Diabetes In Check

Written by Madoline Markham
Photography by Beau Gustafson 

joy one

Joy Myers. Photo by Beau Gustafson.

Joy Myers literally woke up one day to a diagnosis of Type 1 diabetes. What she thought were flu and strep throat symptoms had in fact been caused by exceptionally high blood sugar levels that sent her into a coma for nine days starting in November 2014.

In the days that followed, learning about the implications of diabetes was completely new to her at age 41, and it was intense. As Myers came to understand, diabetes is an auto-immune issue that has always been inside her but that reached a tipping point and manifested itself later in life. Most people think of Type 1 as juvenile diabetes because it is usually diagnosed at a relatively young age, but it affects adults too and often leads to their misdiagnosis and improper treatment.

But at UAB, familiarity with diabetes is just the opposite. In the Comprehensive Diabetes Center, more than 200 faculty members are working on different aspects of the disease. And as Myers was receiving her diagnosis, the center was preparing to begin a clinical trial to see if common blood pressure drug verapamil could completely reverse diabetes in humans like it had done in animal models.

It was Myers’ best friend who found information on the study at UAB and sent it to her. Myers was reluctant to participate at first because she had already found an endocrinologist she liked, but her thoughts changed after she met with nurses and doctors and found she fit the requirements: ages 19-45, less than three months since diagnosis with Type 1 diabetes.

“I really saw it as a really awesome opportunity,” she recalls. “The fact that it was here in Birmingham and I fit the profile were just more and more reasons for me to get involved.” Plus, she got medical equipment with no added cost—a welcome reprieve at a time when she was facing medical bills. And so she started the yearlong trial in March 2015.

The verapamil trial takes a different approach than any diabetes treatment on the market. Beta cells in the pancreas produce insulin needed to control blood sugar, but in people with diabetes, these beta cells die off. Over the past 15 years, UAB researchers have found people with diabetes overproduce a protein called TXNIP. Too much TXNIP in the beta cells causes them to die, and as a result the body produces less insulin and diabetes progresses. Verapamil, by contrast, can lower TXNIP levels in beta cells. In mice, researchers found, it could even eradicate the disease.

Dr. Aneth Shalev

Dr. Aneth Shalev. Photo by Beau Gustafson.

“Even though treatment options have improved a lot over the last several decades, none of them effectively address the underlying cause of the disease, namely the loss of insulin-producing beta cells,” says Dr. Anath Shalev, director of the Comprehensive Diabetes Center. “The overall goal of our research is to change this.”

As the researchers have found so far, verapamil is effective in lowering TXNIP levels in humans, and 95 percent of study participants screened still had a significant amount of beta cell function left. Ideally, the treatment would also reduce the amount of insulin a person needs to take. Regardless, it would most likely be combined with other therapies to treat diabetes.

During your first year with diabetes, your condition can change rapidly. You are learning how much insulin you need to take when, and how different factors affect it. Myers says the study provided her accountability to be regimented in her care and pay extra close attention to what was happening with her body and what physical symptoms of low and high blood sugar feel like.

She checked her blood sugar seven times throughout the day for the study as she learned how different foods affected her specifically. For instance, the first time she tried sushi after her diagnosis she didn’t realize how many carbs are in it. The goal is to keep your blood sugar between 70 and 100.  “That’s a really narrow window,” Myers says.

Also as a part of the study, new technology in the form of a continuous glucose monitor checked and recorded Myers’ blood sugar every minute, allowing her to see how it changed before and after she ate. Overall, the study encased her in an “incredible medical support system” that provided her with valuable knowledge, she says.

Today, when her insulin is off, Myers knows how to fix it and fix it fast. “What’s amazing is you can have your 4 ounces of juice, and within 10 minutes, you feel normal again,” she says.

After diagnosis, people with diabetes experience a honeymoon period where their pancreas is still producing insulin. Part of what verapamil does is preserve some amount of insulin production, helping patients to prolong their honeymoon period for as long as possible. In turn, they are less dependent on insulin and still have active cells, enabling them to be more likely to be helped by future therapies. However, half the of the patients in the UAB study take a placebo and half take verapamil itself, so Myers doesn’t know for sure if the verapamil is to thank in part for her current condition.

As of the end of her participation in the study in March, Myers’ body was still producing insulin, and by this fall, she was only using about 20 to 25 units of insulin, whereas many people at her height and weight would usually use 30 to 50. “If you do have tight control on the diabetes at the onset for that first 12 months, that results in better outcomes over the lifetime of the disease,” Myers says. “We have a long road ahead to see what the benefits of this will be for me.”

Myers also eats a lean diet, but she said that she will truly see the verapamil’s effects over time. It’s only been less than two years since her diagnosis, after all. But she knows that overall if you do control the diabetes, the complications from it will be fewer later.

In retrospect, Myers now realizes she didn’t feel well for years, but she blamed the everyday stress of trying to be supermom, work, and generally stay busy. And the change in her body was so gradual that it felt normal. “Now I know when I feel bad it’s almost 100 percent of the time related to what my blood sugar level is,” she says. “If I am in a good place and managing it well, I feel phenomenal.”

Although her time with the study is complete, Myers has agreed to do another test a year later to help contribute to the data because she wants to continue to be a part of the science that’s working to address the disease. She was only the fifth person to participate in the study, so she’s hoping they make it to 52 participants so the data will be significant.

So far, about half of the participants needed have been recruited, and 14 have completed the full year of the study with no adverse effects reported. The study has found that patients do not show any difference in blood pressure if they are on the medicine. It will take “some time” before the data can be analyzed properly to show more results, Shalev says, but if and when they are revealed, the next steps would go quickly. This would be able to help the 12.3 percent of Americans ages 20 and older who have diabetes, either diagnosed or undiagnosed, and another 37 percent who have pre-diabetes, a condition marked by above average blood sugar. After all, diabetes is still the seventh leading cause of death, and it raises risks for heart attacks, blindness, limb amputation, and kidney disease.

“Since verapamil is already FDA-approved, the findings could be almost instantaneously translated into the clinic,” Shalev says. “… I always wish we could offer our patients something better, something that addresses the actual cause of the disease.” And as Myers will discover in due time, maybe that will hold to be true.

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