The Future of Diabetes Part Two

Will we ever find a cure for diabetes? Are there technologies that will help people manage diabetes more easily?

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Episode Transcript

Speaker 1 (00:00):
Brought to you by Toyota. Let's go places. Welcome to
Forward Thinking. Hey there, and welcome up Forward Thinking, the
podcast that looks at the future and says, dance with
me across the sea. I'm Jonathan Strickland and I'm Joe McCormick.

(00:24):
What is the connection there, doctor doctor, You don't know
the Thompson twins. Oh my god, Oh my god. I
was joking in our last episode that I'm too old
and now I really am too old Thompson twinses, doctor Doctor.
It's a great song and it has to do with
the doctor, so medicine. And then we're talking about diabetes

(00:47):
again in this episode, and that's why. So, guys, this
is part two of our our series about the future
of diabetes. In our first episode we talked about what
the diseases and it's history. It's a long, long, long history,
the history that dates back more than years. So we
talked all about that in the last and includes drinking.

(01:08):
We should, yes, yes, So if you if you missed
that episode, you clearly want to check it out. Let
me revise drinking is probably not fair tasting, like a
wine taste where you're not supposed to swallow us the urine. Yes,
absolutely true, because diabetes is all about glucose level management

(01:29):
in the blood but also comes through in the urine,
and UH, water tasters would be able to detect the
presence of sugar in patient's urine and thus diagnose them
with diabetes. Now, of course, our diagnostic and research methods
have improved significantly since the dark ages with sipping urine UH,
and in fact, we're learning a lot about diabetes just

(01:51):
in recent years that really could lead to significant changes
in understanding what the disease is at its core and
how to treat it. Now, one thing should say before
we even go any further is that that there are
two major types of diabetes. There's type one and type two.
And as Lauren pointed out in our last episode, type
one is a type of autoimmune disorder. Type two is different,

(02:15):
UM it is UH developed in a different way, And
so some of the stuff we're going to talk about
is largely focused on on type two. I mean, the
treatment levels can be for both UH, but there will
be some stuff on type one as well, right, and so,
but but just keep that in mind that when we
talk about diabetes, it's not always universal across both types. Okay, well,

(02:39):
I thought we we should look at some studies that
have come out mostly this year here in that have
detailed interesting developments in diabetes research, a lot of which
you might not have predicted if you just went a
few years back. And here here's a really interesting one
to start with. Now, I would not have expected that
you would ever disc cover any link between a metabolic

(03:03):
metabolic disorder like diabetes and air pollution. Yeah, this is
a very strange correlation that has been found. That that
is odd. Like, you know, air pollutions one of those
things where certain conditions you could easily imagine like asthma,
other you know, respiratory illnesses, um complications and things like
bronchitis or possibly pneumonia. All of that I could easily

(03:25):
even heart disease I can think of. But when you
if you had told me a couple of years ago
that there was a link between air pollution and diabetes,
I well, I mean, I'm like, well, small gets into
your pancreas and then what Yeah, I'm still confused. Specifically,
what we're looking at here is not not fully diabetes,
but insulin resistance. So it's a you know, a pre

(03:47):
precursor related issue here so to diabetes type two, yes, yes,
So in August, there was a study published in the
journal Diabetes that looked at the link between long term
exposure to air pollution and signs of insulin resistance. And
insulin resistance, of course, it's a condition that often precedes

(04:07):
type two diabetes. It's influenced by inherited and lifestyle factors
as well as environmental factors, as we're about to see.
So the study had a sample size of two thousand,
nine hundred forty four people in southern Germany between two
thousand six and two thousand eight, and these people had
previously they've been participants of a project known as the

(04:27):
Cooperative Health Research in the region Augsburg and they so
the researchers looked for links in the data on these
people between exposure to air pollution at their place of
residence and the presence of biomarkers that give you a
sign that the person is probably experiencing insulin resistance, and

(04:50):
they found a correlation. So, they found a correlation between
the level of airborne pollutant concentrations at residence sites and
some biomarkers, particularly those associated with pre diabetes, more so
than than full diabetes, and so from the press release,
the lead author Dr Catherine Wolfe said, quote, the results

(05:11):
revealed that people who already have an impaired glucose metabolism,
so called pre diabetic individuals, are particularly vulnerable to the
effects of air pollution. In these individuals, the association between
increases in their blood marker levels and the increases in
air pollutant concentrations is particularly significant. Thus, over the long term,

(05:33):
especially for people with impaired glucose metabolism, air pollution is
a risk factor for type two diabetes. And that's interesting.
I mean, I didn't come across any information about what
the what the link is? Well, and maybe, I mean,
there are times where one we don't fully understand the mechanism,

(05:54):
and sometimes it ends up just being that they are correlated,
but there's not necessarily causal relationship up right. It may
be that there may be some underlying link that that
connects the two exactly right. There might be you go
further back and you realize, oh, well, this one thing
is affecting both branches. The branches themselves are independent and

(06:14):
are not necessarily affecting one another, but are both a
result of this prime source. We don't know, at least
not based upon the research that we came across for
this podcast, But it is an interesting thing to look
at and obviously would be something that if if in fact,
there is causation there, would guide us to know about

(06:35):
or or to to look into the possibility of increase
rates of diabetes in parts of the world where this
type of air pollution is particularly prevalent. Or it could
also lead to uh to you know, prevention measures even
if you recognize this, even without necessarily understanding what the
cause is yet. Uh. Let's say you develop pre diabetes.

(06:58):
You know a doctor who if this research is validated,
if it's replicated and shown multiple times, the doctor might
want to say, if you want to avoid progression into
full type two diabetes, you you know, depending on where
you live, you might want to move right And for
some people that might be a possibility. Some people, of course,
that may not be an option. UM. You could also

(07:19):
argue that this is one more reason out of the
thousands that we have often listed on this show too
clean that stuff up man of our carbon emissions. We've
got plenty of reasons for that already, but adding another
one is yet another argument to say, look like, if

(07:42):
you add up all the even from an economic standpoint,
if you just add up all the negative impact from
pollution and you assigned a dollar amount, it makes financial
sense to get to to make a transition, not just
you know, yeah, it's gonna be hard. It's not. It's
not an easy thing. It's not a convenient thing, but

(08:03):
it ultimately is the best thing, not just for people's health,
for the environment, but for the wallet and so and
thus we can excuse Ferngully to capitalism, and and it
will be a terrific movie that is beloved by future
generations of children. Um, there was a fern gully too,
wasn't there? Oh? I'm pretty sure there was. Was there? Really?

(08:24):
I think there was? And I is there a rapping
bat in it? I don't know that there's a rapping
Probably not. I was about to say, Bruce Willis, where
did that come from, Robert Williams. Yeah, you're turning into
me Lauren where I just will take names and then
if there's a name that is even remotely similar, I'm like, Nope,
that's the name I wanted. You know what. There was
a lot of infern gully Flora, there was oh and

(08:47):
that's a great transition to our next one. This is
actually my favorite one because gut flora is my new
favorite topic. I love. I love how much the bacteria
that overpopulate um or don't don't overpopulate, but but but
massively overwhelmed the amount of cells of you that there
are in your body have so much to do also

(09:08):
all of your health. Gut Flora is also a great
name for a future Bruce Willis movie. I'm just going
to throw that out there before we get too far
away from Bruce Willis. We're never too far away from
Bruce Willis, but do continue well, So so let's talk
about this. So what is the influence of gut flora
on diabetes? Well, this one is perhaps a little more

(09:30):
intuitive than than a possible correlation between air pollution and diabetes.
So this was based on a sixteen study in the
American Journal of Pathology that reported on effects of a
type of gastric bypass surgery on mice with a with
a model condition designed to sort of replicate the effects

(09:51):
of type two diabetes. And it has been observed that
gastric bypass surgery, so a surgery that that sort of
reroutes part of the digestive process can cause remission of
type two diabetes in humans and in mice. So you
think that this might be because gastric bypass leads to

(10:14):
weight loss. Right, that's probably good, and weight gain is
is one of the comorbidities, what one of the co
signs of diabetes. Right but right, But medical researchers conclude
that the remission can't be explained by weight loss alone.
There's something else going on here. And so after the surgery,

(10:35):
subjects show improvements in both insulin sensitivity and glucose tolerance.
So what's going on here And what they found in
this study was there was an examination of gut micro
organisms before and after the bypass surgery that showed a
decrease in pathogenic bacteria and an increase in other micro

(10:57):
organisms in the gut that are considered beneficial old for
gut health. And these changes seem to coincide with improvements
in metabolic and glycemic regulation. So the researchers, again, this
is one of these things where they've just found an
early interesting result and they're recommending more direct research into
the subject. But essentially, what we need to figure out

(11:19):
is how changes in gut micro biota influenced diabetes and
metabolism in general. Mm hmm, that is really I mean,
the more I learn about gut flora, the more I
am pretty convinced that I'm not in charge of myself. Yeah,

(11:39):
you're you're a you're a hybrid organism. Well, you know,
I like to think of myself as an involved being.
There's a book out about that that I've actually been
meaning to read. I haven't read it yet, but it's
by the science writer Ed Young, who I like. In
the book is called I Contain Multitudes, and it's about
that title. It's about microbiota. It came out either this

(11:59):
year of the year before, and keep meaning to read it.
I've heard it's very good. Wow. Cool. All right. So
uh again, more understanding of that could lead to a
greater understanding of how to to manage diabetes. But the
picture is about to get even more complicated. So yet

(12:20):
another study came out this year in and Diabete a
logica diabeto logica, however you pronounced. That study found that
people who have an abundance of healthy fat stem cells
in their body were more resistant to developing diabetes, even
in equally obese patients. Um, so people with obesity that

(12:42):
have the presence of the certain adipose cells fat stem
cells makes their organs more more better, more efficient at
storing fat in a way that is not ultimately detrimental
to the body and leading to conditions that are associated
with obesity, like cardiovascular disease and diabetes. And so they

(13:06):
the researchers concluded that understanding the molecular mechanisms that underlie
this difference between obese patients with healthy fat stem cells
and obese patients without them could help us develop new
therapies to prevent insulin resistance in type two diabetes. But man,
we're starting to get a really complicated picture of all

(13:27):
the different influences that might work themselves out in the body.
To me, this is a continuation of that story that
we explored in the first episode about the history of
our understanding of diabetes, which not a big surprise, but
over time becomes more complex and involved. Uh. I mean, obviously,

(13:48):
anytime you're looking at a really complicated subject, that progression
is going to go in that direction. Right. We're not
gonna suddenly have a huge understanding and then go backward
unless we have another dark ages. But I'm just sure,
but yeah, no, it's just interesting to think that, like
the same way that people in the nine twenties might
have been looking back at previous centuries and millennia of

(14:09):
researchers going like, you thought it had to do with
the kidneys, you idiots, But now we're like, oh, it
has to do with the bacteria and stem cells. And yeah,
one really more brief note to complicate it even more,
there was also there was also a study this year
in the journal psycho neuro into Chronology that essentially identified

(14:30):
a pathway from psychological state two diabetes, and the pathway
was from a type of executive function known as low inhibition.
Essentially that is correlated with the state that's known as
anxious arousal emotional anxiety, and then correlated to inflammation, which

(14:56):
is then correlated to diabetes, which is that actually also
correlated to gut bacteria, the so so all of these
things so so anyway, but this becomes a self fulfilling
prophecy because knowing this is making me anxious, which is
therefore eat a yogurt you'll be fine. So yeah, this
is even possible. I mean, this is one of these

(15:19):
things that's making me think that there have got to
be a lot of false trails here. I mean, I'm
sure all these different areas of research or turning up
some things that are going to turn out to not
really be primary causes. Right. They may be may be
a factor that influences but perhaps not is is you know,
definitive in causing, or or it could be an indicator

(15:40):
that this other thing is happening and not not a
cause of right. Right, But anyway, I mean, I feel like, nevertheless,
our picture of the cause and effect relationship with whole
body state versus metabolic regulation is getting very complicated. Yeah,
seems likely based upon the last few stories you've shared

(16:01):
with us, Joe. But then, of course there is another one.
This one has more to do with type one diabetes. Okay,
this is uh. There was a study that came out
in called hotspot Autoimmune T cell receptor binding underlies pathogen
and insulin peptide cross reactivity explicable. Let's let's let's break

(16:22):
that one down just a little bit. This was in
the Journal of Clinical Investigation. All these have been sixteen studies.
This one is um Uh. It found something pretty interesting
the presence of pathogens germs maybe the cause or a
cause of type one diabetes. So how how would you

(16:43):
figure that? Well, here's how it goes. There are these
insulin producing cells that we talked about in the previous episode,
known as pancreatic beta cells, and in type one diabetes,
immune system cells known as T cells. White blood cells
attack these beta cells and destroy the body's ability to
produce insulin. But what causes the autoimmune response? Like, why

(17:06):
do the T cells attack the beta cell? They didn't
like the cut of their jib because they're dumb as
a bag of hammers. They are pretty dumb. They don't
even have brains. You wouldn't believe it. I well, as
someone who suffers massive all allergic reactions, I am not
a big fan of the way my my body's immune
system will misidentify certain allergens and then go into yeah,

(17:27):
you know exactly then, Jonathan, how how strange, how poorly
understood states within the body at the cell level of
cell function um can cause complex systemic reactions that are
not necessarily what your body intended intended in quotes, you know,
as we said, the cells don't have brains, but they
do have a sort of programmatic function. They're supposed to

(17:48):
be attacking pathogens to keep them out. But the study
here found that these T cells were cross reactive in
a particular way, and that means they react to a
complex set of conditions that determine their behavior. And these conditions,
the study found, could be brought on by the presence
of particular pathogens. Uh. A quote from the study abstract

(18:10):
is T cell cross reactivity with pathogen derived antigens might
break self tolerance, which that that's a great term self tolerance.
I assume that means the immune system not attacking your body.
I've got very low self tolerance. But that's something else, yeah, yeah,
in the end to induce autoimmune disease. So it demonstrates

(18:33):
the value in looking at the various ways external influences
such as germs and other pressures might alter T cell
function to cause autoimmunity. Autoimmunity being not a good thing
when the immune system attacks you, and that would include
type one diabetes. So there can be certain there can
probably be certain germs present in your body in certain

(18:54):
ways that can trigger this chain reaction of autoimmune response
against your betas holes. So that's heavy stuff you've laid
down on us. Joe, it's really fascinating learning more about
this disease that we keep thinking we've got, like or

(19:15):
at least the indication I always felt this was that
we had a pretty good handle on it, but it
turns out that it's far more complicated than I had anticipated. Well,
I think we do understand a lot of the basics.
Sure well, sure, yeah, but it's just that our pictures
becoming and you know, the broader picture is becoming more
and more complicated, right, right, But we also have a
lot of research into the practical means of how we

(19:38):
could uh improve the treatment for diabetes. And I've got
one more little bit of of research that I found
that that that could potentially help lead to better understanding
and better therapies in the future. Um. There was a
recent study that was published in the Journal of Clinical
Investigation that looked into those early stages of type two

(20:00):
diabetes that you were talking about a minute ago, UM
that that that insulin resistance. UM. The authors of this
study were investigating whether there's a link between the processes
processes that lead to accumulated fat in muscle tissue, which
again obesity being a common alongside to insulin resistance. Um

(20:21):
the others of this one. We're looking specifically at UM
whether there's a link between accumulated accumulated fat and muscle
tissue that that that obesity kind of issue that we
were talking about earlier, and the decreased glucose uptake that
is one of those early indicators of insulin resistance and

(20:42):
therefore of type two diabetes. And there is UM. There's
this protein that's called mondo A that is a link
between accumulated fat and muscle tissue and decreased glucose uptake UM.
And this protein, the single protein appears to regulate genes
that control both fat synthesis and insulin signals. They think

(21:05):
that this protein might be what's telling your cells to
stop taking in glucose and instead convert it into fact um.
But they think that when the protein is activated too often,
when there's just so much glucose in your blood, that
that that this protein is being triggered constantly, it could
make your cells permanently resistant to insulin instead of just

(21:26):
temporarily resistant to glucose UM. So, you know, but potentially
in the future, this this could lead to treatments that
could target and inhibit mondo A. Maybe hopefully, um. I mean,
the researchers think that it could even help people manage
their overall metabolism and body weight by managing the function

(21:46):
of the single protein. That's cool. And so it's important
to also uh reiterate that a lot of these areas
of research may ultimately not uh not result in a
useful treatment, but there's a lot of potential out there,
and there's so many different avenues of exploration that there's

(22:08):
a lot of hope that we can find much more
effective ways of either preventing type two diabetes from forming,
or even type one in the case of the possibility
that germs play an important role in the development of
that type of diabetes, or the management making management more

(22:29):
less of a pain, both literally and figuratively. Uh. And
to that end, there's a lot of different approaches that
people have been looking into on one aspect of diabetes management,
and that is monitoring your glucose levels in the first place,
because we mentioned like the original tests were all about
testing the sugar levels and urine, which are not necessarily

(22:50):
as precise as you would want as reading of your
blood glucose levels. That's more of a relevant measurement. But
blood glucose. The way you measure that typically is that
you have to prick a finger or some other part
of your body and uh get a blood sample and
then use a device to analyze it. So it's invasive

(23:12):
by definition, right, you have to get at the blood.
So there's been a lot of look into the possibility
of developing non invasive means of measuring blood glue close levels,
which would remove at least one of those barriers. And
one of those frustrations that people UM encounter when it
comes to diabetes, could you do a breath a wizer,
one would hope, And that was not one of the

(23:34):
ones that I read about. There was a paper published
in the National Institutes of Health back in two thousand
twelve that was sort of a review of various processes
that had been UM experimented with. In some cases even
products were brought to market, but ultimately uh spoiler alert
did not perform very well, and uh they wanted to.

(23:57):
It was specifically looking at these noninvasive appre which is like,
are there any that are on a level that is promising,
if not as good as monitoring glucose levels through actually
analyzing blood directly. So here's some of the ones that
they looked at, they looked at UH bio impedence spectroscopy.

(24:19):
So this is measuring the resistance to electric current flowing
through tissue impedence UM. So this is not that different
from things that use like capacitis touch screens, that kind
of stuff. I mean, our bodies we've talked about many times. UH,
we conduct electricity. We also have stuff in us that

(24:39):
impedes the conductance of electricity, and that changes depending on
our body chemistry. So the key here is that there
are variations in glucose concentrations that change the number of
sodium id ions and potassium ion concentrations in our blood.
So typically sodium ion concentration goes down, potassium ion concentration
goes up. This changes our resistance to electricity. UM. So

(25:03):
if you were able to measure that in a meaningful way,
you would be able to make some UH, you would
be able to to figure out what the gluecoast levels
of blood were. However, all of these different approaches I'm
going to talk about have different drawbacks. The one for
this one is that it's not as reliable as other
methods of checking blood glucost levels, and at the time

(25:24):
the paper was written in two thousand twelve. It also
required the diabetic person to rest for sixty minutes before
taking any measurements. So yeah, you have to be at
rest for an hour before you could take a measurement. Obviously,
that's not practical for a lot of people, particularly people
who are suffering type two diabetes. And it maybe it's
not a very severe case, but it's enough for them

(25:46):
to have to monitor their glucose levels. Uh, they might
have a fairly active lifestyle, which is part of the
way to help treat or manage diabetes. Um. So yeah,
that is a little bit. That's it's not ideal, right,
so are other ones to electromagnetic sensing similar It's also
reliant upon the dielectric properties of tissue, but in this

(26:08):
case you're talking about electromagnetic frequencies, not passing an electric
current through tissue. They use two different inductors to sense
any variation of dielectric parameters of the body and glucose
levels would affect those parameters. Also, this approach has drawbacks. Uh,
it's very sensitive to temperature for one thing, so there
are optimal frequencies you would want to use based upon

(26:30):
the temperature and that means that if you haven't set
your inductors properly, then you're gonna get erroneous readings. And
since those depend upon temperature and it's very sensitive, that
is a level of ambiguity that is problematic when it
comes especially when it comes to something that you would
want in a home uh kit, write something that a

(26:51):
diabetic person could use on their own without having to
go to a professional to have this. I mean, if
you if you're gonna have to go to a professional,
I think most people just a like I hate having
to prick my finger, but it's better than having to
go multiple times a day to somebody else. Um, then
you have reverse ion toe fesis. I was about to say,

(27:13):
do you have anything in the in the electrical end
that's more difficult to pronounce? I to foresis is probably
up there, and I'm certain I am mispronouncing it. Uh.
That's a fancy way of saying. You measure the flow
of low electrical current between an anode and a cathode
that would both be placed on a on the skin's surface.
Now this one, I'm gonna be straight up with you, guys.

(27:34):
I do not fully understand the mechanism here because I
read the I read the whole paper, and I read
the section, and even after I read it three times,
I was like, I'm still not sure what's going on here.
But the way they described it was that you would
put the electrodes on the skin and it would rely
on quote a physiologically relevant fluid sample end quote. Don't

(27:56):
know what that means. Physiologically relevant would obviously means something
that would also have glucose in it and would be
relevant to the blood glucose levels. But since it's not invasive,
it's not the blood itself, because you're not putting the
electrodes in you, You're just putting them on the skin surface.
Do you have to cry to use this? You do?

(28:17):
For another one? You do for another one. You get
in ahead of me because that's next. Um. But the
product there wasn't Probably that was actually brought to market
using this particular approach, but it was discontinued after numerous
issues became apparent, largely that well, one thing, the electrodes
would tend to irritate the skin, and also you had

(28:38):
to have them in place for an hour before you
could take a reading similar to the previous one. I
talked about. So not only do they irritate the skin,
you had to wear them for a long time before
you could even get your blood glucose level reading. Also,
sweating would throw off the accuracy of the measurements. So, uh,
if you started sweating during that hour while you're waiting

(28:58):
to get your blood glucose level measurement, you would throw
things off. So not ideal. But now we're getting into
tears and crying. Yeah, fluorescence technology. Fluorescence is exactly what
you think it is. It's using an enzyme of some
sort that would cause, uh, in this case, your tears
to fluoresce when exposed to a particular type of light,

(29:20):
and you measure that fluorescence, and uh, the level of
fluorescence and the type of fluorescence would depend upon the
levels of glucose found in your tears, which according to
a study, uh that this particular paper cited. I am sorry,
I didn't write down the name of the other paper,
but they cited a study that suggested that glucose levels
and the tears correlate with glucose levels in the blood. Um.

(29:43):
Not exactly like on a you know, it's not saying
that the level that you find in your tears is
the same as in your blood. But yes, and that
if you know one, you can you can uh, exactly,
thank you. How many times a day do you have
to watch the end of Homeward Bound? Uh? Well, the
pends you can. You can change it up, right, like
you can watch Brian's game, or you can rouge. Yeah.

(30:06):
I cry whenever anyone suggest turning on Mulan Rouge. Um.
Not not the actual movie, just the thought of having
to watch it again. Okay, look I'm not saying it
is no fern Gully to the Magical Rescue? Is that
the actual name of fair Gully too? It is. I
looked it up while you guys were talking. Um. So,

(30:29):
so this this method would involve using this enzyme in
your tears and then analyzing the tears to find the
blood glucose level. So it's not invasive. However, the enzymes
have a short lifespan, and there's some questions about biocompatibility,
which is obviously something you want any kind of medical process.
You don't want to find out it's non compatible with

(30:49):
your biology. Yeah, that's what we call bad. Yeah, toxic
is probably one of those things you want to stay
far away from, right so then you had infrared spectroscopy.
Both mid infrared and near infrared uses of this technology.
Obviously they're using different frequencies on the infrared spectrum. UH.

(31:10):
This would involve measuring absorption rates, really the reflective rates, UH,
the the amount of light that comes back after you
would expose an area where you're you know it's tissue
area to get an idea of blood glucose levels. Right,
and this is this is a method that they're using
to to certainly take pulses, not invasively and mechanically right

(31:30):
and so electronically. Rather you're looking at reflection because uh,
infrared does not penetrate very far into tissue, so you're
not gonna like shine and infrared light through It's not
like an X ray, it's not going through your body.
So you're looking at the reflective reflection of those um,
those infrared rays, those that infrared light, and then you're

(31:52):
being able to to extrapolate from that what the glucose
levels and the blood are. But these also have issues. UM.
For one thing, there are other elements that can affect
the absorption of the infrared rays, like water content in
your blood, so you might get a false reading because

(32:13):
of the water content, not the glucose levels in your bloodstream. Obviously,
if you're looking at medicating, that is a problem if
you're going on a false reading. Also, with near infrared spectroscopy,
you have to exert a great deal of scanning pressure.
In other words, you have to really dig in there. Yeah,
you can't just you can't just lay the device against
your skin in that case, there's other methods ultrasonic approaches.

(32:36):
In the report that I was reading, the researcher actually
noted that very little research had gone into using ultrasound itself,
but a variation on ultrasound called photoacoustic spectroscopy had been
experimented with, and it's kind of a funky approach. So
here's here's how it works. And when I read this,
I was like, wow, now we're getting into some who
thought of this. At what point did someone say, hey,

(32:59):
I got an idea again. So you use a laser
to excite fluid within tissue. So you're using the laser
to essentially heat stuff up essentially, and then you listen
to that tissue. You actually listen to the excitement of
the tissue. Yeah, you you put a microphone up to
that tissue and you're like, go crazy, guys. And then
you analyze the sound that comes from the tissue from

(33:22):
thermal expansion and you measure, you analyze it, measuring it
peak to peak, and this will give you enough information
to figure out the blood glucose levels tissue. I think
they were watching the scene and Ghostbusters too with the
Pink Goo where they play the music for it and
it starts dancing when you play your love is Yeah,
it's lifted to hire. Yeah. Uh so, yeah, it's um maybe.

(33:47):
But apparently they can analyze the peak to peak value
of the acoustic signal and determine the glucose levels from that.
But like the other methods I've mentioned, this one also
has limitations. Changes in temperature and pressure in particular or
cause problems with precision and accuracy using this methodology, as
well as proximity to Vigo the Carpathian Yes, yeah, and

(34:08):
those giant portraits. Uh so. They also looked at a
lot of other different scanning technologies, similar to some of
the spectroscopy I had mentioned already. I didn't want to
go into all of them, but they across the board.
The conclusion was that the demand for non invasive glucose
monitoring is very high for multiple reasons, right as a

(34:28):
quality of life issue, as a means to to remove
that barrier from people who are afraid of getting UH
diagnosed because they don't want to deal with that reality.
And some people are very UH do have phobios of
of of skin pricks and absolutely so being able to
remove that, there's obviously a demand for it. However, according

(34:50):
to the research, there's we're just not there yet. None
of these technologies had reached a level of maturity where
it could be as dependable as the accepted methodology. So
without that, it's you can't really recommend people switch over. Sure,
speaking of technology that isn't quite there yet, Um, yeah,

(35:10):
there's one in development. Yeah, yeah, I found I found
I found a food sensor. Yeah, I looked into this,
So you're you found a company called tell Spec T
E L L S P e C. And it's a
sensor that you used to and to find out what
ingredients are in the food at a molecular level. You
like pointed at a food and it tells you the

(35:31):
entire nutritional content. I think we've actually talked about this
device on the podcast before. We may have. I think
we have. It sounds really familiar, well, and there are
forgotten way more than I've said. There's some related topics
as well, Like there was a Kickstarter campaign for a
type of mug that was supposed to give you a
readoubt of the specific stuff that was in the mug

(35:53):
um and then ultimately I think what the Kickstarter campaign
delivered was just a mug like like like they downgraded
their their promise from this will tell you the ingredients
of the stuff that's in here in this too. This
will hold liquid um, a fluid will take the shape

(36:14):
of the mug itself, just like any other container. Uh
But the idea was I just thought of a great idea.
You could sell something that will guarantee that whatever liquid
you put in it has a ten percent increase in
lead content. Not not something I'm gonna market anytime soon, Joe,

(36:37):
But I appreciate your MOXI. Uh so. So tell Spec
is working on a product that, as far as I
can tell, is not yet at UM brought to market.
It's still in the prototyping stage where it will use
near infrared spectroscopy and bioinformatics to measure the ingredients of
food on a molecular level. And uh, what you would
do is you'd use the small device. It would pair

(36:59):
with a small art phone. You scan the food you
want to eat with the device. The device would send
the data collects up to the cloud for analysis. That
analysis would then be beamed down to your smartphone and
an easy to read format on an app. And then
you would be able to see what what what is
made up of the food you're about to eat. And

(37:20):
this could help diabetics plan out their insulin dosage is right,
Like if they realize, oh, there are a lot of
carbohydrates in this that I didn't anticipate when I ordered it,
that would impact how they would, uh manage their insulin
throughout the day. So it could allow people who have
diabetes a better understanding of what they are eating and

(37:43):
thus be able to manage their treatment on a more
granular level. Yeah, and this this is a very common
I mean, I'm sure that that most human people at
this point in in the universe have an experience of
like looking at a food label, trying to decide whether
the food that you're about to eat is terrible or okay,
and having no idea right in some cases, you're like, Okay,

(38:06):
I got it. If I'm going to eat a deep
fried onion, that's bad. That's obviously not the best. But
I think it's the most not the best, at least
a few years ago. I think it was something like
what if it's awesome? Well, so many jokes, but I'm
gonna avoid I don't let me just say that. I

(38:27):
think I read something where it was like the highest
caloric intake of any regular menu. I don't. Well, first
of all, if you're eating an entire awesome blossom, I'm
not sure. I'm not, but I watch your entire blooming onion.
I will put that away. But they're okay, do not
tell me they are the same thing. You will have words, Okay,
I really don't know. The breading okay. Also the just

(38:53):
the way they cut the onion, it's different. I didn't
know you had a real opinion. I thought you were playing.
I haven't add one in many, many years because I
realized how bad they were for me. But there are
the craving is always there, like a vampire. I always
craved the bluemen onion. Yeah, I I just lived my
life denying myself that. But but point point being yes,

(39:16):
UH nutrition is difficult, and making anything that you can
do to make this kind of thing easier for people
good news. Yeah. I think if they're really worry a
device that gave you really solid, complex nutritional information with
this sort of non invasive scan of your food, that
would be cool. I'm I don't know, I'm kind of

(39:38):
skeptical of this device. Yeah, And we've seen we've seen,
um the approach from the providers side, like from the
actual like the food vendor side. We've seen that change
over time, right, more and more places require UH restaurants
to include nutritional information about their menu items. It's not

(39:59):
that yeah, yeah, I would love to see a broader
adoption of that policy across all regions. It's not like
it's everywhere, but you might notice that if you go
to certain restaurants, like a fast even fast food restaurants,
you can look up and get at least some basic
idea of the nutritional value of food. And often it's
not very you know, it doesn't go very deep. But
then if you go to the website you might get

(40:20):
more information. This gets a little more complicated when you're
talking about like a mom and pop place, not not
a chain you know. Then you're like, well, this is
that's when a little handheld device would really come in handy,
because chances are you don't have like a website that
gives you deep nutritional information about all those different dishes
or make um easy to use mass spectrometers available to

(40:43):
everyone and as profitable as it is to mark up
drugs in the market. Yeah, yeah, well let's talk about
something else. It's a totally different So you have to
atomize your food before you eat it, you know, just
you know the mom and pop shop. You know, it
gets gets there, they're they're kick back, atomizes a plate
of that and then you know the past the nutritional

(41:07):
data savings onto you. Yeah, definitely, Well how about alt
we switched gears for a second. I want to talk
about cell transplants. This was another another piece that was
that we we had in our notes and then I
started research again. It's it's really fascinating and there there
have been several cell transplant procedures and in different ways,
and I'm going to go through some of them, but
the one I really wanted to talk about was one

(41:29):
that happened last year the Diabetes Research Institute at the
University of Miami Health System developed a transplant procedure in
which they took insulin producing islet cells, or those beta cells,
and they implanted them into a layer of fat in
a recipient's abdomen uh, and they submit them into place
using a sticky gel like substance so that that holds

(41:51):
them so that they are able to um to to
to produce insulin and move it into the bloodstream where
it's needed. I think actually did use ghack, wasn't it ghack?
It was not. Oh, I just remember the smell of
that stuff. You guys are you guys are killing me
here with your young references. I know what gag is,

(42:13):
but that's after my time. It smells like petroleum in
my head. Now. Well. They they performed this procedure on
a diabetic patient named Windy Peacock who uh said that
within a month, actually the doctor said that within a month, Uh,
those cells were producing insulin the way a healthy pancreas went,
and they were responding to glucose levels. Naturally, they would

(42:35):
produce more insulin if the glucose levels increased, and produced
less when they went down. She was still taking doses
of insulin as a supplement in order really in order
to not put too hard a strain on these cells
immediately out of the gate, right to have kind of
an onboarding process where the cells could get up to speed. Uh.
And it seemed to be working. Uh. There had been

(42:56):
other cell transplant procedures before this, most of them involved
transplanting islet cells onto the liver. Now this works, but
it also was somewhat limited uh and and slightly less
successful than this other approach, which was less invasive as well,
uh than the liver surgery. But the long term effects

(43:18):
are still being studied. So with the liveral approach, typically
you see a five year lifespan for those cells and
then you would need another procedure after that. Uh. They
tend to produce insulin properly for about five years before
they die off. They don't know as much about the
experimental process where they did it in the layer of

(43:41):
fat on the abdomen because it was only last year
when the procedure was done, So we don't know if
the cells will last longer or if they won't last
as long. Uh. That remains to be seen. So that's
part that's part of the ongoing study. AH. But there
is a massive trade off to the cell trans approach.
It's not something that is automatically a cure that is

(44:04):
going to make people feel better for the rest of
their lives. UH. That massive trade off is that you
have to take um immune suppressing medications for the rest
of your life because because you are taking some something
else that sells into your body. Yeah, yeah, you've got
you've got essentially foreign cells. And if you want to
make sure that your body does not identify those cells

(44:26):
as hostile and thus go into attack mode. Similar to
what we talked about with the type one diabetes, you
have to take immune suppressing medications, and that of course
has its own suite of risks. Obviously, you have a
higher risk of infection, particularly UH the month or so
after you've undergone a surgical procedure. UH. For this reason,

(44:50):
the procedures for cell transplants are typically reserved just for
people with type one diabetes and and those who have
severe hypoglycemia that low blood sugar. UH. If they have
episodes that are really severe and come with little to
no warning, then they are candidates for this kind of
cell transplant surgery because the trade off of having to

(45:11):
go on immune suppressing drugs for the rest of your life.
Is still better than having to deal with type one
diabetes where you're constantly having to to administer insulin in
some form, either you're doing shots or you've got an
insulin and that even on your very best days when
you're keeping up with it, you still you still have
a pretty high risk for form going into seizure comma. Yeah, yeah, exactly,

(45:34):
not the good times. But there's some research that I
was looking into that might might help mitigate this autoimmune
response to transplant itself. Um because like like kind of
in this case, all you have to do is figure
out a way to protect the cells. All that's all
you have to do is simple. Um, So enter some
fun materials science. Um. There was a team headed up

(45:56):
by researchers out of m I T and the Boston
Children's Hospital, and they were working with materials that have
been derived from brown algae. Uh. These alginate, yes, alginate
gels can encapsulate the beta cells and you know, protect
them while still allowing materials some molecules like like sugar

(46:17):
and proteins to to go in and out, so allowing
the cells to remain living. If you encapsulate cells so
that they're perfectly safe. But they all die, then you're
not really doing much good. Um. So, so when you
implant cells that are encapsulated with these alginate gels in
primates and humans, they tend to cause scar tissue to develop, however,

(46:38):
which is bad news. You know. It indicates that another,
although slightly less troublesome, immune response is happening. So so
they created like eight hundred chemical derivatives of these alginate
gels um each with like we little molecular changes to
see if they could get one of them to just
slip under the immune systems, right, and uh, and they

(47:01):
did so far it works in mice um and there
that their next step is planning a non human primate trials.
So it's moving along and uh, you know it might
be it might be a while before they get it right,
but it could give it could give this this transplant
of cells concept of a new breath of life. Yeah,
that'd be great to see a reduction in that necessity. Right,

(47:25):
and also too because if that happens, if in fact
you can reduce the risk of essentially the body's rejection
of those cells, you open up the potential of applying
that strategy to a broader range of diabetic patients. First,
you would assume that you would apply it to more
type ones, but who have less or fewer hypoglycemic episodes

(47:49):
or or they tend to come with enough of a
warning so that you can you can preemptively avoid it. Uh.
And then possibly, if it's an effective enough treatment, you
could start discussing the idea of looking at type two.
I think that would be far less likely. Yeah, yeah,
you'd have to you have to figure out whether or
not the you know, what type of therapies are more

(48:13):
effective for for type two diabetes, and whether it really
whether you could just start replacing those insulin creating cells
in the pancreas, or whether it would be more effective
to to look at the sugar the glucose re uptake
right right, because remember with type two you are still
producing insulin, you're just not doing it necessarily as well.
And yeah, so it's it's a different different beasts than

(48:36):
type one. So one other interesting study that came out
this year that I thought was worth looking at was
about a new research approach for the understanding the function
of beta cells, which could actually lead to the creation
of regenerative medicine therapies for diabetes. So of course regenerative medicine,
what is that that that's dealing with the cell level,

(49:00):
being able to re engineer, regrow, or replace cells that
that are having problems within the body. They're dysfunctional or
they've been damaged or destroyed. And so what did this
study in Nature find, Well, they identified a protein known
as f l t P or flat top, that's really

(49:22):
what they called it, flat top, and it's a marker
that helps divide pancreatic beta cells into groups. So you've
got these two different types of beta cells. One group
does the work there the workhorses of the beta cell brigade.
They regulate glucose metabolism, and the other group is marked
as immature cells that undergo accelerated cell division, meaning they

(49:46):
multiply more frequently. And how can you tell the difference. Well,
when the protein flat top is present, the cells assumed
their mature cell function, meaning that that is the mark
the mark of a mature beta cell that's doing the
jaw but that it's meant to do regulating glucose in
the surroundings and releasing insulin. But beta cells without flat

(50:08):
top that they're the breeding cells the rabbit cells. Basically
they proliferated four times as much as cells without flat
top and UH. And the question one of the questions
the researchers were wondering about, as well, can we be
sure that these rapidly proliferating cells in the pancreas or
pancreatic cells eventually do turn into mature beta cells that

(50:31):
are going to be doing the work that that a
diabetic would need done, you know, releasing, or that anyone
would need done, especially that you have lost function of
if you have diabetes. And the researchers found yes, they
use this technique that's known as lineage tracing, so they
made all the cells go on too ancestry dot com. No,
they use color coded genes. That these genes have different

(50:53):
color signals that activate when a gene is being expressed,
and you can use that to trace the life cycle
of an individual cell. And all this means that hopefully
through research based on these new findings about the division
of cells of pancreatic beta cells, we might be able
to better understand how to regenerate beta cells to replace

(51:16):
the ones that have been damaged to destroyed through diabetes.
Now that we know this about these about the relationship
between these immature proliferating rabbit cells and the mature cells
that do the work. Oh, that's fascinating. And then we
have the concept of the artificial pancreas. There are three

(51:36):
essentially three main approaches to this, UH, one of which
is actually called the artificial pancreas so UH. In two
thousand and six there was a project launch called Artificial Pancreas.
This was essentially the technological approach to creating a device
that does a lot of the functions of the pancreas
um at least as far as monitoring and responding to

(52:00):
lucost levels is concerned. It couldn't actually produce insulin. You
would have to ah feed it insulin essentially. But what
it boils down to is what I talked about in
that last episode with the wireless insulin pumps. It's a
more sophisticated approach to that, where you have a glucose
monitor that is connected to a wireless pump that is

(52:23):
automamatically responding to changes in the blood glucose level as
indicated by the monitor, so that people can live, you know,
relatively unimpeded lives. They don't have to put thought into it.
They don't have to actually monitor the pump or make
any modifications to it. It all has taken care of

(52:45):
and can increase a person's quality of life dramatically as
a result. Ah. So it's kind of a wireless pump
on overdrive. At least that's the the the goal, and
it's a project that's still going on today. Are people
who have had the basic level of technology. UM, They've
been part of pilot programs and they the reports I've

(53:08):
seen have said that it is a very positive experience
compared to what they were coming from. UH. But ultimately, again,
this is a technology that will really monitor and glucose
levels and deliver insulin. It doesn't it doesn't replace a pancreas.
It's not like a robo pancreas that you have in
your body that does the work of producing insulin and

(53:30):
distributing it properly. That being said, there are other alternatives
that also fall into the artificial pancreas category, one of
which is the bioengineering approach. This is essentially that cell
transplant UH strategy I was talking about earlier, where you
would create a bio artificial pancreas using the cells that

(53:52):
produce insulin. But as we mentioned in that previous section,
this can have pretty drastic consequences. It's not meant for
every person who suffers from diabetes, at least not in
the implementation that we have right now. And then there's
the gene therapy approach. There are some researchers who are
looking into using gene therapy to transform cells within the

(54:13):
digestive tract essentially within the intestines themselves, into insulin producing cells,
so that you would uh repurpose some cells in the
body to take on the job of producing an insulin
and releasing it into the bloodstream in in response to
glucose levels in the blood. So these are all possibilities

(54:34):
that we could see. Where it's not so much I
don't know so that's so much a cure as it
is an automated management system for diabetes. It's hard to
mention it be like it's not like you no longer
have the disease, but rather that you have systems within
your body that can manage the disease. So it is

(54:54):
almost as if you do not have it. Um it's
a little you know, It's not the same thing as saying, Wow,
I used to have diabetes, but now I know I'm
diabetes free, right right? Well, and and really, I mean,
I I love I love doing these episodes where we
look into something that I think that I know things about,
and then by the end of it, I'm like, oh,
not only do I have no idea how it works,

(55:15):
but literally no one has any idea how it works.
Like there's like, like, we we know the basic mechanisms
by which diabetes works, and we've been talking about a
lot of the new research that's that's gone into it.
But um but but really, like like on a inter
cellular molecular level, we're still not sure what's going on.
And so it's it's so great that all of this,
all of this is being done and under and within

(55:35):
so many different avenues to to look for potential, if
not cures, at least um much more effective and less
invasive treatment options. Yeah. And uh, I mean the incentive
to do so is clear that we covered that in
our first episode really extensively. The millions of people that
this would benefit, not to mention the financial impact it

(55:58):
would have. Um, there there is every incentive to continue
this kind of of line of of of research and
experimentation and uh advances in various forms of management and
treatment and diagnosis as well. So I feel like I
learned a ton um Like, I didn't know about anything

(56:20):
from three thousand years ago with a relation to diabetes
until we did this episode, and now I feel like
pub trivia, I'm ready for it. So assuming that they
have just an entire section on diabetes, who knows that
is a very very popular pub trivia night. Yeah nothing, nothing,
Nothing gets the party going like talking about a terrible
disease that millions of people have. Um. That being said,

(56:45):
I know some pub trivia masters who probably would have
done at least a question, if not around on the
subject because of their their particular sensibilities. I'm not passing judgment.
I'm merely making an observation. Guys, if you have any
suggestions for future episodes of Forward Thinking, Maybe it's a
big broad topic that you want us to do a
deep dive on, or maybe it's just something you know

(57:07):
that you're just curious about. Maybe there's a technology or
or scientific development that you've heard about and you want
to you want to learn more about. Send it our way.
We'll take a look. You can do that by sending
us an email our addresses f W Thinking at how
Stuff Works dot com, or you can drop us a
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(57:27):
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