DIABETES MELLITUS

Treatment of Type 1 Diabetes

Diabetes type 1 is treated with insulin replacement therapy — often by injection or insulin pump — carbohydrate counting and careful monitoring of blood glucose levels using Glucose meters.

Untreated diabetes can lead to one form of diabetic coma, diabetic ketoacidosis, and ultimately death. Insulin treatment must be continued for a lifetime, until a cure is discovered. Continuous glucose monitors have been developed which alert to the presence of dangerously high or low blood sugar levels.

In some extreme cases, a pancreas transplant can help regulate glucose levels. But the surgery and accompanying immunosuppression required is considered by many physicians to be riskier than insulin replacement therapy and is therefore often used as a last resort (such as when a kidney must also be transplanted or in cases where the patient's blood glucose levels are extremely labile). Experimental replacement of beta cells (by transplant) is being investigated in several research programs and may become clinically available in the future. Beta cell replacement has only been performed on patients over age 18, and with tantalizing successes mixed with nearly universal failure.

Pancreas transplantation

A pancreas transplant is an organ transplant that involves implanting a healthy pancreas (one that can produce insulin) into a person who has diabetes. Pancreas transplants are not generally recommended because introducing a new, functioning pancreas to a patient with diabetes can have negative effects on the patient's normally functioning kidney. However, for patients with kidney failure, a pancreas transplant is a viable option and is generally done simultaneously. Such patients, like all transplant patients, must take immunosuppressive drugs in order to prevent rejection.

Artificial Pancreas

The artificial pancreas is a technology in development to help diabetic persons automatically control their blood glucose level by providing the substitute endocrine functionality of a healthy pancreas.

There are several important exocrine (digestive) and endocrine (hormonal) functions of the pancreas, but it is the lack of insulin production which is the motivation to develop a substitute. While the current state of insulin replacement therapy is appreciated for its life-saving capability, the task of manually managing the blood sugar level with insulin alone is arduous and inadequate.

The goals of the artificial pancreas are to improve insulin replacement therapy until glycemic control is practically normal as evident by the avoidance of the complications of hyperglycemia, and to ease the burden of therapy for the insulin-dependent.

Type 2 Diabetes