DRC & Research News

Scientists are still trying to understand the different ways that the SARS-CoV-2, or COVID-19, virus affects the body both in the short and long term. As more studies are conducted, scientists are finding that the virus may be linked to the development of other health conditions, such as diabetes.

Recent studies involving non-human primates and humans (both living and deceased), have led researchers to discover the presence of SARS-CoV-2 within cells throughout the pancreas, including islet, ductal, and endothelial cells. COVID-19 enters cells through angiotensin-converting enzyme 2 (ACE2) and transmembrane serine protease 2 (TMPRSS2), both of which showed increased expression in pancreatic tissue of non-human primates (NHPs) and humans.

This may impact the survival of these cells, as well as their ability to produce and release insulin. Insulin deficiency is a primary cause of diabetes and leaves the body unable to regulate blood glucose levels on its own.

Researchers found that “two out of eight NHPs developed new-onset diabetes following SARS-CoV-2 infection. Two out of five COVID-19 patients exhibited new-onset diabetes at [hospital] admission. These results suggest that SARS-CoV-2 infection of the pancreas may promote acute and especially chronic pancreatic dysfunction that could potentially lead to new-onset diabetes.”

More research and larger studies are necessary to determine the effect of the virus on pancreatic function and insulin production. However, multiple studies have shown that SARS-CoV-2 infects multiple types of cells found within the pancreas, and this could increase the risk of new-onset or late-onset diabetes.

The Diabetes Research Connection continues to follow the latest developments in the field and is interested to see how COVID-19 may impact diabetes as well as potential prevention and treatment efforts. Though not involved with these studies, the DRC provides critical funding to support early-career scientists pursuing research around type 1 diabetes. Learn more about current projects and how to help by visiting https://diabetesresearchconnection.org. 

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As the coronavirus pandemic persists, scientists continue to learn more about SARS-CoV-2, commonly known as COVID-19. One area of interest is how the virus may affect beta cells within the body, and more specifically, pancreatic beta cells. Two recent studies have examined the connection between COVID-19 infections and diabetes.

The pancreas contains insulin-producing beta cells that help control blood glucose levels. In individuals with type 1 diabetes, these cells are mistakenly attacked and destroyed by the immune system. Research has shown that following a COVID-19 infection, a similar process may occur, reducing the quantity of pancreatic beta cells and the amount of insulin produced.

According to researchers, “Beta cells and other cell types in the pancreas express the ACE2 receptor protein, the TMPRSS2 enzyme protein, and neuropilin 1 (NRP1), all of which SARS-CoV-2 depends upon to enter and infect human cells.” Autopsy results from patients who died from COVID-19 showed the presence of the virus in pancreatic cells.

In addition to decreasing insulin production, the SARS-CoV-2 virus may also lead to beta-cell death or transdifferentiation of the cells. During transdifferentiation, cells are reprogrammed to alter their function. Researchers found that some cells produced less insulin, more glucagon, and more trypsin 1, a digestive enzyme. However, blocking NRP 1 may prevent cell death, and trans-ISRIB treatment may help reduce the stress response of cells. This may help reduce the risk of developing diabetes.

More research is necessary to gain a better understanding of the impact of COVID-19 on pancreatic beta cells and the damage that it may cause. One of the best defenses against COVID-19 to date is getting vaccinated.

The Diabetes Research Connection (DRC) is interested to see what future studies reveal and how this may impact treatment and prevention efforts. The DRC provides critical funding for early-career scientists studying all facets of type 1 diabetes. Learn more about how to support these efforts by visiting http://diabetesresearchconnection.org.

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Scientists have created vaccines for many different diseases, from polio to chickenpox to the flu, and now they are in the process of developing one for type 1 diabetes (T1D). T1D develops when the body mistakenly attacks and destroys insulin-producing pancreatic beta-cells. These cells are vital for naturally controlling the amount of glucose in the bloodstream. This new vaccine is geared toward preserving insulin-producing cells by targeting the glutamic acid decarboxylase (GAD) protein.

Around half of the patients with T1D have an immune system gene know as HLA-DR3-DQ2, which is a specific version of the human leukocyte antigen (HLA) gene. This particular variant triggers the body to produce antibodies against the GAD protein and destroy insulin-producing beta-cells, which increases the risk of developing T1D. If this process can be stopped or delayed, and patients can retain even some natural insulin production, it could benefit their overall health and reduce the risk of hypoglycemia.

The diabetes vaccine increases exposure of the cells to GAD to improve the immune system’s ability to tolerate the protein and not launch an attack on pancreatic beta cells. This may enable patients to retain more natural insulin and better regulate glucose levels.

To test this theory, researchers conducted a phase 2 clinical study involving 109 patients ages 12 to 24 who had been diagnosed with T1D within the past six months. The HLA-DR3-DQ2 gene variant was present in about half of the patients.

Patients were randomly divided into two groups, one of which received the diabetes vaccine and one of which received the placebo. The vaccine was administered once a month for three consecutive months. Natural insulin production, blood sugar levels, and daily supplementary insulin use were recorded at the study’s beginning and then again 15 months later.

The results showed that “as a whole, there was no difference in treatment and placebo groups. But the subset of patients who had the HLA-DR3-DQ2 variant did not lose insulin production as quickly as other patients did.”

For patients with this specific gene variant, the diabetes vaccine may be beneficial in preserving natural insulin production and slowing or stopping the progression of T1D. More research and more extensive studies are needed to further study the potential benefits of the vaccine and its use in treating patients with T1D.

Though not involved with this study, the Diabetes Research Connection (DRC) is dedicated to improving prevention, diagnosis, treatment, and quality of life for patients with type 1 diabetes and one day finding a cure. This vaccine could be a step in the right direction toward altering the progress of the disease. The DRC is interested to see what future studies reveal.

The DRC provides critical funding to early-career scientists pursuing novel research around type 1 diabetes to support advancements in this field. To learn more about current projects and support these efforts, visit https://diabetesresearchconnection.org. 

Please DONATE NOW so DRC can keep bringing you credible, peer-reviewed T1D news and research.

Thank you.

Packing meals for outdoor day trips can be a challenge, and like with everything else, even more so when doing it with Type 1 Diabetes. The food and container have to be able to withstand temperature fluctuations, provide energy in the form of slow-release carbohydrates, and tasty sustenance for our bodies as well as our soul. 

Hands down, preparing your own meals is the best way to predict how your diabetes will behave around mealtimes. You control the ingredients, so you can have the exact carbohydrate calculation, and if not, a much better idea of how to estimate the carbohydrates. Hidden sugar content is a real problem with restaurant and store-prepared food and can seriously dampen a diabetic’s good time. 

There are an infinite amount of recipes online with new ones being concocted every day. Thankfully, a fully balanced meal consists of just a handful of things, and having these elements in mind is a great starting point in discovering and creating meals that work for you, fit your preferences, dietary needs, and regional accessibility. 

So when planning your next day adventure, consider packing a balanced meal that consists of these five elements:

• Low-carb base
• Fiber
• Protein 
• Fat
• Acid

Us T1Ds can eat whatever we want, but it’s no surprise that slower acting and lower carbohydrate foods are easier for us to digest with minimal insulin. I have found that replacing the base of my meals with hearty vegetables like shredded spaghetti squash, lightly roasted broccoli or zucchini, and dark greens (rather than a complex carbohydrate like potatoes or rice) is so much easier to predict and calculate for. Alternatively, beans and legumes provide a similar carbohydrate base with added vitamins, minerals, and protein to slow the glycemic impact, making it slightly easier to time insulin injections. 

Fiber is necessary for slowing the glycemic load and lowering the overall net carbohydrate. I don’t usually notice the difference of the total carbohydrate count is ever enough to adjust my insulin requirement, but it does delay and sometimes negate a postprandial rise. Shaved carrots, roasted or raw broccoli, shredded cabbage dressed in lime juice and salt – it really doesn’t take much to turn a few raw ingredients into a delicious and fibrous addition to the dish. 

Protein is arguably the most important aspect of daily nutrition as the building blocks of bodies. From tofu to deli slices, there’s no wrong way to go when building hiking-friendly meals. Substantial protein can also be found in hard cheese, legumes, beans, and seeds, and should be considered in the overall protein content of the meal. Stick to basics that don’t spoil quickly, such as chicken thighs, lean pork, and cured meat.

To top off most meals, I usually finish with a generous squeeze of lemon or lime juice, a healthy drizzle of extra virgin olive or avocado oil, and a sprinkle of seeds. The acid and fat balance out everything and pull the entire dish together, not to mention provides necessary puzzle pieces our bodies require to properly digest everything. Vegetables are packed with carotenoids that act as antioxidants and have cancer fighting properties, and studies are finding that we absorb more of these phytonutrients from plants with the aid of fat. Considering that, if I can, I love to include an avocado with every meal. It’s also my favorite standalone snack – full of healthy fat, fiber, and FLAVOR. Lastly, a sprinkle of seeds packed with protein, fat, vitamins, and minerals is just the extra bit of zest I need in my life.

With these building blocks in mind, assembling simple meals that are delicious, nutritious, and the perfect accompaniment to a hike or day trip should be a breeze. The considerate ratios of our glucose levels should be to your satisfaction as well. 

This article was contributed by Jackie Talbott, DRC Volunteer, who has had T1D for 23 years.  

It’s officially summer! As the world seems to be hotter than ever, and life goes back to a new normal with social activities commencing, it can be surprisingly easy to forget about having diabetes during group play dates in the great outdoors. 

I think it’s safe to say we all feel an extra level of pressure, and to an extent mindlessness, when we’re with our friends and family that we haven’t been in the company of for so long. I find myself being less in-tune with the physical glucose signals, and you know what they say about time when you’re having fun, right? Hours seem like minutes and a lot can happen to our diabetes before we realize it. Miscalculations are just waiting to sneak in, timing injections are likely to be less than ideal, and even how we react to the normal stuff might be different when we’re buzzing about full of our environment’s energy. 

Along the T1D journey, we will experience things and gain new perspectives that help make diabetes management more understandable. In this constant period of trials and errors, I have found some “food for thought” that helps my decision making when embarking on summertime excursions with friends. 

So that everyone can have the best possible time, I’ve compiled a handful of tips to stow in your supplies pack.

Stash Smart Snacks:

Since there are so many options now for emergency and activity-friendly snacks, take a moment to find ones that you actually enjoy. It’s so easy for T1Ds to look at food as merely a necessity, but food is also nourishment for the soul. Even for emergency use, we don’t have to just rely on choking down dry tablets – there are gummies, syrups, liquid shots, and powders that can be used in a variety of ways that suit several needs. I find powder glucose the most versatile and takes up the least amount of space.

I also like to carry high carb granola bars, ones that are at least 40 grams per bar. I find them to be extra helpful in that you can split the bar into more than one use (depending on how much you need, of course). Dried fruit does a similar trick – the idea is to consider carbohydrate rich options that provide enough nutrition with just a bite or two.

Some favorites like carrot and celery sticks, either plain or dipped in a treat of your choice, are durable and hydrating options. Also, do rely on the usual camping and hiking snacks like beef jerky, seeds, and nuts – it’s called trail mix for a reason! Focus on high protein and fat to delay carbohydrate absorption.

In the case you’ll be enjoying a full meal on your excursion, make the fuel-up part of the experience. Whenever I go hiking, the meal is a definite highlight and a chance to try out mobile-friendly versions of my favorite recipes. Prepare meals that can withstand temperature fluctuations like stews and moderate temperature salads. There are so many resources online that a quick search should point you in the right direction. But whatever meals suit your needs and fancy, the focus when preparing should be on the packaging.

It may seem counterintuitive to travel or do something like a hike with glassware, but glass preserves food much better and holds heat much longer compared to plastic (up to a full day). Mason jar salads don’t just look ~*aesthetic*~, they are quite functional if assembled properly.

Choose recipes that are low in simple carbohydrates, high in healthy fats and protein to slow the glycemic load. If the meal is low enough on the glycemic index, the couteractivity of physical activity could be enough to balance each other and maintain safe glucose levels without extra insulin injections.

Pack a Backpack of Backups:

Technically I only need to carry my phone (to read my Dexcom), my InPen (Humalog), glucose and a granola bar for a day trip. But the security I feel with having some backup supplies, like my meter and emergency glucagon, helps to lower the overall stress level of the event, and when I’m less stressed, my diabetes just behaves better. Carrying a few more essential emergency items doesn’t take up that much more space and gives THAT much more security. A fanny pack or mini backpack is plenty of space and full of convenience.

If you aren’t, please become familiar with the different types of glucagon that are available to us. Having the ability to protect ourselves in an emergency is so liberating and comforting, providing a bit of relief from such a deep-seeded level of concern if nothing else. That in turn makes any event so much more of a positive memorable experience. Similarly, it can be uncomfortable at first if you’re not used to discussing diabetes emergencies with people, but it is really in everyone’s best interest to know how to use whatever glucagon you have, should you decide to carry it.

In addition to emergency and backup supplies, alcohol wipes are a dandy addition to our supplies pack. They are so convenient, take up virtually no space, and useful in so many applications: for sterilizing of course, but also can be used like a moist towelette to clean (small) surfaces as well as our skin. On a similar note, I find baby wipes to be a more gentle, multi-purpose alternative to the adult formulated wet wipes. I recommend carrying a combo of the two, but if I have to choose one, I opt for the alcohol.

Heed the Heat:

I keep all of my diabetes supplies in a padded, insulated bag. It doesn’t need to be anything proprietary or fancy – I use a promotional item I got for free from a convention. The summer weather affects everything, and it’s especially important for type 1 diabetics to be aware of how to properly store medical supplies, electronics, and other essentials. 

Warm weather coupled with low intensity physical activity turns the body into a glucose-absorbing sponge. Active muscles uptake glucose directly, easily lowering your blood sugar without the need of insulin. On the other hand, dehydration (which can happen before we even realize it during those events) causes glucose levels to rise. Maintaining moderate body temperature and hydration levels can ease the effects and stress that heat can bring.

Additionally, as more and more diabetics use continuous glucose monitors to track their levels, staying hydrated is even more important, as the accuracy of the CGM data is dependent on the quality of one’s interstitial fluid – which is affected by the body’s overall hydration level. Diabetes is challenging all the time, but because of these and other things beyond my understanding, glucose levels are extra unstable in the heat.

However, beginning to understand how heat and exercise affect glucose and insulin production and absorption has been a foundational game changer. So to combat it, I have these tips:

• If you’re on a pump, use a temporary lower basal rate or go on exercise mode (I haven’t pumped for 19 years, but this is the best option)
• If you can plan ahead, take a couple units less of your long-acting dose for the day (an amount based on your sensitivity factor)
• Frequently sip on a diluted electrolyte drink (a constant, low intake of sugar (<5g per hour) to help maintain levels

Practice Presence: 

Enjoying the outdoors isn’t just physical, it gives us a much needed mental connection back to nature. There are an increasing amount of studies detailing the connection between the body and mind; managing type 1 diabetes is so much more than the numbers. Take breaks, breathe deep, smell the air, and feel the breeze. Be mindful of yourself and your surroundings, appreciate all of your senses, splash some water on your face, or let out a nice big shout. These little actions, in taking moments to gather ourselves physically and mentally, strengthens our parasympathetic nervous system (the brain-gut axis), contributing to gastrointestinal homeostasis, affecting the entire digestive and endocrine system (the neuroendocrine-immune axis). Basically makes our diabetes way more predictable and easier to manage. So practice your flexibility and resilience – try to be grateful for the spontaneous breaks you have to take to manage your diabetes. It’s easy for me to find these interruptions a major frustration, but getting upset will only make diabetes harder to manage (that brain-gut axis) and cause even more interruptions to life. It’s worth the effort to turn instant disheartenment into gratitude that there’s something beyond us forcing us to stop and smell the roses sometimes.

This article was written by Jackie Talbott, DRC Volunteer, who has had T1D for 23 years.

Summertime meals are all about freshness, flavor, and fun. This grilled spiced salmon salad with avocado cucumber salsa by Sylvia Fountaine is a perfect dish for a hot summer day. If you’re looking for a crowd-pleaser, this is the type of meal that will make you look like a professional after you whip it up. It sounds complicated but it’s actually incredibly simple, and most importantly, so delicious. Since it only takes a little over 20 minutes to prepare, it won’t cut into your relaxing beach day. It’s also low carb and filled with healthy fats. Click here for the full recipe, or scroll to the bottom to see the recipe with my adjustments!

What screams “summer” more than a sizzling grill? To begin, preheat the grill to medium (you can also use a grill pan). Pat your salmon dry. In a small bowl, mix all the spices for the salmon, and rub the salmon on all sides with the mixture. Set it aside. Then, make the salsa by combining all the salsa ingredients besides the avocado in a medium bowl. Gently fold in the avocado– make sure not to squish it! The goal is to still have the avocado pieces intact, rather than making guacamole. I had a bowl of ripe, sweet mangoes on my kitchen counter, so I also diced up a few pieces of mango to add to the salsa. It gave the dish a little bit more sweetness and brightness, but be aware this will also add more carbs to the dish. Then, make the dressing by whisking all the dressing ingredients in a small bowl. Chop up the romaine to your desired size for the salad. Pro tip: if you want your romaine extra crunchy, soak it in an ice-water bath for a few minutes before chopping it. Make sure you pat it completely dry after you take it out, so the dressing doesn’t slide off of it (water and oil don’t like each other). 

Make sure the grill is hot. Grease the grill with neutral cooking oil (I used Canola). Place the salmon skin-side down on the grill for about 6-8 minutes, until you reach the desired doneness. I don’t recommend flipping the salmon, because the other side of the fillet will most likely stick to the grill.  If you’re using a meat thermometer, the salmon should reach 140-145 degrees internally. Once done, take the salmon off the grill and let rest for a minute. Squeeze with a little lime juice. Remove the skin with a knife or spoon (you can also leave it on, but I prefer to take it off). 

Toss the lettuce with the dressing and assemble it on a plate. I also crushed a few toasted almonds to put on the salad. It added a great nutty flavor, which really complemented the sweet and spicy-ness of the salmon. Then place the salmon on top of the lettuce. Spoon the salsa over the top of the salmon, then garnish with lime slices. 

Serves 4

Carbs per serving: 17 grams 

For the Spiced Salmon: 

4 6 ounce salmon fillets

1 teaspoon salt

½ teaspoon pepper

2 teaspoons cumin

2 teaspoons chile powder

Lime 

For the Avocado Salsa:

1 ripe avocado, diced

1 cup diced cucumber

½ jalapeno, finely chopped

¼ cup chopped fresh cilantro

1 lime juice and zest

2-3 teaspoons extra virgin olive oil

½ teaspoon salt

¼ mango (optional, will add about 12 grams of carbs)

For the yogurt dressing: 

½ cup plain Greek yogurt 

Juice from one lime

1 garlic clove, minced

1 tablespoon extra virgin olive oil

⅛ cup chopped cilantro

½ teaspoon salt

½ teaspoon pepper 

For the salad: 

2-3 heads of romaine lettuce 

A small handful of toasted almonds, crushed

Directions:

Preheat the grill to medium. Pat the salmon dry. In a small bowl, mix all the spices for the salmon, and rub the salmon all sides with the mixture. Set it aside.

Fill a bowl with ice water. Place the heads of romaine in the bowl. 

Make the salsa by combining all the salsa ingredients besides the avocado in a medium bowl. Gently fold in the avocado.

Make the dressing by whisking all the dressing ingredients in a small bowl. Take the romaine out of the water and thoroughly dry it. Chop up the romaine to your desired size for the salad.

Grease the grill with a neutral cooking oil. Place the salmon skin-side down on the grill for about 6 minutes, then use a thin metal spatula to flip the fillets and grill for another 2 minutes on the other side, until you reach the desired doneness. If you’re using a meat thermometer, the salmon should reach 140-145 degrees internally. Once done, take the salmon off the grill and let rest for a minute. Squeeze with a little lime juice. Remove the skin. 

Toss the lettuce with the dressing and the crushed almonds. Assemble it on a plate, then place the salmon on top of the lettuce. Spoon the salsa over the top of the salmon, then garnish with lime slices. 

This blog was written by Lauren Grove, DRC Intern, who has had T1D for 15 years and is responding to the article, “Grilled Salmon with Avocado Cucumber Salsa.”