Letter To A Diabetic

Or I Understand What You're Going Through

Tag: insulin

A Normal Life…

I recently read an article in which a Diabetic recalled being told at the time he was diagnosed that he would be able to “live a normal life.”

A normal life…

I do normal things. I go to work five days each week. I take showers and crochet. I walk my dogs. I chat with my sister on Facebook. But other than diabetes management being something that I have to do every day, it is not normal. Normal isn’t always normal just because it becomes regular or comfortable or predictable. There is nothing “normal” about a diabetic life. It will never feel normal to go to bed each night knowing that your blood glucose could dump in your sleep, send you into a diabetic coma, and never let you wake again. There is nothing normal about having to bleed, inject, log, and measure every day. But we all do it. There is nothing normal about having to run home on a break to inject a new sensor for the week or having to set aside 10-15% of my income to cover the cost of diabetes copays.

So, let’s stop trying to lead normal lives. Let’s embrace the difference. Let’s allow everyone to see how incredibly amazing we all are just for being able to not die from this disease every day. We are Diabetics. We are not normal. We are unbelievably strong. We can complete complicated mathematical formulas in seconds just to eat a meal. We are all endocrinologists, dietitians, counselors, and diabetes experts. We know how to adjust dosages, how to recognize and treat hypo- and hyperglycemia, and how to pick ourselves up off our rear-ends and run back out into the world without anyone even noticing that we nearly just died because our blood sugar dropped 100 points in 20 minutes and we were dizzy and swaying and so close to passing out that we considered in those moments the frailty of our existence.

We are not normal. We are the epitome of amazing.

Love and light.

And Now It’s Time For A Diabetic Laugh…

I found this on facebook and had to share it here for those of you who have not seen it. I think jokes about diabetes are funny as long as the person telling them actually understands diabetes. Clearly this person gets it.

Copied from this website.

 

29 Things Only a Person with Diabetes Would Understand

Written by Lizmari Collazo

1. Every paper cut is an opportunity to test your blood sugar.

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2. You have an entire drawer, dresser, or closet devoted to diabetes supplies.

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3. You have hundreds of lancets and only a few test strips. But on the plus side, your health insurance company is willing to pay for more lancets!

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4. When it’s time to test, all you have to do is squeeze your finger.

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5. The phrase “once in a blue moon” is a reminder that it’s time to change your lancet.

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6. You hesitate to wear white in case you prick your finger and hit a ‘gusher.’

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7. Your fingers appear to spell something in braille.

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8. Being high means something completely different to you than it does to most people.

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9. You can calculate the carbohydrate total of every meal in your head without breaking a sweat.

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10. You should test your blood sugar six times a day, but insurance only approved you for one strip a week.

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11. You can put a mathematician to shame: insulin on board, carb factors, insulin to carb ratio, no problem!

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12. Well-meaning friends have offered you every diabetes remedy under the sun, from cinnamon to birdseed milk.

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13. You’ve heard, “But you don’t look like a diabetic!”

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14. You’re familiar with all the diabetes horror stories of the relatives of anyone you’ve ever met.

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15. You’ve heard, “You can’t eat that!” too many times.

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16. Everyone wants to know where you got your cool pager.

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17. You find used test strips in your refrigerator but don’t know how they got there.

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18. You have a pile of diabetes cookbooks holding up your sofa.

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19. You own 15 glucose meters, but you only use one.

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20. CSI would have a very hard time ‘investigating the scene’ at your house.

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21. You have two cases of juice boxes at home, and none of them are for your kids.

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22. You have to remind yourself that it isn’t polite to punch people who say ‘diabeetus’ in the face.

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23. The pharmacy is number one on your speed dial, and you’re on a first name basis with the pharmacist.

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24. People often say “You can eat it, it’s sugar free!” about something that’s loaded with carbohydrates.

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25. Everyone asks you what to do about their ‘noncompliant’ diabetic spouse.

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26. You read every article that promises ways to improve your glucose level, but they all end up being about prevention instead.

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27. According to TV commercials, it’s a good thing you’re young, because only old people get diabetes.

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28. There’s never been any butter in your refrigerator’s butter compartment — it’s used for storing insulin.

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29. To lick or to wipe? That is the question.

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How To Test Basal Insulin Levels

For five days in a row, I woke up with 200+ readings. Okay, a pattern. I get it. So back to basal testing to make the necessary adjustments to my pump settings. So I tested every two hours last night and ran low 100’s, then get up this morning with a 71. If anything, that indicates my basal insulin needs to be reduced a few hours before waking. Zoinks! So I’ll see what I wake up to tomorrow and retest if needed. But it brings up a good point: do you know how to test your basal insulin levels?

For pump users especially, because we can adjust our settings, this is a very important piece of info. Even if you are on MDI therapy, it is still a must-have piece of info. How it works:

Eat your normal dinner at least four hours before heading to bed. Then don’t eat again until the next day. No food! Not even a skittle. 🙂

Set an alarm to go off every two hours. Something annoying that can’t be ignored is good.

Test just before going to bed and write down your bgl. If it anywhere between 100 and 250, don’t do anything to correct.

Every two hours, when that super annoying alarm goes off, test and record your bgl.

If the numbers stay within a thirty point range, you’re great. Don’t make any changes.

If they drop or increase more than 30 points, talk to your doc about adjusting your basal levels.

My doc has me increase or decrease in 10% increments as needed to make adjustment. Example: I have my basal insulin set at .5 units/hour. A 10% decrease to lessen the amount of basal insulin (if my numbers drop more than 30 points between any two testings) would put me at .45 units/hour. The basal adjustment has to be set for somewhere between 1 and 2 hours prior to the change in bg readings to allow time for the adjustment to take place.

BUT REMEMBER! If this whole basal testing thing is new to you (or even if it isn’t), talk to your doc!!! before making changes to your regimen.

Diabetes Inspired Anniversary Cards

Check out Blue Cupcake. Every day that we make it through this thing called diabetes is a little miracle but every year (diaversary) is worth some serious celebrating. It’s a way of sticking it to diabetes, like saying F*** You Big D, I made it anyway!

Visit Blue Cupcake for these spectacular cards!

Common Diabetes Terms Defined

English: Diagram shows insulin release from th...

English: Diagram shows insulin release from the Pancreas and how this lowers blood sugar leves. (Photo credit: Wikipedia)

Today we’re covering some basic terms. Many of these terms, terms which EVERY diabetic should know, were never explained to me. And with 90% of all Diabetics being Type 2, and most diabetes education classes be designed for Type 1, there’s a good chance that if you have diabetes, these haven’t been explained to you either. Let’s get started:

Bolus: A bolus is the dose of insulin give just prior to a meal (usually 15-20 minutes) to cover the carb count within the meal.

Basal: Basal refers to the “background” insulin. Basal insulin is a long-acting insulin that covers the insulin necessary to cover the glucose that your body naturally produces and uses throughout the day.

A1C: A test that measures average blood glucose levels for the previous three months.

Insulin/Bolus on Board (IOB, BOB): IOB or BOB refers to how much active insulin is in your system after a bolus. How long fast-acting insulin lasts in each person’s body varies and you must work with your endo and diabetes educator to determine IOB as well as correction factors and insulin to carb ratios.

Correction Factor: The amount of fast-acting insulin that covers a set decrease in BGL. For example, 1 unit of fast-acting insulin will bring my BGL down 50 points. Again, cover this with your doctor.

Insulin to Carb Ratio (I:C): This is the how many grams of carbs by covered by 1 unit of insulin.

Blood Glucose Value (BGL): The amount of glucose in a set amount of blood. It is measured in mg/dL.

Diabetic Ketoacidosis (DKA): An accumulation of ketones in the blood. Meters are available to check for ketones. This is a no-joke condition. If it is not treated, it can be fatal.

Hypoglycemia: Low blood sugar under 70 mg/dL.

Hyperglycemia: High blood sugar. Goals are different for everyone but as a rule, BGL levels should remain between 70 mg/dL and 130 mg/dL. Don’t be discouraged if your numbers run higher than this because they will. Set range limits with your endo and correct as needed.

Insulin Resistance: An inability to utilize available insulin in the body.

Lancet: A needle designed to fit into lancing device.

Lancing device: A spring loaded mechanism which contains a replaceable lancet that allows an easy draw of blood for use with a glucometer.

mg/dL: milligrams over deciliter, the measurement used to read the amount of glucose in a sample of blood.

For more terms, check out the American Diabetes Association glossary of common terms.

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OH! Wouldn’t it be lovely to not be tied to this disease…? We’ll see.

 

Vaccine May Stop Immune Attack in Type 1 Diabetes, Study Suggests

By Serena Gordon

A new type of vaccine may stop the autoimmune attack that occurs in people with type 1 diabetes, researchers report.

Although an initial trial of the vaccine wasn’t able to free anyone from their daily insulin injections, it did boost insulin production, which could help prevent some of type 1 diabetes’ most devastating complications.

 

Read more here.

 

Exercise and Insulin Pump Article

Updated February 27, 2007

Exercising With an Insulin Pump

by Sheri Colberg, Ph.D.
Whether you consider yourself an athlete or an occasional recreational sports participant, you benefit from any activity that you do, because all exercise can improve your body’s ability to use insulin. If you do not inject or infuse insulin to treat your diabetes, exercise should result in a decreased release of insulin by your pancreas and a more efficient uptake of blood glucose by muscle cells. If you use insulin, however, you may be concerned that exercise can complicate the normal maintenance of your blood glucose level.

Active people who use insulin need to make frequent adjustments in their diabetes regimen to maintain blood glucose in target range, especially when doing higher-intensity or longer-duration exercise. But the effort can pay off in improved blood glucose control, reducednighttime hypoglycemia, improved cardiovascular fitness, and weight loss. When it comes to managing exercise effectively, continuous, subcutaneous insulin-infusion therapy (or more simply, insulin pump therapy) is an option to consider.

How insulin pumps work
Scientists attempting to mimic the insulin delivery of a normal, healthy pancreas first developed insulin pumps in the late 1970’s. Today’s pager-size pumps are much more sophisticated and give both basal insulin doses (background insulin delivered every few minutes in small increments to cover your body’s general need for insulin) and boluses (larger doses given to cover meals and snacks or to lower elevated blood glucose at any time).

Currently, over 180,000 individuals with diabetes worldwide wear portable insulin pumps, and this number has been increasing each year. Most pump users have Type 1 diabetes, but some people with Type 2 diabetes who require insulin are choosing to pump insulin as well. A main advantage of insulin delivery via an insulin pump is more reliable insulin action through a constant infusion of short-acting insulin, along with precise dosing and timing of insulin to cover food intake. Many insulin pump users experience improved overall blood glucose control, reduced risk of nighttime low blood glucose, and improved awareness of low blood glucose (hypoglycemia).

Insulin pumps contain a reservoir or cartridge filled with insulin, either Regular or one of the rapid-acting insulin analogs, insulin lispro (brand name Humalog), insulin aspart (NovoLog), or insulin glulisine (Apidra). Compared to Regular insulin, these insulin analogs have a more rapid onset of activity (5 to 15 minutes versus 20 to 30 for Regular) and an earlier peak in activity (90 minutes versus 150 minutes). Their use allows for a blood glucose response following carbohydrate intake that is closer to that of a person without diabetes and for a more rapid correction of hyperglycemia (above-normal blood glucose levels).

All insulin pumps currently on the market deliver insulin subcutaneously (under the skin) in the abdomen, buttocks, legs, or upper arms, either through a needle or through a plastic infusion catheter. Pump users replace the needle or catheter infusion set every two to three days with a new set at a new site.

Pumps and exercise
Pump users with active lifestyles can experience a metabolic response to exercise that is similar to that of people who do not have diabetes. In part, this is simply because of how an insulin pump works, by delivering small amounts of fast-acting or rapid-acting insulin continually. But it also depends on the user monitoring his blood glucose level frequently, adjusting basal and bolus doses to fit the exercise, and learning from experience.

Click here for rest of article.

Diabetes Emergency Kit

See the video and get more info here.

diabetesandmore.com

 

Diabetes Cured in Dogs?

There are some obvious ethical issues here but in the end, I suppose the forward progress may be worth it. Still though…

Written By: 
Posted: 03/6/13 7:56 AM

http://singularityhub.com/2013/03/06/scientists-cure-diabetes-with-gene-therapy-in-dogs-will-it-work-on-humans/

Scientists have now cured diabetes – at least in a group of dogs – and they used a gene therapy to do it. Amazingly, only a single therapy session was needed to return the dogs’ blood sugar levels to normal. It wasn’t the first time the researchers used the therapy to cure diabetes – they’d done the same previously in a group of mice. But the fact that the treatment worked in the larger canine is a promising sign that it might also one day work in those even much larger animals: humans.

The therapy used in the study actually included two different genes: one for glucokinase, an enzyme that acts as a “glucose sensor” in the muscle, and another for insulin, the hormone that causes sugar in the blood to be absorbed into cells to be used for energy. The genes worked in concert to detect high blood sugar levels and then produce insulin to promote the uptake of blood glucose into cells.

The study included five beagles between 6 and 12 months old with type 1 diabetes, which means their pancreases made little or no insulin. Dogs do develop diabetes naturally, but the diabetes cured in this study was chemically induced, after which they began receiving daily injections of insulin. They then received the gene therapy and insulin injections were stopped. After a single administration of the gene combination that included several injections to the hind leg, the dogs’ blood glucose levels were effectively controlled for the over four years that they were monitored. In fact, the therapy was better at controlling their blood glucose levels than daily doses of insulin. Furthermore, their body weights returned to normal and they were generally healthy, lacking any complications from the gene therapy.

Scientists in Spain needed only a single treatment session to renormalize blood glucose levels in dogs with chemically induced diabetes type 1. [Source: Universitat Autònama de Barcelona]

The study, which was published earlier this month in the journal Diabetes, was “the first to demonstrate a long-term cure for diabetes in a large animal model using gene therapy,” according to Fàtime Bosch who led the study at the Universitat Autònama de Barcelona’s Centre for Animal Biotechnology and Gene Therapy.

A one time gene therapy would be a much welcomed alternative to a lifelong dependence on insulin injections. Type 1 diabetes is thought to be an autoimmune disorder by which the insulin-producing beta cells of the pancreas are attacked by the body’s own immune system. Incapable of producing insulin the body’s blood sugar levels rise, which, left unchecked can wreak havoc on multiple organs and cause heart problems, kidney damage, and nerve damage which can result in blindness. A person with type 1 diabetes needs to receive insulin injections or have an insulin pump to survive.

Although the results are promising, there are some shortcomings to the model. The fact that the type 1 diabetes was not naturally occurring in the dogs and needed to be induced means there could be some surviving, functioning beta cells in the pancreas that weren’t chemically killed off. Likewise, any effective treatment for humans will need to deal with an immune system that is waging constant attack against its own insulin-producing cells. Another of the study’s limitations is the controlled environment in which the dogs were kept. Their regimented diets and amounts of exercise don’t replicate reality – the varied lifestyles of people with diabetes.

Dr. Massimo Trucco, Head of the Division of Immunogenetics at the University of Pittsburgh, isn’t hopeful that the therapy would be effective in humans. “Dogs get the food you want them to have,” he commented in an NIH report of the study. “They probably spent most of their time in a cage. But kids eat what they want and play when they want, meaning their [blood sugar level] varies dramatically.” He also finds fault with the gene strategy. “Beta cells are more complicated than muscle cells. Muscles just can’t secrete insulin quickly and efficiently like beta cells do.”

To address the behavioral concern, Bosch plans on following up the study with one that uses dogs with naturally occurring diabetes and who are also pets. Their voluntary eating and activity patterns will more closely model that of a person with type 1 diabetes.

All studies have their limitations. At the very least the gene therapy’s longterm safety in the current study is an achievement. We’ll just have to wait for future results to find out if the therapy only works in an artificial model in dogs or it holds promise for dogs with naturally occurring diabetes and their diabetic best friends.

Can stem cell treatment cure type 1 diabetes?

The Conversation: Can stem cell treatment cure type 1 diabetes?

By David Lesher
Special to The Bee
Published: Sunday, Mar. 3, 2013 – 12:00 am | Page 1E

JOIN THE CONVERSATION: How has diabetes affected you and your family, and what would it mean to have a cure? Add your comment below. To write a letter, go tosacbee.com/sendletter. Or comment on our Facebook page at facebook.com/sacramentobee.

If California voters are ever going to be happy with the $3 billion stem cell bond they passed overwhelmingly in 2004, it might be due to a company called ViaCyte. By next year, the modest lab in San Diego hopes to begin human trials for a treatment that could essentially curetype 1 diabetes.

The scientific review panel that recommended it last fall said this could be the “holy grail of diabetes treatment.” And the president of the state stem cell agency, Alan Trounson, declared at a recent board meeting: “This is verification of our program. … I think this will resound in California, I think it will resound in the United States and I think it will resound in the whole world.”

Nearly a decade after the California bond passed, stem cell science is starting to emerge from the laboratories with potential treatments that might approach the high hopes raised by a campaign of celebrities and Nobel laureates.

The California bond is currently supporting 24 experiments targeting chronic and costly conditions like Alzheimer’s, cancer, blindness, HIV and spinal cord injury that are expected to be in human trials during the next four years.

And at an annual State of the Industry conference in January, scientists and investors who often disagree said publicly for the first time that the field has reached an “inflection point” where years of promise are “starting to live up to that potential.”

“The first big success will be a major deal,” Jonathan Thomas, chairman of the stem cell agency, told me. “Whether it’s ViaCyte or whatever, once you’ve established stem cell technology as the route to a cure, you’ll see a shift in public perception, in investor perception, in the regulatory folks.

“I think 15, 20 years from now, when stem cell-related therapies or cures are routine, you’ll look back at this as being a pivotal period really in medical history.”

 

Keeping research afloat

 

As the state agency approaches the end of its bond funding four years from now, ViaCyte may be the best hope of satisfying the high expectations raised by Proposition 71. No project has won more of the bond money than ViaCyte – nearly $40 million total. Without it, the struggling company may not have survived. With it, scientists see the possibility of a historic achievement for medical science. 

As many as 3 million people in the United States suffer from type 1 diabetes at a cost of nearly $15 billion per year nationally and more than $2 billion annually in California. For those suffering from the condition, scientists hope ViaCyte’s treatment will end the need for daily insulin injections and blood monitoring as well as the long-term risk of life-threatening conditions such as blindness,heart disease and kidney damage.

ViaCyte estimated the potential U.S. market for a type 1 diabetes treatment at about $30 billion, which could expand to a market worldwide and to some type 2 patients.

“Obviously we’re hoping that we can hit it out of the park and that this is essentially a cure for patients with type 1 diabetes,” ViaCyte President Paul Laikind told me. “One of the nice things about this program is that the end points are really clear. We’re bringing in patients that don’t make insulin. So if we put this in and they start producing insulin, it’s pretty clear why.”

ViaCyte is located near the University of California, San Diego, just off Torrey Pines Road, a longtime corridor of cutting-edge research that is now a concentration of biotech labs. The company does not have one of the many new laboratories, where stunning, modern architecture perched on a panoramic ocean bluff conveys the big money and futuristic treatments at stake in biotechnology today.

ViaCyte is about two blocks away on the urban-facing side of the bluff in a cramped cinder-block office that was built by the military to study peaceful uses for nuclear power soon after the first atomic bomb was dropped. Today, those labs are a nursery for human embryonic stem cells.

 

Stem cells in an envelope

 

The power of embryonic stem cells is that they can grow into any cell in the body. In this case, the recipe and schedule of nutrients provided to the cells is designed to mimic the growth of the human pancreas. After about two weeks of precise and patented nurture, the stem cells develop into precursor pancreas cells, which are expected to produce insulin in response to blood sugar levels when they’re placed in a human body. 

Part of the excitement about ViaCyte’s approach is that the cells would be contained in a porous and synthetic envelope that is inserted just under the skin. The circulatory system plugs into the device, called Encaptra, which is smaller than a business card and performs like an artificial pancreas. It would contain insulin-producing beta cells while it allows blood to flow in and insulin to flow out. With the cells inside, it also can be frozen and stored or shipped to doctors anywhere.

The device resolves two of the greatest challenges facing most stem cell treatments. First, it protects the cells from the body’s immune system, which often rejects stem cell treatments. Second, regulators are expected to be more comfortable – and perhaps quicker to approve – a treatment that contains the experimental cells in a retrievable package instead of letting them roam around the body.

In hundreds of experiments with mice and rats over the last few years, the device has successfully managed the blood sugar levels of animals with experimentally induced diabetes. They’ve shown that it will release insulin in proportion to the body’s need even when scientists triggered extreme high or low blood sugar levels.

Type 1 diabetes is the best application for the ViaCyte device because it is a disorder in which the immune system attacks and kills insulin-producing beta cells in the pancreas. About 90 percent of diabetics suffer from type 2, where the device might be helpful to those who need insulin treatments. For most, however, type 2 diabetes means that cells have grown resistant to insulin, requiring a different type of treatment.

 

Still a funding gap

 

ViaCyte has had two meetings with federal regulators as it prepares for Phase I human trials, which are expected to include about 50 patients and last for up to two years. If all goes well, Laikind said, the treatment could be commercially available in five to 10 years. 

The biggest challenge is obviously to prove that the treatment will work in humans as it did in animals. But another is funding. Surprisingly, even with a promising treatment in a state that passed a bond for stem cell research, ViaCyte is scrambling to pay its bills.

Last fall, pharmaceutical giant GlaxoSmithKline indicated that it would shepherd the project through the expensive and uncertain human trials. Unexpectedly, however, the company dropped its interest in December, pointing again to the increasingly risk-averse posture of private investors that has become a major threat to biotech research.

In response to an email question, GlaxoSmithKline said it “remains very interested in the ViaCyte technology. We made a business decision based on timing that was not related to scientific or technical issues.”

The funding gap is well known to scientists as the “Valley of Death,” a period of high cost and high risk before a treatment is proven to work. The failure rate of treatments that reach human trials is very high. At a conference last year about a variety of diabetes treatments under study, ViaCyte’s project was called “extremely promising” with the caveat that “it’s often the last mile that proves the most difficult.”

As private investors have grown more reluctant to take such risks, the valley has widened. So, unexpectedly, the state bond that passed because of federal restrictions has instead become a critical replacement for disappearing private money.

 

Stakes are high

 

ViaCyte was at a pivotal point in 2009, the start of the Great Recession, when it won a $19 million grant from the state stem cell agency. Laikind said it’s difficult to imagine another source for the money at that time, and without it the company was at risk. With the grant, the company doubled in size to about 50 employees and is now completing the safety tests required for human trials. 

Those trials have high stakes for ViaCyte, of course, but also for the stem cell agency.

The California Institute for Regenerative Medicine, as the agency is known, has been under significant pressure to demonstrate success. Recently, it was stung by controversy once again when a report from the prestigious Institute of Medicine echoed earlier complaints that too many board members represent institutions that receive grants from the agency.

It’s a conflict inherent in Proposition 71, which ordered that most of the 29 board members be selected from California universities and research institutions, the same places where most of the money must be sent. And it’s another lesson about the inevitable flaws of California’s ballot-box budgeting.

Three other initiatives that passed around the same time – for mental health, preschool children and after-school programs – have cost the state more than $20 billion and counting. None of them have received the kind of scrutiny paid to the stem cell agency. If they did, we’d likely find flaws.

Proposition 71 has yet to achieve its goals. But nobody doubts that it established California as a global leader in this emerging science. It also seeded two dozen treatments headed to human trials soon and many more under development in 12 new laboratories that the bond funded around the state.

There should be concern about conflicts of interest with public funds. But Californians should also know there is much more going on with their bold investment in a risky science. They passed a flawed ballot measure that created an imperfect organization that is expected to save lives and boost the economy through an unprecedented state industrial policy.

And it just might work.

 

JENN McCOLLUM

Victorianist. Scholar. Professor.

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