Type 1 Diabetes

Treatments for Type 1 Diabetes

There are 23.6 million, or about 8% of children and young adults who have type 1 diabetes. Type 1 diabetes is when your pancreas is not able to create a hormone called insulin that is vital to the process of breaking down sugar, starches and other foods into energy. People who have type 1 diabetes need to maintain a daily insulin regimen in order to stay alive. This means taking multiple injections daily, or wearing an insulin pump as well as monitoring their blood sugar by pricking their fingers for blood 4-6 times a day. Diabetics must also be cautious with the foods they eat and how much they exercise to help regulate their glucose levels. The monitoring of glucose levels is an attempt to avoid hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar), which can both be life threatening and lead to complications. It is often that Diabetes goes undiagnosed because its symptoms seem so harmless and non-threatening. Symptoms for diabetes are frequently mixed with those of the stomach bug or the flu. Some symptoms of a person being diagnosed with type 1 diabetes are extreme thirst, rapid weight loss, fatigue, frequent urination, extreme hunger, irritability, blurry vision and tingling in your hands and/or feet. Early detection of diabetes is essential to preventing any type of long term or short term complications. Type 1 diabetes, previously known as juvenile diabetes is more common among young adults, teenagers and children. The reason is still unknown as to what exactly causes type 1 diabetes. However researches are starting to believe that genetic, autoimmune and environmental factors are all a part of the basis of this illness. Unfortunately there is no way to prevent type 1 diabetes, however there are finger-stick blood tests which can test for auto-antibodies which can help identify who is at a higher risk for developing this illness. As of today there are many different therapies for type 1 diabetes. The therapies that are available to most diabetics are insulin therapy, insulin pump therapy, islet cell transplant and the experimental TB vaccine. Each treatment has it pros and cons and ultimately the choice of therapy depends on the person and which is more convenient or better for their lifestyle. Although there are many theories as to which treatment is most successful, in my opinion and experience, insulin therapy seems to be the most effective means of treatment out there.

Insulin therapy is the basic and original form of treatment for diabetics. Insulin is a hormone, in people without diabetes, that the body makes in order to regulate the amount of glucose in their system. For diabetics, this hormone is received via injection into the arm, leg or belly. Every time we eat food, our bodies break down the food into glucose. The cells in our bodies use the glucose as a source of energy for certain functions such as growth, movement, etc. The insulin in our bodies help the cells absorb the glucose. Without insulin, our cells would starve since they would not have the ability to access glucose to perform their daily functions. This is why when diabetics take too much insulin they experience hypoglycemia and do not have enough sugar in their bodies. In hyperglycemia, diabetics do not have enough insulin in their bodies to absorb all the glucose in their system.

Insulin was founded in 1869 by Paul Langerhans, an undergraduate student in Berlin known primarily for his microscopic anatomical research. He used staining methods to conduct research on different organs in the human body with his main focus being the pancreas. While he was studying the pancreas of rabbits, when he noticed “little clumps of cells” speckled across sections of the pancreas. During this time, they were unsure what these “clumps” represented until Edouard Laguesse suggested that these “clumps” played a key role in the digestion process. Since the discovery of insulin, scientists have been working non-stop around the clock to form the many types of insulin we have today.

There are many variations of insulin, but the two main kinds, long acting and short acting. Long acting insulin is a “base” insulin that normally last from 12-24 hours. It is an insulin that is absorbed slowly into the body after injection and is used in combination with a short acting insulin insulin. Short acting insulin is a type of insulin that begins to work to lower blood glucose within 15 to 30 minutes and works hardest 1 to 3 hours after injection. There are many types of long acting and short acting insulins but to determine which is best for your lifestyle constant glucose monitoring is required. All decisions in life come with their pros and cons. With insulin therapy there are both pros and cons. Some cons include multiple daily injections, insulin leakage (when you take the needle out of your arm, small amounts of insulin may leak out of your arm playing a part in hyperglycemia), skin bruising and a more restricted food and exercise regimen. Some pros include not having to wear any devices 24 hours in a day such as the insulin pump. It is a more discrete method of treatment that can't be seen such as wearing an insulin pump. With a tighter control on your regimen you generally would have better glucose readings.

Insulin pump therapy is another way to deliver insulin into your body. Instead of taking multiple daily injections with a syringe, a pump, a small electronic device about the size of a cell phone, holds and delivers a nonstop flow of insulin into your body. This nonstop flow of insulin is known is the basal rate. The pump is attatched to a small tube which connects to the body through an infusion set. The infusion set gets injected into your abdomen and the syringe is removed leaving what looks like a small IV under the skin. The insulin enters your body through this IV and isn't supposed to be removed unless you are putting in a new infusion set. Insulin pumps can be programmed to fit almost any lifestyle and deliver a wide variation of calculated basal rates by your doctor. Although you have a continuous basal rate being delivered into your body, you can take a “bolus” dose, which is a manual amount of insulin entered into the pump for it to deliver into your body. Insulin pumps run on batteries, they are the size of a deck of cards and you can either put it in your back pocket, clip them onto your belt, or for women with a special clip attach them to your bra. Many studies show that people using insulin pump therapy have shown major improvements in glucose management. With the pump, it increases flexibility in lifestyle and right now is the closest technology there is to an artificial pancreas. Although there is much more flexibility with the pump, you still are required to pay close attention to your regimen. The insulin pump was founded by Dean Kamen in the 1970's. He is an inventor whose goal is to improve the lives of others through technology. He became interested in working with medical technologies because he was inspired by his brothers experiences in medical school. Some advantages of having an insulin pump include, eliminating the multiple injections daily to once injection every couple days, increased flexibility in regimen control, more freedom to eat less or more frequently. On the other hand some disadvantages include, a risk of infection if you do not change the infusion set every couple of days, more frequent glucose monitoring, easier risk of going to DKA (diabetic keto-acidosis) and continuously wearing a pump maybe bothersome at times.

Islet Cell Transplantation is the transplantation of isolated islets from a donor pancreas into another person's body. When the islets are transplanted, ideally they start to produce insulin and begin to function regularly in maintaining glucose levels. Islet cell transplantation was first founded in the 1960s by Paul lacy who during this time was experimenting on rodents. By his methods of experimentation he found that he could successfully transplant islet cells from one animal into a diabetic recipient to restore normal glucose levels. Once the islets are infused into a patients liver, their body may or may not see the islets as a foreign contamination. If these islets are viewed by the body as an infection or threat, the immune system will attack these cells and cause a risk of transplant rejection. Since there is always this risk of rejection, the patient must receive treatment involving immunosuppressant's which would reduce the immune systems wants of destroying the foreign cells. Statistics show that islet transplantation has progressed to a point where 58% of patients in one study were insulin dependent after one year of having this operation.

The first successful islet cell transplantation took place in 1990 at the University of Pittsburgh by Dr. James Shapiro. The results of this procedure were a 100% success. The patient no longer needed insulin and was a part of a steroid free protocol which included a large number of donor islets. Out of all the procedures that were conducted only about 10% of these recipients were able to achieve normal blood level results. In 2000 Dr. Shapiro and his colleagues published a report describing those patients and what they went through from a medical standpoint to achieve such a success. The pros of islet cell transplantation include eliminating the need for frequent blood glucose measurements and the need for daily insulin injections. Some patients still do require an injection every couple of days and are not 100% injection free. It can help protect against the serious long-term complications of diabetes, including heart disease, kidney disease, stroke, nerve and eye damage. It can also give more flexibility with your food regimen. The cons in this case are also the risks which include, rejection of the treatment, rejection medication that must be taken daily by mouth, with these rejection drugs may come an increased risk to cancer.

In Australia in 2004, an experiment was conducted to see whether the dead tuberculosis virus could prevent type 1diabetes. They based this idea off the fact that back during WWII people had TB and the rate of type 1 diabetes was very low. Their hypothesis was that if type 1 diabetes is related to lack of exposure to bacterial infections then receiving the dead tuberculosis virus would prevent diabetes. The dependent variable was whether or not childhood diabetes could be prevented. The independent variable is the milk containing the dead tuberculosis virus. The control was a group of diabetes prone mice. In this experiment, scientists took the mice and exposed them to unpasteurized milk which contained the dead tuberculosis virus. The mice drank the milk and were observed for several hours. Results showed that the mice did not develop diabetes although they were pre-screened and prone to diabetes. In their conclusion it stated that they were successful in testing their hypothesis in mice and that further down the road they are scheduling clinical trials on humans to see if they have the same success.

Prevention of complications is the goal of diabetes treatments. Through time diabetics can damage their heart, nerves, blood vessels, kidneys, eyes, feet, etc. Due to the fact that the damage to the body is taking place unknowingly, it is important to diagnose and begin treatment for diabetes early on. Since the damage is occurring unknowingly, a person may not begin to feel ill from the damage being done until it is too late. Most common among long term complications are changes in the small blood vessels and nerves. These changes may be the first of many problems that diabetes may cause. Scientists can't predict who will develop complications as a result from diabetes, but complications will most likely occur with diabetics who have had diabetes for many years or to those who are just not taking care of themselves. Ultimately, a person can have diabetes without even knowing it, therefore a complication may be the first sign.

Through the explanations of the treatments, insulin therapy, pump therapy, islet cell transplant and the experimental TB Vaccine, I feel insulin therapy is the most successful means of therapy. Each therapy has its pros and cons. With insulin therapy there is no risk of equipment malfunctions which could happen with the pump. There is also no risk of rejection which is what comes with the islet cell transplant operation. Insulin therapy is a proven method of therapy that is effective and safe, which the TB vaccine is not out of the woods yet. Insulin therapy was the basis of diabetes care and the beginning stepping stone for all therapies that followed.

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