October 30, 2021 Curbing blood sugar lows

Who:

Dr. Rémi Rabasa-Lhoret, professor, Department of Nutrition, University of Montreal; director, Diabetes Clinic and Metabolic Diseases Research Unit, Montreal Clinical Research Institute

Research highlights/discoveries:

• Co-developed an external artificial pancreas for the treatment of diabetes

• Researching ways to reduce the frequency and consequences of low blood sugar in people with type 1 diabetes

• Received three awards for excellence in teaching from the University of Montreal; has published more than 300 manuscripts and book chapters

Dr. Rémi Rabasa-Lhoret at a glance:

• Awarded Diabetes Canada’s Brian Dufton Memorial Manuscript Award (2017)

• Appointed Professor, University of Montreal (2016)

• Received Young Investigator Award, Canadian Society of Endocrinology and Metabolism (2010)

• Recruited by the University of Montreal (2002)

• Completed his medical degree, Faculty of Medicine, Paris, France (1990)

How did you end up becoming a diabetes researcher in Montreal?

I’m from Paris, France, and started my work in diabetes in 1991. My interest was sparked while working with people living with diabetes as a young resident. I came to Quebec to complete my PhD in 1995 and when I was offered a job in Montreal in 2002, I moved here permanently.

Are you a practising physician as well as a researcher?

Yes, as a physician I follow close to 1,000 patients, 50 per cent of whom have type 1 diabetes, 40 per cent have type 2 and the rest have cystic fibrosis-related diabetes. A typical week would include two days in the clinic [seeing patients] and three days dedicated to research, teaching, and administration.

What are you currently researching?

My team is looking at the risk factors that can cause hypoglycemia [low blood sugar], the consequences [fear of future low blood sugar events, cardiac problems], and ways to better assess and prevent these episodes to improve overall treatment.

Hypoglycemia can happen often, especially when exercising. It can impair one’s driving ability, efficiency at work, sleep. It can happen day [or] night, leaving patients worried, frustrated, and tired.

Supported by Diabetes Canada, we are looking to better understand the best strategies to reduce and prevent exercise-induced hypoglycemia in [people with] type 1 diabetes.

How do you do this?

We are looking at how much and when patients should reduce insulin and/or eat snacks before and after different types of exercise to reduce hypoglycemia frequency. For example, we recently showed that for patients using an insulin pump, reducing basal insulin infusion rate [the amount of insulin given as a continuous infusion, which is set per hour] by 80 per cent should be done 90 minutes before they start exercising.

In collaboration with a large group of partners, we launched the BETTER project to develop a registry of people with type 1 diabetes in Quebec to understand patients’ perceptions about hypoglycemia, and recently submitted our first data for the project. We are also investigating if online training and new therapies [such as new insulins] and technologies [such as continuous glucose monitoring] can reduce hypoglycemia. We also try to answer questions that aren’t often addressed, such as how to manage diabetes technology [insulin pumps] during intercourse.

What is your long-term goal?

Given my experience both as a clinician and researcher, I hope to be a bridge from the lab to the bedside. Hopefully, combining patients’ experience together with medical and research knowledge can bring new perspectives to hypoglycemia prevention and treatment.

If I can minimize the burden of type 1 diabetes by reducing at least a bit of the frequency and consequences of hypoglycemia, I will be extremely proud.

The last word

“Dr. Rabasa-Lhoret is searching for ways to reduce and prevent hypoglycemia, a concern for all people living with type 1 diabetes. His research could greatly benefit their lives.” — Dr. Seema Nagpal, vice president, Science & Policy, Diabetes Canada

Did you know?

Even after 100 years of insulin, 1 in 3 Canadians are living with or at risk of diabetes. We can all play a role in ending diabetes. Whether it’s raising awareness, having your A1C tested, knowing your risk, or supporting research towards a cure—every action, no matter how big or small, makes a difference.

This November during Diabetes Awareness Month, help us reach 100,000 actions to End Diabetes. Take action now and share it on diabetes.ca/takeaction #LetEndDiabetes

This article appeared in Diabetes Dialogue, Winter 2020.