#1344 Screen For Type 1 with Dr. Blevins
Dr. Blevins discusses the importance of screening for type 1 diabetes.
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Scott Benner 0:00
Welcome back, friends. You are listening to the Juicebox Podcast.
Dr Blevins has been on the podcast a couple of times. He's talked about GLP medications, inhaled insulin, and today, he's going to share with us the importance of testing for type one diabetes. Please don't forget that nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your health care plan or becoming bold with insulin. Are you an adult living with type one where the caregiver of someone who is and a US resident, if you are, I'd love it if you would go to T 1d exchange.org/juicebox and take the survey. When you complete that survey, your answers are used to move type one diabetes research of all kinds. So if you'd like to help with type one research, but don't have time to go to a doctor or an investigation and you want to do something right there from your sofa, this is the way t 1d exchange.org/juice, box. It should not take you more than about 10 minutes. If you're looking for community around type one diabetes, check out the juice box podcast, private, Facebook group, Juicebox Podcast, type one diabetes.
This show is sponsored today by the glucagon that my daughter carries, gevok hypopin. Find out more at gvoke glucagon.com forward slash juice box. This episode of the juice box podcast is sponsored by the Dexcom g7 the same CGM that my daughter wears. Check it out now at dexcom.com/juice box. This episode of the juice box podcast is sponsored by us Med, us, med.com/juice, box. Or call 888-721-1514, get your supplies the same way we do from us. Med, all right. Dr Blevins, welcome back. I appreciate you coming back on the show again. How have you been? Hey,
Dr. Blevins 2:13
good Scott. It's good to be here. I've been I've been doing well, excellent,
Scott Benner 2:16
excellent. I asked you back today and you were interested in talking about screening for type one diabetes, which is kind of all the rage at the moment, and I was hoping that you could help me to understand why it's so important.
Dr. Blevins 2:29
Yeah, be happy to I think it's a really big deal that people start really moving toward the screening, because there's some really good reasons for it, and the reasons are getting better and better, and I think people need to be as educated as possible about about who may develop type one diabetes, and pick things up as early as possible. This is a concept in medicine in general, is pick up things early screen, find out risk. And I think it's the entering the the real world when it comes to type one diabetes. And I think everyone out there should be very, very very educated about this. Do
Scott Benner 3:03
you think that it matters if you have type one in your family line or not? Do you think everyone should be screened?
Dr. Blevins 3:12
You know, when it comes down to it, the people that have the highest risk are people who have diabetes in the family line, or they're called first degree relatives, which means, like brothers, sisters, children, parents, people, and even even probably second degree but that's the highest risk group. And I'll, I'll point out probably a little in a little bit, that that's certainly not going to get everyone, by any means, but that's a really good place to start. Okay, and people with diabetes are in the driver's seat. They can tell their family, hey, you need to get screened. They can get their kids screened. They can tell their brothers and sisters, and, you know, family members get screened and find
Scott Benner 3:53
out, yeah. So I guess the most obvious reason to know ahead of time is to not be in DK at the time. I was gonna say that hits the fan, but sort of when you know push comes to shove and diabetes is here, you can be ahead. I mean, do you see that as the as the first reason for knowing?
Dr. Blevins 4:10
Yeah, you should say when the ketones hit the fan. I think that might be more more okay, but the answer is yes. A few years ago, a study showed that 60% of people in this country were in DKA when they found out they had type one diabetes, and would sure like them to to know sooner than that. That's that's a traumatic event, and in the hospital, sick as they can be. I mean, sometimes ketoacidosis can even kill you and and so you don't want to wait until that time to find out you have type one. There's some studies around the world in which people were screened. Children were screened either because of risk, like family history, and there was, there was one study that just screened everybody, and The finding was that when people are are found to have the risk, that means the positive antibodies. And this is kind of a, know, your antibodies concept. Then they knew, and they could, they could check themselves, and when their sugar started going up, they got it treated. And it was insulin, of course, instead of just not knowing anything and suddenly having the symptoms, the weight loss, the frequent urination, the drinking a lot of water, you know, the typical ones that and then end up in the hospital. So, yeah, it makes a difference. I
Scott Benner 5:23
found that over the last year or so, I'm hearing more people talk about the stages of type one, and I have to admit that prior to us paying attention to screening, I never really heard people talk about that so much like, are you? You're in stage one, stage two, stage three. Can you break down for me what those are, yeah, sure, stages
Dr. Blevins 5:42
of type one diabetes. And, you know, we know about type one diabetes. We know about type two. We're not talking about that. We're talking about stages of type one. And this does lead to a level, I think, of complexity, because it requires that people kind of memorize some more numbers and some more characteristics, but you start staging things when you start finding ways to intervene and interact. So that's always a good thing. And so stages of type one. Now remember, each one of these stages technically would equal the diagnosis of type one. There's stage one. Stage one is also, or might be called pre symptomatic. Stage one is when the blood sugar is completely normal, but the person has greater than, or equal to two auto antibodies. So you have to have the antibody testing here to even diagnose stage one. So stage one, the sugar can be normal. It is normal, and you can still say the person has type one if they have greater than or equal to two antibodies. We'll talk about the antibodies here in a minute. And then there's stage two. Well, stage two is a progression from stage one, and these people have greater than or equal to two of those antibodies that we'll talk more about. And now they have blood sugar elevation, but they don't have the elevation you would normally associate with diabetes. They have an elevated fasting sugar and it typically is going to be between about 101 25 and you know that 126 and above equals diabetes. So these are people that are in this kind of like pre diabetes blood sugar range. They have the antibodies, so they're not they don't have normal glucoses. They don't have diabetes Range glucoses. Yet they have the antibodies, and they have this kind of pre diabetes picture. And if you do an oral glucose tolerance test, these people will have glucoses that fit into the we called impaired glucose tolerance range and and then stage three. So let me just summarize that one again, antibodies plus glucoses that are elevated, but not in the high range, not in the in the diabetes range. Stage three is now, okay, greater than, or equal to two antibodies, and now you have high blood sugars, and you could, you could be diagnosed having diabetes because the blood sugar, the fasting being over 126 could be diagnosed if the glucose is greater than 200 after a glucose tolerance test at two hours or just high, and the A 1c is typically elevated over or greater than equal to 6.5 that's stage three. And I'll back up a second say the a 1c in stage two is going to be in the pre diabetes range, which is going to be 5.6 up to about 6.4 Okay, greater than 5.6 up to 6.4 so those are the stages, and the bottom line is each stage requires, well, at least stage one and two. When you have stage three, the antibodies are helpful, but you have diabetes already, and So stage one and stage two do require antibodies to be measured. Does
Scott Benner 8:43
everyone who enter stage one make it to stage two? I have always disliked ordering diabetes supplies. I'm guessing you have as well. It hasn't been a problem for us for the last few years, though, because we began using us Med, you can too us med.com/juice, box or call 888-721-1514, to get your free benefits. Check us med has served over 1 million people living with diabetes since 1996 they carry everything you need, from CGM to insulin pumps and diabetes testing supplies and more. I'm talking about all the good ones, all your favorites, libre three, Dexcom, g7 and pumps like Omnipod five, Omnipod dash, tandem, and most recently, the I let pump from beta bionics, the stuff you're looking for, they have it at us. Med, 88887211514, or go to us. Med.com/juicebox, to get started now use my link to support the podcast. That's us. Med.com/juice box, or call 888-721-1514, you can manage diabetes confidently with the powerfully simple Dexcom g7 dexcom.com/ Juicebox. The Dexcom g7 is the CGM that my daughter is wearing. The g7 is a simple CGM system that delivers real time glucose numbers to your smartphone or smart watch. The g7 is made for all types of diabetes, type one and type two, but also people experiencing gestational diabetes, the Dexcom g7 can help you spend more time in range, which is proven to lower a 1c The more time you spend in range, the better and healthier you feel. And with the Dexcom clarity app, you can track your glucose trends, and the app will also provide you with a projected a 1c in as little as two weeks. If you're looking for clarity around your diabetes, you're looking for Dexcom, dexcom.com/juicebox,
Dr. Blevins 10:47
the answer is a very high percent. If you look at, if you look at like lifetime risk of developing diabetes going from stage one to stage two, and then stage two, stage three, it's it's up there if a person has greater than or equal to two auto antibodies, their risk of developing. And this is with just, this is a stage one and stage two. And some people say there's pre stage one with might be one antibody, but forget about that. We're talking stage one and stage two. Yeah, about 44% go on to have diabetes in five years, 70% in 10 years and lifetime risk. 100% if a person has greater than or equal to two auto antibodies, whatever stage they may be in. So some people ask me just what you ask? And they say, well, I might have an antibody or two, but I may have two antibodies, but Will I really go on to have diabetes? And the answer is, yeah, you will in some medical conditions, people can have antibodies, and they don't go on to have the the manifestation, but in this one, the data says you do. And
Scott Benner 11:49
so we're testing now because there's something that can be done about this to kind of slow down the progression.
Dr. Blevins 11:55
You know, we're testing now for that reason that you mentioned, and that is, yeah, Scott, you mentioned earlier about preventing DKA, which is a big deal. We're testing so that we can tell people, Hey, your sugar is going to get high. We can't tell you when, but you better watch out and start measuring it and be attentive to it, and that will help you prevent DKA. That's, that's, that's a big reason, right? The other reason is that there is a medicine currently that is available that is approved to delay diabetes in people who have stage two. So you have to have stage two, remember the antibodies and the kind of pre diabetes numbers to qualify for it. But it delays and it delays it for forever. No, we don't. We don't know that. We don't really know how long it delays it. We do know that if you look at time to progression to the next stage that is over diabetes, it was an on an average, four years, and people who were treated with that medicine, and it was, it was two years of people on placebo. So you know, nice prolongation, delay, nice delay. Did it prevent? We can't say that at all, and we don't even know the long term. Do we need to retreat people? It's a one time treatment, but now we have a medicine that can delay the onset of going on to have stage three or to have overt diabetes, and that's another reason to screen and there are quite a few studies going on currently, not as many as would all like, but a few that are testing other agents. And if people know they have antibodies stage one or two, then they might get into one of those studies if they elect not to take the delay treatment. So there's a lot of rumble in this space, and the pre kind of pre stage three diabetes type one. If a person knows their antibodies and knows their status, they they're in the driver's seat too, they get to kind of make a choice, yeah.
Scott Benner 13:50
So not only just quality of life in the short term, but if you're one of those people who has a very, very slow onset, and you're living with average blood sugars in the 120s but you aren't into the 126 I mean, you are degrading, right? You're doing damage to your body. Yeah, yeah, yeah. And just because you don't maybe feel it in the moment, like, maybe it's like, Oh, I'm tired a lot. Or, you know what I mean, like, something that you can write off for something else. It doesn't mean that as time collects, you're not going to wake up one day and either, of course, boom, have diabetes or have other issues that come from elevated blood sugars that don't qualify as diabetes in the moment?
Dr. Blevins 14:26
Yeah, I really agree with that. Yeah, not only just power. And I used to hear, Well, I don't want to know, because there's nothing I can do about it. Number one. Number two, I don't want to test my family member because that might make them, you know, upset. These are various reasons that people have given to say, not screen. I think all of those. I mean, I do understand those reasons, and people have their reasons and that they're they're in charge of themselves. Bottom line, though, really now there are reasons to know, and they're better and better reasons to know prevent. And I know this is kind of redundant, but certainly worth. Saying it over and over again, prevent DKA. Maybe get involved with the medicine that might delay, maybe get involved in study, or maybe just know, you don't have to do any of those things, you just know and prevent DKA. And, you know, get get ready, and get everything kind of organized and all that. Yeah,
Scott Benner 15:18
is there a reason I'm thinking of this one episodes that I that I've done in the past. This gentleman 50, I think he's 50 years old. He's diagnosed type one, and he uses insulin, you know, for six years, sure. And then one day, his doctor suggests maybe you should take Manjaro for your weight, and maybe it'll help you with some of your insulin resistance, right? And now he hasn't been on insulin for a couple of years. Now, he's got type one diabetes. He's got the he's got his antibodies, you know, yeah, yeah. And he fully expects that one day he's going to be back using insulin again. But now he's, he's got this moment in time where, you know, something else is helping him. And what I mean that's something else could be any number of things, because I think the idea is, I don't know how to say this, like, I don't want to, I don't want to seem like scary. But like, if you were driving in a car, Dr Blevins, that you were going to go off this cliff 60 years from now, and I could do something to make you go off the cliff 70 years from now. Like, let's do that thing. Sure. Yeah, right. Like that to me is, it's a lot. I'll say again, it's a lot about your quality of life in the moment, but it's also a lot about, you know, a long and healthy life as well. I love the idea of knowing, and I do take your point, and I agree. There are some people who might just say, for my own mental health, I can't, I don't think I could know this information right, right, personal decision for certain, yeah, but anyway, it's just kind of how I think about it, I guess, yeah, I think people still
Dr. Blevins 16:45
make that decision. They'll decide they don't want to know, but it's but I think it's important they they be educated to say, hey, you probably really ought to know, because just what you said, we can, no matter what we decide to do, it's good to know. And why not? And so I think, I think that that sort of not wanting to know is kind of a bit of a mindset, and it's kind of ingrained a little bit. But I think this is the time to get everybody off that, that center and say, hey, you need to know. And you need to screen everybody in your family so they can know, yeah. And you know, screening is not the screening also is not over at the at the first screen. You have to keep looking every so often because things change. This is truly the dawn of a new era. And I think everybody, once they kind of understand that, will get on board with that too. And I hope everybody becomes advocates, because it really, I'd like to a stone. You have to really push it hard and get it moving, and finally, get some momentum, and it starts rolling on its own a little bit. This is big, and it's a dawn of a new era. It's a whole nother angle. The current organizations like breakthrough type one diabetes totally behind this idea of screening and trying to delay and trying to discover other treatments that might delay and maybe someday, prevent, yeah,
Scott Benner 18:01
that'd be awesome. So what are the risks of developing Type one? If you have a first degree relative that has type one,
Dr. Blevins 18:07
yeah? And this is one of those, know, your numbers things, and you get to, get to decide which number you want to know. I would let me advise everyone to there's so many different numbers and drive you a little crazy. But you know, if a first degree relative has type one. The person's risk of having type one versus the general population is about 15 one five times normal. So that's one number. And to me, that's That's enough 15 times. And then another way to look at it is, what about certain family members? Well, we have data if a person's mother has type one, their risk is about 3% of course, the in the population of people who don't have relatives is like quite low at 0.4% the 3% may not seem like a high number, but relatively speaking, it is. And then if the father has type one, it's about 5% for some reason, if the father has type one, the risk of the offspring is a little higher, and then sibling is about 8% we can go on and on, but know your number. I like the 15 times. And there are other ways to look at this too. I could drive you a little batty. I
Scott Benner 19:12
have a question, though, based on my my experience talking to people, is there data for if both parents have an autoimmune issue, but not necessarily type one.
Dr. Blevins 19:21
You know, your points are really well taken, and that is that other autoimmune conditions other than diabetes also would signal increased risk of autoimmune glandular like diabetes. But do we have data on that? Not that I know of, but your point is so true that if family members so the so that you might say, the the straightforward screening group would be to screen the the offspring first degree relatives, or, you know, they might be offspring of people with diabetes. Screen them. That's where you get the biggest bang for your buck, in a way. But 90% of people with diabetes, type one do not have. Have a positive family history? Well, wow. So how do you find them? Well, you do what you said. You look at people who have other autoimmune conditions, like Hashimoto, thyroiditis, your thyroid, adrenal autoimmune even like celiac, things like that, even rheumatoid, yeah. And then if you have a lot of that in the family, then your risk you would, you know, logically, would be hired to even have another autoimmune condition like type one. Not much data on that, but clearly that's another group to go after and screen the offspring or first degree relatives of those people. People have those conditions, and still, there's a lot of randomness too. The only way to pick up everybody, and everybody who might be not developed type alone would be to screen the entire population. And that's not going to happen right now. And there are people talking about that doing screenings of children like every child right now. That's not happening. I mean, that's a really interesting thing to think about food for a lot of thought, but, but not food that we're going to eat today. So what you can do today is screen people who have family history. And you're right, people who have a history of other autoimmunity should be screened as well. How
Scott Benner 21:10
does ethnicity play into this? Yeah,
Dr. Blevins 21:12
ethnicity, you know, I think, I think people have the concept that the people with type one mainly are people who are Caucasian. And in fact, it is true that 72% of the type one population in this country, it would be considered non Hispanic, white. And interestingly, though, and this is where these these misconceptions, get busted, about 15.7% of the type one population is Hispanic. And then non Hispanic, Black, 9.3% and Asian, about 2.4 so, you know, there are lots of misconceptions, and that's one of them. And so think about type one, really any ethnic group, and the growth in the type one the greatest growth, when you talk about relative growth, is in the Hispanic and the non Hispanic black group.
Scott Benner 22:06
You know, I want to go backwards just for a second, but we talked about, hey, maybe if either thyroid or other autoimmune in your line. But does that open you up to be eligible for screening? Like, who do they say no to at the moment, do you know what I mean? Like, what I mean? Like, what do you have to have on your on your chart for someone to say you're eligible to be screened if you take insulin or so faucinyas, you are at risk for your blood sugar going too low. You need a safety net when it matters most, be ready with G vo hypo pen. My daughter carries G vo hypo pen everywhere she goes, because it's a ready to use rescue pen for treating very low blood sugar in people with diabetes ages two and above that. I trust low blood sugar emergencies can happen unexpectedly and they demand quick action. Luckily, jivo hypo pen can be administered in two simple steps, even by yourself in certain situations. Show those around you where you store GEVO kypo pen and how to use it. They need to know how to use jivo kypo pen before an emergency situation happens. Learn more about why GEVO kypo Pen is in Arden's diabetes toolkit at gevok, glucagon.com/juicebox, gvoke shouldn't be used if you have a tumor in the gland on the top of your kidneys called a pheochromocytoma, or if you have a tumor in your pancreas called an insulin OMA, visit gvoke. Glucagon.com/risk. For safety information,
Dr. Blevins 23:38
yeah, you know something we by the way, we're still learning what that answer is. Okay for the most part, the diagnosis of family history of diabetes or auto immune disease or endocrine disease is probably the best diagnosis code to use. And because you're screening the person who doesn't have a condition and you're trying to find out if they do and what you said is so true, we're learning. We know what to do. We know what tests to do. How do we get those covered for people so that they can do them without great difficulty? That's another, another challenge that's been worked on. And I'll mention something here in a minute, anytime you want me to about particular effort that looks like it's fairly cost, effective and relatively inexpensive that would allow large numbers of people, even if they don't have coverage, to get covered. We are still making our way through that one. Number one, there's a cost certainly, to the antibodies. And number two, we'd like to get them covered. We want to know. We don't want cost to get in the way. I'm just talking about the collective we in the medical world and the people who have diabetes, we don't want costs to get in the way of having people do what they should do. And so we're still learning about that.
Scott Benner 24:50
Okay, I want to know about the antibodies. There's five. Is that right? Or six? There are five? Oh, no, wait, five.
Dr. Blevins 24:56
Okay, well, there are four good ones, and they're five. And. And I'll kind of give you a bit of a coverage of those. There's the the anti insulin antibody, and that's a good one. There's a gad antibody, Glutamic acid decarboxylase. That's a really good one, too. And then there's the antibody called the insulinoma associated antibody, and that's a good one. And then there's a zinc transporter, all these strange names. So gad antibody, insulin OMA associated antibody to insulin, anti insulin, antibody, zinc transporter. Those are the best four. Then there's one called the islet cell antibody, and we do that one, but it's probably the least accurate of the whole group. Okay, and so do the more antibodies you do, the better clarity you get. And the there are different panels that are run by different groups. And in our own office here, we run the four that I mentioned, but not the islet cell, because those are, we think, the most accurate. And that's kind of what the literature would say. There's a group called trial net, and they're around the country, and they'll do antibodies too, because they're looking for people. They're really looking for people that have this stage two. And they're also, you know, enrolling people in studies, and they do the GAD and the and the anti insulin antibody. And then there, there are various groups. The Barbara Davis group in Colorado will provide a screening kit to people, and they do all of the four antibodies that I mentioned. They too exclude the islet cell antibody. And then there are various groups that that offer screening. If you want to do screening, you know, what do you do? We can talk about that whenever you'd like to know. I
Scott Benner 26:46
would like to know more. I also want to say that currently, as we record this screen for type one.com, is a sponsor of the podcast. I just want to be, I want to be, Oh, good, like clear about that, so that people, okay, yeah, that
Dr. Blevins 26:57
is excellent. Because I was about to say, if people want to go learn more about screening, they can say they could go to, I have it written down right in front. We screen for type one, and the musician, a very well known musician, has jumped in to help increase awareness. And that would be Usher. Usher is there, you know, go on that site and take a look, and it'll also let people kind of sign up for a screening kit and tell them what the cost would be based on their insurance. I mean, I can't go into great detail about that. You really have to go on the side to figure that out, but, but I've give that even more AirPlay screen or type one.com. That's the site. I believe
Scott Benner 27:38
that that is it. Yeah, they've been with me for a bit now. And good,
Dr. Blevins 27:42
yeah, I didn't know that. Yeah, that's good to hear. Because, you know, when it comes down to it, we're talking about screening, and how do you do it? You know, if I see a patient in my office who has type one, I'm gonna say you should get your kids screened. You know, do it? Can I order it? I don't see their children. I don't, I can't do that. I can't order it, but I can recommend it. Some people I see have relatives who have type one, and I'll say, Hey, I'm going to do a screening on you. Or I see a person who has an elevated blood sugar, and I decide you're going to get screened. But they're not, they're not diabetes range yet, but, and maybe they are, but I'm going to, I'm going to screen them, if they're my patient, I can do that, and I can write the diagnosis code that that I find to be the most useful, but I can't order screening and people that are family members. So what do I do? Well, I have a little sign on the back of one of my doors, and it says, Here, the antibodies you should get done talk to your doctor. But another way to go about that is to go to that site, screen for type one com. That kind of a site is going to help us all get people screened and really kick up the gain. And there'll be other ways to do it in the future, and everybody's struggling. This is a kind of a new site. Don't have a new era. New things have to be learned and have to be developed.
Scott Benner 28:57
How often do I get so if I say I don't know, I have my my child's screen, they don't have any antibodies. Do I do it again? Or is once enough?
Dr. Blevins 29:08
That is a really, really important point. And the answer is, if they're negative, or you might ask yourself, are you home free? And the answer is, no. Do we really know? The final answer is that, how often someone should be screened, not really, but the current, current suggestion is re screened in a few years and and keep, keep looking, because these antibodies can crop up at different times. And also, what about people who have antibodies positive and they don't have type full, full blown stage three? There's a consensus guidance that's been recently published, this whole science is starting to grow, and essentially says, well, re check their glucoses routinely see if there's any sign of progression. They might want to get into the treatment that we talked about. They might want to get into a study, and it goes through this whole list of kind of follow up, because, no, you're not home free once you have. A negative test, and that's an important bit of information, yet you want to keep checking. We do the final answer to all this is not totally clear.
Scott Benner 30:08
You know, if a person screened, they're found to have these auto antibodies, then they're going to go forward with the medication, like, what's available right now the
Dr. Blevins 30:16
medicine? There's exactly one medicine that's available that is approved to delay type one diabetes, and it is the medicine to please a map and it's all the brand name is the T sealed Med, so that's the one that I mentioned earlier. Was was shown to delay the time of progression to stage three about on average, four years, and the group of people treated versus two years in the people who were on placebo, remember, these are people with essentially stage two. They don't have diabetes yet, but we know they're going to progress on so the people that were treated median time, that is more or less the name time without progression, four years versus two four years, two more years on average of no diabetes, no progression to stage three.
Scott Benner 31:04
Does science know how it works? Or is it just one of those things we know works, and we're not sure why
Dr. Blevins 31:11
science thinks it knows. Actually, this drug, teflizumab, is an anti CD three monoclonal antibody, and let me just explain that a little bit, T cells in your body identify beta cells that make insulin as being foreign, as a mistake, and then they attack them, and they attack them and they attack them until they knock them out. And that's why it takes time. It takes time. There are millions and millions of beta cells, but they have to be knocked out for the most part, to per person they have high blood sugar. This drug is an anti CD three antibody. What it does is it interacts with a component like a one of the regulators of the T cell. Now, T cells are in your body, they help you. I mean, they protect you from foreign things and things you don't want in your body. But they're making a mistake here, and they're attacking one of your own cells. Not good but, but it's what happens. Well, if you go in and and have an antibody that sort of goes against one of the regulators of the T cell, the CD three, then you can deactivate those T cells, and you can cause them to be sort of exhausted and and that's what T cell does. It interacts with the CD three part of the T cells, inactivating them, not all of them, of course, but knocks them down. That kind of slows that process way down against the beta cell, and allows the beta cells to hang on longer, and and so that's what it does. Okay,
Scott Benner 32:49
that's awesome. That's and you say there's other drugs too that are under investigation at this point? Or No,
Dr. Blevins 32:56
yeah, there are other drugs, and there are other drugs that are being investigated. And I can, I can tell you that the breakthrough type one diabetes group you know, which is, of course, you all know, was the JDRF, and they renamed, right? Is looking at another drug called beracitinib. It's a it inhibits a different component, but same idea and and so there are other drugs that are being studied. And I can tell you that, though I know nothing about this there, I know there are other other ones following behind. Also they're going to be looked at. So
Scott Benner 33:30
if a person's in stage two, they qualify for T sealed and then it's, I guess, you know, that game of going through insurance and whatnot. But then once, once they're you're okay for the drug. What's the process of of getting
Dr. Blevins 33:44
it? Yeah, you have to have just the right criteria number one. So you're talking about, how do you get the drug? It's not straightforward. It's actually, the process is straightforward, but it's a fairly expensive med. It costs, like, I think, about $200,000 per treatment. And I'll tell you more about the treatment in a minute, too. But so you have to go very carefully through the approval process, and then the company has, you know, some things they can do, and insurance companies look at it very carefully. It's a brand new it's not brand new as much as it's just very still low usage, and they're going to spend a lot of time. We've treated one person here, and I have another person who's hopefully in the wings to be treated soon. And it's a slow process. And when, when people are waiting, I tell them, hey, check your blood sugar. Keep me informed. But, but it's, it's, it's something that has to be approved by the insurance. It takes time. Then this is a treatment that's an IV administrated medicine 14 days in a row. You have to have a place that can can treat people on Saturday and Sunday for at least a couple couple times, couple weekends. And that's that's very doable here, but it's not doable everywhere. And so there are certainly factors. Yeah. And then the medicine does have potential side effects, and those have to be monitored for. So it's a process, yeah?
Scott Benner 35:07
And so what? What are the common are there common side effects? Or no? Yeah,
Dr. Blevins 35:11
there actually are one side effect that I'll mention that is occurs in about 2% of people, which is the low percent, but still happens is cytokine release syndrome. That's just simply, when you give a medicine like this, you get the release of a lot of kind of inflammatory substances from the T cells and from the immune system. And that can lead to like fever, rash, nausea, vomiting, and can be disturbing. It also could lead to elevation of liver tests and things like that. This medicine could with the cytokine release syndrome. So these things all have to be monitored for. They're kind of ex they're not like expected, like, where it's going to happen is 2% of people, but it's not a it's not an allergy, it's it's a reaction to the medicine. So with treatment, we're going to monitor the liver test, and if they go up a certain amount, we're going to stop the medicine. We watch the white blood cell count. They can drop. We watch the lymphocytes, in particular, because they can drop. And if they dropped a certain level, then we would stop the medication. There's a somewhat of an increased risk of infection when people are getting the medication. And the good news is that lymphocytes tend to rebound. And those are, those are symptoms that are manageable. We give people anti diuretics, you know, like acetaminophen, for example, or non steroidals too. And we give people anti nauseals. Those are ways to mitigate the symptoms. So the top four adverse reactions are going to be lymphopenia. That happens. That's the lymphocytes, the white cells, and then they do fight infection. So we don't want them to go too low lymphopenia. About three quarters of people rash can happen in about 35 36% and leukopenia, that means low white blood cell count, 21% or so in a headache too. And so those are all things that we we know can happen. It doesn't mean there's an allergy. It's a reaction to the medicine. That's that's kind of expected, and we just have to, kind of get people through that. You have
Scott Benner 37:19
one person, you said, who's been through the process, and one person you're trying to get set up for does anything about the possible side effects stop you from suggesting it to patients. You
Dr. Blevins 37:28
know, I'm an endocrinologist, and I'm not really all that used to using immunologics, although some of the medicines we use are monoclonal antibodies. Like to treat osteoporosis, for example. And when I first looked at this, I thought, gosh, those are some side effects I want to be really careful about. But the truth is, with proper monitoring and with the right place to give the infusion that is a an infusion, we use an infusion center here in Austin, and it's been doable. We know that there are certain, certain side effects that are potential, and so we're prepared. And the, you know, there, I guess there could be surprises, but we're always ready for that. But, but this is outpatient. People walk in, get the infusion, they go home, and they go back the next day. They do it for two weeks. It's an infusion for two weeks. You know, the pause that I had initially is kind of his past, okay? And I educate the people very carefully. The person that's waiting right now, talk to her very often about the potential side effects, and she's very aware, yeah, you're a proponent,
Unknown Speaker 38:32
absolutely. Yeah, yes, I
Scott Benner 38:34
listen. I used to have to get iron infusions. And you know, the first time somebody says it to you, you're like, Well, it sounds frightening, but then it's, it's not, you know, I don't, actually, I don't have to get them anymore, since I've been on a GLP med. But that's a different thing, yeah, but, but nevertheless, it's just, it's not as, not as scary as you think it is. Is like, I guess my point, I
Dr. Blevins 38:55
know what you're saying. Iron is different than this. This is a immunologic and a CD three antibody. But you read through the side effects of iron infusions, you saw that it could cause probably a reaction at the at the infusion site, it could cause a diffuse reaction. There are things that these infusions can do, and I think it's really important for the person who's being considered for this to be really assertive about finding out all the potential side effects and be ready, sure, and that that's really, really important. Yeah,
Scott Benner 39:25
I'm not comparing the two. I just even met. The idea of going to an infusion center seems kind of like off putting, you know, yeah, yeah, no, I understand, yeah, but it's not, it's just, it's not bad at all. And you have this great thing of being in a place where these people do the same thing over and over again. They're very at least in my experience, they're good at it. They know what they're doing. It runs well, like that kind of stuff. They are, yeah, they
Dr. Blevins 39:46
are. And that we're really happy with the infusion center that we use, because they that's what they do. They do infusions, and they infuse all kinds of different things. So they are quite ready. I think some practitioners might end up doing their infusions in their office. Us, and that's okay, too, as long as you monitor people and check blood pressure, check temperature and essentially walk in and walk out. So different offices are going to come up with different ways of doing it. Some people may do it in the outpatient facility at a hospital, which is essentially the same thing as an infusion room, and there are different ways that this will be administered, and the
Scott Benner 40:22
possible side effects, they exist during the infusion, but once the infusion time is over, are they there's no side effects? Left? Is that right?
Dr. Blevins 40:30
Well, that is true, although you could still see some white count changes later on. The rash could even continue on well past the time of of the administration liver test elevations could occur later too and continue and so we continue to monitor people for a few weeks. Most. For the most part, any of that effect is going to be gone after two to four weeks. But it is important to not only monitor during the infusion process, but also after for a few weeks. Gotcha?
Scott Benner 41:01
Okay? Yeah. Dr Blevins, is there anything we haven't talked about that we should have?
Dr. Blevins 41:05
I think one thing that I found that's important for people to realize too, is that we talk about screening and and some people have the idea, well, people over the age of 20, they can't get diabetes. We don't need to bother screening them. And that's totally, totally not true. What's interesting, and even surprises me, when I see the numbers that 59% of the people diagnosed with type one are over the age of 20. You think it's like kids and teenagers and adolescents and all, but so it's a pretty large population, so that's never too late to screen. I guess you might say I think that's the other thing I wanted to talk about, and just to let people know that, you know, if a person has risk, then type one can happen at any, any age. Yeah, I have,
Scott Benner 41:53
I'd have to go back to check to be 100% sure. But I believe that I have interviewed someone who has, personally or their child has been diagnosed at every age, from one up into the 60s. So yeah,
Speaker 1 42:05
yeah, I've got it covered pretty much, I think so,
Scott Benner 42:09
yeah. Well, I appreciate you doing this. I really do. I know this is not a, probably not an exciting topic for people, but I think it's very important, and I appreciate that you, that you thought so too and wanted to come on and do it.
Dr. Blevins 42:21
Yeah, no. Thank you so much for having Thank you. This is really enjoyable. And I really like talking about this subject. Because when I went into for one thing, when I went into endocrinology years ago, there was no delay. It was a lot of talk, but there was really nothing. And we would like, you know, we would all like a cure and some kind of way to just give some cells and it's all over with. That's certainly making its way along. I think the pace is picked up there. But this is a totally important angle that is to delay or eventually, hopefully pick up. People who have this, these antibodies, who are going to go to diabetes Always have, always have, in the past, and say, just alter the course of the disease and delay it or prevent it. So I think this is something everybody should know about and really be talking to their the family about and so get screened and go look at that, that website. I think that's actually a pretty, very informative website, right?
Scott Benner 43:21
Yeah. Listen, as exciting as the idea is to be able to delay the onset of type one, the other excitement is, what are they going to learn from this, right? And where does it go from here? And exactly, is there going to be a time in the future where you're screened, you have that auto antibody, they give you something, and you don't develop type one? And that would be, I mean, that would be crazy. And for all the people living with type one, you know, I agree. Just think about that for a second. Yeah,
Dr. Blevins 43:47
everybody jump up and help push that rock I talked about earlier forward and get some momentum and keep it rolling. Yeah,
Scott Benner 43:54
no, I appreciate that very much. Okay. Dr Blevins, if you'll hold on for a second, I have a question for you, but not for a while ago recording, thanks again,
Unknown Speaker 44:01
we'll do Thank you, Scott, thank you.
Scott Benner 44:10
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