Random Nature #139
Type 3 Diabetes: In Type 1--the former juvenile--diabetes, the body doesn't produce insulin. In most people, this is caused by an auto-immune disorder where the body attacks the beta cells in the pancreas that produce insulin. The more common Type 2 (adult-onset) diabetes involves reduced insulin sensitivity and/or insufficient insulin production. Over half of the people that develop Type 2 diabetes are obese.
There are other types of the syndrome which are sometimes lumped under the term "Type 3" diabetes, the best-known being gestational diabetes. In about 4 percent of pregnant women, hormones from the placenta cause insulin resistance late in the pregnancy. If untreated, it can cause health problems for both the mother and baby. Eventually, 20-50 percent of those women will develop Type 2 diabetes. There are also some rarer forms of diabetes, generally related to problems with the beta cells and insulin production.
The following is an interesting line of research into another possible form of Type 3 diabetes--Alzheimer's disease.
...scientists at Northwestern University have discovered why brain insulin signaling--crucial for memory formation--would stop working in Alzheimer’s disease. They have shown that a toxic protein found in the brains of individuals with Alzheimer’s removes insulin receptors from nerve cells, rendering those neurons insulin resistant. (The protein, known to attack memory-forming synapses, is called an ADDL for “amyloid ß-derived diffusible ligand.”)
With other research showing that levels of brain insulin and its related receptors are lower in individuals with Alzheimer’s disease, the Northwestern study sheds light on the emerging idea of Alzheimer’s being a “type 3” diabetes.
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In the brain, insulin and insulin receptors are vital to learning and memory. When insulin binds to a receptor at a synapse, it turns on a mechanism necessary for nerve cells to survive and memories to form. That Alzheimer’s disease may in part be caused by insulin resistance in the brain has scientists asking how that process gets initiated.
“We found the binding of ADDLs to synapses somehow prevents insulin receptors from accumulating at the synapses where they are needed,” said William L. Klein, professor of neurobiology and physiology in the Weinberg College of Arts and Sciences, who led the research team. “Instead, they are piling up where they are made, in the cell body, near the nucleus. Insulin cannot reach receptors there. This finding is the first molecular evidence as to why nerve cells should become insulin resistant in Alzheimer’s disease.”
Scientists speculate that some types of drugs used to treat Type 2 diabetes may also help with Alzheimer's.
Passing It Along: Huntington's disease is a incurable degenerative disease of the neurological system that from onset usually takes 15-20 years to kill people (though death is usually due to complications). HD typically strikes adults in the prime of their life (30-45)...Woody Guthrie is probably its best-known victim. However, it can strike early in childhood, with its victims rarely seeing adulthood.
- Early in the disease, manifestations include subtle changes in coordination, perhaps some involuntary movements, difficult thinking through problems, and often, a depressed or irritable mood. At this stage, medications are often effective in treating depression and other emotional symptoms. It is a good time to begin planning for the future. Financial plans should be made and legal documents drawn up.
- In the middle stage, involuntary movements (chorea) may become more pronounced. A staggering gait can sometimes be mistaken for drunkenness. Speech and swallowing will begin to be affected. It is important to consult a speech therapist who will be able to offer suggestions and strategies for improving communication and swallowing abilities. Likewise, occupational and physical therapists can develop programs to help maintain the highest level of functioning and thereby improve quality of life.
Thinking and reasoning skills will also gradually diminish. At this stage it may become increasingly difficult to hold a job and to carry out household responsibilities. Here again, simple strategies may be employed to help decrease frustration, increase functioning and prolong independence. For example, disorientation and short-term memory loss can be addressed by labeling drawers, maintaining a daily routine and posting a calendar appointments and events.
- People with late stage HD may have severe chorea, but more often have become rigid. Choking on food becomes a major concern, as does weight loss. At this stage people with HD are totally dependent on others for all aspects of care, can no longer walk, and not able to speak.
Although cognitive abilities are severely impaired, it is important to remember that the person is generally still aware of his/her environment, remains able to comprehend language, and remains an awareness of loved ones and others. He/she may continue to enjoy looking at photographs and hearing stories of family and friends.
Scientists know the gene that causes Huntington's disease and can test for it, including in the womb. That gene can be passed along to half of one's offspring, which is why HD has become part of the abortion debate. Children are not tested for the disease...at least until they've turned 18. Meanwhile, doctors have long known that people with Huntington's disease have more children than average. Speaking of that...
The Tufts team analyzed the often-noted fertility gap between people who have Huntington’s and those who do not. Studies comparing family members indicated that individuals with the disease had between 1.14 and 1.34 children for every child born to an unaffected sibling. In explaining this difference, previous researchers have theorized that psychological deterioration and difficulty in discriminating between right and wrong--both symptoms associated with Huntington’s--are reasons for promiscuous behavior in people who had the disease. But Eskenazi, Wilson-Rich and Starks observed that such behavior takes place later in life--not during peak reproductive age. They noted that the onset of Huntington's disease occurs, on average, at 41.5 years of age.
In their alternative hypothesis the Tufts researchers suggested that individuals affected with Huntington’s have better health earlier in life at the time when their fertility is highest. “We’ve raised the possibility that the high birth rates are a result of better health,” explained Starks. “We know that healthy people have more offspring than those who are sick."
Starks and his team suggested that one key factor behind these health benefits may be p53, and pointed to a 1999 study by doctors at the Danish Huntington Disease Registry at the University of Copenhagen that found lower age-adjusted cancer rates for individuals affected by Huntington’s. "Research has shown that individuals with Huntington's produce higher levels of cancer-suppressing p53, and we hypothesize that they may also reap the health benefits associated with a generally more vigilant immune system," said Starks. "These individuals also suffer from the negative impacts of heightened immune function, as they are more likely than those without Huntington's to suffer from autoimmune diseases."
Obviously more research is needed, but it's an interesting hypothesis.
Painkiller Resistance: Fibromyalgia is a poorly-understood syndrome where pain is amplified due to problems with sensory processing in the central nervous system. While it comes on gradually in some people, most start suffering fibromyalgia after an illness or injury which evidently triggers the problems.
Fibromyalgia (FM) is a chronic pain illness characterized by widespread musculoskeletal aches, pain and stiffness, soft tissue tenderness, general fatigue, and sleep disturbances. The most common sites of pain include the neck, back, shoulders, pelvic girdle, and hands, but any body part can be affected. Fibromyalgia patients experience a range of symptoms of varying intensities that wax and wane over time.
It is estimated that approximately 3-6% of the U.S. population has FM. Although a higher percentage of women of all ages and races are affected, it does strike men and children. Because of its debilitating nature, fibromyalgia has a serious impact on patients' families, friends, and employers, as well as society at large.
Managing chronic pain is one of the keys to helping patients improve and cope with this sometimes-debilitating syndrome. But frustratingly, some pain medications don't work well with fibromyalgia. Scientists are gradually beginning to figure out why. The following is from a fairly small study, but the results are interesting.
The study included positron emission tomography (PET) scans of the brains of patients with fibromyalgia, and of an equal number of sex- and age-matched people without the often-debilitating condition. Results showed that the fibromyalgia patients had reduced mu-opioid receptor (MOR) availability within regions of the brain that normally process and dampen pain signals...
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Opioid pain killers work by binding to opioid receptors in the brain and spinal cord. In addition to morphine, they include codeine, propoxyphene-containing medications such as Darvocet, hydrocodone-containing medications such as Vicodin, and oxycodone-containing medications such as Oxycontin.
The researchers theorize based on their findings that, with the lower availability of the MORs in three regions of the brains of people with fibromyalgia, such painkillers may not be able to bind as well to the receptors as they can in the brains of people without the condition.
Put more simply: When the painkillers cannot bind to the receptors, they cannot alleviate the patient’s pain as effectively, Harris says. The reduced availability of the receptors could result from a reduced number of opioid receptors, enhanced release of endogenous opioids (opioids, such as endorphins, that are produced naturally by the body), or both, Harris says.
That's certainly useful information from a treatment perspective.


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