University of Kentucky, Ky.

My name is Dr. Dennis Karounos. I am an endocrinologist at the University of Kentucky. I treat people with diabetes and conduct research in diabetes and immunology. One exciting project I'm working on is preventing diabetes.

Specifically, we're looking at type 1 diabetes, which is usually diagnosed in children and young adults. In type 1 diabetes, the body does not produce insulin because the immune system destroys the cells that produce insulin, so the body cannot metabolize sugar. (In type 2 diabetes, the body either does not produce enough insulin, or the person's body cannot effectively use insulin.)

Our studies indicate that if we treat with insulin before the development of elevated blood sugar -- a sign of diabetes -- we will be able to prevent diabetes. A key factor is using an effective dose without negative side effects. Insulin lowers blood sugar, and the dose required for prevention is very high. As we're starting with normal blood sugar levels, we want to avoid significantly lowering blood sugar. In preclinical studies, we're studying a unique insulin which has been modified so that it does not lower blood sugar. It can be given as a daily injection and has been shown to be well-tolerated long-term. Our data suggests the insulin induces a protective response which prevents diabetes. We hope to measure this response and adjust the therapy with the ultimate goal of preventing diabetes.

This is a team approach with my colleague in the Division of Hematology/Oncology, Dr. Scott Bryson. We also are also an affiliate center for a national research program called Type 1 Diabetes TrialNet, screening relatives of people with type 1 diabetes. With this study we hope to understand more about the development of type 1 diabetes and to further look at ways to delay or prevent it. Through a blood test, we determine if someone may be at risk for diabetes -- years before symptoms appear. While we know that we have much more work to do before we will see an end to this disease, the work we're doing is promising.