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June 29, 2000

Research: Causes and Prevention

Question from Chennai, Tamilnadu, India:

My brother, aged 24 years, was diagnosed with diabetes (he is not dependent on insulin) about 3 years ago. Both my parents are also diabetic. The following are my queries: Can he lead a normal married life? Is diabetes hereditary? Is there any permanent cure? I would be very grateful if you could answer my queries at the earliest because the whole family is totally disturbed.


To answer your three questions:

If by ‘normal married life’ you are expressing concern over impotence then I can reassure you by saying that it is most uncommon if your brother takes good care of his diabetes and maintains control of his blood sugars, As a last resort there are now drugs like Viagra that may circumvent the problem.
With both of his parents being diabetic, it is probable that this is a hereditary condition. Unfortunately it requires some rather complex tests to say what kind of diabetes he has and these tests will be expensive and may not be easily available. An antibody test would confirm Late Onset Autoimmune Diabetes in an Adult and a C-peptide level would indicate Type 2 diabetes; but there are several other possibilities which at the moment are very difficult to diagnose specifically. These problems do not really affect management; but they do affect the incidence in any children. Nowadays though the management of diabetes has become so much better that the small risk that children might be affected should not be a hindrance to starting a family.
At the present time there is no ‘cure’ ; but it seems almost certain that in a few years there will combined glucose sensors and insulin pumps which will effectively provide an artificial pancreas. In experienced hands a pancreas transplantation has a success rate of over 90% after 3 years; but it is hardly a cure as too often the patients have to continue indefinitely with immunosuppressive drugs. Stem cell transplantation is promising; but in its infancy and now there is hope that islets themselves can be successfully transplanted although there is clearly a problem with the availability of donors. A last possibility is that porcine islets can be encapsulated to prevent their immunological destruction and can be successfully transplanted.