develop a cure which is effective in a large majority of cases. The cure must allow the patient to control their blood sugar naturally, giving them insulin independence. It is also very important that the cure be able to prevent the serious side effects of diabetes. In order to investigate how diabetes could be cured it is critical that we know how important body functions, that diabetes affects, work. Much of the carbohydrates you eat are broken down in the small intestine into the sugar β -glucose which is then transferred into the blood stream where is absorbed in body tissues and respired. The body regulates blood glucose levels with two hormones, glucagon and insulin. Insulin causes liver cells to absorb glucose from the blood and convert it into a molecule called glycogen which is stored in the liver and skeletal muscles. Glucagon works in the opposite way, causing the liver to convert glycogen into glucose which is released into the blood stream. The group of diseases that affect insulin production and therefore prevent natural, effective blood glucose control are called diabetes. The two types of diabetes affect the body in completely different ways but cause the exact same problem. Type 1 is the most severe form of diabetes. It is an autoimmune disease, meaning that the body launches an immune response against some of its own cells. In the case of type 1 diabetes the cells being attacked are those responsible for the regulation and production of insulin, known as islet cells, located in the pancreas. As these cells have been destroyed, the body is unable to regulate the concentration of glucose in the blood. 8 Perhaps the simplest solution for type 1 diabetes would be to do a whole-organ pancreas transplant. In theory this would replace the islet cells and all surrounding tissue which has been destroyed by the immune system in type 1 diabetes sufferers. This treatment is currently used in a very small percentage of cases, only about 1,300
per year worldwide. After a year, 83% of patients are no longer dependant of insulin therapy and regain their ability to regulate their blood glucose. However, there are a tiny number of pancreases available for transplantation compared to the number of people with type 1 diabetes meaning that the treatment is unsuitable for widespread use. A greater disadvantage to this treatment relates to the drugs used after the surgery. In order for the transplanted pancreas to be accepted by the patientÊs body, immunosuppressant drugs (drugs which inhibit the immune system) must be taken throughout the rest of the patientÊs life. This makes the patient more susceptible to other infectious diseases, which may be more dangerous to the patientÊs health than the original diabetes. As a result, very few hospitals offer this treatment on its own unless the diabetes is life threatening. However, many hospitals will offer a pancreas transplant to patients if they also have to undergo a kidney transplant as the regime of immunosuppressant drugs after the operation is the same for both. In conclusion, pancreas transplantation is an effective cure for type 1 diabetes however it poses a risk to the patientÊs health and as a result, relatively few people are eligible for it. 9 Another experimental treatment currently being tested is Âislet cell transplantationÊ. This treatment involves removing islet cells from a deceased donor and transplanting them into the patientÊs liver. Firstly, the donorÊs pancreas is placed in a purified collagenase solution which allows islet cells to be extracted after the pancreas has been digested. These pure islet cells are then infused into the patientÊs liver through a catheter in the hepatic portal vein. As with a whole-organ pancreas transplant, an immunosuppressant drug regime must be followed for life. Islet cell transplantation is still at trial stage and only a select few hospitals are authorized to carry out the procedure. Presently the success rate for the procedure is low. Only 58% of patients in
9 http://stemcells.nih.gov/info/scireport/pages/chapter7.aspx.
8 http://en.wikipedia.org/wiki/Diabetes_mellitus_type_1.
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