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CENTRAL  SOUTH  DAKOTA  MEDICAL NEWS
THE CLINICAL VIEW
By: Phillip E. Hoffsten, M.D.
3  MAY  2001

New Hope for Type I Diabetes Mellitus

Diabetes mellitus is divided into two types. In type I which affects primarily younger individuals in their teenage years, it appears that they become allergic to their own insulin secreting cells in the pancreas. These are called beta cells and they are located in an area of the pancreas called the Islets of Langerhans. If one looks at the pancreas from a type I diabetic, it is seen that beta cells in the Islets of Langerhans have all been destroyed; therefore, this person with type I diabetes mellitus does not have the cells that make insulin and they have no insulin. As long ago as 1920, two doctors working in Canada, Dr. Banting and Dr. Best, isolated insulin. Soon, insulin was available as a commercial product that type I diabetics could inject into themselves and avoid the fatal outcome that occurred in most type I diabetics in the first few years of the disease.

With the discovery and commercial availability of insulin, type I diabetes was transformed from a fatal disease to a chronic incurable disease with blood sugars running high and low. In addition, there were progressive degenerative changes that occurred in the person's eyes, kidneys and their nerves. In spite of insulin treatment, these degenerative changes still occurred because the blood sugar was never actually controlled in the normal range.

Thus the thrust of research to treat type I diabetes mellitus has been to find a method to detect what the blood sugar is and then secrete an amount of insulin appropriate for the slight increases in blood sugar that occur with meals. Now we have diabetics check their blood sugar multiple times per day and inject small amounts of insulin frequently to keep the blood sugars in a controlled range although not normal. Anyone who has had experience with a type I diabetic or who is a type I diabetic can testify to the difficulty of maintaining blood sugar control by this method. Unfortunately, this is the only method available now.

Last week, Dr. Jonathan Lakey, a research scientist from the University of Edmonton in Canada, came to Rapid City to give a presentation on his research. I had the opportunity to attend his presentation. He is developing a method of isolating the Islets of Langerhans from a human pancreas and then transplanting these Islets into the liver of a type I diabetic to cure them of their disease. He has now successfully transplanted 15 individuals and rendered them free from the need for insulin injections. Those 15 individuals now make their own insulin in just the right amount to control their blood sugar in a normal range just like a normal person. Amazingly, the surgery is a one-day procedure. The diabetic goes into the hospital and has an intravenous device threaded into a blood vessel in the liver and then the small amount of Islets are injected into this blood vessel. The person goes home the next day with nothing more than where the intravenous site was rather than a large incision, general anesthesia, etc.

Questions from the audience that night basically wanted to know how soon they could go to Edmonton and get this procedure done or better yet how soon would it be available in the United States. At the present time, a research project to do 40 more type I diabetics across the country is in process. There are six centers in the United States which will be participating in this research project but practical application of this research is years away and not available to the general public yet.

Since it takes two and perhaps three cadaver pancreases to obtain enough Islets to transplant in person, this will probably never be a generalized applicable treatment for type I diabetes. However, the fringe benefits of this research array be more important than the basic goal. Specifically, Dr. Lakey has devised a group of drugs to prevent rejection of transplanted Islets. His program is very different than those that have been used in the past. It not only prevents the person from rejecting their transplant, but also and very importantly, seems to prevent the person from redestroying their new Islets in the same way they did the old ones that got them in trouble in the first place. In addition, it appears that the new Islets that are transplanted into these 15 diabetics seem to grow and exceed the original capability present at the time they were transplanted. Thus, the more important fringe benefit of this research is that this antirejection cocktail that Dr. Lakey has devised may help treat the young diabetic at a time when they can still have preservation of their own pancreas at an early time in the disease.

To me, the greatest hope for treatment of type I diabetes resides in electronic technology which will allow continuous monitoring of a person's blood sugar, feed that information into an insulin pump and have a true re-establishment of the glucose-detecting and insulin-treating capability that a normal person has. Granted this will be electronic and artificial but the blood sugar will be controlled and the chronic degenerative problems of type I diabetes will be stopped. Better yet, we can make thousands of electronic devices relatively cheaply as a pancreatic transplant requires two or three cadavers, a long and complicated isolation procedure to get the Islets out of the pancreas and then permanent medications which cost $45,000 per year to maintain the pancreas transplant. Do not abandon your technology stocks yet. The best is yet to come.