As a young teenager, he was driven to work in the field of diabetes research. Mostly, he wanted to pursue what he saw as his mission in life—to find a cure for type 1 diabetes. When the father of a friend told him that he needed to do well in chemistry if he wanted to pursue life sciences, he made studying for chemistry his priority.
Born in Germany, he was diagnosed with type 1 diabetes in 1986, when he fell ill while away at a youth camp. Originally from Bavaria, in Southern Germany, he worked hard to get his PhD in chemistry and biochemistry. After getting in touch with labs all over the world, he landed a position in Denver, at the University of Colorado for his post-doc work. That was more than a decade ago, and just last year, Dr. Delong was hired to a tenure-track position.
In the more than three decades since his diagnosis, his hard work has paid off: Dr. Delong, now a dad of two who lives with his family in Denver recently discovered a new type of hybrid-protein in the body that the immune system appears to go after, thus causing type 1 diabetes. The American Diabetes Association has noted that Delong’s research may pave the way for significant new discoveries about what triggers type 1 diabetes. Dr. Delong was one of the ADA’s prestigious Pathway to Stop Diabetes grant recipients in 2015.
A study published in the journal, Science, which Dr. Delong co-authored, could help explain the question of how type 1 diabetes can result when a person’s immune system doesn’t work properly.
“T cells” in a person’s immune system are meant to fight infections in the body. In healthy people, when these cells identify markers called “antigens” originating from viruses or bacteria, they mount an attack on them. A person’s own cells are protected from the attack because “T cells” don’t recognize self-antigens. In type 1 diabetes as well as in other autoimmune disorders, something goes wrong.
“We knew that T-cells were causing type 1 diabetes in mice and that they play a role in the destruction of insulin-producing beta cells,” he says. “But we didn’t know what the T-cells are seeing in the beta cells. It turns out the T-cells see a new type of antigen or hybrid protein modification.” Dr. Delong calls them hybrid insulin peptides (HIP).
In short, the research suggests that these HIPs could have a key role in tricking the immune system into attacking the body’s insulin-producing cells, triggering type 1 diabetes.
“Imagine you are in a nice restaurant with a very nice waiter,” Dr. Delong says. The waiter is like the immune system, making sure you have everything you need, he says, and the hybrid insulin peptides are like sporks (those half spoon-half forks.)
“Your waiter does not allow sporks on the table since they belong in a cheap restaurant so he keeps throwing them off the table,” Dr. Delong says. The question is, do these sporks, or hybrid insulin peptides, play a role in the development of type 1 diabetes?”
Making sense of the misguided immune attack by the HIPs is the first baby step in eventually learning how to switch off the attack, Dr. Delong explains. Down the road, it may help researchers to develop new therapies for type 1 diabetes, or even to prevent type 1 diabetes.
“We need to find ways to re-educate the immune system so it no longer targets these hybrid insulin peptides or other antigens,” he says. “Since my beta cells are gone, we will also need to find ways to grow back the insulin-producing cells. We have to re-educate the immune system so it will tell the T-cells to stop attacking and then we need to figure out how to grow the beta cells back.”
While he devotes himself to helping find a cure, Dr. Delong follows a high-fat, low-carb diet that he feels keeps his blood sugar either in or close to the normal range. The diet calls for lots of fish, nuts, vegetables, olive oil, and eggs, plus a little cheese. Pasta, pizza, and bread are off the table. “You can still have a very varied diet, it’s just low in carbs,” Dr. Delong says, adding that he no longer worries about being too low or too high where blood sugar is concerned.
“This diet gives me peace of mind,” he adds. “I don’t think I’ve had a low blood sugar in months.”
He has a continuous glucose monitor that he says makes following his blood sugar much easier. “It beeps when the blood sugar gets too low or too high so you don’t have to go to sleep worried about this,” he says. “It’s nice. And in combination with the high-fat, low-carb diet, it’s ideal. I don’t worry about my diabetes as much as I used to.”
He tests his blood sugar with two finger pricks a day to calibrate the continuous glucose monitor, along with several insulin injections per day. But he does not have an insulin pump. “If you leave too much to a machine all the time, you stop thinking about your diabetes,” he explains. “And I think that it is important to think about it, like why did my blood sugar go high? If you leave everything to a machine, you aren’t thinking about staying in good control.”
As a researcher, Delong likes to keep abreast of other studies. For instance, he discussed research currently underway to transplant insulin-producing cells into patients with type 1 diabetes who no longer make these cells.
“It’s a great approach,” he says. “I’m not sure how long the cells would be viable, or if they would cause some damage to the tissue. Would you have to get a new batch of cells every few years when these wear out?”
Dr. Delong also praised the research work of the father of a boy with type 1 diabetes who is trying to come up with an artificial pancreas. The dad, a biomedical engineering assistant professor at Boston University, is attempting to get his “bionic pancreas” approved by the Food and Drug Association before his son leaves for college.
The only problem with devices like these, Dr. Delong says, is that if you don’t have batteries, all bets are off. “If I was stranded on a desert island without batteries, I’d be in trouble,” he says. “So I feel that the best solution is the biological solution: in which we figure out how to re-educate the immune system and come up with a way to grow back the beta cells so everything will be in place.”
While research projects like these interest Dr. Delong, he feels that the best solution is a biological one: “to re-educate the immune system and figure out a way to grow back the beta cells so everything would be in place.”
Dr. Delong feels that his research has great potential, but adds it will be quite some time before all the research results in a cure for type 1 diabetes. But, he says, the presence of HIPs may one day be used to diagnose type 1 diabetes or even to identify individuals who may be at risk for developing it.
“I have always hoped that a cure would happen in my lifetime,” says Dr. Delong. “The way to stop diabetes is to figure out ways to prevent it,” he says. “This is a realistic goal, but these things take time.”