Not many people have heard this story – until now. Of course my loved ones know that I have type 1 diabetes, but knowing I also have diabetes complications was something I did not wish for them.

It was June 1^st 2009, four days before my 24^th birthday, when the Ophthalmology Department at my nearest hospital told me I could be blind in two years or less. I will never forget that moment.

Diabetic retinopathy means that the tiny blood vessels inside the retina at the back of my eye are damaged. Retinopathy is not a word most people are familiar with, but if you ask someone who has a family member with diabetes, they will probably know something about this condition.

According to JDRF, nearly all people with type 1 diabetes show some symptoms of diabetic retinopathy, usually after about 20 years of living with diabetes. After 20 years, around 20-30% of people with type 1 diabetes will develop advanced diabetic retinopathy.

For me there were no warning signs or symptoms, however many people experience blurred or distorted vision that makes it difficult to read, watch TV or see people’s faces.

Soon after the diagnosis of diabetic retinopathy I began 12 weeks of intensive laser treatment, which I wouldn’t wish on anyone. The procedure gave me blurred vision, sore weeping eyes and headaches, though not everyone experiences such intense side effects. Laser treatment is the main procedure for treating retinopathy, it is designed to slow the progression of the disease and decrease the risk of vision loss.

Luckily the laser treatment has meant that my risk of diabetic retinopathy decreased from 100% to 30%, which is a great result. I am now very aware that people with type 1 diabetes should take a positive approach to their eye health. This should include annual visits to an eye care professional, carefully management of BGLs and a healthy diet. As someone with type 1 diabetes, I know this is easier said than done.

Type 1 diabetes can be unkind. I did nothing wrong to get this disease. I didn’t eat sweet things when I was growing up – mum wouldn’t let us. In time I discovered that being angry was not doing my body and my blood sugar levels any good. It has taken me years to find a way to be positive about this disease.

I never thought diabetes complications would happen to me. I was 14 when I was diagnosed with type 1 diabetes, and 24 when I was diagnosed with retinopathy. It feels like my diabetes complications have come at least 10 years early.

The day I sat down in the chair for the laser treatment I said to myself, “I will fight you and I will win”. But I was also thinking about life if I went blind, that my family would have to re-home our family dogs so we could get a guide dog, and how upset everyone would be.  Facing the possibility of going blind was terrifying for me.

The fears prevailed for a time and unfortunately I was forced to put my studies on hold and leave my teaching course at university. I had some very dark days. I will get back to those studies in time, and for now that’s okay.

This year I received news that the doctors are pleased with my progress. My checkups are now 6 monthly instead of 3 monthly. So now I am focusing on my goals; getting well, being healthy and happy. I will go through life as Jason, not a diabetic. Type 1 diabetes is just one part of who I am.

I wanted to share this story in the hope that I can connect with others who are facing a tough time. I also want to call on any young people who are adjusting their insulin to influence their weight – please don’t do it. I found out later that high BGLs and not meeting HbA1c targets is the main cause of diabetic retinopathy.

Be happy about who you are, keep fighting and remember, type 1 diabetes only comes to good looking people!

By Jason Triggs with thanks to Vision Australia and JDRF International

The Australian Civil Aviation Safety Authority (CASA) has changed its regulations to allow people with type 1 diabetes to pilot planes in some circumstances.

So what’s the catch? The license that is initially available is a Class 2 certificate, which allows piloting of private and recreational planes only. Additionally, flying with a safety pilot will be mandatory for 15 incident-free flights.

CASA will require that two ‘recording devices’ (BGMs) are used during flight, with a preference for continuous blood glucose monitoring over traditional methods.  Patients must not have any significant diabetes complications, including retinopathy.

The Medical Journal of Australia (MJA) stated that the relationship between ‘diabetes and aviation has been emotive and controversial, with a perception of conflict between individual rights and the need for aviation safety.’

This means that the regulations are navigating a complex path between the rights of a person with type 1 diabetes and acknowledgement that a blip in diabetes management could lead to harm for the pilot, their passengers and people on the ground.

In the normal course of life, those with type 1 diabetes are the best ones to judge their health and their ability to conduct challenging tasks. This is more possible now than ever before, with help like improved control and management practices, technology like insulin pumps, the latest BGMs and continuous blood glucose monitoring around the corner. Yet regulatory challenges remain for high risk career paths like flying.

The new regulations mean that main challenge facing those who want to pilot planes is control. Applicants will need to prove that they have not had a hypo in the previous year that required the assistance of another person, and that their last 3 HbA1c results over 6 months have been less than 7.5%.

So what’s happening overseas? In the US, private pilots can fly without a safety pilot, as long as they keep their BGM in the range of 5.5 – 16.0 mmol/L. Those levels would be considered ‘running high’ by most people. The MJA noted that this creates an perplexing ethical issue by effectively forcing pilots with type 1 diabetes to risk complications by keeping their BGL relatively high.

For year nine student Brendan, the change in Australian regulations is a promising sign.

Brendan’s dream is to be an Air Force pilot but having had type 1 diabetes for nearly 10 years, this dream is currently out of reach. It is diabetes not airplanes that he thinks of when he first wakes up in the morning and last thing at night.

Brendan is carving out his own air force path. He participates in camps to learn to make model airplanes, as well as other activities like aircraft recognition and survival. He says these activities have been ‘a great way for me to learn more about myself and living well with type 1 diabetes.’

Brendan’s life is full and he says ‘I am having a lot of fun but I believe things must get better as we continue to change the type 1 world we live in.’

‘To make my dream a reality we need to find a different outcome for people living with type 1 diabetes.’

Diabetic Macular Edema (DME) is a common health complication of type 1 diabetes and involves swelling in the centre of the retina (otherwise known as the macula). The swelling is caused by leaking blood vessels, damaged by periods of high blood glucose. People with macular edema lose their detailed vision and as such the ability to perform common daily activities. Severe damage results in legal blindness.

Laser therapy, the standard treatment for DME, has been used for almost 25 years. While it’s effective in early stage disease, new treatments are urgently needed for people with more aggressive forms of the condition. JDRF have been supporting a number of trials in this area, and in the last few months, results from two of these trials have shown promising results.

Ranibizumab (Lucentis) is currently used to treat age-related macular degeneration but trial results published in May 2010 have shown that a combination of laser treatment with ranibizumab injection is a safe and effective treatment for DME.

According to trial investigators, the improvements seen during the trial could enable a person with DME to resume activities such as reading or driving. Whilst the treatment is expensive, and can only be administered in a medical clinic, investigators have recommended that ranibizumab be considered as a standard treatment for patients with DME.

Meanwhile, early data from another clinical trial has shown that an existing blood pressure therapy called mecamylamine is also safe to use in patients with DME and appears to slow the progress of severe forms of DME in people with type 1 diabetes.

Administered as eye drops rather than injection, the study showed that 40% of trial participants with severe DME recorded a significant improvement during the 16 week trial. Because this potential treatment can be self-administered, it may also ease the burdens of healthcare costs and compliance. Further trials are now planned to establish effectiveness in a larger group of patients.

Both of these trials were funded through JDRF grants or partnerships.

Thirty years of data from international trials show that the rate of serious complications amongst people with type 1 diabetes is lower that was has been reported historically.

Researchers from the JDRF-funded Diabetes Control and Complications Trial (DCCT) and the Epidemiology of Diabetes Intervention and Complications Trial (EDIC) have analysed the incidence of long-term type 1 diabetes complications amongst trial participants and found that the rate of type 1 diabetes complications has changed dramatically, particularly for people who intensively manage their condition.

Researchers announced that the incidence of type 1 diabetes complications such as retinopathy, nephropathy and cardiovascular disease were significantly lower in the group that used intensive therapy to manage their type 1 diabetes.

In the case of the DCCT trial participants, intensive therapy was defined as use of insulin pump or three or more insulin injections, blood sugar monitoring at least four times per day and monthly visits to their diabetes healthcare team.

The researchers believe that with more people using intensive therapy, the rate of complications amongst people with type 1 diabetes should continue to decline to less than 50% of the levels seen at the start of these trials.

Treatment innovations such as insulin pumps and insulin analogues, increased understanding of type 1 diabetes management, and improved treatment of co-occurring symptoms such as high blood pressure, and abnormal cholesterol have also contributed to this change.

Arch Intern Med 169(14):1307-16

New clinical trial data suggests certain blood pressure medications can significantly slow the progression of diabetic eye disease.

US researchers have published data from a five-year multi-center clinical trial that demonstrates that the use medications commonly used to treat high pressure can help to prevent and slow progression of diabetic retinopathy.

The two medications – losartan and enalapril – work by targeting the rennin-angiotensin system, a hormone system that is controlled by the kidneys and that helps to regulate blood pressure within the body.

The trial, the longest ever to be conducted in this area of research, involved trial participants living with type 1 diabetes but with no detectable incidence of kidney disease or hypertension and minimal eye disease. Patients were randomly assigned to receive a daily dose of either losartan, enalapril or a placebo, and were monitored for five years.

Results showed that people given either medication were at least two times less likely to experience progression of their eye disease, a significant result. Interestingly, neither intervention showed a prevention of diabetic kidney disease – a surprising result that is contradictory to previous research.

According to Dr Paul Strumph, Chief Medical Officer of JDRF International, this study adds to the existing body of knowledge available about treating and preventing type 1 diabetes complications but emphasizes that work still needs to be done.

“This study adds to our understanding of the progression of eye disease in some people with type 1 diabetes – those with normal blood pressure, no detectable kidney disease and very mild eye disease.”

“Because the study did not evaluate the drugs effects on eye and kidney disease in people already experiencing diabetes complications such as elevated blood pressure, kidney disease and eye disease, it will not impact on clinical practice guidelines for that group.”

Future research will concentrate on identifying which groups of people with type 1 diabetes will benefit most from taking these medications in relation to any risks involved with ongoing use of the drug treatment.

New England Journal of Medicine. 2009 Jul 2;361(1):40-51.

There is extensive research to show that tight blood glucose control is the best way to prevent the onset of type 1 diabetes complications such as kidney failure, retinopathy and heart disease. According to results from the Diabetes Complications and Control Trial, every one point reduction in HbA1C reduces the risk of long-term complications by approximately 40%.

Unfortunately, research has also shown that one of the hurdles to tight blood sugar control is the risk of hypoglycemia – both real and perceived.

Over the past 15 years the use of different insulin analogs as well as improvements in insulin pumps and blood glucose monitoring has had a positive impact on the ability of people to achieve blood sugar control targets. The rates of severe hypoglycemia, however, remain high and occurrence of such events is often followed by a decline of glycemic control due to fears of further hypoglycemic episodes.

In two multi-centre clinical trials – the first concentrating on people with bad glycemic control and the second on people who intensively manage their blood sugars – JDRF researchers have now demonstrated that an excellent solution to this problem is the use of a continuous glucose monitor, or CGM.

According to these trials, people using CGM spent two hours more time per day in the target blood sugar range of 3.9 to 10.0 mmol/l compared with people using fingerprick testing alone. They also found that CGM subjects had a significant overall improvement in HbA1C over time without an increased number of hypoglycemic attacks.

CGM devices are worn in a similar fashion to an insulin pump and provide both a real-time snapshot of glucose levels as well as trend information on whether glucose is moving up or down. They can also provide a warning when glucose is becoming too high or too low.

The continuous glucose monitor is a key component of the JDRF international Artificial Pancreas Program and these results take researchers one step closer to making the artificial pancreas a reality.

Diabetes Care published online 25th May 2009

JDRF-funded researchers in Canada have successfully used specially selected stem cells to grow new blood vessels to treat the vascular complications of diabetes.

Lead researcher Dr David Hess isolated and purified three different types of stem cell from bone marrow, then injected this compound into mice with major blood vessel damage. He found that the stem cells had a natural ability to hone into the area requiring repair, and treatment resulted in significantly improved blood flow for the mice.

This research is now being tested in a multi-centre clinical trial run by the biopharmaceutical company Aldagen.

Blood epub ahead of print

Scientists discover a link between eczema and diabetic wound-healing

Researchers from the University of California have discovered that a protein called caspase 8 is deficient in people with eczema but produced excessively by people with diabetes.

Caspase 8 stimulates inflammation at the wound site, it also stimulates the production of stem cells that work to rapidly close the wound and promote healing. People with eczema therefore have an overactive response, where the body accumulates an overabundance of skin cells resulting in the characteristic thick and peeling skin common to this condition.

People with diabetes have a lacklustre wound healing response meaning small wounds, minor cuts and scrapes can develop into something more dangerous and complicated.

Nature 458(7237):519-23

New treatment for retinopathy

JDRF-funded researchers from the Joslin Institute in Boston, in collaboration with biopharmaceutical company ActiveSite, have developed a promising new approach for treating retinopathy.

Using a rodent model, researchers were able to prevent retinal blood vessels from leaking – a major cause of retinopathy in diabetics – by inhibiting the action of a specific enzyme called kallikrien. Another positive side effect of the treatment was that it also reduced high blood pressure, another contributing factor to diabetic eye disease.

Researchers are now looking to expand their studies with the possibility of human trials in the near future.

Hypertension 53: 175-181

Breath testing for diabetes

US researchers have developed a novel breath test method for detecting the onset of type 1 diabetes in people who are known to be at risk of developing the condition.

Scientists conducted a blood glucose tolerance test on a number of subjects with and without diabetes, collecting breath samples as well as blood samples. They found that people with known pre-diabetes had a significantly reduced amount of carbon dioxide in their breath when they had high blood glucose. Whilst this test is still in early stages, it is hoped that it will soon provide an option for non-invasive and speedy testing of at-risk individuals.

Diabetes Care 32: 430-435