Although the name may conjure images of wind-swept outcroppings
off the northern coast of Scotland, the islets of Langerhans, or
"beta-islet cells of the pancreas" as they are more commonly called,
are the body's natural store of insulin-secreting cells.
It is these cells that are destroyed or severely damaged in
type 1 diabetes and deficient in some cases of type 2 diabetes. Lacking a
natural source of insulin, a hormone essential for controlling blood sugar,
people with type 1 diabetes must take daily insulin injections.
Sometimes, living with diabetes can seem like a full-time job -- trying to
keep up with everything you need to do for proper diabetes care.
"Diabetes is a very time-consuming disease to manage well," says
Karmeen Kulkarni, MS, RD, CDE, and former president of health care and
education for the American Diabetes Association. "The medication, the food,
the physical activity -- you add life in general to that whole picture and it
ends up being quite challenging."
But throughout the last decade, researchers have been
investigating and fine-tuning techniques for replacing beta islet cells, with
the goal of restoring natural insulin production and release and eliminating
the need for insulin injections in people with type 1 diabetes. People with
type 2 diabetes, which is caused by a different disease process, would
generally not benefit from this type of therapy.
One proven method of islet-cell transfer is through
transplantation of the pancreas, the large gland (located behind the stomach)
where beta-islet cells live. Studies have shown that pancreas transplantation
can eliminate the need for injected insulin in approximately half of all cases
for at least five years.
Yet because of the risks of transplant surgery and the
necessity for taking anti-rejection drugs after the transplant, this procedure
is primarily an option for patients who are also receiving kidney transplants
due to advanced kidney disease. According to the American Diabetes Association
(ADA), simultaneous kidney and pancreas transplants in select patients do not
increase the risk for the patient, may improve survival of the transplanted
kidneys, and will restore normal control of blood sugar.
The ADA diabetes guidelines also note, however, that pancreas
transplantation is only partially successful at reversing some of the serious
long-term side effects of diabetes. The procedure does reverse kidney problems
and the need for daily and sometime multiple injections of insulin. But chronic
conditions like eye disease and nerve abnormalities frequently continue to be a
problem in these transplant patients.
At the time this article was written, there were 1,389 people
on the national waiting list for a pancreas transplant, and an additional 2,409
people waiting for a combined kidney and pancreas transplant, according to the
United Network for Organ Sharing (UNOS).
A slightly less invasive alternative to pancreas
transplantation is islet-cell transplantation alone. In this experimental
procedure, beta-islet cells are identified, isolated, and removed from donor
pancreases and are injected into a major vein connected to the liver. The
injected islets find their way into microscopic blood vessels and become
surrounded and fixed in place by liver tissue. Once there, the cells take over
insulin production and secretion, effectively turning the liver into a
One problem with this approach is that human beta-islets are
few and hard to find; they actually comprise only 1% of all cells in the
pancreas (most of the remaining cells produce and secrete enzymes that aid in
digestion). In addition some of the islets are inevitably damaged or destroyed
during the harvesting process, explains a diabetes researcher in an interview
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