Hippo saw daylight on the 14th of November 2008 " world diabetes day"

A cute cuddle with type 1 diabetes! Just like children with type 1 diabetes, he measures his blood sugar levels several times a day and administers insulin because his pancreas produces too little or no insulin. He is a unique compagnion for children with type 1 diabetes! The name was not chosen by accident. Hippo sounds like 'hypo': the name for an abnormal drop in blood sugar that makes a person with diabetes unwell. In the meantime, Hippo is an indispensable support and refuge for many children with type 1 diabetes. Many people with type 1 diabetes received this cuddle in the past and still take it with them to consultations or hospital admissions. With financial support from the pharmaceutical world (Abbott), Belgian children are offered a Hippo cuddle free of charge when they are diagnosed with type 1 diabetes.

How was Hippo & Frends created? 

Hippo & Friends started in 2008 as a non-profit association (vzw), founded by Barbara Flamand, who herself has a daughter with type 1 diabetes. When her 8-year-old daughter was first diagnosed with this diagnosis, she started looking for playful ways to familiarize her daughter with the world of insulin, injection sites, and injection techniques. Barbara came up with 'Hippo', a cute hippo cuddle having itself type 1 diabetes and demonstrating children how and where to administer insulin. After many years of dedication and effort, the non-profit association was transferred to the KULeuven on the 8th of July 2013 and this was the start of the Hippo & Friends type 1 diabetes fund. With the fund, we focus mainly on scientific research, while through the new non-profit organization Hippo and Friends, founded on the 24th of June 2019, we also want to improve awareness and knowledge about type 1 diabetes among the general public and improve the quality of life of people living with type 1 diabetes via projects like diaT1op.

In-depth research into the origin of type 1 diabetes

Thanks to generous donations to the Hippo & Friends type 1 diabetes fund and the non-profit organization Hippo and Friends, the diabetes team, led by Prof. Dr. Chantal Mathieu, Prof. Dr. Kristina Casteels, and Prof. Dr. Pieter Gillard, can conduct more in-depth research into the origin of type 1 diabetes, which in time can lead to more targeted treatment for patients and hopefully also to the prevention of the disease. At KULeuven, we work together with various international groups and industry to achieve useful results faster. In addition, the diabetes center works closely with UZLeuven so that basic research can be translated into clinical studies more quickly. A great focus is placed on translational research that makes the link between 'bench' and 'bedside'. There are various lines of research, including RNA and protein research in human cells, which aims to find new biomarkers to detect and monitor type 1 diabetes faster and better, but also to prevent and treat this chronic disease. These are ambitious goals, but we are aiming for nothing less than a world without type 1 diabetes. In addition, the KULeuven team coordinates INNODIA, one of the largest European consortia working on type 1 diabetes. In this way, there is immediate availability of human samples from patients and their relatives for translational research.

Research into immunological biomarkers

Research into immunological biomarkers for the early detection but also for a more targeted treatment of type 1 diabetes is reaching cruising speed. Some of these biomarkers, such as autoantibodies, are well established but not sufficiently sensitive to reveal the heterogeneous disease process in different individuals.
The protein research in human insulin-producing beta cells focuses on finding proteins that change in the insulin-producing beta cells in response to inflammatory reactions (inflammation) or other types of stress and thereby themselves contribute to triggering erroneous immune responses against the beta cells. cell. Some of these altered proteins move to the cell surface, making the beta cells more visible to the immune system (link). These findings were first established in mice with type 1 diabetes (link) and later in type 1 diabetic patients (link). Recently, we have also started to introduce very new technologies in the diabetes center. Single-cell RNA sequencing makes it possible to look at the entire transcriptome per cell.

Neutrophils

Currently, it is proposed that type 1 diabetes is mainly caused by the adaptive immune system and more specifically by the beta-cell-specific auto-reactive T cells. These invade the islets of Langerhans in the pancreas where they trigger an inflammatory response that results in influx of other immune cells and the production of chemokines, cytokines and other molecules. Recently, interest in the role of neutrophil granulocytes in the disease process of type 1 diabetes has arisen based on studies with patient samples and mouse models of type 1 diabetes. However, it is unclear how neutrophil granulocytes contribute to the onset and progression of the disease. There are also data from other autoimmune diseases showing that neutrophil extracellular traps (NETs) play an important role in the disease course of these diseases. A NET is a kind of sticky web of DNA strands. A neutrophil can shed this web to trap bacteria. Unfortunately, not only bacteria can stimulate neutrophils to make NETs, ​​but also substances in the blood of people with autoimmune diseases can activate NETs. In the diabetes center at the KULeuven, neutrophil granulocytes from humans and mice with type 1 diabetes are phenotypically and functionally characterized using the latest technologies. How do these cells communicate or interact with the adaptive immune system and how can new insights contribute to the development of preventive and curative treatment methods?

Immune therapy

Through the gut, our immune system is exposed to a wide variety of proteins from ingested food or bacteria (intestinal or microflora). Ingested proteins do not trigger an immune attack and this phenomenon is called "oral tolerance". In collaboration with Precigen ActoBio, the diabetes center at KULeuven is investigating how proteins that are inherent to the insulin-producing beta cells can be presented to the immune system of the intestine via a genetically modified bacterium (Lactococcus lactis). It is expected that the body will tolerate these proteins and hopefully also the entire beta cell. With this approach, the disease process in laboratory animals with type 1 diabetes can be permanently stopped in 2 out of 3 cases (link; link). Based on these results, a first clinical study was started in newly diagnosed type 1 diabetes patients at the end of October 2018 (link; link).

Electronmicroscopic (EM) pictures of Lactococcus lactis bacteria                       ©Precigen ActoBio, Zwijnaarde (Ghent), Belgium

Vitamin D

Vitamin D is a classic vitamin and hormone. Sunlight is our main source of vitamin D. Our body can make it in the skin under the influence of sunlight. A small portion comes from our diet. In addition to the beneficial effects on bone and muscle strength, we know that vitamin D is also important for the proper function of pancreas and immune system. Vitamin D protects the insulin-producing beta cells against inflammatory reactions and has a beneficial effect on the immune system, including the generation of "regulatory" immune cells that restore the balance in the disturbed immune system in type 1 diabetes (link; link). Our research has inspired scientists at the Leiden University Medical Center (LUMC) in the Netherlands and City of Hope in Los Angeles (US) and a first clinical cellular therapy with vitamin D is currently underway in diabetic patients (link; link). The KULeuven team also showed that oral vitamin D partially prevents the development of type 1 diabetes (link). The research on vitamin D focuses mainly on understanding how this vitamin can change and re-educate the immune system. Understanding this, we can potentially bring about the same changes with much more targeted drugs. Enough reason to go for a walk in the sun at least once a day for 15 minutes, but don't overdo it of course!

Practical info about type 1 diabetes

Still have questions after reading this extensive story? The website of the UZLeuven diabetes center provides clear and concise explanations about many diabetes themes (although in Flemish). Have a look. We also refer to the website of JDRF or Diabetes UK for more practical information

Treatment of type 1 diabetes

Type 1 diabetes is currently incurable and requires lifelong treatment that requires considerable effort from the patient and his environment. Type 1 diabetes can only be treated with insulin. Strict sugar control, keeping blood sugar levels in the normal range, is important not only to suppress symptoms in the short term, but also to prevent later complications. However, the blood sugar levels should not drop too low, because then you risk a hypoglycemia or hypo for short. After the diagnosis, your doctor will work with you and the other experts on the team to choose the best solution for you. It is therefore important to do regular self-monitoring of blood sugar levels anyway. Good control allows a diabetes patient to live longer with fewer complications.

Causes of type 1 diabetes

We don't know exactly what causes type 1 diabetes. It starts with a genetic predisposition to type 1 diabetes, but often without diabetes in your family. All kinds of factors from your living environment can influence the development of type 1 diabetes.
Scientists have shown that there is a genetic predisposition, but this is only a small contribution. Even without type 1 diabetes in a family, and the influence of environmental factors, people can develop type 1 diabetes (in 90% of cases). The possible causes can also differ from person to person. The likelihood of type 1 diabetes when a family member has it is as follows:

• Sibling with diabetes: 1-8%
• Father or mother with diabetes: 1-4%
• Both parents have diabetes: 20-40%
• Cousin with diabetes: 1-2%
• Monozygotic twin brother or sister with diabetes: 23-50%

There are a number of environmental factors associated with the development of type 1 diabetes: viral infections, certain types of food in early life (including gluten at a very young age), too little exposure to sunlight (or too little vitamin D) ... All factors that scientists suspect contribute to the development of type 1 diabetes.

Diagnosis of type 1 diabetes

If type 1 diabetes is suspected, one or more tests are performed in the hospital, including a blood pressure and weight check and a blood sample to measure sugar and/or fat content (lipids).

The blood collection is best done sober. A fasting blood sugar value greater than or equal to 126 mg/dl (7.0 mM) indicates diabetes. At a value between 100 and 125 mg/dl (5.6 and 6.9 mM) we speak of a disturbed fasting glycemia or "prediabetes". When the blood sample is not fasted, we speak of diabetes when the blood sugar is more than 200 mg/dl (11.1 mM). Most hospitals also measure "saccharified" hemoglobin or HbA1c. More than 6.5% indicates diabetes.

©Despina Children's diabetes foundation, Nicosia, Cyprus

Support the Hippo & Friends type 1 diabetes fund

Help us cure type 1 diabetes. Support us so that researchers have the opportunity to carry out outstanding research in complete academic freedom. We sell fun gadgets through the non-profit organisation Hippo and Friends, but you can also organise an event or action to support scientific research. You can also make a gift or donation to the Hippo & Friend type 1 diabetes fund. For all these actions, we are always looking for volunteers. We are happy to assist you during the organisation. We want to put type 1 diabetes in the spotlight at numerous events (e.g., benefit concerts, the Christmas market in Leuven, yearly science day for people with type 1 diabetes , school and company visits...) and the profits of these actions go towards scientific research.
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