Medical research; Diabetes, part 2

The following program is produced by the University of Michigan broadcasting service under a grant in aid from the National Educational Television and Radio Center in cooperation with the National Association of educational broadcasters. This is the second and last program on the subject of diabetes from the series human behavior social and medical research produced by the University of Michigan Broadcasting Service. These programs have been developed from interviews with men and women who have the too often unglamorous job of basic research. Research in medicine the physical sciences the social sciences and the behavioral sciences. Occasionally you will hear what may seem like strange or unfamiliar sounds. These are the sounds of the participants office his laboratory or clinic where the interviews were first recorded. The people you will hear today are Dr. F D W Lukens of the University of Pennsylvania Dr. Garfield Duncan of the Pennsylvania Hospital in Philadelphia and Dr. Randall Sprague of the Mayo Clinic in Rochester Minnesota.

And my name is Glenn Phillips. Last week some of the most often asked questions about diabetes were discussed by Dr. Lukens Dr. Spragg and Dr. Duncan. Today we turn our attention to research on the disease. Some of the most recent research problem the major research advances of the past and what the future may hold for research knowledge of diabetes tells us that sugar is a major factor in the disease. Recalling that an old believed thought that the use of table sugar in coffee or on cereal for example led many parents to tell their children that this over use of sugar would contribute to or directly cause diabetes. I asked Dr. Lukens if there was validity in this. And he answered this way. I would say not. The development of obesity which means that much more food is taken then the body can ordinarily dispose of by exercise and useful

activity. This places a burden on the insulin mechanism for insulin is required to convert glucose to fat. But. Aside from that I doubt if anyone could say that eating glucose or anything else was a cause of diabetes. After all there are fat people who are in their 80s who do not have diabetes because they've had enough insulin all their lives. There are diabetics who get fat and who do not have enough insulin and thus the disease has revealed this weakness is revealed as the disease. One of the major research advances has come through the use of drugs or oral agents as they are called in treating diabetes. I ask each man for his opinion on this subject. First Dr. Spraggs said per the present I would say no. The ideal solution to the problem of daily insulin injections by the diabetic patient. Would be a preparation of insulin that is

active by mouth. Not the development of a better non insulin compound. Efforts to. Put insulin into a form which will prefer to preserve its activity when it's taken by mouth have been made for many many years. And to date. There is no real hope that this problem will be solved in the near future. The pills are all agents of course are effective in the control of certain cases of. Diabetes. But in patients who require insulin there is at present no good indication that an oral agent of any type will replace insulin. Dr Lukins added this comment about the use of drugs. There's quite a number of. We

were diabetic patients who have acquired their diabetes have to middle age who are fed taking insulin now may be transferred through all preparations. This will represent a big change guys in this group at least two thirds of these patients will do well on their oral preparation. One of the. Difficulties that where an eye for see however is that the oral preparations will be used as substitutes for strict control of the diet. And this is something we have to keep in front of our diabetic patients all the time particularly overweight

patients. And this is no small group because approximately 80 percent of our diabetic patients when they first seek treatment for diabetes are overweight. And these patients it would be a neat pity if they're allowed to maintain their degree or wait and put reliance on a pill taken once twice or three times a day. Dr Duncan said in Philadelphia. Well the immediate outlook for that is no. On the other hand. The fact that pills have been developed that have some effect at all on diabetes suggests that more might possibly be done as it is now insulin itself cannot be taken by mouth because it is a protein in the digestive juices destroy this protein and render it entirely ineffective. In the case of the present pillows they do lower the blood sugar.

But nobody has exactly measured. How they do this. And nobody has really measured the quantitative effect. Now that's an awkward word. You won't like it. Nobody has measured how much they do. For example how much additional glucose is used by the body. When these pills are taken by a diabetic. How much additional insulin is secreted as a result of these pills and so forth. We know that the amounts. Are very slight. The diabetic who needs just a little help and that's a great many of them can therefore be benefited by these pills but they are no substitute for insulin. They will not handle any of the serious or complicated about it typical of major research efforts are being conducted in Philadelphia at the University of Pennsylvania Hospital under Dr. F. W. Lukens control and at the

Pennsylvania Hospital under the control of Dr. Garfield Duncan Dr. Duncan explains the research of his organization. Well we have been particularly interested in the detection of a pre-diabetic. And to use the measures mentioned and also in this respect have been using the sensitivity to to insulin. You can take an overweight patient from a diabetic family may prove rather resistant to insulin. And this may be a forerunner of diabetes. That is one problem that is under study at the moment where a community can continue to accumulate the. It results in patients having complications

and their advantages of giving equal amounts of nourishment said six hour intervals around the clock with suitable doses of regular insulin before each. In contrast to having three meals relatively close together during the daytime hour long periods of night without food. This makes it very difficult to control the diabetes whereas equal distribution of the diet and insulin is a big help. Another fact in which we have been interested in and many year from many years is the AM and speedier prompt diagnosis of diabetic coma. If one suspects a patient is and I bet it caught my eye in a farmhouse let us say if Iran takes a drop of blood and puts it on a tablet with suitable chemicals in it.

And when the blood clots and is lifted off the tablet the color indicates the degree of acetone bodies present in the blood. When this indicates a four plus quantitative acetone content and the sugar in the urine We have established the diagnosis of diabetic coma. This is of great importance. It's of a simple test can be done in any farmhouse by just having the ingredients to test for sugar in the on hand these tablets to test for acetone which can be applied to testing the plasma. This means then that once the diabetes is diagnosed in the home treatment can big stack that the adult for instance weekend was safe to give 100 units of regular insulin ER's Creston insulin and have the patient drink it Ailsa's of salty broth

and ship them off to the hospital. These two measures tend to slow up and bring to a stop they process the switch in this patient's life whereas if they a diagnosis is delayed as I have seen. Often. Until a patient is in the hospital hours may have been lost and this is crucial. The earlier the diagnosis is made of course I had better go home and the speed year begun. They may have better. There are several other problems but I would say that those who have occupied considerable time. Oh yes and then there is of course the evaluation of the various oral preparations as they come out. One of the results of our research with theists has

been that and changing a patient from treatment with insulin to treatment with an oral preparation. We have found that. If an appreciable reduction in the Ensign is made and acetone appears in the urn in increasing amounts. Then it is not likely that there are preparation that is either. Tub of the med which is known as ore on A's or top broke a med which is known as now I have a nice day. Neither one will be effective in this group whereas if with an appreciable reduction the answer no ketones a pair then it's quite probable that these or preparations will work. This is of a simple test that can be applied with just merely reparse you're reducing the insulin dosage as a safety

measure or as to whether the answer on the score or whether they are preparation will suffice or not. Then we have been using to the they and that gland I'd or non-commercially as D.B. II. As the third or preparation. We're still accumulating that the A's doesn't seem to me that they will have the same field of usefulness because of the high frequency of nasi and vomiting which they have caused in operations at least. And now Dr. look at his discusses the research at the University of Pennsylvania Hospital. We have two principal things going on in this laboratory. The larger and obviously more important program is that of doctors one grad and Shar who are studying the metabolism

of adipose tissue fat tissue and fat as a tissue has been somewhat neglected. But it is quite active. It uses insulin to make glucose into the fat which is stored. And that happens directly in that tissue. And it therefore provides a golden opportunity to study the effect of insulin in a tissue hitherto somewhat neglected. We have found that. The growth hormone and antagonist of insulin specifically inhibits the utilization of glucose for fat synthesis or lower the total glucose utilization is the same. Here is an example of a high protein hormone not affecting the transport of glucose into the cell but altering its utilization. Within the cell. And insulin appears to do somewhat the

same thing for insulin accelerates fat synthesis. Even when glucose transport is the same as that of growth hormone. In other words this study has already given us a somewhat new slant. On the action of insulin itself. Which certainly increases glucose transport and which also may do something within the cell. You know in addition to these studies which have a variety of other ramifications we have been conducting studies in steroids diabetes. Here they partially depend critize cat is given a diabetic genic steroids such of the cortisone type synthetic steroids and diabetes can be produced when this is done the same course of island damage and diabetes is seen that was seen with growth hormone and partial pancreatic to me in earlier days. And we therefore see

at the islands of longer hunts suffer the same type of damage regardless of what agent is used to produce diabetes. Doctor look at referred to steroid diabetes. I requested that he explain this a bit further for clarification because Deroy diabetes simply means that there is enough pancreas left so that the animal is not diabetic. Then when a steroid is given diabetes develops. And consequently one can see the development of a diabetes by an agent. Here the two unstudied in this species and compare it with former experiences in experimental diabetes. All present day research finds its roots in something that has gone before Dr. Spraggs suggested these as the greatest research advances. I think the greatest advance although it is not a recent one is without

question the discovery of insulin. Going into more recent times. I feel that the greatest advance has been the. Discovery of. The oral agents that is pills which are. Used. In the treatment of diabetes us at this time. I would hasten to add that in my opinion. These oral agents. Are not. So much themselves a great advance. As they are an advance in the sense that they have. Given a great stimulus to research and it is generally. And indeed the stimulus has led to a better understanding of some of the fundamental metabolic abnormalities of diabetes. I believe that this has been the greatest

contribution of the. Oral agents. With the findings of both yesterday and today will come the good dances of tomorrow. Dr Lukins and Dr Duncan commented on the future prospects for research on diabetes. First Dr. look at where this should have an enormous future for one special reason. Diabetes is a disease of metabolism a disease of the body's biochemistry and modern methods of biochemical investigation are progressing so rapidly and moving so far ahead of what they used to be that we have every reason to think we may have a whole new world. As far as diabetes is concerned sometime in the future. And now Dr. Duncan gave this comment regarding the future of diabetic research. Of course I am. The greatest advantage is that the war preparations have brought to

us is that it has focused a tremendous amount of attention on research into diabetes and its problems and the application of our present day knowledge in the search for knowledge in this field special field. And so that I think the understanding of the problems that we didn't understand before are being clarified. I don't think that we're any closer that we can see to a cure for diabetes. I still think that we must consider that once a patient has diabetes they always have. There's a very very very rare case. I've had two of them. You know over a quarter century practice who had manifest

diabetes which completely disappeared both of these are in children and that makes them more significant. But a cure for diabetes. Certainly there's no indication for it but the amount of research that's being focused in the understanding the problem was not covered before. We open up realms that we have dreamed up. So. I would be am. I had I I would feel this that one has to be of a practical boil one's patience and tell them what I tell my patients when they ask if they can be cured. And I tell him I we don't know enough to know how to cure this disorder now but there's a tremendous amount of work being done. And let's hope certainly some progress has been made the past few years with your preparations. But

I think one of the dealing with a public eye the press as a I bad habit of of giving out Promises where they really are not genuine. And I think that we have to avoid that and not give them false confidence in something that really at this moment doesn't exist. All well and I were travelling up a roll of that we haven't traveled before in the evolution of knowledge in this particular field. A question that always intrigued me perhaps because of the interesting replies that it elicited from the participants was this. If you could be given the answer to one question that intrigues you most about diabetes what would that one question be. Here's what Dr. Spraggs said. It is easy for me to. Answer. But the answer to the question which I am going to propose is most.

Difficult. I would most like to have an understanding of the basis for the development. Of the degenerative vascular complications of diabetes which. Occur in such a high proportion of. Diabetic patients. With the passage of years. This general problem. Is today. The greatest problem in my opinion in the field of diabetes so we are. Keeping. Diabetic patients alive for many years by adequate treatment with diet and insulin. And yet in spite of such treatment they are going on to. Develop a variety of. Very distressing vascular complications. We badly. Need a greater understanding of the basis for the

development of these complications. One other area that Dr Sprague commented upon was what could be done to prevent degenerative vascular complications in diabetes he said. There is increasing agreement in the medical profession that the one. Step that can be taken by the. Physician and the patient for the prevention of. These complications is the maintenance of. Accurate control of the beat us over the years. With maintaining the. Urine. AS. Nearly sugarfree as possible and the blood sugar levels as nearly normal as possible. Other than us. There is. Little really known about the prevention of such distressing complications.

I asked Dr. look and if the emotional outlook or adaptability played a role in the diabetics treatment. He said there is no mental condition that produces diabetes as far as I know. There have been a few. Situations particularly do well described by Dr. Lawrence incl of New York. In which emotional upset and stress in that sense have led to some exaggeration of existing diabetes. But as far as we know the cause of diabetes still lies in a deficiency of insulin and an emotional or physical stress of itself will not produce diabetes. Doctor looking to discuss the earlier symptoms of diabetes in his interview. One question addressed to him was Can diabetic traits be observed in a person at early stages.

He answered Well the best way we have now is such a test is that used by Dr. Khan or the more alert testing during infection by physicians in general. Since an infection is. About as affective or sometimes more effective than Dr Khans courtesan glucose tolerance test when asking this next question invariably the reply came. That is the $64000 question. The question was this. What causes the overt disease of diabetes. Dr. look unscented No we still have a great deal to learn about that. The fact that the pancreas has enough function to carry these people into adult life and the. The fact that something that was at least adequate breaks down makes us realize that we have a good deal yet to learn about the life history of

diabetes before its development. I mean to say you can. You really pick these people by doing what con is done you say will the relatives of diabetics. Are the most susceptible. The general population will have so few that it's a question of how much you should apply it. I mean a test like kids on the other hand a more simple screening for diabetes a mere urine tests or mass routine blood tests or something can now be done at such with such ease that any public health campaign any multiple screening campaign could well include the search for diabetics. And we are and Charlie in favor of diabetes detection in that sense because it is so simple to do it and even if you pick up a few people you've added something we might wonder if the cure for

diabetes would be more affective or if it would be helpful for cure of the diabetic if the disease could be observed at an early stage. An answer to that question Dr. Lukin said. The fact is that early treatment and very well. And very careful treatment certainly. Diminishes his chance of getting the late complications of the disease. And the useful life of the diabetic is now being so prolonged that we don't even know the maximum of it it may be we've only had insulin 38 or 39 years. And diabetics have lived with the disease for 45 years or more. We don't know. The possibilities I think they will match the normal lifespan when the disease is well treated. That was Dr F the W look ns of the University of Pennsylvania who was joined earlier by doctors Garfield Duncan of the Pennsylvania Hospital and Dr

Randall Spragg of the Mayo Clinic in Rochester Minnesota. As they discussed diabetes next week you will hear many of the people you have heard over the past weeks discussing research needs and future training on the next program from the series. Human behavior social and medical research consultant for today's program was Dr. Jerome Kahn of the University of Michigan Medical School. Len Phillips speaking asking that you join us next week and thanking you for being with us at this time. This program has been produced by the University of Michigan broadcasting service under a grant in aid from the National Educational Television and Radio Center in cooperation with the National Association of educational broadcasters. This is the NEA E.B. Radio Network.