what should be the goal when we talk of sugar control ?

when I saw this quote of the day in google,I was struck by how apt it is for diabetics .
few weeks ago suddenly my wifes blood sugars were high and widely fkuctuating and her PCp started her on actos ( I have my own reservations about this drug )
her Hba1c which used to be between 6 and 6.2 % went up to 6.9 %.
when I was trying to reassure her saying that it is still under acceptable limits she wouldnt take it and wanted to get back to her previous numbers.

so it is important to aim at the stars .

"It is a paradoxical but profoundly true and important principle of life that the most likely way to reach a goal is to be aiming not at that goal itself but at some more ambitious goal beyond it. " - Arnold Toynbee

something in Hindi on Dm for now in PDF

a simle PDf document regarding Dm in Hindi
http://www.protegediabetes.org/language/hindi.pdf



http://www.ndep.nih.gov/diabetes/pubs/TCH_AsAm_flyer_Hin.pdf

new experimental trial for type 1 Diabetes cure

A study from Children's Hospital of Pittsburg and Pittsburgh Medical Center, has shown that type 1 diabetes can be reversed in a mouse model. The scientists extracted the mouse's dendritic cells from the blood and enhanced them with specific molecule blockers. They then reinjected them into the mouse. This procedure stopped the process that kills beta cells, by blocking the T cells which attack them.
A series of injections over the course of several weeks interrupted the T cell attack on the beta cells of the pancreas and allowed the beta cells to regenerate. This resulted in the pancreas of the mice producing insulin again.
Now, the researchers at the Children's Hospital are moving on to human trials. Phase I of the trials was set to start this this past March, to determine the safety of the procedure. Scientists are hopeful that the trials will be successful.
the details are available here
href="http://www.clinicaltrials.gov/ct2/show/NCT00445913?term=type+1+diabetes+dendritic+cells+AND+pittsburgh&rank=1">http://www.clinicaltrials.gov/ct2/show/NCT00445913?term=type+1+diabetes+dendritic+cells+AND+pittsburgh&rank=1

Never thought there is so much science to yogurt and paneer

Yogurt: Electron Microscopy



FOODS UNDER THE MICROSCOPE



Yogurt has been part of the diet in southeastern Europe and the Middle East for millennia and is now part of the dairy counters even in the smallest grocery stores in many countries. It is a cultured milk product easy to make, so there are many other websites with advice on how to proceed, e.g., here or here and elsewhere. Lactic acid bacteria are essential to making yogurt from milk.
Compared to other milk products such as cheese, ice cream, or butter, yogurt contains most milk constituents except lactose, which the bacteria convert into lactic acid. This acid gives the yogurt a pleasant acidic flavour and, at the same time, the sweetness caused by lactose is reduced. Live 'friendly' lactic acid bacteria protect the yogurt from harmful pathogenic microorganisms and thus give it a longer shelf life. The fat content in some yogurts may be reduced for dietetic reasons. Some yogurts may contain very low concentrations of so-called thickening agents, such as various plant polysaccharides (gums), gelatinized starch or gelatin. Their role is to firmly hold water in the body of the yogurt.

Yogurt has traditionally been made from milk that had been partially condensed by evaporation while it had been heated almost to boiling. Coagulation of the milk proteins is induced by thermophilic bacteria, such as Lactobacillus delbrueckii subsp. bulgaricus and Streptococcus salivarius subsp. thermophilus, i.e., bacteria which propagate well at an elevated temperature of 40° to 45°C. The milk is coagulated by a slowly increasing concentration of lactic acid as the bacteria metabolize lactose. The proteins do not precipitate (as would happen following an addition of a large amount of lactic acid) but form a gel. Its ability to retain all the water present in the milk is the result of a peculiar microstructure of the protein network. It consists of short branched chains of casein micelles and resembles a sponge with very small pores.

Yogurt is unique from both the structural as well as compositional viewpoints, because it is solid and has the highest water content of all solid milk products. Yogurt that has been stored for a long period of time may show some syneresis as the separation of a liquid phase from a gel is called. This is only a minor cosmetic defect and the liquid soaks back into the body of the yogurt as soon as the yogurt is stirred.

Electron microscopy reveals interesting features in the development of yogurt structure. The crucial condition in yogurt making is the heating of the milk. Its temperature must reach at least 85°C (90°C is more commonly used) and held at this temperature for at least 10 min. This treatment alters the casein micelles and prepares them for the unique structure to form.
Casein micelles are described as protein globules about 100 nm in diameter, which consist of yet smaller submicelles. Of several different casein molecules, kappa-casein (k-casein) on the surface of the micelles has a pivotal role in their stability. As long as this protein is intact, the micelles stay in milk as individual entities. Any change in the integrity of k-casein destabilizes the micelles and they aggregate.

Casein micelles in unheated milk have relatively smooth surfaces with very small humps caused by the submicelles. Heating above 85°C leads to an interaction between b-lacto- globulin (one of the whey proteins) and k-casein on the casein micelle surface. The result is a complex which makes the casein micelle surface markedly coarser (figure at upper left). Casein micelles with the k-casein-b-lactoglobulin complex formed on their surfaces have a limited ability to aggregate (figure at left). Consequently, short branched micelle chains are formed (upper diagram at right).
In cheese manufacture, where k-casein disintegrates under the effect of a proteolytic enzyme called rennet, the micelles aggregate into large clusters (lower diagram at right).
Increasing the total solids content, particularly the amount of protein in yogurt, generally increases the density of the protein network and decreases the pore sizes. Consequently, water is more firmly bound in the product. This fortification of yogurt may be achieved by adding milk powder, whey powder, milk protein concentrate, whey protein concentrate, or sodium caseinate. Differences in the microstructure of yogurt containing 12.5%, 20%, and 30% total milk solids from added skim milk powder are shown below, where shorter casein particle chains are noticeable:



Milk solids: 10% Milk solids: 15% Milk solids: 20%


Whey protein concentrate which forms very fine dispersions and does not contain casein micelles, forms bridges between the casein particles in yogurt. Transmission electron microscopy (TEM) is better suited to show the fine bridges.

The image at left is a TEM micro- graph of regular yogurt made from unfortified milk in which the protein network consists of casein particles. The micrograph at right was obtained with a yogurt made from skim milk fortified with 1.5% of an ultrafiltered whey protein concentrate. These experiments have been published by H. W. Modler and M. Kaláb.

Watery yogurt?

Separation of the liquid phase in gels is called syneresis. In yogurt, it is undesirable and it occurs when the protein network is unable to firmly retain water. There are several reasons why syneresis may develop. One of them is insufficient preheating of the milk destined for yogurt production which means that casein micelle clusters are formed in addition to branched chains and the clusters do not hold as much water as the porous structure based on chains. The total solids content also has a great effect on the ability of yogurt to hold water. This is evident from the micrographs above which show the structures of yogurt samples made with 10, 15, and 20% total solids. The higher the total solids content, the denser the protein network, the smaller the pores, and the stronger the water-holding force of the yogurt. Traditionally, milk used for yogurt making was evaporated by heating but nowadays the total solids content is controlled by the addition of milk solids such as milk powder or by concentrating the milk by ultrafiltration or reverse osmosis. The acidity (expressed as pH which indicates the concentration of hydrogen ions) of the yogurt also plays an important role. Most yogurts have their pH value in the range of 4.0 to 4.4. The presence of thickening agents such as gelatinized starch, gelatin, or various plant-based agents such as carrageenan or locust bean gums reduces syneresis but may impart sensory properties which are not welcome by some consumers whereas others may like them (e.g., increased viscosity). Vibrations, to which goods are exposed during transportation, also increase susceptibility of set-style yogurt to syneresis.
Susceptibility to syneresis can be measured in laboratory conditions using a drainage method suggested as early as 1959 by D. B. Emmons et al. (Journal of Dairy Science Vol. 42, pp. 866-869). The method is based on making yogurt in 250-mL beakers, cutting it into 4 parts, and transferring the contents onto a stainless 120-mesh screen. The volume of the whey separated is measured at 5 min. intervals for 60 min.
During their studies of milk gel structure, V. R. Harwalkar and M. Kaláb designed a centrifugation method (Scanning Electron Microscopy 1981:III, 503-513) which was later applied to yogurt (Milchwissenschaft Vol. 38, No. 8, pp. 517-522, 1983). The relationship between microstructure and susceptibility to syneresis was explained there.

Yogurt is made in 15-mL centrifugation test tubes. The test tubes are then subjected to centrifugation for 10 min at forces ranging from 30 to 2000 xg. The volume of the separated whey is measured and plotted against the centrifugal force applied. The g-force of the inflection point on the resulting S-shaped curve has been used as an arbitrary measure of susceptibility to syneresis. Two yogurts are shown in the diagram at left, where 'V' is the volume (in % at steps of 0, 10, 20, 30, and 40%) of the whey collected from each individual sample and g is the centrifugation force at steps of 500, 1000, and 1500 xg). The blue curve was obtained with yogurt containg 10% total solids. At the maximum centrifugation force, the whey released was a little over 40% of the total volume of the yogurt. The red curve was obtained with a yogurt fortified with skim milk powder to 15% total solids. The inflection point occurred at a higher g-force and the volume of the whey released was markedly lower than in the former yogurt.
An electron microscopy study of yogurt samples subjected to centrifugation and comparison with the drainage test suggested that lowering pH increased the rigidity of the protein network thus reducing susceptibility to deformation. Thus, at least two factors control syneresis - density of the network and resistance of the protein chains to deformation.



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Labneh

Labneh is strained yogurt popular in the Middle East. Unlike yogurt, it is made from whole milk. Apart from cow's milk, sheep's and goat's milks are used in countries such as Lebanon, Syria, and Turkey, where the climatic conditions are not favourable for cows to keep.
In the United Kingdom, labneh is marketed under the name of Greek cheese and in North America it is often called yogurt cheese. In Arab countries, labneh is garnished with dried herbs and olive oil and is served with bread.



Transmission electron microscopy of sheep's milk labneh: Fat particles (yellow - small arrows) are encapsulated in aggregated protein particles (dark structures - large arrows). Bar: 1 µm. Scanning electron microscopy of nonhomogenized goat's milk labneh (left) made by the traditional procedure and nonhomogenized labneh made by the ultrafiltration of cow's milk yogurt (right). Protein is light, pores are dark. The labneh protein matrices were denser than those of commercial yogurt shown higher up on this page. Bars: 25 µm.

The traditional method of producing labneh consists of straining whole-milk yogurt in a cheese cloth bag. Modern procedures are now increasingly used to make labneh. Excess liquid from traditional yogurt can be removed in mechanical separators.
Changes to the traditional production of the yogurt have also been introduced, e.g., retentates obtained by the ultrafiltration (UF) of milk are cultured to produce a yogurt with a higher solids content, thus avoiding the need for concentrating it. In another procedure, warm yogurt may be ultrafiltered, as suggested by Adnan Y. Tamime, the coauthor of several scientific papers on labneh and a book on yogurt.
Protein matrices in labneh made by straining yogurt (traditional method) and in labneh obtained by ultrafiltration of warm yogurt were examined by electron microscopy. The labneh samples were made from cow's and also goat's and sheep's milks. The total solids contents of labneh were between 20.5 and 22.5%, protein was 6.7-8.2% and fat was 7.8-8.9%.
Homogenization, which was used to make the product smoother, cannot be recommended because it would decrease the firmness of labneh (cow's milk product was less affected than the other two labnehs, where the pore sizes were found by microscopy to be larger). Homogenization (single-stage ALM homogenizer at 7°C and a pressure of 8 MPa) resulted in the disintegration of the fat globules and association of their fragments with milk proteins, which could be observed only by transmission electron microscopy (TEM) (figure at left).
There were differences in the microstructures of labnehs made from nonhomogenized yogurts depending on the milk and the method of concentration used.



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A book on yogurt:
A. Y. Tamime and R. K. Robinson: Yogurt - Science and Technology, 2nd edition - 1999
Published in the United Kingdom by Woodhead Publishing Limited, Abington Hall, Aginton, Cambridge CB1 6AH England
ISBN 1 85573 399 4
Published in North and South America by CRC Press LLC, 2000 Corporate Blvd., NW Boca Raton, Florida 33431
ISBN 0-8493-1785-1

Scientific papers on labneh microstructure:

Tamime AY, Kaláb M, Davies G: Microstructure of set-style yoghurt manufactured from cow's milk fortified by different methods. Food Microstructure 3:83-92 (1984).
Tamime AY, Kaláb M, Davies G: Rheology and microstructure of strained yoghurt (Labneh) made from cow's milk by three different methods. Food Microstructure 8:125-135 (1989).
Tamime AY, Davies G, Chehade AS, Mahdi HA: The production of Labneh by ultrafiltration - a new technology. J. Soc. Dairy Technol. 42:35-39 (1989).
Tamime AY, Kaláb M, Davies G, Mahdi HA: Microstructure and firmness of labneh (high solids yoghurt) made from cow's, goat's and sheep's milks by a traditional method or by ultrafiltration. Food Structure 10:37-44 (1991).

Total quality management

Today as I was reading a book about total quality management. I came across the following paragraph.
what is said here largely reflects what ails diabetes education.


A philosopher, Moshe Hayyim Luzzato (1707-1747) wrote:
"I have not composed this work to teach people what they do not already know, but to remind them of what is known to them. For the most of what I have to say is nothing more than what most people do know. But what is said in the following pages is constantly ignored most often forgotten, because it is common knowledge and obvious. That is why no profit will be derived from a single reading of this book, for quite likely after such a reading the intelligent reader will, find little that is new. Only constant reading and rereading will prove beneficial."

WHAT HAppened to this artificial pancreas ?

it is being touted as the solution from 1995!
and we are no where near implementation.

Focusing on an Artificial Pancreas

For decades, medical scientists have dreamed of a technology that would end insulin-dependent diabetics’ daily need for needles to inject insulin and the endless pinpricks to draw blood for glucose monitoring. That dream took hold of Tejal Desai when she was a Whitaker Graduate Fellow at the University of California, Berkeley. Despite warnings that it was too difficult and she might not graduate, Desai set out to create an artificial pancreas, a small, implantable device containing live pancreas cells.
Scientists have tried to develop an artificial pancreas, among other organs, since the 1970s. One challenge to this approach is keeping the insulin-producing pancreas cells, or islets of Langerhans, alive while protecting them from the body’s natural immune system. At the same time, the islet cells must respond to changing glucose levels and release the needed insulin.

Desai saw that many of the challenges could be overcome with the right container, one that allows only nutrients, waste products, and insulin to pass through while barring harmful antibodies from entering. She built a small capsule employing micromachining techniques, similar to the technology used to make silicon computer chips, which allowed her to etch each pore merely a billionth of a meter wide in a paper-thin silicon membrane. That gave her control over pore number, location and size—enough to allow the small-sized glucose, insulin and oxygen to pass through while blocking immune components, which are larger. After filling a capsule with islet cells, she demonstrated its short-term effectiveness in diabetic rats.

“There are far-reaching applications of microtechnology and nanotechnology that seem sort of distant,” says Desai, “but this is something that has a real application in diabetes or other diseases. It’s a nice example of the convergence of cell science and material science and true biomedical engineering technology.”

Desai not only surprised the doubters; in 1999 she became the first Whitaker Graduate Fellow to earn a Whitaker Research Grant. The support helped her refine the device before handing the idea to a private company, iMEDD, in Columbus, Ohio, which was granted a license to the technology.

“We’re improving it toward more of a pharmaceutical product,” says Carl Grove, president of iMEDD. The company has enhanced the initial design—two silicon wafers glued together with islet cells between—with such improvements as a port to replenish the cells and a more reliable titanium housing. The new device, about the size of a half-dollar, is being tested in rats.

While iMEDD performs most of the scale-up work, Desai continues to do the basic science. One area of special focus aims at inducing capillaries to grow around the device, or vascularization. Improved vascularization gets insulin to the rest of the body faster and increases the transport of nutrients, especially oxygen. “You want a blood supply to be as close as possible to the isolated device,” says Desai, now an associate professor of biomedical engineering at Boston University. But there is a trade-off, she warns; too many capillaries could induce an inflammatory response.

Increasing the oxygen available to cells is one of the main hurdles, not only to an artificial pancreas, but to all artificial organs. “I think success is still going to rely on getting enough oxygen into the device, whether through vascularization or some other means. That is truly going to be a stumbling block.”

A block, she says, not a barrier. “I think we can do it short term, but the question is, how long can it really go? A permanent implant, of course, would be ideal, the Holy Grail. But I think even a two-year viability would be great.”

Desai received a Whitaker Foundation Biomedical Engineering Research Grant in 1999 for research toward a bioartificial pancreas and a Graduate Fellowship in 1995.


Annual Report 2003
© The Whitaker Foundation
1700 N. Moore St. #2200
Arlington VA 22209

Disposable Insulin Nanopump For Diabetics



Swiss firm Debiotech is teaming up with French/Italian manufacturer STMicroelectronics to bring to market a miniaturized insulin pump, bound to change the lives of countless diabetics, provided it makes through the regulatory process.

The Nanopump, which relies on microfluidic MEMS (Micro-Electro-Mechanical System) technology, is a breakthrough concept that allows a tiny pump to be mounted on a disposable skin patch to provide continuous insulin infusion. The Nanopump will enable substantial advancements in the availability, treatment efficiency and the quality of life of diabetes patients. The original technology was awarded the Swiss Technology Award in 2006 and this agreement brings it closer to the market.

Insulin pump therapy, or Continuous Subcutaneous Insulin Infusion (CSII), is an increasingly attractive alternative to individual insulin injections that must be administered several times a day. With CSII, the patient is connected to a programmable pump attached to a storage reservoir, from which insulin is infused into the tissue under the skin. Continuous delivery throughout the day, more closely mimics the natural secretion of insulin from the pancreas.

The highly miniaturized disposable insulin pump combines Debiotech's expertise in insulin delivery with ST's strengths in manufacturing high-volume silicon-based microfluidic devices. Microfluidic technology allows the flow of very small amounts of fluids to be electronically controlled. This pump represents a significant step in the development and adoption of CSII therapy and the leading-edge technology will also find applications in many other biomedical applications.

Today, existing insulin pumps are about the size of a pager. The new ST-enabled Debiotech miniaturized MEMS device is about one quarter the size of these existing pumps and can be worn as a nearly invisible patch on the skin. The small size frees the patient from concerns with holding the pump in place and concealing it under clothing.

The MEMS-based Nanopump also provides better control of the administered insulin doses. Dosing precision is a critical factor in treatment efficacy and contributes to reducing adverse long-term consequences. The Nanopump is able to control delivery at the nanoliter level, very close to the physiological delivery of insulin. The device prevents over-dosing and detects under-delivery, occlusion, air bubbles and other potential malfunctions in the pump to further protect patients. As a disposable device, manufactured using high-volume semiconductor processing technologies, the MEMS-based Nanopump will also be much more affordable, allowing the patient or the health system to avoid the typical up-front investment associated with current pump solutions.

Read Also:
Disposable Insulin Nanopump from Debiotech and STMicroelectronics Marks Major Breakthrough in Diabetes Treatment (STMicroElectronics News)
Debiotech's Insulin Nanopump (Medgadget)