I am 29 years, have had type�1 diabetes since the birth of my first child 11 years ago, and I have been deeply disturbed over what I am hearing about pancreas transplants and cures not being available to those of us who have not yet developed complications. I want to be given a chance to live!

To be normal would be a dream come true. I am not one of those people who can easily stay on diets and control my blood sugars. I don’t want to accept the fact that this is how my life has to be. I was told I had to have my tubes tied after my second child, which was heartbreaking for me.

Why can’t those of us with diabetes have the opportunity to live the rest of our lives without complications and the depressing knowledge that our misfortune will eventually be the end of us? Why wait until the damage is already done? If my information and understanding of this is wrong, please forgive me and help me understand. I am deeply frustrated!

While it is unreasonable to promise you a cure at any given date, there is much research being done towards improving the situation. For many illnesses, diabetes included, there are not enough possible transplants available at the moment so there is a lot of research looking for alternatives such as stem cells. A lot will depend upon the next few years’ research and whether or not the President and the conservatives in the United States political establishment allow such research to thrive or go underground/overseas.

You sound very sad and very angry. I wonder if you need to speak to a good diabetes doctor and work with a team who can teach you what you need to make diabetes live with you. There are a great many things that you can do to take control of your life and your diabetes without feeling so frustrated, but you will have to commit the time to be educated and to work with a group of specialists who can get to know you and make specific and individualized recommendations. Similarly, working with a high risk obstetrical team who have experience with diabetes pregnancies may provide you other options to consider besides getting your tubes tied.

If you cannot find a good diabetes team by talking to your own physician, then call the local American Diabetes Association or Juvenile Diabetes Research Foundation since they may be able to give you some options as well.

SB
Additional comments from Dr. Donough O’Brien:

Transplantation has two major problems. The first is the paucity of donors, and the second is the need for continuing immunosuppression. In light of this, it was understandable that as the technology for pancreas transplantation improved it became restricted to subjects with type�1A (autoimmune) who already had end stage renal disease requiring either dialysis or transplantation. There was also already substantial Federal support for the management of chronic renal disease.

The recent success of the group in Edmonton in islet cell transplants only, will almost certainly encourage similar programs elsewhere, but the two basic problems remain. However, there is light at the end of the tunnel.

Researchers have developed techniques for producing a variety of insulin producing glucose sensitive surrogate cells either from stem cells or by genetic engineering and in some instances by the encapsulation of porcine cells, that will get around the problem of the availability of donor tissue. To match this, there is promise (so far only in laboratory animals) that permanent graft tolerance can be induced by a very short course of monoclonal antibodies.

This still has some years to go before any human trials, but in the meantime, new insulins, new regimens, and new ways to measure blood sugar are making life a little easier.

DOB
Additional comments from Dr. Mary Luidens:

In most medical centers, currently, pancreas transplants are being done only in people who also need a kidney transplant. This is because of the risks of complications from the surgery itself, and from the medications that must be taken to prevent rejection of the transplant(s).

Studies are underway regarding islet cell transplants (instead of a whole pancreas), but these are still in the preliminary stages. Lots of other research is ongoing regarding treatment and ultimately a cure for Type 1 diabetes. There is still a long way to go, but the future looks hopeful. In the meantime, controlling blood sugars with insulin, trying to keep them as close to normal as possible, will help prevent or delay complications.

I hope that you have a team of diabetes professionals working with you to find the best possible treatment plan for you. This means a lot effort on your part, but it should generally not limit your daily life or keep you from doing most things that you want to do.

ML