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Dr. Paul Thornton, MBBS Medical Director, Endocrine and Diabetes Program, Cook Children's Endocrinology

Dr. Paul Thornton, MBBS

Over 34 million Americans have diabetes, that’s 10%+ of the entire population.  Let’s talk about it!  Dr. Paul Thornton, Director Endocrine & Diabetes Program, Cook Children’s Endocrinology joins J.W. on this episode of Fortitude and shares information on what he is doing from the research and treatment side of the disease as well as offering useful advice on what parents should look for in their child to assess if they might have diabetes and what, if anything, can be done to minimize the risk of your child or anyone from getting the disease.

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Episode Transcription: 

roxo media house welcome back fortitude guys JW Wilson
with a special guest today Dr Paul Thornton this episode brought to you by cap Tech spank our friends over there
one of the only two local banks in Fort Worth thank you Mike Thomas I know you’re out there watching right now
probably late at night we appreciate you back to this man to my left Dr Paul Thorne is the medical director of
endocrine and diabetes programs at Cook Children’s Hospital uh which we’ll get
into that for the majority of this discussion today Dr Dr Thornton thank you for being here first off we’re
honored to have you in our presence uh before we get to that though it says here you grew up in some place called
Dublin is that Dublin Texas yeah where they make Dr Pepper yes is that not that’s not accurate I don’t think is it
uh it’s like halfway there I grew up in Dublin Ireland okay uh country of the
number one Rugby World the number one rugby team in the world very nice uh but
uh yes I grew up there my parents were both from Dublin so I’m what they call a jacking okay
um and I went to school there went to University there started my medical training it’s a fun place to go and if
you get a chance to go visit Ireland you should do it okay I love that when did you know in your life I know it’s early
on that you wanted to be in the medical profession I was one of those people that it was
the only thing I ever wanted to do and boy am I lucky I got to do it because I would have been so unhappy otherwise but
like as long as I can remember 10 11 12 I knew I wanted to be a doctor and I
think a lot of it had to do with I guess my mentor in getting me there which was our family practitioner right um a guy
called Dr Brandon DC and he he just inspired me and that made it all
I wanted to do and you know I was not the best in my class and I had to work very hard to get into med school but boy
was it worth it in the end yes sir we’re grateful you did and for what it’s worth I wasn’t the best in my class either so
look here we are here we are on TV so from Dublin from Dublin you went to London to train part of your training
from London after that you went to Children’s Hospital in Philadelphia where you completed your residency your
fellowship in Pediatric Endocrinology uh get that right yep how was your time in
Philly I loved it I mean I hate to tell you this guys but I am a die-hard Eagles fan devastated with that call last week
I figured you would be I was gonna now of course we’ve just dated the timing of this yeah it’s okay it’s okay it won’t
it won’t sit in the car first for too long I promise a little hand on your back come on guys yes yes like if we
lost because we lost to a better team I’d be I’d be fine still still fine
from Philadelphia you went back to Ireland from 96 to 99 where you ran the national Center for inherited
metabolic diseases uh which is a significant in itself described quickly what that what that means or how what
that was like yeah so you know I’m one of those endocrinologists who’s sort of trained in metabolic disease and
endocrinology and a position open up in Ireland and you know when you train in Ireland your goal for most people is to
get back to Ireland and to be a consultant in the hospital system there and so this opportunity opportunity came
up and it turns out that uh the job I got was um as a com a combination of a metabolic
physician and an endocrinologist right and in Ireland there was only one hospital that looked after all the
metabolic patients in the country including the adults um so that was very exciting and one of
my big achievements when I was there albeit for three years was to get a
recognition that children become adults and children with metabolic disease become adults and they need care as
adults so we got an adult program going while we were there and we got that recognition and you know this is a big
thing in in Pediatrics is that there are certain things that we do better because
they’re more pediatric but those kids grow up and we need to transition them to adult carers yes yes sir well so
those who are listening and wondering right now what is endocrinology it’s basically the study of hormones
um so you know our our bodies are finely tuned machines and the reason for that
is that we have hormones that control everything
um for example the thyroid is controlled by the pituitary gland and when you’re when your body doesn’t make enough
thyroid hormone your pituitary gland sends a message to say hey make some more hormone than when it makes enough
it sends a message back saying I’m making enough and so everything is kept nicely in balance and endocrinology is
the study of hormones on hormones are basically compounds in the body that travel from one part to another and then
perform their function there so for example insulin is secreted by the pancreas but it goes to all the cells in
the body to increase glucose uptake into those cells yes indeed very good thank
you for and after you went back to Ireland for the for your visit your short three-year visit you went
back to Philadelphia I guess you loved it so much yeah as The Clinical Director of the congenital hyperinsulinism Center
which we’ll talk about here in a second that spur that lasted for a few years and then in 2003 you moved here to Fort
Worth yeah where you still sit today at Cook Children’s Hospital one of our favorite places I’m gonna have to
interrupt you here now because we said that wrong twice okay tell me and if I don’t correct you I’m going to be in
real trouble okay it’s cooked Children’s Medical Center Medical Center okay I can do that Cook Children’s Medical Center I
won’t make that mistake again okay and um one of the things that or many of the things you do you deal with
Endocrinology obviously that’s why we’re here today but specifically Pediatric Endocrinology you’re dealing with
children where they have these these hormone issues as you put it earlier correct yes and you know in in different
countries the term pediatric is used differently so for example where I trained in Ireland we only saw kids up
to 14 but here we see them up to 18 and some sometimes um if we feel that the child will
benefit as a young adult from staying for a year or two we’ll see them a little bit longer very good and that
really helps us transition them over especially kids with chronic diseases and you know as I’m sure we’ll talk
about children with diabetes often struggle more during their adolescent years and so sometimes it takes a couple
of extra years to get them ready to transition to adulthood fair enough those of you who have kids probably
understand that the transition of adolescence to adulthood can be tricky never mind even in adulthood too so yes
well let’s start from the ground floor if you don’t mind tell us what diet what is diabetes
diabetes is a condition basically where um the body doesn’t have enough insulin
to do its functions and so you end up getting higher blood sugars now people think of diabetes as being two types of
diabetes type 1 or type 2 diabetes but it turns out there’s probably about 15
or 16 different types of diabetes wow um but traditionally people think about
type 1 diabetes being an autoimmune disease where our body’s own immune
response damages the beta cells which are the cells that make insulin in the pancreas and as a result we don’t have
enough cells making insulin and so we have insulin deficiency and then in the
acute phase that causes a rapid rise in the blood sugar the kids start to become dehydrated they start losing weight and
eventually you can become very sick before the diagnosis is made now type 2
diabetes on the other hand is a whole different uh kettle of fish and what
happens there is that usually as a result of increasing obesity
insulin resistance develops so your pancreas is able to make insulin but it’s just not unable to make enough and
one of the funny things that we see in in children is that when our families come in the first thing they ask us is
do I have type 1 or type 2 diabetes and we’ll do some testing and using clinical
Acumen we can pretty accurately determine which one people have and you know every so often and unfortunately
more often than we would like to see now we’re seeing a lot more type 2 diabetes and it’s interesting to us that the kids
all think having type 2 diabetes is better than type 1 diabetes but the sad reality is is that if you are
uh have type 2 diabetes in childhood that is a very serious long-term disease
and they have a way worse outcome than our kids with type 1 but yet the kids with type 1 seem to be the worst because
they have to take insulin and they have to check their blood sugar four to six times a day and take four to six shots
and Count Their carbs and do all these terrible things and the type 2 patients just take a tablet and they’re fine and
of course that’s not true at all fair what’s the ratio Dr Paul from type one to type two yeah we’re currently seeing
um about five to one ratio for every five kids with type one we’re seeing one
or two with type two it used to be ten or Twenty to one uh now it’s down four
or five to one I mean you know in Cook Children’s we have about 2 000 children with type 1 diabetes and we’re up to
three or four hundred children now with type 2 diabetes so that suggests that type one is is rising more quickly or
type 2 is type 2 is rising more quickly okay so as the rate of obesity increases
in the Pediatric population I mean we’re now seeing 25 to 30 percent of our kids significantly overweight and that’s the
main driver of the cause of type 2 diabetes so this and let’s talk about type one for just a second here uh the
silly question you could hear you probably hear a lot all the time is did I get it because I ate too much candy do it because of my diet what causes
someone to get type 1 diabetes yeah we hear that all the time and you know a lot of families are feeling guilty that
maybe they could have had a healthier food diet for their kids and they would have prevented this but the reality is that indeed is not the case type 1
diabetes is an autoimmune disease meaning that our bodies attack the cells
in the pancreas that make insulin and we don’t fully understood understand why
that reaction is triggered you know people have talked about exposure to a viral illness maybe exposure to you know
Modern Life and the chemicals that we see somehow triggers this overactivity of the immune response and then our our
body in essence harms itself um and
sadly it seems that we seem to be seeing seeing more of that so you know why is
that you know there was there certainly was a spike of type 1 diabetes uh after we got hit by covid but you know we
don’t know what the cause of that is so what we do know is that something
triggers an autoimmune response that causes our own cells that fight
infection to attack the beta cells and from there it’s an inevitable progression to diabetes and you know the
thing that’s interesting is that now we can look at children and measure some of
the markers in their blood like the eyelid cell antibodies or the god 65 antibodies that tell us if that process
is starting and this is some of the exciting stuff we’ll probably talk about later is that now we have drugs that can
stop that immune reaction and hopefully prevent the onset of diabetes but you
have to catch it at the right time sure just to be clear Dr Paul there’s no nothing you can do necessarily Obviously
good lifestyle good habits good exercises is a pinnacle of life that we don’t follow well but there’s nothing
you can really do to keep you from getting that type 1 diabetes correct no it’s not it’s not because of a lifestyle
habit it’s not because you ate too much candy you ate too much sugar it’s not
because you didn’t exercise enough all those things are good for you know exercising healthy food diet for a
cardiovascular health health but it doesn’t prevent diabetes
yes there are certainly risk factors that are genetic so some people are more
prone to develop autoimmune disease than others now those Healthy Lifestyles can
help prevent type 2 diabetes so if we can prevent obesity and excessive weight
gain which then triggers you know hypertension or high blood pressure all
of those things those Healthy Lifestyles that’s how we prevent type 2 diabetes and we you touched on this earlier on
what causes type 2 it’s it’s probably bad diet obesity as you should use cleared so if everyone or suddenly to go
to a healthy lifestyle get suddenly fit would would that essentially eradicate
type 2 diabetes in a sense certainly in childhood it would um you know eventually as you get older
and older 70 80 90 years of age our organs start to give up and so type 2
diabetes can occur there but type 2 diabetes in childhood is specifically because of obesity and we have the power
to prevent that you’re basically wearing out your your pancreas because you’re needing so much insulin all the time
that’s right very good there’s only so much you can make in a day yes sir okay so some of the some of the treatment so
let’s talk about symptoms real quick how would somebody know if they have a symptom of diabetes if we need to stick
to one type one or type two but type one specifically what are the symptoms of type one yeah I mean and this is very
important for everyone out there to know so probably the first thing that you start to notice and most people notice
this as they look back at the last six weeks rather than right at the beginning but you start to notice that you’re
having increased thirst that you’re starting to be thirsty a little bit more and that drinking water just doesn’t
seem to do it anymore so you have to start drinking a lot of water you start noticing that you might be peeing a
little bit more you might have to get up out of bed at night to urinate um and that some kids are notice that
they’re eating less because they’re drinking so much water to keep up and of course if you’re drinking high sugar
fluids as opposed to water that just makes everything worse because that causes your blood sugar to go higher
which makes you thirstier Etc the next big thing that people notice is weight loss so they’ll have unexplained
weight loss um it’ll start you know mild but very quickly you start losing one two three
pounds a day and this is because your blood sugar is so high you’re drinking so much water all that Sugar goes down
the toilet and that’s calories so you’re you’re losing calories you start to lose
weight you’re starving yourself yeah so even though your blood is full of sugar it can’t get into the cells so the cells
are cells are starved so what starts happening is the cells start giving the body a message I’m starved I need fuel
so they start breaking down your fat stores as if you were in on a diet and
not eating enough so you start losing weight and then that’s sort of the end
of the simple easy stuff where you’re not in really danger but what starts happening next is as you start to break
down more and more your fat stores these things called Ketone bodies start to rise and this is a form of acid in your
blood and that causes you then to start to breathe a little faster because your body thinks I’ve got acid in my blood I
need to breathe it out and now you’re into getting close to having to come into an ICU situation because you’re going to
what’s called diabetic ketoacidosis where you have so little insulin that all your fat is being converted into
ketones that’s an acid um your blood sugar is getting higher and higher you get into this vicious
cycle of severe dehydration and then you start to drop your blood pressure and
that’s what we see kids coming into the emergency room you know deep breathing unresponsive you know parents found in
lying in the bed they couldn’t wake them up and that’s really the most dangerous
situation in most those cases you just like you just mentioned is immediate insulin is that the saving uh yes at
that point in time you you need what we call in medicine the ABCs you got to
start off with the airway breathing circulation um but that’s where you have got to
recognize that this is Nuance at diabetes and it’s easy a simple blood test will show the blood sugar 1000 you
what’s a normal blood sugar for a human 70 to 110 okay um so you know it’s obvious by the story
of excessive peeing drinking weight loss kid comes in like that so yes you need
to get fluids in to rehydrate them insulin to switch off ketosis
um and then start the whole process of recovery but the thing that’s most important for families out there to know
is that most of the time you can notice these subtle signs like excessive
urination excessive drinking and it’s a simple test you go to your doctor you
say I noticed my child is drinking too much you know they never they never seem to be able to resolve their thirst let’s
just check a blood sugar finger prick in the doctor’s office uh avoid that you
know downhill spiral that ends up in the Intensive Care before we talk about insulin are there any symptoms of type 2
diabetes besides obviously an obese child or an East person you can tell but any symptoms other than the things you
mentioned not not for type one but for type two yeah so one of the other things that people will notice is that they’ll
see that the skin on their neck gets a little darker it’s what we call acanthosis and agricans and it starts on
your neck and it spreads up and down and the skin can sometimes get thickened and look like almost like elephant skin
where you’ve got those like wrinkles set into the skin it happens on your arms and on your knuckles as well and so if
you have a child who’s gaining excessive weight and they’re getting that Darkness on their skin that’s an early sign of
impending type 2 diabetes and actually if you take them to see your doctor they can do a test either a random blood
sugar or a hemoglobin A1c and let you know if you’re on that early stage of development because that’s when this
disease type 2 diabetes is reversible yes sir and you know that’s the thing is all our families with type 1 diabetes
say gosh if only we could have done something to reverse this but yet here
we are and now 20 to 25 percent of our children and are having type 2 diabetes
and you know we need to put that same effort in to prevent that and reverse it when we have the warning signs fair to
say there should be a more Universal testing for this across the board versus just when you get to that point where
you know something’s wrong yeah I think certainly for type 2 diabetes and warning signs of excessive weight gain
are very easy to see and you know it’s hard for me as a parent to be told my
child is gaining too much weight but we’ve got to understand that this
could lead to problems and not just when they’re going to be 40 and 50 and have
high cholesterol and high blood pressure but right now it’s a risk for diabetes yes okay thank you for that now insulin
what is insulin and why is it so important to the human existence right
so insulin is one of those hormones we talked about up front and that’s made in the pancreas and without it we cannot
survive um it it what it insulin does is it allow allows sugar our glucose to be
transported into the cells and glucose is the most important fuel we have for producing energy there are other fuels
we can use like lactate and Ketone bodies but as a general rule they’re not
available all the time unless we get into a situation where we’re not eating so insulin is critically important for
allowing each cell to be able to make the energy it needs to do its function you know before 1921 when we discovered
insulin we knew that people had diabetes and the the it was a death sentence you
got diabetes and if if you were lucky um you lived six more months and that
six months was only because you exercised every day you didn’t need any carbohydrates and you drank water and
all you did was prolong the inevitable death from insulin deficiency and so a hundred years later here we are and
we’ve got designer insulins that allow our children with diabetes to have a
much more I wouldn’t say completely easy lifestyle but compared to the bad old days it’s a
big difference you mentioned a little while ago the high blood sugar in this and the problems with that and ultimately could lead to your death and
it will if not treated uh what are they in in from what you said insulin is the
is the way to bring that low that high blood sugar down to the regular rates tell us about a low blood sugar and what
that’s like yeah low blood sugar um is not just simply the opposite of
high blood sugars it’s a whole new set of problems on its own so when your blood sugar drops low especially when
you start getting down below 50 then you’re not having enough fuel for your brain and that causes you to become
disoriented confused um it stops your brain from making good decisions it starts off like you’re a
little bit drunk where you start making bad decisions because you’re not thinking through it straight
um and then you become irritable cranky you can get confused you can become lethargic and if it keeps dropping and
stays low then you can start having seizures and you can die from a low blood sugar how calm it is is a low
blood sugar death how it’s rare thanks be to God because it should never happen but sadly it does
happen um and so you know this is why we have to really carefully balance the risk of
a low blood sugar today from giving too much insulin versus the risk of the long-term side effects and complications
from diabetes and so one of the things our our new onset parents often struggle with is the idea that well okay you know
my child could have a serious problem with a low blood sugar and a seizure today so I’ll run them a little sweeter
to try and stop that but that generates long-term problems so we’ve got to
balance the risks of low blood sugars and versus chronic high blood sugars and
that’s why all these new modern insulins you know where we have very short acting intermediate acting long-acting insulins
allow us to have the tools to prevent the hypoglycemia while still preventing the hyperglycemia some people have asked
I mean I’ve heard these stories over the years if you if a regular person and someone without diabetes gets up in the
morning doesn’t eat a meal or breakfast goes and works does a strenuous workout they have a low blood sugar a natural
one I wish I would call it which we all have been there at some level I think how much more severe and what does it
feel like to have a low blood sugar can you describe what the what it might feel like to have that well luckily for me I
don’t have diabetes nor do I have hyperinsulinism um so
um you know what our families tell us is that they start off with the warning
signs of a low blood sugar which is that you start to feel a little shaky
um you might start to feel hungry um and this is actually the body sending
out protective messages so the hormones that a low blood sugar triggers uh teach
the brain to go food seeking so it makes you hungry and then you want to eat and then you eat and you can correct the low
blood sugar so there are some symptoms that we call in the profession neurogenic symptoms
meaning symptoms that the body has that send messages to the brain to say my
blood sugar is falling I need to do something to stop it falling and those symptoms and those levels of blood sugar
don’t cause any harm whatsoever but that’s designed to prevent you from getting into the really severe symptoms
that we just talked about earlier which is where your brain doesn’t have enough sugar to function so that’s why we call
it mild hypoglycemia and severe hypoglycemia and the symptoms of mild hypoglycemia are the things that I could
notice in you where if you became pale sweaty shaky you know maybe a little bit cranky those sort of symptoms
um someone else can recognize and go and help you and say you feeling okay do I need to get you you know a glass of milk
some apple juice to help you get your blood sugar up quickly
um when you get into the SIM symptoms where your brain is not functioning well that’s where you might actually need
some serious help like someone else to give you a shot of glucagon as a rescue to bring your blood sugar up because you
can’t help yourself anymore you could you’d be so confused potentially that you wouldn’t even know to drink to take some sugar to get there okay yeah uh
treatments for uh for low butcher we talk about uh getting something sugar to bring your blood sugar up but generally
speaking for type one we’ll talk about type two what are the what are the the general treatments for type 1 diabetes
yeah typically we would say that if your blood sugar is falling but not yet low
just take a small amount of carbohydrate so you don’t rebound up maybe five ten
grams of carbohydrates when your blood sugar gets down into the range where you’re having symptoms you need to take
15 grams of carbohydrates and then recheck your blood sugar in 15 minutes to make sure it’s coming up so 15 grams
of carbohydrate might be like um you know drinking a glass of milk some apple juice
um you know a lot of people um especially the young adults who don’t want to be carrying around you know
juicing their backpack all day long would use glucose tablets some people use glucose gel which you can either get
specific glucose gel things for this specific thing or people use cake icing
Icing cake icing sugar all of these things are basically a
handy way to carry carbohydrates that are not going to go off or spill in your backpack if we get and then treatments
for low budget what about treatments for type 1 diabetes how does one who has Type 1 diabetes
it sounds like they need to be on insulin for forever I think that’s the correct answer I’m asking you it’s a
lifelong uh thing you’re going to deal with but what kind of treatments do these people have to endure for the rest
of their life yeah so now we’re talking about the general treatment of type 1
diabetes and basically you know the general principles are that you need to take insulin and you need to take
insulin whenever you eat and you need to take insulin whenever your blood sugar is high so number one treatment is
insulin the second thing is you have to be aware of what you’re eating so if you eat a piece of meat for example it’s
primarily all protein a little bit of fat that’s not really going to change your blood sugar a lot it’ll go up a
little bit but not a lot whereas if you were to sit down and drink a can of Coke your blood sugar is going to shoot up
high so we have to teach people how to figure out how much carbohydrates is in
the food that they’re eating which are the foods that have good carbohydrates and which are the foods that are bad
carbohydrates because if you’re food looks like a vegetable will you when you’re eating it it’s generally got much
lower carbohydrate and it’s not going to swing your blood sugar around as much as if it looks like a red can of Coke
um so so kids with diabetes have to think about what they’re eating it doesn’t mean that they can’t eat any
specific type of food it just means they have to eat that food the right way give the right amount of insulin to deal with
it and then of course they have to check their blood sugar so they know how much insulin to give and then we can of
course start talking about all the different ways we can give insulin we can give insulin with needles and syringes with pen like devices you know
of course the way now is insulin pump therapy um and you know checking blood sugars we
can check blood sugars by pricking our fingers but now we’ve got what’s called continuous glucose sensing where you put
a device on your arm or your leg or your abdomen and it can record your blood
sugar by measuring what the sugar levels in your interstitial fluid are so you know compared to 25 years ago when I
started training we had three types of insulin you took two three doses of
insulin a day you had to eat the same amount of food every time there was it
was rigid there was it was an Unforgivable living disease now we can
tailor each individual child our young adults program to fit into their
lifestyle and make the diabetes fit your lifestyle you no longer have to change your lifestyle for the diabetes so
technology and research has obviously helped we’ll talk about research here in a little bit complications of type 1 and
type 2. if you could speak to that for a break yeah so we’ve sort of hit on that a little bit earlier talking about the
short-term complications of low blood sugar problems but really what most people think about is the long-term
complications and you know when we talk to our kids about this I
can just see their eyes they go blah blah blah blah blah but you know I think it’s important you don’t have a puppet
or something in the in the room with the kid yeah yeah um but um yeah it’s tough because we
have to understand what the long-term complications of diabetes are because diabetes is a disease that needs to be
respected because it will kill you if you don’t respect it um and so you know the major
complications are um what we call vascular disease so uh
problems with your blood vessels that lead to heart disease so these uh eventually you have a higher incidence
of high cholesterol hypertension and then you’re at risk of heart attacks
um blood vessel disease going into your legs means that you might end up with
poor circulation into your legs which means that if you get an injury or a wound to your leg it might not heal and
that can lead to gangrene and loss of toes and feet and legs and you know
we’ve all probably heard of some distant relative we have who had like type 2
diabetes and lost their leg and we don’t want that for our children um you know other problems are damage to
the kidneys and I should say that all of these things take 10 to 15 to 20 years
of poor diabetes control so this is not a given good control can prevent
complications of diabetes but in order to be motivated to have good control our
families and the children and the young adults need to understand the consequences of poor control and so
we’ve talked about the kidneys the last thing of course is eye damage and so it can damage the retina in the eye which
can cause you to have problems with your vision so you know one of the things we do for
our kids is we give them a nice chart where we show okay you know if you have this degree of control it could possibly
take 10 or 20 years for you to get complications of diabetes but if you get much better it could take 30 to 50 years
and if you can keep your A1C which is a measure we use to tell us what the average blood sugar looks like if you
can get that close to the normal range Which is less than 6.6 then you can
really prevent those long-term complications and that’s what we’ve learned you know in 1921 when we
discovered insulin we taught we’d cured diabetes you know now you know we talk about the cure for
diabetes all the time well in 1921 when Banting investor McLeod discovered insulin they were sure they had cured
diabetes they won Nobel prizes for curing diabetes and then 10 years later we discovered diabetes complications and
that set a whole new standard for how we need to treat so what I would say to the
young people out there who have diabetes is is that these things sound terrible
and they are but they are all preventable and you know when we work together as a team we can prevent these
complications beautiful as a pediatric endocrinologist that termed just tells
everybody that you deal with children I’ve read this about you Dr Thornton and that you deal with I mean brand new
babies at some at some level yeah how do how does how do you deal with a brand new child that’s
the term hyperinsulinism is going to come up here in a second but basically there’s a part of their pancreas that is
producing too much insulin right procedure and I’m speaking for you forgive me but I would love to know your
thoughts on this but your procedure you’re doing on brand new babies to to remove this part of the pancreas that’s making too much insulin and they become
a normal uh diabetic or potentially not based on the the treatment you’re providing for them correct right so you
know what we’re talking about here is that there are some forms of diabetes that occur because you lose your
pancreas either through trauma involved in some sort of an accident or because the doctors remove it because it’s
causing a problem so everyone has heard about adults you know with pancreatic cancer having to have their pancreas
removed and they get diabetes Well there are diseases that affect children where their body has what we call the opposite
of diabetes they make too much insulin and so instead of the problem being high
blood sugars all the time the problem is low blood sugars all the time and just like we talked about earlier on when a
child with diabetes takes too much insulin and gets a low blood sugar reaction it’s dangerous so too is this
condition in these newborn babies so these are babies who present with low
blood sugars all the time the problem is that their pancreas makes too much insulin and so our job in this area is
to find out what part of the pancreas makes too much insulin and in Cook Children’s we have a special research
protocol where we use this drug called 18 fluorodopa and we inject it into the
babies and then we put them into a pet scanner and we can look at the pancreas and we can see which part is making too
much insulin and so in the old days when children had this disease we just took almost the whole of the pancreas out and
they all got diabetes so you swapped one terrible disease for another terrible disease but now we can find that part of
the pancreas take it out and remove it and cure the patient without the risk of diabetes so you know we talked our
earlier about how there are 14 or 15 types of diabetes Well one of them is post-surgical diabetes
and so now that’s something that we’re seeing far less of because of these new innovations that we can use how often
are you seeing these young young babies with this hybrid insulinism yeah this is
a rare disease we’re talking about 1 in 25 to 1 in 50 000 babies are born with
it and about half of them end up needing pancreatic surgery so you know in the
United States with four million births a year just under now we’re talking about 120 babies a year and they come from all
over the United States to us here in Fort Worth for our program at Cook Children’s
um now let’s talk a little about research you’re involved in a lot of this yourself um what what kind of research are you
involved with and what’s happening in the in the research field of for diabetes yeah so
um currently in diabetes you know the big thing is how do we cure diabetes
like I said we thought we had it figured out in 1921 we learned we did and and so
now a hundred years later huge amounts of money are being invested
in curing type 1 diabetes and there are Partners all over the world working on
this right now we think about curing diabetes
in really two or three ways one is can we get the technology leveraged to
essentially allow someone who has diabetes to live a completely normal life and really not have to do much
other than manage a little technology so this is what we talk about closed loop pump systems where you have a device
like a continuous glucose sensor that tells you what your blood sugar is you
know anywhere from every one minute to every five minutes it is able to communicate to an insulin pump that then
decides that your body needs more or less insulin so it gives you a higher or lower dose and then you get this
immediate feedback because your blood sugar changes and then the pump decides in the next one to five minutes how much
I’m going to give so the idea is that we could do a technological cure for
diabetes in the sense that the patient would still have to be aware of what
they’re doing they’d have to wear the equipment but they’d be able to get on with their daily life and not really
have to think about it too much so that’s good but it’s not the Holy Grail Holy Grail is to totally cure diabetes
and so right now people are focused on ways to give back eyelids so we’ve talked a little bit earlier about how
the autoimmune process damages our own beta cells in the islets and so you know
could we make beta cells that would then we could put back into the body and can
we do that in a way that prevents our body from attacking them again and so that’s a whole nother area that we’re
looking at now is islet cell transplant artificial islets artificial beta cells
how do we wrap them and get them into the body so that our body’s immune system don’t fight them you know do we
use our own tissue like for example we Harvest our own stem cells and then generate those to become Pilots so that
our body doesn’t reject them so that’s another approach to curing diabetes and
then the last approach really is the concept of could we identify those
people who are going to develop diabetes next year and then stop the process before it damages and that’s very
exciting because we’ve got our first drug has just become FDA approved to do this very thing so now if you have
diabetes and you’ve got kids or one of your children has it and they’ve got
other siblings we know there’s a five percent chance that they will develop diabetes sometime between now and the
age of 40. and so if we can go out and identify is it likely that you’re going
to get diabetes in the next year then there are drugs that we can now give that will quieten down that immune
attack on your body and hopefully prevent at least for three to five years
the current technology looks like we can prevent the onset of diabetes but eventually we hope to be able to
completely prevent it so you know people have seen the ads on TV they’ve heard
the news they’re calling our Clinic it’s important to remember that currently our
technology allows us to delay the onset not completely prevent but hopefully every three or five years that we buy
the science will be better the drugs will be better and eventually we’ll be able to prevent completely I imagine you
get asked this question with every patient you see but when will we see a cure when do you think what do you tell
people when they ask you that because I it seems like all the research we’re all heading that direction one day in this
world there will be a cure I know we’re all wanting that right what uh what do you tell people interestingly I’ve been
telling them the same thing for the last 20 years which is five years and so we’ve been wrong
up till now um I think we’re actually getting closer
um uh we you know were able to make beta cells we’re able to dampen down the
immune response so with right now I think we’re at a point where the
technology will allow all our children and young adults who have diabetes already
to be able to stay healthy and well so that when that cure comes they’re ready for it and we can do it
um and I think realistically we’re probably still five to ten years where
we can start talking about a significant cure without a bad burden of disease for
example right now I can cure diabetes by doing an islet cell transplant from a cadaver so someone dies donates their
pancreas to science we take out their eyelids and we put them back into a person but now I have to immune I have
to dampen down their immune response so we’ve just switched you from having diabetes into now having uh being immune
compromised because I’ve had to dampen down your immune response so so the people who have that would say yeah I’m
cured but my life isn’t perfect so we have a long way to go yet but we’re
getting so close nice do you think it is is it is the cure it’s not like once one day they just say we’ve discovered
something it’s more like several different therapies medicines have all come into conjunction with one another to relieve the the burden of diabetes
but it’ll likely be at the expense of another something of that nature I I’m not so sure it’s at the expense of
another but I think it’s exactly like you described there are going to be many little steps you know for example how do
we develop a container that we get if we can make these islands that we put them in so the body can’t fight against those
islets so we’re already there with with those components right how do we make eyelets enough to be able to give to
everyone with diabetes so there’s going to be many Little Steps it’s not going to be suddenly one day there’s a cure
for diabetes Dr Thornton can go play golf all the time now that’s not going to happen it’s steady little steps and
we are seeing those combination of steps happening right now so this is a very exciting time very good you mentioned
islet cell transplants transplanting the cells into the pancreas that produce insulin that type ones have lost how how
common is this um so I’m not sure how many were doing a year now but
um this is something that’s been around for quite some time and the problem is is
that there aren’t enough uh people who are donating their pancreas it takes the pancreas of two to
three people to get enough eyelets for one person and um I think uh the statistics on the
number of people with type 1 diabetes is so huge that it’s just right now it’s not practical what we have to do is
learn to make um cells that make insulin so make beta
cells and that’s where all the stem cell work is coming from um that’s where
um these modern Technologies are going and so that we’re not reliant on cadaver or donor pancreas you mentioned earlier
in the interview about covid causing uh you know think of a spike in type one can you talk to that just briefly what
that just the virus it triggered the an attack yeah more or less we haven’t really figured out completely why this
has happened but we’ve known notice is that there was a spike in the increase of frequency of of type 1 diabetes
during covert now you know some people have said well that’s because a lot of kids became overweight because they were
you know in their house they had nothing to do no exercise no friends no running around so yes there was a there was a
definite increase in obesity and type 2 diabetes but there was also a spike in type one
um so the presumption is that somehow or other this new infection triggered an
overwhelming immune response in the body and that overlapped into
attacking the beta cells um and you know the reality is is that we don’t know what that normal trigger
is you know we’ve always assumed it was viral infections and maybe this is just
another one of those viruses that in some people it will trigger a response against the beta cell but nobody has
solved that problem exactly at this time I read somewhere that or someone said
somewhere in a something that I read that in 10 years time or less that one
out of every three people they believe will have some form of diabetes does that sound accurate or is that somebody
taking a while no that that’s accurate when you include type 2 diabetes
so most of that increases in type 2 diabetes and although my world is
focused on type 1 diabetes the reality is is that older our population gets the
more likely people are to get type 2 diabetes I mean I remember my dad got type 2 diabetes when he was 70. and I’m
thinking how could you get type 2 diabetes you’re a skinny old guy but it’s just age So eventually As Time
wears on our pancreas is not able to function as well as it did and so type 2
diabetes is also a diabetes of old age not always just obesity so in the kids
it’s obesity mediated in the adults it’s sort of age mediated right can you get
type 1 diabetes at any age now it’s not a it’s not it used to be called I think juvenile diabetes but I don’t think
that’s accurate correct that’s correct um it is absolutely true that the vast
majority of people who develop type 1 diabetes develop it when they’re young but you still can get autoimmune
destruction of the eyelid cells when you’re older and you know we sort of have this arbitrary cut off of 40
um that if you know if you get autoimmune diabetes before the age of 40 it’s called type 1 or autoimmune
diabetes and if you get it after that then it’s type 2 diabetes but of course the lines are blurred and you can get a
low-grade autoimmune attack on your on your body as an older person and so people call that latent autoimmune
diabetes of of adulthood um but it’s generally not a fast and
quick progression um you know one of the things we didn’t talk about is you know how long does it
take a child who’s completely normal from the first time their body starts attacking their beta cells till they
have Frank diabetes and the answer is probably anywhere from six weeks six months it’s a very fast decline and most
of the time you don’t you get to 90 percent of the decline in loss of your beta cells without even knowing it you
don’t get any symptoms and then right at the end that last time from when you start getting symptoms you know six
weeks it’s a pretty short time yes sir so you don’t have much time to notice these things and you know take your
child to the doctor and say look at I’ve noticed we’re losing weight we’re drinking more water let’s do a test for
diabetes I think I know I don’t know the answer to this but I think I know where you’re going to go with this but how many
people do you think are walking out there in the general public that have no idea they have type 2 diabetes I’m assuming type 2 is as much can go on
much longer than type one but what percentage of people would you say probably
can’t remember the statistic exactly but it’s like 30 to 50 percent of people who
have started to get type 2 diabetes don’t know and that’s the funny thing is that when we see the kids with type 2
diabetes and you ask the right questions and you look back you can see in
retrospect they’ve had signs and symptoms for up to two years so the progression of type 2 diabetes is much
slower much more subtle and so there there are probably as many people out
there who have early stage type 2 diabetes who don’t know what US who actually do
and so you know this one-third of all people in in you know developing diabetes that’s predominantly the type 2
problem that’s incredible um Cook Children’s Medical Center as we
refer to it here on the show uh they’re a world leader in this in this department among others but uh is it you
guys stand at all on the Mount Olympus of the diabetes research and treatment I
believe how did you guys get there what’s why why does Cook Children’s Medical Center stand so high on this on
this disease well I I think there’s really two ways of thinking about this
um what I would say is that we provide excellent care in the
diagnosis and management of type 1 diabetes we’re not working in the lab
trying to develop you know new ways to make beta cells or figuring out new ways
to do islet cell transplants what we’re doing is we’re taking all the technologies that we have at our
disposable and working with our kids and their families to try and give them the
best shot at a healthy life from the perspective of their diabetes so what we would say is that we are at the clinical
Cutting Edge of the care of diabetes not so much that we are
um leading in in in like basic science research and how we’re going to prevent diabetes now you know are we doing some
of the studies to look at how do we you know ameliorate the the the rate of
progression of this Nuance at diabetes yes we’re working with industry doing some of those studies but not the sort
of you know Cutting Edge gene therapy things Cook Children’s is a leader in
clinical research rather than basic science research very good one dumb
question and then we’ll end with a good question okay great I saw this question somewhere online there’s too much money
there’s so there’s so much money in the treatment of diabetes that a cure is not practical
for these uh diabetes companies what do you say to that I I hear this all the
time that people say oh my God they’re making so much money on insulin why would they want to cure diabetes and
probably if you’re a shareholder in a company that makes sense and you don’t want to cure diabetes but luckily for us
that’s not how we feel trust me if I did not have to take care of 2 000 kids with
diabetes I’d be the happiest man alive not that I don’t love you all of those 2
000 kids out there but yes that is a common I think misconception that people
do not want to cure diabetes let me tell you that there is a huge scientific move
to cure diabetes if you look at organizations like the JDRF or the
American Diabetes Association all of their focus is on helping children and
adults with diabetes have a better life but also on curing and preventing diabetes for anyone so yes I think
there’s always going to be people who say there’s too much money but when you look at the amount of money being invested in preventing diabetes it’s
huge so I would say to our listeners don’t give up hope don’t be thinking that just because XYZ company is making
a lot of money on Diabetes that that we don’t want to cure your diabetes we do we’re with you and everyone’s working
together and this is probably one of other than maybe cancer one of the best
invested diseases I mean when I look at my kids with hyperinsulinism which is the opposite of
diabetes they make too much insulin we’re begging for the amount of research
and interest in curing that condition compared to diabetes so yeah no
don’t give up hope the medical profession is fighting on your behalf and there is money in curing diabetes as
well so that you know think about it that way Dr Paul Thornton Medical uh
let’s see endocrine and diabetes program medical director at Cook Children’s Medical Center thank you for sharing
with us this incredible fascinating world and thank you for the work you do for all those kids and for adults for
that matter we appreciate you being here and I’m honored to have you in this in the studio so uh before we go we ask all
of our our interviewees uh beside wife and children and family Affairs is there
a Best Day of your whole life you could share with us wow
um You didn’t tell me about that one and uh we never do oh yeah gosh
[Music] um there’s been a lot of a lot of things I think the day I got into medical school
was a very happy day because here’s the interesting thing I didn’t actually get into Medical School initially so I was
on my bike about to ride to Trinity College in Dublin to start my first day
in dental school can you imagine how horrible that would have been so now that I know how much money dentists are
and maybe it’s not that horrible however just as I was leaving the postman came
along and there was this letter and it was my admission to medical school so that was a very exciting day
that’s wonderful thank you for sharing that yeah thank you guys for watching that’s been another episode of fortitude
Dr Paul Thornton uh we appreciate you thank you cap Tech’s Bank as always uh
appreciate you watching the show until next time [Music]
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