Feelings, nothing more than feelings…
“The sleep of reason begets monsters”– Goya
To begin with, I was fully vaccinated but my stepson was not vaccinated. So he got COVID, and I got it too. Presumably it was the delta variant, which took over the country last spring. I was in the hospital with pneumonia from September 13-21. Subsequently, I have recovered to the extent that I can walk a half mile in 35 minutes. That’s pretty good for a doddering feeble old man.
By the way, right after getting out of the hospital, I went in to get a booster vaccination (Pfizer.) It was six months after I completed the initial series of COVID vaccines. I presume that my immunity had waned sufficiently in six months for me to be unable to resist getting sick from a fairly heavy exposure.
I will not spend much time on the news that a new variant of concern, formally labeled Omicron, has arisen, primarily in South Africa. You can look it up. I’m done repeating the news about COVID, except to state that developments have met my most pessimistic projections.
Secondly, I read that the Solomon Islands has transferred their China recognition from Taiwan to the People’s Republic– in 2019. Now, as of November 24, there is rioting and Chinatown in Honaira (the capital of Solomon Islands) was almost completely burned down, except for one or two buildings that had the flag of Taiwan prominently displayed. I read this in the Washington Post, and so can you.
So, reading the Wikipedia entry for Solomon Islands, I discover that the Solomons are the site of the island of Guadalcanal, where a major 3-year battle was fought between the Japanese Empire and the United States of America (with British forces participating, and Australians as well.) The fighting resulted in the destruction of the former capital city, which was transferred to Honaira.
The Solomon Islands also outlaws homosexuality and has a major “gender-based violence” problem, reportedly the worst in the world. I don’t think the two situations in the previous sentence are coincidental. The gender-based violence problem primarily consists of men beating their wives, supposedly make them more obedient. This is partly because men buy their wives, making them think that they “own” them. This is clearly a violation of the Universal Rights of Man, also known as the basic human rights that we’re supposed to recognize.
Thirdly, this is not something that I wish to know. I would rather know about something sweet and substantial, like the announcement that we are going to not raise the Earth’s average surface temperature anymore because we are going to stop producing carbon dioxide and methane. Better for everyone. It’s a fantasy, but it’s a nice fantasy.
You can see that I have gotten out of the habit of writing blog entries. I will stop now. I promise to do better.
picture credit: Wikipedia
Yesterday’s Washington Post had a personal article by an oncologist in Florida who was forced to turn away a patient with metastatic brain cancer who was unable to walk and needed urgent radiation therapy to control the disease because his hospital was full of covid patients.
He said that he was told by his medical association that the current wave of covid would crest in mid-October. That means that the medical system, which is already overloaded with covid patients, will continue and get worse, with no relief for the next three months.
The national count of new daily infections has doubled in the last two weeks. The daily count has risen from an average of less than 20,000 to nearly 150,000. The death rate average has increased from a few hundred to a thousand.
Notoriously, southern and southeastern states have had the largest increases. This includes particularly Florida, Mississippi, Tennessee, and Louisiana. There are no ICU beds available in these states. The vaccination rates in these states have lagged behind those in the rest of the country.
States with high vaccination rates, like Vermont, Massachusetts, and Connecticut, are doing much better. In the Northeast, daily case rates are 20 per hundred thousand, while in Mississippi, rates are 120 per hundred thousand. Overall, the south is averaging 72 new cases per hundred thousand daily.
(Statistics are from the New York Times virus tracking database.)
This is a sin and a crime. Vaccination rates and case rates are showing a close correlation with political persuasion, with Republican-held counties having low vaccinations and high cases. Democratic counties are mostly showing the opposite trend.
I am sick and appalled at the indications of political sway over vaccinations and mask-wearing. The reason for this is that Fox News and Republican disinformation in general has convinced large parts of the country that they should not comply with the most effective means at controlling the covid pandemic.
Republican politicians have become prisoners of the former guy’s lies. Individual-one was booed when he told his supporters to get vaccinated. I don’t know what can be done to change this situation. How can the “opinion leaders” on the right-wing side reverse course on their disease-enhancing propaganda when so many people are so convinced that they are doing the right thing?
Only time will tell us if large numbers of Republican opinion-leaders getting sick and dying of covid has any effect on this disaster. The fact that so many people will get mild cases despite ignoring basic anti-infective procedures will not help.
That is not the worst problem. The next bad thing, coming hard on the heels of the pandemic, is really serious climate change. The same right-wing lies will convince so many people to pretend that this is not coming. This is much worse than covid, and it will continue to get worse until the quality of life for everyone is destroyed.
I fear that, in ten to twenty years, climate change will get so bad that large numbers of people will begin to die of starvation and heat stroke. Forced migrations of people away from drought-stricken hot spots will cause civil strife and erode our common humanity. Cruelty towards migrants will become the norm.
We are headed for some very hard times in a few years. My only consolation is that I will soon be dead and I have no personal offspring to suffer. I feel sorry for my nieces and nephews.
coronavirus photo by Tumisu via pixabay
A tale of cat illness: the Kitten
We are going through (are still going through) a hard time with one of our cats– the one named “the Kitten.” On Friday morning, Mary told me that Kitten was acting very lethargic. She wasn’t moving around at all. When I looked at her she seemed to be asleep and didn’t want to wake up. She growled faintly when I petted her. She wouldn’t get up or walk.
Mary could pick her up and carry her around but she growled faintly. We put her on a red cushion on the bed and watched her for a while. She just wouldn’t wake up. After a few hours, I was able to wake her up by putting smelly food (smoked salmon) under her nose and she licked my fingers. We looked around on Google and called a regular vet. They were booked up but they suggested a newish vet, so we called them and made an appointment for the next morning (Mary had an appt to have her eyes examined, which turned out to be a good thing, see below.)When we saw the vet the next morning, they did a blood count and the usual tests, blood sugar, creatinine, liver function, feline leukemia virus, and two other viruses I don’t remember.
They wanted to do an Xray but I declined because I was sure she didn’t have any broken bones and I couldn’t feel any lumps in her stomach (neither could the vet.) The vet said her teeth were badly decayed (probably from eating canned food all the time, although he refused to confirm my contention that it was canned food.) So he gave her clindamycin for the teeth infection (assuming she had a tooth abscess) and a prescription-only flea medicine, topical, which supposedly lasts twelve weeks. He also gave her a subcutaneous fluid injection (250 cc) although she had accepted fluids from a dropper; I OK’d this because she hadn’t peed in 24 hr at least. Finally, he gave her an antibiotic shot whose name escapes me just now. The whole thing costed $501.00. So we took her home but she didn’t get better. I was hesitant to give her the clindamycin because I remember how it gave me a terrible stomach-ache when I took it on an empty stomach. This was mentioned in the pamphlet that came with the med as an “occasional” side effect. Mary gave her a half-dose every twelve hours instead of 2cc every 24 hours and it didn’t seem to bother her. She called the vet that evening to say she wasn’t getting better, and they said to watch her overnight.
Mary gave her some smoked salmon, which she ate. Then she gave her tuna, which she ate enthusiastically, even standing up to eat. Later she gave her some roast beef, mostly the liquid, from a can, which she also scarfed down. Mary gave her droppersful of water every couple of hours because I was afraid she would get dehydrated. She peed a couple of times during the night, not getting up but just peeing on the bed. Luckily, we had a towel under her which kept the bed from getting wet. The vet’s receptionist called us back at nine this morning to ask about Kittten, and I told her that she ate and peed. This morning we brought in a litter box to the bedroom and stood her in it so she’d know it was there. She stood there for a minute, then stepped up and stumbled as she climbed out. This was at noon. Since the vet had asked us to call back at noon, I did and told the receptionist about the stumbling. She asked the vet, but he didn’t have any bright ideas as to why she would be ataxic.
He again recommended an Xray. I said we’d bring the Kitten in tomorrow, assuming she didn’t get better. Now, first of all I’m glad we didn’t take her to any of the “emergency” vet offices because all the google reviews said they charge like $3000 or more. This was “only $500 and they were very nice and showed that they cared about the cat (which the google reviews complained that the emergency places didn’t)
What shocked me was that about 25 years ago, we had a cat that was hit by a car and we took him in to an emergency place (it was eight at night) They seemed very nice and they treated his dislocated hip with a heavy tape-cast like thing; I think it was less than a thousand dollars, but that was 25 years ago… Anyway, the google reviews (of which there were a hundred or more) mostly complained about the cost, thousands of dollars, and the lack of concern, and the long waiting times (several hours, just to be seen.) So I guess everything has gone downhill over the years.
But the Kitten is still sick; I think she has some kind of neurological disease. We will take her back to the vet tomorrow.
Mary thinks it’s the heat.
The heat, oh the heat. The forecast is for 108 degrees tomorrow. It has been a hundred or more every day since mid-June. But “it’s a dry heat.” That’s why I get up at five every morning and go for a long walk right around sunrise; it’s usually around 70 then, sometimes less. This morning it was 73 and humid.
The dogs get to come inside every day around noon, and I don’t kick them out until after 8 PM. They sleep very comfortably all afternoon.
(cat photo from my personal collection)
Bad news about the delta variant has just been publicly released. The CDC has recently been made aware of this shocking change in the pandemic. Studies conducted too recently for peer review show that vaccinated people can be infected with the delta variant; a small proportion of fully vaccinated people have been productively infected and can transmit the coronavirus to others, at least for a few days. Fortunately, the infections are usually mild and confined to the nose and throat.
The coronavirus delta variant has evolved to be more contagious and more severe than the original virus, or indeed any other variant so far. Lack of stringent controls on people travelling from India has resulted in seeding of the delta variant in the US. Its superior infectiousness has resulted in its rapid domination of new infections all over the US (and indeed, all over the world)– this has happened just in the last two months. Over eighty percent of new cases in the US are now delta type.
Early studies indicate that unvaccinated people are more readily infected and develop more severe disease than with the original coronavirus (COVID-19.) Estimates suggest that some unvaccinated people produce a thousand times as many infectious virus particles in their breath with the delta variant than with the original virus. Infected people may spread the virus to nine others on average (this is the R number), resulting in very widespread dissemination.
This is why the CDC has changed its recommendations for mask-wearing. They now advise even vaccinated people to wear masks in places where infected people might be present– basically all pubic indoor areas. This includes in the presence of unvaccinated children, who frequently have asymptomatic infections and can be contagious without realizing it.
The rate of new infections in the US has skyrocketed, from a low averaging ten thousand a day a month ago to a reported 122,000 new cases yesterday (see the New York Times if you don’t believe me. If you don’t believe them, don’t read this blog.)
Symptoms of sore throat, runny nose, and especially loss of smell are typical for vaccinated infectees. The presence of antibodies in the blood usually prevents the delta variant from spreading to the lungs and systemically. This is a drawback of vaccinating by injection: antibodies are produced in the blood (IgG and IgM) but not on the mucosal surfaces (IgA.) Thus, the coronavirus may gain a foothold in the nose and throat; delta is particularly effective at this. Studies suggest that vaccinations administered intranasally may be more effective at preventing upper respiratory infections.
The evolving knowledge about the coronavirus delta variant tells us that it will be necessary to develop a specific mRNA vaccine that can be administered through the nose in order to most effectively stop the virus from spreading and relieve us of the necessity of wearing masks.
coronavirus photo by Tumisu via pixabay
The Wall Street Journal yesterday published an article describing the current state of the coronavirus pandemic worldwide and saying that we are “back to where we started.” Actually, we have made some progress with the development of a vaccine platform that will help us to build immunity and reduce the severity of infections. However, the emergence of the delta variant– which first appeared in India last November– has greatly accelerated the spread of the infection throughout the world.
The Wall Street Journal article is available here but it’s behind a paywall. If you have Apple news on your iPhone you would have seen the complete article yesterday, but it has probably disappeared by today. I was foolishly hopeful that it would be available online, but no such luck– and it was such a good article, too. If you desire to have me break their copyright (and others as well) by posting copies of such articles on this blog in the future, please let me know in the comments.
Africa has seen rapid increases in new infections with the delta variant, with penetration into areas that had not been affected by the original virus. In Asia, countries like Vietnam (with virtually no vaccines) which had been able to prevent the virus from spreading last year, are now being inundated with new cases.
India has recently seen a decline in new cases and deaths– primarily because roughly three-quarters of the people there have antibodies that indicate they have been infected by the virus. They have apparently reached herd immunity the hard way.
The world’s fourth largest country, Indonesia, has seen an explosion of new cases and is in about the same position that India was in a few months ago. There have been reports of oxygen shortages as well as a lack of beds for COVID patients at hospitals. (See this New York Times article from July 17 for details of Indonesia’s situation.)
China, which had been quick to suppress the virus with draconian isolation policies, is now experiencing barely controlled spread. They report small numbers of new cases daily, scattered all over the country. They do not include “asymptomatic” cases in their case counts, although they isolate all cases and contacts thoroughly. They also have a home-grown vaccine which has been widely administered to large parts of their population, although its effectiveness is significantly lower than that of the mRNA vaccines used in the United States. (This blog has daily updates on case reports and other statistics for China: China-briefing.com.)
The delta variant was recently reported to constitute 83% of newly sequenced virus isolates in the United States. In some other countries, delta represents more than 99% of new isolates. The delta variant is at least 50% more transmissible than the alpha variant, and there are indications that the clinical picture in delta infections is more serious.
As a result of the delta variant’s competitive advantages, it has taken over new infections. Most likely, it is able to establish infection with much smaller inoculates than previous variants, thereby appearing to be more contagious. Thus, delta beats out other variants when spreading from person to person.
The mRNA vaccines currently available are effective against delta, but less so than against the original virus for which they were developed. The vaccine manufacturers will be able to quickly tailor their product to directly address the changes in RNA sequence present in the delta variant, if they have not already done so.
So far, however, there has been no word on a new vaccine– merely discussions of a third dose of the original vaccine. I find this puzzling as the changes needed to tailor the vaccine are so easy and quick to make. Perhaps there has been no awareness of this change at the manufacturer’s public relations department– I hope that is the case.
Or perhaps the directors at the highest levels want to avoid confusion in public. The only thing that worries me is the possibility that there will be bureaucratic resistance and delays to approval of a changed vaccine. There has already been an unconscionable delay in the FDA’s approval of the original vaccine, with the vaccinators operating under emergency authorization to administer hundreds of millions of doses.
Lacking full FDA approval can only further impede uptake of the vaccine in this country. Doses sufficient to inoculate everyone in America are available; some of the earliest-produced material will reach its expiration date soon and will have to be replaced by newly produced vaccines. The main thing stopping population-wide acceptance of the vaccine and development of herd immunity is disinformation from politically motivated people and corporations.
Fox News has made the business decision that maintaining its ratings position as number one depends on maintaining disinformation about the virus. They find that their ratings are supported by lies, both about the virus and about the behavior and motivations of Democratic politicians and the left wing. Rupert Murdoch is killing people with virus lies, stoking false outrage with lies about Democrat’s behavior, and inciting hatred of people who have different political views as well as people of color. He is doing all this because he believes it helps his ratings and thereby, increases prices for ads on his stations– which means more money in his pocket.
The bottom line is that, for the world, the pandemic will spread against all control for the rest of 2021 and most of 2022. Worldwide administration of highly effective vaccines to everyone (or at least 75% to 95% of them) will end this pandemic. The alternative is for health systems everywhere to collapse and for up to a hundred million people to die– then we will reach herd immunity the hard way.
coronavirus photo by Tumisu via pixabay
The right-wing (extreme right) news networks have been spreading lies about the COVID pandemic and vaccines for months. Recently, they have been stepping up their propaganda with more outrageous falsehoods. I won’t repeat them because you have heard them already.
Their reasoning seems to be that the fight against the virus can be framed to their viewers as a left-wing hoax. They pay no attention to the devastation in other countries or to the positive results achieved by vaccination. They are throwing away the advantages that we have obtained in this country by our incredibly expensive research and development programs.
Our government is paying trillions of dollars to drug companies for their new vaccines– and it is worth it– but the money is being wasted because these propaganda outlets are discouraging people from accepting vaccination. They are also claiming that masks don’t work, which is patently ridiculous in the face of scientific data showing that they do– the tighter, the better, and two masks are better than one.
The results are painfully obvious. A winter-spring wave of infections and deaths was temporarily stemmed with mask-wearing and an intensive vaccination program, but now infections are rising again. The new summer wave is apparently caused by the spread of the delta variant (from India) in unvaccinated people, which variant is both more contagious and more deadly than previous variants.
Over 99% of deaths are now in unvaccinated people, mostly being infected with the delta variant. Total deaths have not risen yet, but they are sure to do so. Daily infections, which fell to 10,000 on average in the US, are now back up to 20,000 and will to continue to rise.
Everyone, even vaccinated people, is endangered by the refusal of about a third of the adults in the US to accept vaccination. If current trends continue, infections and deaths will rise again and overwhelm hospitals again.
What is worse, new variants will arise due to the number of people being infected. These will endanger people who were vaccinated because the variants will eventually become immune to the vaccines. New vaccines will be required to counter the new variants and we will have to start all over again vaccinating everyone who is willing.
When will these people learn that the scientists are telling the truth and trying to protect them? Maybe never, given the intensity with which the propaganda against vaccines is being pushed.
Ironically, the owner of Fox News, Rupert Murdoch, was himself vaccinated before anyone else. Why is he allowing his wholly owned “news” company to spread lies about the vaccine? He must think it’s good for his bottom line. The hypocrisy is appalling.
tombstone by Stefan Keller courtesy of pixabay.com
This comes from sciencedaily.com and was relayed via a comment on the New York Times website to an article about illicit drugs in general. The comment was written by “TDHawkes” of Eugene, Oregon on July 9, 2021. The Science Daily article is a popularization of another article published in Genome Research and entered in PubMed, a repository of generally available scientific articles maintained by the federal government.
The Science Daily article states that a new, more complete transcription of the Cannabis sativa genome revealed that the genes for the production of the prized active ingredient, delta nine tetrahydrocannabinol (THC) are contained within a region that appears to be transposed from an ancient virus. This suggests that the cannabis plant did not evolve its ability to produce this ingredient on its own but received its powers through a process known as horizontal gene transfer (HGT).
What is Horizontal Gene Transfer?
HGT occurs when an organism from one species contributes genes to cells of another species, which are then incorporated into the genome. This genome is passed down to all the cells’ offspring as a permanent part of its DNA. This way to pick up DNA is widely understood between bacteria and from viruses to bacteria, but the ability of viruses to give genes to higher animals, including man, has only recently been elucidated.
When genes are transferred through HGT, a species can suddenly get entirely new functions, conferred by complete proteins or sets of proteins. A multicellular organism could theoretically gain a new organ, like an eye or a liver, which it never had before.
Transfer of genes from one bacterial species to another was first discovered in 1928. HGT from a virus to the causative agent of diphtheria was described in 1951, explaining how virulent bacteria can arise from non-virulent strains, sometimes within a single patient who has, at first, an infection with Corynebacterium diphtheriae without any symptoms, but later develops fever and sore throat.
The role of HGT in the development of resistance to antibiotics was discovered subsequently in the 1960’s. It wasn’t until the turn of the century that geneticists learned that large parts of the genomes of higher animals and man contains the remains of many viruses. The ability of human immunodeficiency virus (HIV) to incorporate itself into the human genome was discovered in the 1980’s and was thought to be an anomaly; later research revealed that this incorporation is extremely common.
The presence of HGT in higher animals and humans and its importance as a feature in evolution has not been recognized until the last twenty years. Recently, hundreds of different human genes have been proposed to be the result of HGT from viruses; this proposal is highly controversial.
Horizontal Gene Transfer and the Cannabis plant
Deciphering the genetic map of cannabis has been made very difficult by the presence of millions of duplicated stretches of DNA originating from viruses, resembling puzzle pieces all of the same color. The new study reported by the Science Daily article results from an advance which combines these duplicated stretches into larger pieces with, so to speak, different colors on their edges.
These advances have made it possible to determine that the two major products of the cannabis plant, THC and cannabidiol (CBD), are made by different enzymes, both of which come from a common ancestor gene probably derived from a virus. They also revealed a third product called cannabichromene (CBC). CBC has potent anti-inflammatory properties which have not been well-studied.
There is yet another cannabis product known as delta-eight tetrahydrocannabinol which has largely unknown properties, other than the ability to induce an unusual “high” which is not well-characterized but clearly differs from that produced by THC. This chemical is being actively studied, but it is not clear from whence it comes.
Evolution and Horizontal Gene Transfer
The discovery of HGT and its near-universal presence in all forms of life has caused consternation among classical evolutionary biologists. Once the “tree of life” was a neat analogy that explained evolution and allowed scientists to believe that there was a “common ancestor” that was shared by all species of organisms. Now the “tree of life” has been shown to be an inadequate metaphor; evolution appears to be more like a mosaic or a meshwork of many shared genes that underlie the profusion of different organisms.
Implications for Cannabis breeding
The discovery of separate genes that produce CBD and THC suggests that it should be possible to selectively breed cannabis strains that specialize in producing only one of the two chemicals. So far, breeding experiments have failed to satisfactorily separate the two.
In addition, the experiments show that the many different cannabinoids can probably be separated and may be useful for numerous different medical purposes. In particular, the chemical CBC may be a useful anti-inflammatory product that could be produced entirely separately from THC. This is important because medicine could find another anti-inflammatory very helpful, especially if it has different properties from the other known drugs used for this purpose– with troublesome side-effects that limit their effectiveness.
Caveats
Horizontal gene transfer really exists, but it has been proven only in viruses, bacteria, and unicellular animals like protozoa. Plants also appear to engage in this odd behavior. Higher animals may not have many genes that come from viruses, although those that cause disease (pathogenic viruses) often display the ability to incorporate themselves into the genomes of their victims.
The phenomenon of HGT may thus be unique to unicellular organisms and plants as a factor in evolution. However, higher animals originated as unicellular organisms billions of years ago, and large parts of their original genomes may have been assembled from the genomes of viruses. The telltale tracks of repetitive DNA sequences and other residual elements indicate that horizontal gene transfer was an important mechanism of evolution in the early days that is still used as a method for viruses to infect vertebrates, including humans, to this day.
photo courtesy of Brent Barnett via pixabay.com
Wal-Mart has announced that they will be selling a generic version of analog insulin, sourced from Novo-Nordisk, for $73 a vial, considerably less than the more than $300 a vial normally charged at regular pharmacies. This news appeared in the Los Angeles Times on June 30, 2021, and I read it on the iPhone news reader application. You can also find this information through a google search.
An article in WebMD notes that “advocates complain the price is still too high.” They are comparing the current price to the fact that the patent for the discovery of insulin was sold for a dollar almost a hundred years ago. The price of human insulin in 2001, shortly after it was introduced, was $30-$40 a vial– so it has gone up by ten times in the last twenty years. By comparison, in other countries, human and analog insulin is much cheaper.
Analog insulin is an advance on human insulin; the corresponding human insulins sell for $25 a vial at WalMart.
The motivation for WalMart to sell cheap insulin is complex. They may reason that, once you come to a WalMart pharmacy for one of your drugs, you are likely to transfer all your prescriptions. People with diabetes often taken a dozen different medications. In addition, nowadays both doctors and pharmacies encourage you to get all your prescriptions filled at one place (for several good reasons, too many to detail here.)
Thus, WalMart could be offering cheap insulin as a “loss leader” and accepting a smaller profit from it in anticipation of capturing more business overall. This retail business technique is well over a hundred years old. While the discount is a good thing for consumers, WalMart is likely not doing it out of deep human concern.
We can only speculate what effect WalMart’s move will have on brand name drug manufacturers. A lot depends on whether WalMart will add other drugs to this discounted sales platform. Unless they do, most drug manufacturers are unlikely to feel much pressure to reduce their prices– particularly when many patients are partially insulated by their insurance plans from price competition.
The price of insulin is certainly too high in the United States, leading impecunious diabetics to try to ration their supplies. This problem has been widely documented in the news media and doctors are all too aware of it. Not taking enough insulin is deadly in the long run– chronic high blood sugar causes major complications sooner or later.
People with severe type I diabetes can die in a day or two without insulin, but people with moderate disease can get by for a few months on inadequate doses. Emergency room visits for high blood sugar or its acute complications– diabetic ketoacidosis– are extremely common, especially among patients without insurance or with inadequate insurance.
Depending on your dosage, a vial of insulin will last from a couple of days to more than a month. Doses vary from perhaps 20 units a day to more than 100 units multiple times a day, depending on your needs and level of insulin resistance.
Human insulin is a great advance over the old type of insulin (which has been sourced from the pancreases of cows and pigs for nearly a hundred years.) Human insulin is better because many people develop antibodies to insulin from other animal species, which gradually reduces the hormone’s effectiveness, sometimes dramatically. The old form of insulin, porcine or bovine insulin, is still available for low prices, but it is a poor substitute for human insulin because antibody formation is extremely common.
So, be happy that (relatively) cheap human insulin is available. Be angry that brand-name drug companies are making a killing off of Americans, with insurance or without. Beware of WalMart– their low prices are the result of an employment model that forces employees to take food stamps and other government aid despite having full-time jobs, while their owners are multi-billionaires.
The rest of this post is background information for the average reader about diabetes and its treatment:
What is Diabetes Mellitus? What is Insulin? What is a pancreas? Please comment if you don’t want to know.
Insulin is, of course, a hormone, produced by specialized cells in the pancreas. This organ, an irregularly shaped solid that resembles a lumpy, curved sweet potato (if you are so inclined to look at it that way), produces insulin, glucagon (which has the opposite effect to insulin), digestive hormones, and other hormones which were unknown when I was in medical school 45 years ago.
The pancreas sits on the lower spine, behind the stomach and duodenum, and disgorges its secretions into the upper duodenum as well as into the blood. It is traversed by the bile duct, which delivers additional digestive secretions from the liver and gall bladder and disgorges into the common bile duct. This duct opens into the duodenum through a hole called the papilla of Vater, which has a muscular coat that opens and closes it.
By the way, the gall bladder serves as a storage sac for secretions from the liver. It contracts when you eat a heavy, fatty meal, and sends its contents down through the pancreas into the duodenum. The gall bladder is not an essential organ, and it can become a trap for stones which form when the liver’s secretions become too concentrated to remain in solution.
The pancreas, on the other hand, is an essential organ, without which you cannot digest your food. Even with insulin administration, people without pancreases rapidly become malnourished. “Liver pills” are not a good substitute for bile from the liver because the essential digestive hormones are destroyed by acid in the stomach and never reach the duodenum– which is where the real digestion starts.
Diabetes– the two major types
People develop diabetes through one of two general mechanisms. The first, and most immediately dangerous, is known as Type I or “insulin-dependent” diabetes. In this condition, often with onset in childhood, the pancreas’ ability to secrete insulin is destroyed by an auto-immune reaction following an infection (usually with a virus.) In Type I diabetes, the patient will die in days or weeks if they do not receive injections of insulin. Multiple types of insulin are often given, with short and long onsets and durations of action.
Most people with Type I diabetes receive insulin through a pump or by self-injecting with a syringe (pictured above; the apple is for decorative purposes and is often used to demonstrate injection techniques.) They must vary the dose depending on the blood sugar, their levels of activity, and what they have eaten or are about to eat.
Blood sugar is measured (since the early 70’s) with a device that accepts a small amount of blood obtained by a finger-prick. The new method of following blood sugar is with a disc glued to the skin that accesses blood continuously and sends a wireless signal to your smartphone every five minutes. This device is obviously far superior to pricking your finger (which does hurt) up to four times a day. The device is replaced once a week.
The second major type of diabetes, Type II (previously called “adult onset”) is far more common, representing 90% or more of all cases. The CDC (Centers for Disease Control) says that over 34 million Americans have diabetes– potentially a huge market for WalMart.
As the old name suggests, it usually presents in mature individuals. Unlike insulin-dependent diabetes, however, the Type II diabetic does not respond well to exogenously administered insulin. It appears that the body in these patients has developed a resistance to insulin.
Usually, especially at onset, Type II diabetics are obese and inactive. Their metabolisms are disordered in other ways as well. Type II diabetics often have high levels of cholesterol and lipids (fats) in their blood. They also have a tendency to high blood pressure and “hardening” of the arteries. Patients with Type II diabetes usually have normal or even high levels of insulin, but their muscles don’t respond well to it.
Type II diabetes is ideally managed by significant (>20%) weight loss through dieting and increased activity. When active, the muscles are able to draw glucose (sugar) from the bloodstream without the help of insulin. At rest, muscles require insulin to use glucose.
In the absence of weight loss and activity, a number of drugs help to reduce blood sugar, although they are not very effective. The problem with increased blood sugar in the presence of adequate insulin is that the blood vessels develop deposits of cholesterol within their walls that eventually narrow and stiffen (“harden”) them. In addition, arteries that normally expand when increased blood flow is needed are unable to do so, resulting in impaired circulation and exercise intolerance.
Treatment of the most common form of diabetes– it’s not insulin.
When you give insulin to a Type II diabetic, it does reduce blood sugar, but it requires much larger doses, and patients often gain weight as a result– rather than losing weight as you would wish. Giving insulin to a Type II diabetic person is, or should be, a last resort, when all other methods have failed and the blood sugar is still way too high.
When the blood sugar is high enough, the kidneys are unable to retain sugar in the blood and instead release much of it into the urine. In severe Type II diabetes, this loss of sugar into the urine may result in unintended weight loss. Frequent urination may be the only symptom of Type II diabetes, as the loss of sugar forces the kidneys to release more water to go with it.
One new type of pill for treatment of Type II diabetes lowers the kidney’s threshold for releasing sugar into the urine. Impairment of glucose retention results in high levels of sugar in the urine, even with relatively mild high blood sugar. Only if the blood sugar is perfectly normal is the kidney able to retain all of the blood sugar.
This pill is surprisingly popular although its potential side-effects can be devastating. The most common side effect, unintended weight loss, may be welcomed, but it indicates a significant imbalance in nutritional status. Chronic sugar in the urine often causes yeast infections of the vagina, penis, and genital skin.
Bacterial infection of the perineum (skin of the area around the genitals) is said to be rare, but is vanishingly unknown except during treatment with this type of drug. The perineal infection, while rare, is deadly, and is known as “Fournier’s gangrene.” (any disease with “gangrene” in the name has got to be bad.)
The kidneys also develop thickening of their filtering membranes with high blood sugar, which impairs filtering ability. It appears that deposits of glucose-altered proteins cause this thickening. Blood sugar gradually attaches itself to body proteins, and when sugar levels are high, this occurs more rapidly.
Proteins normally have a few sugars attached to them in precise places. However, with high blood sugar, the attachments are random and chaotic. With extra sugar attached to it, a protein cannot function as well and eventually must be replaced through repair mechanisms that the body normally uses to replace damaged molecules and tissues.
There are other metabolic consequences of high blood sugar, too numerous to mention in a popular blog post like this one. I will limit myself to saying that high blood sugar damages many organs faster than usual, and the body’s normal repair processes cannot keep up with the damages– which results in accelerated aging.
The eyes are another vital organ which is damaged, worse with time and higher sugar levels. One’s vision is altered by high levels of blood sugar, so that spectacle’s corrective factors change. This is noticeable to diabetics, who find their eyeglasses don’t work the same when their sugar is high.
In Type II diabetics, the most dangerous thing is that there are no symptoms to tell you that your sugar is high until it gets so high that you become drowsy. In Type I diabetes, the most dangerous thing is that your sugar could get too low if you take too much insulin, causing you to become hungry, shaky, and then pass out.
photo courtesy of “Meine Reise geht hier leider zu Ende. Märchen beginnen mit” and pixabay
Last time I posted, my right arm was in a splint, because of a fracture of the humerus I sustained in a fall. Since then, I spent six days in the hospital with a mistaken diagnosis of “septic shock” and “pneumonia.” Obviously that was wrong, because I would have likely died with those diagnoses. Perhaps I will blog later about my experiences in hospital, although I can tell you it will not be a pretty story.
Instead, I went to an orthopedist, a wonderful lady named Dr. Lee, who performed an outpatient ORIF (open reduction and internal fixation) and sewed my biceps muscle back together. The muscle had been lacerated by the fracture fragments.
She told me that I would definitely have had a fracture nonunion because of the size and displacement of the fracture fragments– unless I had the ORIF. I looked at the Xrays and she was certainly right. I now have a beautiful scar on the front of my right biceps, about ten inches long. No stitches– they used glue to approximate the skin edges after finishing.
I have been working on my range of motion, which is much improved although not quite normal. As you can see, I am able to type with both hands. Unfortunately, an incidental finding was arthritis of the right glenohumeral joint, of which I was not aware. My shoulder and lower neck still ache, although this is improving also.
I was assuming an eight to twelve week period of disability but this was much reduced by the surgery (as opposed to wearing a splint for the entire time) so here I am.
I am enticed to blog again because I learned yesterday that Wal-Mart is going to start selling human insulin for about a fifth of the usual brand name price. See next blog entry for details.
Thanks to nobody for commiserating with me… I’m so much a loner that only my family members have been aware of my situation and this blog (which is almost ten years old) has no followers. So if you’re reading this, please comment so that I will know someone has read it.
photo courtesy of pixabay and IAOM-US
a personal note
I fell on Friday night and broke my right mid-shaft humerus… Spent five hours in ER and got a hanging splint. Very, very painful still, but gradually getting better. Can’t use my right arm fir anything, typing with keyboard in lap. Delayed dentist visit for a while. Google says I need a Sarmiento splint in a week or so but like no surgery. Takes a long time (eight to twelve weeks) to heal without surgery.’Can’t tyoe si good. Will send more later. Love, Conrad. ps don’t think my luck is very good since car crash on december 27, 1999.
(fiddler by moshe haron via pixabay)
Conrad Theodore Seitz 