Liver…..It’s Not Just for Dinner

May 19, 2017

By Susan Klick, MSN, RN, CNL Diabetes Educator

The Liver is one of the most important organs in our body. It weighs about three pounds in an average adult, making it the largest internal organ in the human body.  It has a central role in a number of processes, one of which is to help control glucose (sugar) balance in the blood.   Today we will take a look at the liver’s role in controlling blood sugar.

When blood sugar levels are high, the liver will absorb some of the sugar and pack it into bundles called glycogen. These glycogen bundles fill up liver cells, so the liver is like a warehouse for excess sugar.  The liver can then release the stored sugar (glycogen) when the body tells it to.   Here are some examples:

The liver responds to stress by releasing stored glycogen, (the stored form of sugar). In this situation, the release of stored sugar is part of the body’s “fight or flight” response, which prepares the body with energy to respond quickly to a threat.

When we exercise, our muscles take up sugar, and the liver responds by releasing glycogen to replace the sugar that is being taken up and used by our muscles.

Normally the liver slows down its release of sugar into the blood if blood sugar is high. But in people with Type 2 diabetes, the pancreas may be producing too much of a hormone called glucagon.  Glucagon’s job is to tell the liver to release sugar into the blood.  If too much glucagon is being produced, then the liver is releasing too much sugar, keeping blood sugar levels high after meals and overnight.

Insulin is a hormone made by the pancreas. Insulin’s job is to move sugar from the blood into the body’s cells. When you eat, a hormone in your gut tells your pancreas to start producing insulin.  When you don’t eat (i.e. skips meals) there is little insulin being produced and therefore the liver will start releasing its’ stored glucose!  The liver isn’t able to detect blood glucose levels; it only knows what insulin tells it.  If there is a shortage of insulin, the liver assumes the body needs more sugar (even if blood sugar levels are already high).  That is why some people with Type 2 diabetes will have high blood glucose levels even if they haven’t eaten, like first thing in the morning!

People with diabetes have reason to focus on liver health. Overweight people, particularly those who carry their weight around the middle, have the highest risk for liver problems.  Losing weight, eating well and exercising are recommended for helping you to control blood sugars, and what you do to help your blood sugars is good for your liver too.



Resource: The Diabetes Educator and Diabetes Forecast

Afrezza inhaled insulin recently approved

July 14, 2014

Afrezza is an inhaled, ultra-rapid acting mealtime insulin therapy designed to improve glycemic control in adults with Type 1 and Type 2 diabetes. In patients with type 1 diabetes, it must be used with a long-acting insulin.  Afrezza is a drug-device combination product, consisting of an inhalation powder in a single dose cartridge & a small inhaler. Each cartridge can deliver a dose of 4 units or 8units; For doses exceeding 8 units, inhalations from multiple cartridges are necessary.  It is administered at the start of a meal with onset of action 12 to 15 minutes later. Peak action is usually seen about 90 minutes after dosing & the effects last about 160minutes. The insulin contained in Afrezza is regular human insulin.

Adverse affects seen in trials: Acute bronchospasm has been observed in patients with asthma and COPD. Lung Cancer: increased cases were seen in clinical trials; however, data was insufficient to determine whether Afrezza has an effect on lung or respiratory tract tumors. Others include: hypoglycemia, Diabetic Ketoacidosis, cough, throat pain or irritation, headache, fatigue, nausea urinary tract infection, weight gain. Before starting Afrezza, a medical history, physical exam and spirometry (FEV1) tests should be performed in all patients to identify potential lung disease. Long-term safety and efficacy of Afrezza in patients with chronic lung disease has not been established. Afrezza causes a decline in lung function over time as measured by FEV1. Pulmonary function should be assessed at baseline, after the first 6 months of therapy, and annually thereafter, even in the absence of pulmonary symptoms.

Additional info: insulin exposed to temperatures higher than 98.6°F (37°C) should be discarded. Store unopened product in refrigerator. If a foil packet is not refrigerated, the contents must be used within 10 days. Inhaler may be stored refrigerated, but should be at room temperature before using. Before use, cartridges should be at room temperature for 10 minutes.


New insulin pen delivery device

July 4, 2014

NovoNordisk has a new re-usable insulin pen injector device, NovoPen Echo, that was recently approved for use. It uses NovoNordisk Penfill insulin cartridges (prefilled, 3ml=300 units).  The Echo allows delivery of insulin doses in 1/2 unit increments, with a max dose of 30 units per use. It has a “dose memory” that displays the amount of insulin most recently injected and the time that has elapsed since that dose (in full hour increments). The pen device comes in red and blue, which could be helpful if using 2 types of insulin. It uses a non-replaceable battery that lasts about 4 to 5 years.

This information is not meant to replace your healthcare Provider’s advice. It is not an endorsement of this product or of the NovoNordisk company.

Move Over, Insulin: Another Hormonal Treatment for Type 2 Diabetes?

June 18, 2013

When you think of treatments for diabetes, what comes to mind? Maybe oral medications like metformin or glipizide? Injectable insulin?  Hopefully diet and exercise are frontrunners, but what about hormones? Sure, insulin is a hormone, so maybe that doesn’t seem so odd, but what about a hormone that can actually increase the number of cells which make insulin?

Insulin is produced in the pancreatic beta cells.  It serves as a “key” to unlock our cells so they are able to take in energy (aka our blood glucose). The diagram below shows the progressive response of the body to insulin as diabetes progresses. 

Insulin Diagram

In type 2 diabetes, our cells become resistant to insulin, which causes our pancreas to pump out more and more in response. Eventually, this can lead to exhaustion of our healthy beta cells, which can stop working all together (or produce too little insulin for us to use effectively). Once the body cannot make enough insulin, our blood sugars are consistently elevated, and we may need to start using injectable insulin. Researchers at the Harvard Stem Cell Institute have found that when livers in mice were programmed to secrete more of the hormone betatrophin, the number of beta cells in the mice increased threefold. Researcher Doug Melton states, “We would provide this hormone, then the type 2 diabetic will make more of their own insulin-producing cells, and this will slow down, if not stop, the progression of their diabetes.” Unfortunately, the researchers do not believe that this would impact how type 1 diabetes is treated.

Of course, there will be a long testing process before your doctor will be able to prescribe this as a treatment. It will first be tested on mice with diabetes, and only if positive results are seen will testing move to human subjects. In the meantime, another way to manage your type 2 diabetes (without a prescription) involves decreasing our resistance to insulin. This can include eating a controlled and consistent amount of carbohydrates (one of the macronutrients, along with protein and fat, which can be found in grains, starches, fruits, and dairy products, along with sweetened and dessert-type foods), staying active through exercise, and maintaining a healthful weight. Not sure where to start? Your dietitian can determine an appropriate individualized meal plan for weight management.  

Written by: Kelly Houston, Saint Louis Dietetic Intern


Eli Lilly Enters the World of Mobile Phone Apps

October 2, 2012

Lilly Diabetes announced the release of a new mobile phone application designed for caregivers and healthcare providers who support people with type 1 diabetes. The Lilly Glucagon Mobile App is a tool to teach how to use Glucagon for Injection through simulated practice, demonstrating how to prepare and inject Glucagon with visual and audio emergency instructions along with tools to keep track of kit locations and alerts for expiration dates.

Glucagon, 1 mg (1 unit), is indicated to treat severe hypoglycemia (low blood sugar). Severe hypoglycemia due to insulin use may result in loss of consciousness (insulin coma). The app is designed to help people be more prepared and safe. The Lilly Glucagon Mobile App is now available in the iTunes® store as a free download for iPhone® or iPad® mobile devices.

People with type 1 diabetes who experience severe hypoglycemia during insulin treatment may require glucagon, a hormone produced in the pancreas to raise blood sugar levels. Although Glucagon is rarely needed and only used during a severe hypoglycemic event, individuals in the person’s support network, such as family members, teachers, coaches, trusted friends and colleagues, should be trained to give the medicine, which is injected with a syringe. The app can also be used by diabetes educators and school nurses as a teaching tool.

In type 1 diabetes, the body does not produce insulin, a hormone produced by the pancreas in response to an increase in blood sugar, such as after a meal. As many as three million Americans may have type 1 diabetes. Each year more than 15,000 people under age 20 are diagnosed with the disease. Glucagon should not be used in patients who have pheochromocytoma or patients who are allergic to Glucagon.  Patients must inform relatives or close friends that if they become unconscious, medical assistance must always be sought. If a patient is unconscious, Glucagon can be given while awaiting medical assistance.

“Lilly Diabetes is committed to developing personalized solutions to help people with diabetes achieve their treatment goals and improve their outcomes,” said Matt Caffrey, U.S. Product Brand Director, Marketing Specialty, Lilly Diabetes. “The Lilly Glucagon Mobile App leverages the power and reach of mobile technology, providing another opportunity to support people living with type 1 diabetes. Lilly Diabetes is constantly striving to create new and better tools to support the diabetes community in a variety of ways.”

The Lilly Glucagon Mobile App is an interactive tool to help caregivers better understand Glucagon’s role in diabetes management. Its purpose is to educate and prepare the caregiver on how to use Glucagon in the event of an emergency. The app was developed with input from healthcare providers and people with diabetes.

The Lilly Glucagon Mobile App includes:

  • Information about severe hypoglycemia and Glucagon
  • Simulated practice demonstrating how to prepare and inject Glucagon
  • Visual and audio emergency instructions
  • Tools to keep track of kit locations and alerts for expiration dates

Disclosure: St. Anthony’s Diabetes Education Program is providing this information as a notice to our patients and does not represent Eli Lilly, nor has received compensation from Eli Lilly in relation to this post.

Man celebrates being longest living with type 1 diabetes

June 3, 2011

Bob Krause, of Los Angeles, recently celebrated his ninetieth birthday, making him the first known American to live 85 years with type 1 diabetes.  He was diagnosed at age five.  His story is one of motivation, endurance and success as well as a testament to the evolution of diabetes treatment.  Krause was lucky enough to be diagnosed with diabetes shortly after insulin was made commercially available; prior to that, diabetes was a death sentence.  Can you imagine?  Living with diabetes is no easy feat, but Krause reminds us that we are blessed with a great deal of information and many tools that sure do make things easier today.  Whether it’s strong character, determination or just plain “stubbornness,” we can learn a lot from Bob Krause’s amazing story.  Read it here.

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