and different insulin plans in chapter 13, and more about healthy eating in chapter 10. Read about physical activity and exercise for people with type 1 diabetes in chapter 11.
Pancreas Transplants
So far, the only way to treat type 1 diabetes is to give the body another source of insulin. Usually, this is done through insulin injections. However, new experimental approaches also show some promise.
Some patients with type 1 diabetes have experienced positive results from pancreas transplants. Typically, part or all of a new pancreas is surgically implanted. The old pancreas is left alone; it still makes digestive enzymes, even though it doesn’t make insulin. Most organs are obtained from someone who has died but decided to be an organ donor.
A transplant of the pancreas is usually reserved for those with serious complications. Pancreas transplants are most often done when a patient also receives a new kidney. The pancreas transplant adds little further risk and offers big benefits. However, transplant surgery is risky. Each person needs to carefully weigh the potential benefits and risks.
Benefits of Pancreas Transplants
• You may be able to maintain a normal blood glucose level without taking insulin.
• Many of the diabetes-related side effects are prevented or delayed.
• Most people with nerve damage who receive a pancreas transplant do not get worse and sometimes show improvement.
Downsides to Pancreas Transplants
• The body treats the new pancreas as foreign and the immune system attacks the transplanted pancreas.
• Transplant patients must take powerful immunosuppressant drugs to prevent rejection of the new pancreas. Drugs that suppress the immune system can lower resistance to other diseases, such as cancer, and to bacterial and viral infections.
Islet Transplants
Researchers are testing transplanting only the islet cells of the pancreas. These are the cells in the pancreas that secrete insulin. The islets also sense glucose levels in the blood and dispense the right amount of insulin to the blood.
Islets from a deceased person are taken out, purified, and then transferred to a person with type 1 diabetes. These cells then go on to make insulin.
The procedure has been beneficial for some people—allowing them to take less or sometimes no insulin. However, islet transplantation is still considered experimental.
Organ Donors
One of the biggest problems with both pancreas and islet cell transplantation is the shortage of organ donors. About 7,000 bodies are donated for organ transplants each year in the United States—too few to supply islet cells for everyone with type 1 diabetes.
CHAPTER 4
Type 2 Diabetes
Most people (about 95%) with diabetes have type 2 diabetes. Type 2 diabetes tends to develop in people over 40 and used to be called adult-onset diabetes. If you’re reading this chapter, you or someone you love has probably been diagnosed with type 2 diabetes.
However, in recent years, more children and teens are developing type 2 diabetes. Much of this has to do with kids becoming obese and inactive.
Early Symptoms and Tests
Usually, type 2 diabetes does not appear suddenly. Instead, you may have no noticeable symptoms or only mild symptoms for years before diabetes is detected, perhaps during a routine exam or blood test.
Common Symptoms of Type 2 Diabetes
• Frequent urination due to the body trying to flush out excess glucose
• Increased thirst due to dehydration
• Fatigue because the necessary glucose is not getting to your cells
• Blurred vision due to a buildup of fluid in your eyes or elevated glucose levels
• More frequent or slower-healing infections
Tests for Type 2 Diabetes
If your doctor suspects diabetes, he or she will perform a blood test, such as the A1C, fasting plasma glucose test, or the random plasma glucose test, as discussed in chapter 2. If your A1C is 6.5% or higher, your fasting plasma glucose test is 126 mg/dl or higher, or your random plasma glucose test is 200 mg/dl or higher, you will be diagnosed with diabetes. Usually, a second test will be done to confirm the diagnosis.
Causes and Risk Factors
Initially, people with type 2 diabetes will usually make insulin for some time, unlike people with type 1 diabetes, who stop making insulin once their diabetes fully develops. However, sometimes people with type 2 diabetes do not respond properly to insulin (this is called insulin resistance), or their body doesn’t produce enough insulin, or both. These problems lead to the same outcome: insulin cannot deliver glucose to the cells that need it and glucose builds up in the blood.
Many cells in the body contain special proteins called receptors that bind to insulin. They work like a lock and key. In order for glucose to enter a cell, insulin (the key) must first fit into the insulin receptor (the lock). In addition to working as a key in a lock, insulin performs other important jobs. It inhibits the release of glucose and other substances from the liver and helps make proteins in the body. So, problems with insulin production or resistance can also make the liver release too much glucose.
Diabetes is a progressive disease. Initially, the pancreas produces enough insulin to overcome these problems. But over the course of several years, the pancreas no longer makes enough insulin or releases it too slowly. Without enough insulin to meet the body’s needs, glucose levels rise and diabetes develops.
Scientists do not know why the pancreas stops working in people with type 2 diabetes. Some believe that the system that tells the pancreas to make more insulin is broken. Others think that the pancreas—after many years of working overtime to overcome insulin resistance—simply burns out.
Genes and Family History
Genes and family history appear to play a strong role in the development of type 2 diabetes—an even stronger role than in type 1 diabetes.
