World Diabetes Day is celebrated on the 14th November each year to raise awareness of the increasing health risk posed by diabetes. The date was chosen to coincide with the birthday of Sir Frederick Banting, who, with Charles Best, discovered insulin in 1922.
Insulin, a hormone made by the pancreas, is a key player in diabetes. Insulin is required to maintain blood glucose homeostasis. It is produced by beta cells in the pancreas in response to high glucose levels in the blood stream. Insulin then signals to liver, muscle and fat cells to take in this glucose to maintain a constant blood glucose level. Diabetes is a chronic condition in which blood glucose homeostasis is impaired or lost due to either the loss of insulin producing beta cells (Type 1 Diabetes) or when the beta cells become progressively dysfunctional (Type 2 Diabetes). The absence of insulin results in hyperglycaemia, which, when improperly managed can be fatal, and many secondary complications including those affecting the eyes, nerves, kidneys and cardiovascular system can arise.
Type 2 diabetes accounts for at least 90% of cases of diabetes, and often goes undiagnosed for a long time. Sufferers are unable to control their blood glucose concentration due to insulin resistance, in which the receptors responsible for detecting insulin are no longer responsive to normal insulin levels. Additionally, the cells producing insulin become damaged and therefore insufficient insulin is produced to meet the body’s demands. Often however, it can be managed through lifestyle changes including changes in diet and exercise.
Key habits to adopt to try to prevent and/or manage Type 2 diabetes:
Eating healthy food
Regular physical activity: Being active – 30 to 60 min moderate or 15 to 30 mins of vigorous aerobic activity.
Losing weight if you are overweight
Avoiding sitting still for long time periods
The theme for WDD 2020 is: The Nurse and Diabetes, which aims to raise awareness about the crucial role that nurses play in supporting people with diabetes, helping them to adjust to lifestyle changes and understand the disease. One in 10 people are living with diabetes, and the number is projected to increase. As this number rises, so does the need for nurses who play a key role in:
Early diagnosis to ensure speedy treatment.
Providing psychological support and self-management training for people with diabetes to help prevent complications.
Help people to understand the disease, tackle the risk factors for type 2 diabetes by providing important dietary and lifestyle advice and thereby prevent or manage the condition
Nurses are therefore a vital part of the healthcare system in fighting diabetes #Nursesmakethedifference, and currently there are not enough nurses. To raise awareness and get involved this World Diabetes Day, visit the WDD website: https://worlddiabetesday.org/get-involved/
Type 1 diabetes is an autoimmune disease in which the body’s own immune system attacks the insulin producing cells in the pancreas. Little or no insulin is produced and therefore it must be injected daily to control the levels of glucose in the blood. Type 1 diabetes is fatal without regular injections with insulin. It is not fully understood why the autoimmune reactions against insulin producing cells occurs. A healthy diet and regular exercise are also important for people living with type 1 diabetes. Nurses again play a vital role in supporting people with type 1 diabetes by providing information and support with how to take and monitor their insulin levels and maintain a healthy lifestyle with balanced nutrition and regular exercise.
The current most common treatment for type 1 diabetes, injection of insulin, only ameliorates the symptoms of the disease by lowering or normalising blood glucose levels. The goal of RESTORE is to move beyond merely treating the symptoms of a disease, to actually cure those diseases currently deemed “incurable”. Transplantation of islets can normalise blood glucose levels for several years, although in most cases, supplemental insulin is also required. However, islet donors are very scarce and the transplanted cells often evoke an immune response, therefore transplantation is only reserved for a subset of diabetes patients. Thus, it is necessary to develop methods of producing unlimited reserves of functional pancreatic insulin producing beta cells.
In this respect there is a great deal of research on how to produce insulin producing cells from pluripotent stem cell sources, thereby alleviating the issue of insufficient islet donors  and how to generate islets which negate the need for immunosuppression following transplantation, for example using CRISPR/Cas9 technology . At the time of writing, the regenerative medicine company ViaCyte are leading the first and only clinical trials for diabetes therapies derived from stem cells . Furthermore, a recently started Horizon 2020 funded project “ISLET”  is specifically focused on solving the problems currently standing in the way of stem cell based therapy for diabetes and subsequently how to bring such therapies to patients. RESTORE aims to build an Advanced Therapies ecosystem in which the entirety of the therapy development pipeline is interconnected and supported, from the bench to the bedside, to streamline the development and accelerate the availability of such regenerative therapies to patients.
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