The last time PhD student Jasmine Maghera spoke with her teenage mentee, the younger girl made her heart sink.
“She felt like nobody was doing anything.”
The mentee was diagnosed with Type 1 diabetes in 2020, which made it more difficult for her to connect with others who share her diagnosis. Meeting Maghera gave her a chance to meet someone else with Type 1, and to learn about all of the work the PhD student and her colleagues are doing to improve life for people with diabetes.
Maghera, who was diagnosed when she was 11, remembers being told that five years from her diagnosis she wouldn’t need to take insulin anymore: technology would make injecting insulin obsolete.
“Five years went by and nothing happened, and another five years went by and nothing happened. Now I’ve passed 15 years and there’s no widespread treatment yet. This is an immensely complex problem to solve.”
Now Maghera’s goal is to create and share that technology — if not for herself, for future generations. And she’s not alone.
Peter Senior — professor in the Faculty of Medicine & Dentistry, Dr. Charles A. Allard Chair in Diabetes Research and director of the Alberta Diabetes Institute — says that over the last few years, he’s noticed that a number of the grad students at the institute studying Type 1 diabetes are also living with the disease.
Like Maghera, these students strive to offer better treatments and quality of life for people like them, and have been just as active helping their community outside of the lab.
“The institute has a desire to add value to the community, predominantly people with diabetes, by having information sessions where we describe the research we’re doing or how this applies to them,” says Senior. “But for me, it’s great to see these students going out on their own to give back to the community.”
Having researchers who know what it’s like to live with Type 1 is also an advantage for the institute, he notes, because it helps them answer questions that are relevant to people with the disease.
A better tomorrow
For Alice Carr — a postdoctoral fellow in the Faculty of Medicine & Dentistry with graduate student award funding from the Morley and Val Blanch Family — the question is what is the best level of functioning for insulin-producing cells, and how that can best be measured.
Pancreatic beta cells produce insulin — or at least they’re supposed to. In people with Type 1 diabetes, the cells either don’t make insulin at all or don’t make enough to properly regulate glucose in the bloodstream.
Beta cells are found within small clusters of other hormone-producing cells called the pancreatic islets. Currently, the best way to restore functional insulin production in people with Type 1 diabetes is through an islet cell transplant.
“Dr. (James) Shapiro’s group has created an islet cell transplant protocol that uses islets from people who have passed and donated their pancreas,” explains Maghera. “We take those islets and we can put them into patients, but there are a few limitations with that.”
One limitation is that there aren’t enough donors for everyone with Type 1 diabetes to have a transplant. Another is that patients have to stay on anti-rejection drugs to prevent their immune systems from attacking the foreign cells.
Maghera is working with pancreatic beta cells to create better cells derived from stem cells — aiming to create an unlimited supply of cells that someday won’t elicit an immune response.
She also recently assisted PhD candidate Jamie Boisvenue with his Reshape T1D study, a participatory research project in which “patient partners” living with Type 1 diabetes shared their experiences living with the disease, with the goal of recommending changes to clinical practice and improving care. Maghera is producing paintings that illustrate themes from the study’s data, with an art exhibit planned for Diabetes Awareness Month next November.
In the meantime, other researchers are working on improving islet cell transplantation. That was the focus for Saloni Aggarwal, who was diagnosed with Type 1 four years ago and graduated from the U of A with a master’s in science in surgery last fall.
Aggarwal explains that one of the challenges with islet cell transplantation is that a lot of the cells die after being introduced to a new host, which reduces the effectiveness of the transplant.
Working in Andrew Pepper’s lab at the ADI, she tried to increase the number of cells that survive transplantation to make the procedure available to more patients with diabetes. By observing cell death, Aggarwal hoped to find out why the cells were dying and how to prevent it from happening.
“Only a small subset, about 10 per cent, of people with Type 1 diabetes are eligible for the transplant, given the cell death and the immune suppression,” says Aggarwal. “So improving the cell efficacy would definitely increase that number.”
Meanwhile, Carr, who was diagnosed with Type 1 when she was 17, is looking for a biological marker to measure the performance of both stem cells, like those Maghera works with, and islet cells following transplantation, like the ones Aggarwal studied.
More crucially, she wants to measure the decline of insulin-producing cells before someone is diagnosed with Type 1, in the hope that catching the decline of these cells earlier will allow people to be treated with immune therapy and stop diabetes in its tracks.
A better today
Sitting outside the entrance to the ADI in the lobby of the Li Ka Shing Centre for Health Research Innovation, Maghera wears a T-shirt that reveals a glucose monitor on one arm and an insulin pump on the other. Both bear custom covers that she makes and sells online.
The side hustle not only helps her pay for her diabetes technology, it’s a way of helping others who live with diabetes.
“It’s kind of a two-pronged approach: I like raising awareness. I like when people ask me questions about my covers because it gives me an opportunity to teach. It’s also really helpful for kids that feel that their autonomy got stripped from them, because now they can choose between a pink cover or a green cover, or if they want a sports logo on their cover.”
Maghera’s advocacy and community outreach is something else she has in common with grad students at the ADI who have Type 1.
Maghera and Aggarwal both volunteer with I Challenge Diabetes, which runs a program called Diabuddies. The program educates school administrators, staff members, teachers and students to better support kids living with Type 1.
Carr, who moved to Canada from England a few months ago, has also worked with young people through the Juvenile Diabetes Research Foundation.
“I would talk to the children of some of the JDRF donors that were interested in doing science, interested in going into Type 1 diabetes research.”
Reid McClure, another ADI researcher living with Type 1, works to improve the lives of people living with Type 1 diabetes through his research.
A newly minted master’s graduate in the Faculty of Kinesiology, Sport, and Recreation, he worked with his supervisor Jane Yardley on reducing barriers to physical activity by looking at exercise strategies that have the least impact on blood glucose.
McClure explains that people with Type 1 need additional preparation and care when engaging in physical activity, which includes not only vigorous exercise, but even activities such as walking to the grocery store.
“There’s a very long list of factors that can affect your glucose response to exercise, and if one of those things is not accounted for, you could end up having to end that activity to treat your blood glucose. Usually, the main risk during exercise is related to low blood sugar, which can be fatal if it is not treated or you don’t have the tools with you to raise your blood sugar.”
McClure is intimately familiar with managing Type 1 during exercise. He is a former member of Team Novo Nordisk, the world’s only professional cycling team made up entirely of athletes with Type 1 diabetes. As part of the team, McClure raised awareness of Type 1 diabetes and the level of physical activity that’s possible for people living with it.
McClure and Yardley’s work, funded by ADI and the Alberta Diabetes Foundation, focused on improving or modifying clinical guidelines for physical activity for people with Type 1. The current guidelines recommend things like checking glucose levels before exercising and modifying insulin an hour and a half before exercise to prevent low blood sugar.
“But when we consider those guidelines, it’s not like you can just go for a walk,” says McClure.
As part of the research, he conducted trials with individuals with Type 1, and McClure says since he also has Type 1, he could connect a little more easily with participants and give them a clear idea of what the trial would involve.
His colleague Carr also emphasizes that while finding a cure is important, as a person living with Type 1, it’s important to her to look for ways to improve the lives of people living with diabetes now.
“There is a lot of talk in the field about cures and so on, and that’s great, but it does still feel that it’s quite far down the line. I’m trying to think what could help me, a patient who’s had diabetes for 10 years, now. Because I care about what’s going on now and I know that other people with Type 1 diabetes feel the same.”
