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December 11, 2003

Daily Care, Research: Cure

Question from San Juan, Puerto Rico:

I would like my son to have a better quality of life without having to check his blood sugar so many times a day, which makes his fingers hurt. And the insulin injections are already starting to hurt the parts where he has bumps. He plays baseball and the doctor doesn't recommend the insulin pump, plus we don't have that kind of money to buy one. My son is a very clever pre-teen and knows there are alternatives but financially we can't afford them. Would a pancreas surgery would be suitable for him or islet cell transplant? Is there any way we can have any kind of help from an organization to donate a pump? He is very concerned about his life and we as parents as well. Please give us some advise since here in Puerto Rico diabetes is not yet very well managed by physicians not specialized in this field. The last time he was in the hospital he was given a dextrose IV instead of saline one -- thank God I knew that dextrose could have brought him into coma and they change it.

Answer:

I wonder if what is really concerning your son is not so much the discomforts of blood sugar testing and insulin injections as having his peers know that he is diabetic. This is a possibility that you might talk to his doctor about. Aside from that, whole pancreas transplants have not been done in children for diabetes and islet cell transplants have the present disadvantage that each transplant takes two donors and at present it involves a lifetime commitment to immunosuppressive drugs. If your son listens to the news on the TV at all he might last week have heard of a very interesting development in which the injection of spleen cells had induced both the remission of the autoimmune process as well; as regeneration of islet cells. At present this holds only for the mouse; but if he can be patient it may quite soon be proved in humans.

A lot of progress is being made in developing non invasive ways of monitoring blood sugars and with almost painless blood sugar monitors that use very small amounts of blood from the forearm, such as from TheraSense.

I do understand that these advances can be expensive: but ultrafine syringes and needles as well as some of the new monitoring devices are often covered by insurance and you should ask about this. Pumps can be a mixed blessing in a very active boy and you may, at least at the beginning, need quite a lot of support from your medical group.

Teenagers aren’t interested in patience; but I really do feel that there will be big advances in overcoming the discomforts of control and if you ever read how cases were managed even fifty years ago you have to acknowledge a great deal of progress.

DOB