I was reading up on Patrice O’Neal and his issues with out of control diabetes. I believe each 100mg/dl of blood sugar is equal to about 5 grams in the blood.
So why has nobody invented a device that acts like a (portable) dialysis machine that sucks out excess sugar above maybe 200mg/dl? If you eat a meal your blood sugar can spike up to 200mg/dl but if it goes above that the machine starts filtering it out.
At the end of the day you have a couple dozen grams of excess sugar that has been removed from your body and blood sugar in the normal/prediabetic range.
Or would your body just keep dumping more and more sugar if you did that, or would a person who has severe diabetes undergo cellular starvation if blood sugar levels were kept artificially in the normal range because insulin resistance makes it hard for them to use sugar?
I’m sure I don’t know what the hell I’m talking about, and I await your replies.
It’s a lot simpler just to replace missing insulin (or in the case of Type II attempt to treat with medications) than to wear a portable dialysis machine. Huge IV lines are a lot more difficult and have more problems than subcutaneous injections or infusions.
But those do what the kidneys do and filter everything the kidneys filter. I’m wondering if there is a portable dialysis machine that leaves all the fluids in your blood alone except glucose. If your glucose concentration rises above 200mg/dl the dialysis machine removes it from your bloodstream.
Blood sugar can be reduced with dialysis, yes. In fact, more patients than will admit to their doctors will take the opportunity to stop by the KFC on their way to dialysis, knowing that their “cheat” (in the terms of both excess sodium and excess carbs) will soon be reversed.
There are home dialysis machines, too. In fact many organizations’ goals include increasing the number of people using home dialysis instead of clinic based outpatient dialysis. But it’s been my experience (and borne out in a number of studies) that doctors largely don’t tell people when home dialysis is an option, although Medicare mandates that they tell all Medicare patients of the option.
You could certainly fiddle with the solutions so that glucose is the only substance removed. It’s all about the osmosis - keep the sodium and other solutes in the dialysis solution the same as the body fluid, and it won’t remove any of those.
But…here’s the thing: it takes hours. Some people do home dialysis overnight, others do it for a few hours several times a day. So it’s really not practical as a means of controlling blood sugar, which can fluctuate wildly many times a day. Does that mean it never will be? No. But it’s not right now.
I was thinking of a device so portable it could be worn 24/7, which you just carry with you and that filters out any glucose above 200mg/dl.
I saw an article in popular science a few years ago about a portable filtration unit that attaches to the arteries in the forearm. If a soldier was in a war zone where chemical weapons were released, the filter would filter out the toxins from their blood. Something like that for high blood sugar could be useful for people who can’t keep their blood sugar under control with medication and lifestyle changes.
Or do you run the risk that because of insulin resistance, cutting blood sugar down to levels considered normal among people with normal insulin resistance levels could cause cellular starvation among people with higher levels of resistance.
Diabetes is such a complicated disease, and high blood sugar is only a symptom. People whose BS goes out of whack also have serious derangements in their electrolyte and pH balances, and lowering blood sugar too rapidly can lead to cerebral edema.
That would be really cool. How are you at writing grant proposals?
Yes, you’re absolutely right - it’s not (just) reducing the blood sugar that’s important, it’s getting the sugar into the cells where it’s needed. While a person may gorge on carbs and have enough in the cells and still excess in the blood, there’s more commonly the problem in diabetes that the sugar is just in the wrong place - either because the cells are resistant to insulin or because there’s not enough insulin to “open” the gates that let the sugar in*. We want the number on the glucometer down because that indicates that the sugar is moving into the cells, not only because the sugar in the blood causes damage.
*When I’m teaching laypeople, I use the lock and key analogy most often. The insulin is the key that opens the locks on the cell membrane to let the sugar in. You can have the problem of not enough working locks, or not enough keys. Often, and especially in Type II that’s been going on a while, the problem is a little of both. The details are a little more complicated when you bring the liver’s role in carbohydrate metabolism into it, but most people aren’t interested in that level of detail, and it’s rarely relevant in their disease management.
You already posted most of what I came in to say.
The ‘lock’ analogy is a good one and very useful for teaching folks about diabetes. However, as noted, it’s a lot more complicated than that. The liver has a role, the kidneys have a role, and their are other hormones that also contribute. Insulin does other things in the body as well; type 1 diabetics NEED insulin for other reasons than just moving sugar around - this is the reason insulin pumps have ‘basal rate’ settings as well as adjustable doses to cover food intake.
It’s normal for blood sugar levels to vary throughout the day in response to whatever’s going on. It’s normal - to a point - for blood glucose levels to spike after a meal. The problem is when they don’t come back down in a normal fashion (the sugar isn’t moved out of the bloodstream into the cells). This is what a glucose tolerance test measures - not how high the blood glucose gets, but at what rate it falls off over a few hours. The body isn’t meant to have the same blood sugar level at all times and it might be damaging to try to force that to happen.
Totally! And on the rare occasion I get a patient who is interested in learning more than the basics, I have to hit the books and brush up myself…or find them a Certified Diabetes Educator to do it for me!
It would be great if there was a little machine that could do that. But I kinda doubt the technology exists. It would have to be small and very accurate, so it would have to include some kind of glucose testing device. As of now, they’re still struggling to get a continuous glucose monitor integrated with a pump, so that’s one bit of technology we don’t have yet (but it’s close).
Second, I’m not sure what you describe is really better than today’s insulin pumps. Insulin also lowers sugar levels, though it doesn’t remove the sugar, it just gives your body the means to do it by itself. And insulin works really, really well, even for the insulin-resistant. You just need more of it for them (which yes, in itself could be an issue. But a great number of Type 2s can manage their blood sugar with non-insulin drugs, diet, and exercise.)
And, as GythaOgg points out, for Type 1s, the sugar pump is a non-starter. We need that sugar for energy; we just need the means to get our stupid bodies to use it. Thus insulin.
Why develop a machine, when your body does it already, and can be stimulated to do it even more?
There is a new class of drugs advertised during Jeopardy! time that cause the kidneys to shed a portion of the blood sugar instead of recirculating it all. Never mind that sugar in the urine was considered to be A Very Bad Thing just a few years ago. These medications won’t work for Type Is, BTW.
I’ve tried all kinds of treatment options, and in my old age, I’ll just settle for a combination of slow and fast acting insulins; less BS to remember this way.
Lugging around a dialysis machine (which doesn’t exist in a portable form, so that kinda answers your question) so that you can artificially lower your blood glucose levels 24/7 is like towing an anchor behind your car to keep you from speeding, and it’s treating a result of the disease, rather than the disease… if one has too much glucose in the bloodstream, even if such a machine existed it would still probably be simpler to eat a low-carb diet and take more Lantus (long-acting insulin which lowers your blood glucose levels 24/7 by moving the glucose into cells which need it).
I’m not sure I’d say they’re struggling with continuous glucose monitoring on pumps. I’d say they’re refining it. My cubemate has a pump with a CGM on it and these are becoming more and more common - to the point where the ADA’s official position is to strongly encourage the use of pumps with CGMs in almost all type 1 diabetics. It’s an interesting position paper - if you want to read it, you can find it HERE. This is the first time they’ve issued something like this for Type 1 only, so it’s worth looking at.
Taking the entirety of a person’s blood out of their body and putting it back in has tremendous consequences for homeostasis, among other things, and increases your risk of a lot of diseases.** If nothing else, hemodialysis (HD) pts tend to have lower blood pressures and lower temperatures.
HD requires access, either large-bore catheter or AV fistula. The catheters are just an enormous nidus for bloodstream infections, which are a great way to get heart valve infections, which is a great way to have open-heart surgery and be on lifelong anticoagulation (Not that most people with chronic indwelling vascular catheters get these infections, but it is a very serious consequence). AV fistulas clot off and have to be revised
I believe the only kind of dialysis that can be done at home is peritoneal dialysis (PD). I know little about this type of dialysis but I believe the principle is that a filtrate is washed through the peritoneum, which acts as a membrane through which the filtrate can draw potassium, phosphorous, etc from the blood. I guess enough of the peritoneum is in contact with enough of the blood supply that enough of the bad stuff can be drawn off this way. I don’t know of HD being done at home.
I don’t know that insulin really fails, per se. You just need more and more and more of it. Until you develop kidney failure, at which point you need less, because insulin is metabolized by the kidneys.
Home hemodialysis actually predates home peritoneal dialysis. Home peritoneal is more common now, however. But home HD is still done. Some plumbing adjustments have to be made for reverse osmosis filtration of your tap water, but I don’t know all the details. The machines are still pretty big, although smaller than they used to be. So you have to have the right to alter the plumbing (meaning you have to own your home or have permission from your landlord) and you have to have the space for the machine and supplies, as well as the wherewithal for 6-8 weeks of training and then accessing your own fistula on a regular basis. In three years of home nursing, I’ve seen home HD four times. Not a lot, but not never. Machines & Supplies - Home Dialysis Central