it with all your might? Yeah, me too.

Discuss with your doctor the importance of managing your blood pH by using the most appropriate insulin (i.e., closest to a pH of 7.3). Here are your (current) insulin and analogue choices with their respective pH values:

• Lantus (Sanofi-Aventis): pH of 4.0
• APIDRA (Sanofi Aventis): pH of approximately 7.3
• Humalog (Eli Lilly): pH of 7.0-7.8
• Humulin R (Eli Lilly): pH range of 7.0 to 7.8
• Humulin N (Eli Lilly): pH range of 6.9 to 7.5
• NovoLog / NovoRapid (Novo Nordisk): pH of 7.2-7.6
• Levemir (Novo Nordisk): pH of approximately 7.4

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I'm insatiably curious how pharmaceutical reps work their magic. The training involved in polishing pharmaceutical reps is a mesmerizing craft! The formula begins with two factors: the seductive appeal of an irresistible personality, steeped in the broth of tenacity for top sales rewards. Add to this - unlimited buying power to reward good behavior and you've set the stage for the greatest crime in medical history: insulin analogues. When Nancy Regan began her campaign to say no to drugs back in the 80s - her psychic advisors must've known how apropos her plight would be in the dawning of the turn of the century. WARNING: The video is long but the question is LONG OVERDUE!

Insulin marketing to patients is saturated with an arrogant sense of security, like an abusive spouse. "You need me. I have a new insulin analogue. You're going to take it, whether you like it or not. It even has an obscure name -- made by morphing the amino acids we tweaked. Thank your lucky stars for Big Pharma! We answer your inadequacies with our brilliance. We handsomely repay our investors (and save plenty in case you decide to sue us). A pharmaceutical company in the business of making the world safer for people with diabetes is a fairy tale. It'll never happen!! Stick with the profitability of defying science. The complications are par for the course. It's not us -- It's you! Didn't your doctors explain all this? If you don't achieve perfect control you deserve complications. That's exactly what we told them to tell you."

The marketing to doctors' is more like buying friends than substantiating science. A pharma rep would say something like, "this is the best stuff EVER!! You Trust us, don't you? We've had great results with former insulins. This is even better! Plus we're sending you and your better half to Hawaii to learn all about it. Make sure you see the waterfalls while you're there. It's an exquisite experience - my company will pay for everything as a token of our appreciation. "

Doctor then says to his/her endearing pharma rep, "why didn't you stick with the tried-and-true NPH and Regular insulins? In the 70s and 80s my patients were on insulins that worked fine for them. More often than not -- those patients didn't have the level of complications I see nowadays. I'm not so sure of the long-term outcome of these insulin analogues. I've read in "Diabetes Health" that insulin analogues are more carcinogenic than insulins like NPH and Regular. After further investigation -- I found a discussion thread on Islet.org that had patients who used insulin analogues and developed cancer. Why must your company keep changing your products? It's tough enough for my patients to live with diabetes. Constantly introducing and pulling insulins doesn't make my job, or my patients lives, any easier! In med school - insulin was insulin. How many times can you reinvent the wheel?"

Pharma rep replies, "Well, we know our manipulation of insulin may cause complications. You can't please everybody. Off the record -- we need to please our investors…the patients are secondary. That's just the nature of the beast. Death or complications - those are the options we face as a pharmaceutical developer. We can treat your patients with insulin analogues that may cause more complications BUT…complications are par for the course. We've discussed this before. Don't you remember? There is no room for growth (and profitability) if we stick with plain old insulin. Let's be honest, doc. We're not making money by protecting people with diabetes from complications. We're making money by developing new drugs and new revenue models. Speaking of - did you enjoy Hawaii?"

Doctor replies, "Yes, it was beautiful. It saddens me to learn the nature of your business. However -- I guess it's all about give and take. My patients come to me. I give them samples. They take it. I suppose you're right - the complications have been around for centuries. If only we could use modern day technology to reproduce the safer insulins of days gone by. I rarely see a "Honeymoond Period" in my newly diagnosed Type 1s these days. Something about diabetes treatment seems to be catalyzing the destruction of beta cells these days. Whatever it is -- it's causing the rate of diabetes complications to rise with reckless abandon. No sense in bucking the system as long as you've got something I can prescribe to treat complications, right? Speaking of... how about funding C-peptide trials to reverse complications for my patients? Like I said before - the level of complications these days is exponential compared to when I first began my practice in 1972. My patients are doing their best to control their sugars - but the complications seem to keep unmercifully affecting them. I've heard some remarkable results were seen out of Karolinska Hospital, in Sweden. Your company is enormous. Why not fund these trials here in the United States?

Pharma rep replies, "Oh THAT! Our company has decided not to pursue that route. We understand Type 2s don't have a C-peptide problem."

Doctor replies, "Actually, they do. Type 2 patients have microvascular and macrovascular problems that are mitigated by efficient absorbption of C-peptide. Dana Spence PhD, and Anders Sima PhD, have been advocating the vital importance of C-peptide to both Type 1 and Type 2 diabetes. In fact the protection C-peptide provides people with diabetes may be the Holy Grail of overcoming complications caused by the disease! Your company does not realize..."

Pharma rep fervently interrupts, "We have DRUGS to treat those conditions. I'll leave you samples. Now about lunch for the office next week -- how does Chinese sound?"

• From blame to understanding - moving diabetes care forward
• "Diabetes Health article: Can Insulin Cause Cancer?
• The Islet.org discussion on Can Insulins cause cancer? Lantus and Analogs
• HowStuffWorks defines a revenue model: various revenue streams your business will be putting in place and how each will bring in money
• A Role For C-Peptide: Peptide formed during insulin production facilitates glucose clearance and may benefit diabetic patients
• Karolinska Hospital studies in more than 400 type 1 diabetes patients have demonstrated encouraging nerve and kidney efficacy data.
• Your Diabetes May Vary: C-peptide (and a wee rant)

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