How did you get into research, why this area?
My interest in research goes way back, to when I was an undergraduate and thinking of going to medical school. I started working in a research lab and found I really loved doing problem solving and I liked being in a lab so I went to graduate school.
I found basic research a bit dry and wanted to connect with people around my research and do something that was more immediately and obviously relevant to people and their health. So I went to medical school and questioned whether I would do research. I went into general medicine and found I loved endocrinology because of the problem solving part of that work. In fact, I went into endocrinology despite the focus on diabetes, thinking I would look more at hormones and the pituitary.
But the more I saw of diabetes and how much we don’t understand, I decided that I could really help most by studying this disease. There are so many consequences and we especially don’t understand the connection between diabetes and heart disease. So I got interested in the insulin resistant issue and how it impacts the heart as well as diabetes.
Why is this important?
We don’t really understand why heart disease doesn’t respond as well to good glucose control. What we do understand in diabetes is that once you are insulin resistant enough, the pancreas can’t keep up and the blood sugars go up. But other things happen, specifically that your body doesn’t respond as well to the fuels available to the body at the time.
SO – in a normal person your body uses what you eat, and if there is no food your body burns fat.
When someone is insulin resistant that decision is not made as normally. We don’t totally understand this. What we do know that fatty acid levels in the blood stay high, even with glucose available so the body is not switching as effectively or at all.
We don’t really understand how that happens, or how this impacts cardiovascular health, but we know it happens.
I am especially interested, in looking at people who are insulin resistant but don’t have diabetes. We believe that insulin resistance leads to diabetes and heart disease – and it probably takes 10-20 years for this to build. If we could catch it earlier we could make people with this condition more insulin sensitive before they get diabetes.
People with Type 1 diabetes lack insulin, so the treatment is to give insulin and regulate the glucose. However, people with Type 1 diabetes can also be insulin resistant; we can still treat them but we don’t know what this may mean for them developing cardiovascular disease.
So what I am studying now is the blood vessels and their stiffness and the dilation function – these are thought to be precursors to heart attacks down the road. We’ve found good response in the short term, so if we make people more insulin sensitive, does this improve their risk of developing heart disease down the road.
In terms of how this impacts women, I’m very interested in this side of it. Normally, before menopause most women do not get heart disease. In 40-something women without diabetes they do not show heart disease; then they go menopause, catch up to men and the increase in heart disease risk is greater.
In diabetes, that protection that women have before menopause is lost so women in their 40’s who have diabetes have just as much risk as men…. so that’s telling us how heart disease develops in women.
If we can understand why this happens, we can help with the treatment of diabetes and heart disease along the way – if we can figure out what the estrogen is doing, and we know how it works, we can figure out the estrogen replacement in women – and then can we mimic that type of treatment in men.
What do you hope to learn from your research? Hopes and Dreams?
For my research specifically, I like to think that this about preventing badness before it happens. If we can understand the very early things that lead to heart disease down the road, we can get in front of it before the damage is done. I want to discover the real roots of the problem -- what’s the number one "hit" that happens in CVD that we can target early – that’s what we’re trying to find – both in and out of diabetes.
My hope is to figure out that pre menopausal protection in women and why it’s lost with diabetes, and how insulin resistance is a part of that.
The biggest dream is developing novel treatment options in diabetes to prevent heart disease.
What can we do to report on your work in a way that can be understood and valued by the general public?
One big part is what we’re already doing, which is stressing how common diabetes is, how much it’s on the rise – and stressing that the big destroyer is cardiovascular disease. Everyone knows someone who would benefit from better treatment options. We need to be educating about why these diseases are so insidious.