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July 23, 2000

Diagnosis and Symptoms

Question from Crofton, British Columbia, Canada:

My son has recently been diagnosed with type 1 diabetes. He is 24 months old and he is going through the honeymoon phase as he is only using two shots of N per day 2 units in the morning and 1 unit at night. If his remaining beta cells are still producing insulin, why can they not be extracted and cloned? After cloning they can be re-injected without the fear of rejection as it would be his own DNA. Are there any documented cases of children growing out of diabetes when they have been diagnosed so young?

Answer:

To answer your two questions:

1. By the time someone has become insulin dependent less than 5% of their original islet cell mass remains which would not be sufficient to justify removal of part of the pancreas and isolation and re-implantation of residual islet cells. Even if cloning was successful the cells would still be vulnerable to destruction by the continuing autoimmune process. The idea has however been successfully deployed in cases where the pancreas has had to be removed because of pancreatitis.

Successful allograft transplantation of islet cells has recently been reported from a team in Canada; but it will be some years before the duration of the initial success is known or whether there are any complications of the extensive immunosuppressive regimen. Also there is still the problem of the number of potential donors. There is another group in New Zealand planning replacement therapy with pig islets that have been specially encapsulated to prevent destruction in the host. Stem cells may be another source of new beta cells and perhaps most interesting of all is the possibility of modifying the insulin sensitive K cells in the upper bowel so that they will produce insulin. This only works so far in mice so it will be some years before it might be of value in man.

In the meantime, the important task is to do all you can to keep blood sugars near to normal without hypoglycemia.

2. If your son has Type�1A (autoimmune) diabetes that has been confirmed by a positive antibody test, then he will require insulin for the foreseeable future. If that test is negative, which would be much more likely if he is of African American or Hispanic descent, then he would have about a 50% chance of becoming insulin independent at least for a time.

DOB