Diabetes Mellitus

Diabetes mellitus occurs when the pancreas doesn’t make enough or any of the hormone insulin, or when the insulin produced doesn’t work  effectively. In diabetes, this causes the level of glucose in the blood to be too high.

In Type 1 diabetes the cells in the pancreas that make insulin are  destroyed, causing a severe lack of insulin. This is thought to be the result of the body attacking and destroying its own cells in the pancreas – this is known as an autoimmune reaction. It’s not clear why this happens, but a number of explanations and possible triggers of this reaction have been proposed.

These include:

• Infection with a specific virus or bacteria;
• Exposure to food-borne chemical toxins; and
• Exposure as a very young infant to cow’s milk, where an as yet unidentified component of this triggers the autoimmune reaction in the body.

However, these are only hypotheses and are by no means proven causes. Type 2 diabetes is believed to develop when:

• the receptors on cells in the body that normally respond to the action of insulin fail to be stimulated by it – this is known as insulin resistance. In response to this more insulin may be produced, and this over-production exhausts the insulin manufacturing cells in the pancreas;
• there is simply insufficient insulin available; and
• the insulin that is available may be abnormal and therefore doesn’t work properly.

Diabetes is a syndrome or group of diseases (rather than one disease), leading to the prolonged hyperglycemic state. Type 1 is most associated with the killing of the beta cells, most likely by the body’s own immune system. Either the immune system cannot kill an infecting agent, which then kills the beta cells, or the immune system itself goes “wild,” attacking the body’s own tissue and destroying the beta cells. The cells of the islets of Langerhans are inflamed, resulting from an infectious-disease process (for example, mumps) or, more commonly, from an autoimmune (allergic to self) response.

The autoimmune process results in the circulation of antibodies that may either cause or be caused by beta-cell death. If it is found that the antibodies cause beta cell destruction (the body fighting what it now considers foreign to itself), the body’s response to the Type 1 diabetes is much less severe (i.e., easier to control) with treatment. Until then, the outcome is a lack of available insulin. While the onset is said to be sudden, changes resulting in decreased insulin availability may have occurred over a longer period of time.

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In short, insulin-dependent diabetes mellitus is an inherited defect of the body’s immune system, resulting in destruction of the insulin-producing beta cells of the pancreas.

One of the largest, most comprehensive diabetes studies conducted to date showed that keeping blood sugar levels as close to normal as possible through aggressive management slows the onset and progression of eye, kidney and nerve diseases caused by diabetes. In fact it demonstrated that any sustained lowering of blood sugar helps, even if the person has a history of poor control. Specifically it found that lowering and maintaining more constant blood sugar levels reduced the risk of eye disease by 76%, kidney disease by 50%, nerve disease by 60% and cardiovascular disease by 35%.

Since the discovery of insulin nearly 70 years ago, the patterns of morbidity from diabetes have changed. Where the major causes of death were ketoacidosis and infection, they are now the micro-vascular and cardio-vascular complications of diabetes (renal failure and myocardial infarction).

These complications are responsible for a reduction in the life expectancy of a newly diagnosed insulin dependent diabetic by about one-third. The basis of managing diabetes now is an improvement in the life-style of the diabetic and prevention of complications responsible for morbidity and mortality in diabetes.

Research into preventing and/or curing diabetes is ongoing. Current prevention trials involve treating close relatives of people with diabetes to see if certain medicines can prevent diabetes in those at higher risk of developing it.

Currently, the only known cure for Type 1 diabetes (i.e. those who are insulin dependent) is a ‘pancreas transplant’. However, such a surgery brings with it serious risks to a patient’s health. Transplant patients must take powerful drugs for the rest of their lives. These drugs suppress their immune system, so that their body won’t reject the transplant. Having a suppressed immune system leaves the body with very little protection from other diseases, so pancreas transplants are not the answer. Researchers are also experimenting with transplanting just the beta cells. This treatment, though promising in theory, has not yet been successful in the long term.

CURRENT DIABETES TREATMENT METHODS:

Diet and Exercise – All diabetes patients gain benefit and better control of their disease with proper management of their diet and regular exercise. For some Type 2 patients, diet and exercise usually combined with weight loss may be sufficient to correct elevated blood sugar levels.

Oral Agents – A variety of oral medications are used to treat Type 2 diabetes. Different classes of drugs are used to stimulate insulin production, increase insulin receptor sensitivity, regulate liver production of glucose and control carbohydrate absorption from the intestinal tract.

Insulin Shots – Most insulin regimens include both short acting and intermediate or long acting drugs to provide basal insulin and additional doses to cover carbohydrates at mealtime. Optimum glucose control with insulin usually requires multiple injections throughout the day. Such a regimen requires frequent testing of blood glucose levels to manage insulin dosages. Insulin shots are given subcutaneously in the fat layer under the skin of the arm, leg or abdomen.

Insulin Pumps – Insulin pumps can be used to provide a basal flow of insulin during the day, which can be combined with intermittent higher doses for mealtime coverage. Such pumps are more convenient for the patient and eliminate the need for repeated injections. These pumps are unlike the MRT device and do not restore carbohydrate metabolism in the liver as is the case with MRT.

Inhaled Insulin – The FDA recently approved the marketing of inhaled insulin. Inhaled insulin eliminates injections, but because it does not produce concentrated spikes of insulin in the blood and its effects are gradual, it has no effect on restoring the metabolic activity of the liver.

Islet Cell Transplants – Islet cell transplants are used to reduce or eliminate insulin requirements for Type 1 diabetes patients. It requires 2 to 4 cadavers to supply the necessary cells and requires the continuous use of expensive antirejection drugs post transplant to prevent the cells from being destroyed by the immune system. In many cases, islet cell transplant permits reductions in insulin doses and not its elimination.

Pancreatic Islet Transplant

The Edmonton Protocol, which has gained international recognition for the development of a specific and detailed procedure for replacement of insulin producing cells, pancreatic islets, into patients with longstanding and brittle Type 1 diabetes. Over 100 patients have received the islet transplant procedure in Edmonton and over 80% of these patients  remain free of insulin injections at one year post islet transplant. Those programs which have successfully replicated the Edmonton protocol for the treatment of type 1 diabetes, have worked closely with our program, we have provided much of the specialized equipment and provided specific procedures. The Edmonton Protocol clinical islet transplant procedure has recently been recognized by the Province of Alberta as an essential service for Albertans with brittle longstanding Type 1 diabetes. The Edmonton Protocol team has also worked with programs in the United States that are working for establishing Medicare and private insurance companies to cover the transplant procedure.