Talk:Diabetes/Archive 3

Cure for Type I Diabetes
Something that seems to be not well known, is that there is a cure to Type I diabetes -- namely, pancreas transplant.

I have had diabetes for 28 years, and two years ago I was diagnosed with chronic kidney disease, caused by the diabetes. As a result, in July of 2003, I received a double transplant: kidney and pancreas.

This has effectively cured my diabetes. I take no medication to control my blood sugar (neither insulin nor oral medications used to control Type II diabetes). My blood sugar levels are consistantly good (i.e., normal).

While this cure does not eliminate the cumulative damage caused by the 28 years of diabetes, it does prevent any additional damage (and perhaps give the body an opportunity to heal).

Note that this transplant was not experimental, but a standard procedure, covered by insurance.

I received the transplants at the University of Iowa Medical Centers. At that location, they will only consider pancreas transplants (at least to cure diabetes) for patients who already have or will simultaneously receive another transplanted organ (typically a kidney). I understand that other transplant centers have differing criteria, and some will transplant a pancreas by itself.

Note that the donor for a pancreas must be a cadaver, as you only have one panceras and you need it to live.

-rholton, 18 Nov 2003


 * rholton:


 * Actually, there is another currently available (though so far only experimental) 'cure' for Type 1. A few years ago, researchers in Alberta Canada managed to transplant beta cells into about 10 Type 1 patients. Of those, 8 (if memory serves) succeeded. There had been sporadic attempts to do so for years, but immune system reactions (or something else) killed them not long after the transplant; the success rate was 0 in effect. The Alberta foks seem to have found a way around the problem. Getting it to clinical practice will not, it seems, be easy. Perhaps in a few years? Or perhaps figuring out how to get stem cells to produce beta cells (your very own new ones) might be an earlier answer. On the other hand, the politics surrounding stem cell research (at least in the US) may put a hold on that for a very long time.


 * ww

The Edmonton Protocol.

Hardly a cure-- at best a pretty good treatment for hypoglycemia unawareness. See 5 yr follow-up report from last July. . alteripse 03:02, 7 November 2005 (UTC)


 * Looking just at the abstract via that link, it looks better than that - the limiting factor is the supply of Islet cells, and postulating stem cell or other tissue culture provision, that can be ovrcome, in theory.
 * "The HbA(1c) (A1C) level was well controlled in those off insulin (6.4% [6.1-6.7]) and in those back on insulin but C-peptide positive (6.7% [5.9-7.5]) and higher in those who lost all graft function (9.0% [6.7-9.3]) (P < 0.05)." Sounds good to me.

Midgley 00:20, 15 November 2005 (UTC)

It is clearly an advance, just has turned out a bit disappointing after the initial report of 11 out of 11 recipients off insulin at a year-- no one has been able to replicate that and I think now that nearly all those 11 are back on insulin. The original hope was for a cure, not just a reduction of insulin requirement or amelioration of hypoglycemia unawareness. I guess I shouldn't be negative about those things. alteripse 01:11, 15 November 2005 (UTC)

"after three years, 89 per cent of patients are still producing insulin". "Many more patients have now been transplanted with this procedure, including two at UMass. Many but not all of those who received these transplants are now off insulin." . Searching for "Edmonton Protocol" on google gets over 28000 hits, and "James Shapiro" AND diabetes returns 11000 hits. Seems like it should be worth a mention, and probably its own page. Flying fish 05:10, 26 November 2005 (UTC)
 * Go ahead. Turn the link blue.alteripse 13:46, 26 November 2005 (UTC)

Beta cells by themselves tend to behave differently from those in their natural islet environment - they appear to need the companionship of their 'islet-mates' in order to release insulin properly, see page 4 (of 10) in Stem Cells and Diabetes, Chapter 7 http://stemcells.nih.gov/staticresources/info/scireport/PDFs/chapter7.pdf

Also, one's own stem / beta cells would presumably still be subject to the original autoimmune destruction.

Only one successful (to my knowledge) live-donor islet transplant has been performed (it involved extracting islets from a section of a mother's pancreas which were then infused into her daughter who had developed diabetes after pancreatitis), more at: http://www.healthfinder.gov/news/newsstory.asp?docID=525217 JoBrodie 12:46, 25 November 2005 (UTC) Islet Project Coordinator, Diabetes UK.

Successful transplants of whole pancreases and islets for non-autoimmune types of diabetes (like pancreatectomy for pancreatitis) have been successful many times and are done at many centers in North America. This was news only because it was a smaller dose of islets from a living donor. The news conference will be really deserved if she doesnt need a "booster infusion" in a year. alteripse 12:57, 25 November 2005 (UTC)

Why not an ounce of prevention?
The only things I've picked up on so far, are diet, exercise, and whatnot. I see there's no section in the main article. Should there be, or should it be its own article? As for the topic of discussion, I have no background (thankfully) on it. Normally I'd jump right in, but I'll pass on this one. Thanks! Supaplex 06:05, 19 January 2006 (UTC)

There is no preventative measure for T1 and if a section is to be added it should be made clear that lifestyle improvements can only assist the prevention of T2. Waifwaller 03:37, 17 February 2006 (UTC)

im not tooo sure if there is a cure for dabetes but i do know that they have cured type one diabetes in labratory rats

Type 3, Type4 Diabetes
Would someone care to provide a cite on the existance of Type 3 as a bonafide category? The only thing that I can find, is an article dated the 9th of this month discussing the possible need for the lable in connection with an Insulin issue involving the brain, [Scientists believe type 3 diabetes uncovered]. Unless a confirming cite can be presented, that section should probably be excised. Also, I have yet to come across anybody referring to Gestational Diabetes as Type 4, or Type 'Anything Else'. coro 17:13, 27 Mar 2005 PST


 * I'm indeed not sure what the origin of this classification is. Perhaps searching for 3A, 3B etc may uncover something. JFW | T@lk  19:34, 10 Apr 2005 (UTC)

I just saw this article reviewed in a journal. Calling it type 3 is not likely to catch on. We already have dozens of types of diabetes beyond 1 & 2 and even the broad definitions of 1 & 2 feel like they are in flux again (e.g., it seems harder than it did in the 1980s to decide what type many people have, and we are beginning to refer to young people having "type 1.5" or "type 1+2" or "monogenic diabetes"-- I can explain what these are if you are interested). The condition described in your reference does not even involve high blood sugars so it seems silly to refer to it as any type of diabetes. The subject of intracerebral insulin is fascinating, but it isn't diabetes. alteripse 13:54, 27 May 2005 (UTC)

I'm still pretty undecided on how to handle the Type 3 label, but unless someone can come with a justifying reference for the Type 4 label, I intend to get rid of it after the end of the month. And just refer to it as Gestational.--Coro 18:08, 14 Jun 2005 (UTC)

I'd never heard of Type 3 (other than the article mentioned in the first comment) or Type 4 diabetes. The terms do not appear in the WHO article (reference 2 in the main article) or in the index to the Textbook of Diabetes (Ed. Pickup and Williams, 2003, 3rd edition). After a quick Google ( "Type 4" diabetes ) I found an article about them on a Men's Health page but, to my knowledge, these terms are not in current use by researchers or healthcare professionals. Jo Brodie, Diabetes UK. JoBrodie 17:31, 13 Aug 2005 (GMT)

Agreed, that is why I finally changed the Type 4 label to be just Gestational. But how do we handle replacing the Type 3 label? The only thing the variants in that group have in common seems to be that they don't belong anywhere else, and I have never heard of a formal way of referring to them anywhere. Usually the best that I have heard is either Type Wierd or Type 'None of the Above'. Any thoughts? --Coro 23:15, August 16, 2005 (UTC)

Put a sentence in that says: "One classification system used "type 3" to designate all other miscellaneous forms of diabetes not easily recognized as type 1 or 2 or gestational." And then don't even use the term. No doctors use it. alteripse 00:02, 17 August 2005 (UTC)

I think the type 3 and 4 classification somehow evolved from the 1999 WHO consultation on definition, diagnosis and classification of diabetes mellitus (see http://www.staff.ncl.ac.uk/philip.home/who_dmc.htm#Tab5). in their document, they didn't specifically create and label a type 3 category - but they did acknowledge that there were a whole host of clinical entities that didn't fit into types 1 and 2. but you are right - no doctors use it. User:62.6.139.10

Yet another style/content complaint... :-)
In reading through this piece tonight, I note the uneven style that others have commented on here on the talk page... but I believe that I discern another more fundamental problem.

Some of the phrasing in this page leads me to wonder if parts of it have been copied wholesale from other sources ("These symptoms may also manifest in Type 2 diabetes in patients who present with frank poorly controlled diabetes."?), and what those sources might be. Now, if *I* can write "believe that I discern" on a talk page, clearly someone else can write "who present with frank poorly controlled diabetes"... but there seems a thread of that sort of uncommonly precise medical language woven through the article.

Am I the only one who noticed this? --Baylink 23:59, 13 Jun 2005 (UTC)


 * That's because this article is being edited by laypeople and MDs at the same time. When Alteripse, myself and other docs write, we may gravitate towards medical jargon. I don't think anything on this page is from other sources - it's been edited too heavily. JFW | T@lk  22:42, 14 Jun 2005 (UTC)


 * Got it. I knew there were some doctors involved somewhere; didn't know they were first-hand.  *Very* nice work, overall, BTW. --Baylink 19:37, 23 Jun 2005 (UTC)


 * What's first hand, the doctors? *grins* JFW | T@lk  00:08, 24 Jun 2005 (UTC)


 * I too think parts of this article read too heavily; for example, the cures section. I consider myself an educated and literate person, and I get terribly frustrated reading the terminology and clumsy language in this article.  Considering that this page could viably serve as important information for diabetics and interested others who might not have the vocabulary that this page's editors evidently command, I think it's important to alter the language a bit to make it easier to read.  Just my two cents.  Also, I'm taking out that "frank" word mentioned above, as I think it's completely unnecessary and maybe just wrong. Tmkain 02:07, 16 January 2006 (UTC)

Improvement drive
A related article, Obesity, is currently nominated to be improved on This week's improvement drive. Please vote for this article there.--Fenice 08:38, 9 August 2005 (UTC)

contradiction in page
The diagram caption of the glucose response of a beta pancreatic cell says that insulin production is not affected directly by glucose levels; however, in the text, it says that 'rising levels of glucose increase insulin production'. I assume that the text should read 'rising levels of glucose stimulate insulin release'.


 * Yeah, you're right. Care to fix it? JFW | T@lk  13:40, 16 August 2005 (UTC)

epistemology
...


 * Yes, care to elaborate? JFW | T@lk

Diabetes types
The article states that Diabetes type 2 is far more common than type 1. As type two is often caused by diet rich in sugars and fats and other lifestyle factors, would it not be important to say that this were more common in MEDCs where this diet is more easily available (like America), and not so much in LEDCs (like India)?

80.2.26.219 16:12, 19 November 2005 (UTC)


 * Who says the prevalence of DM2 is so much lower in India? The population of that country is so genetically prone to DM2 that the difference may actually be smaller than you are suggesting. JFW | T@lk  21:42, 19 November 2005 (UTC)


 * I would be interested to hear of any country in which classic type 1 outnumbers classic type 2. I suspect there is no such place. alteripse 03:19, 20 November 2005 (UTC)


 * I cannot cite reliable statistics for any such country. But I note that Type 2 is strongly correlated with weight (especially visceral weight), with "Western diet", lack of exercise, and probably with calorie throughput over time. So if we can find a country in which diets are sparse enough to preclude extra weight, with non-Western foods, little exercise, and limited calories, it would be a candidate. Presumably the environmental triggers for Type I (assorted virus infections some carried by insects, at least one rat poison, ...) would be more or less uniform in distribution, especially in areas without hard freezing winters. Pima Indians on the US side of the US-Mexican border have fantastically high rates of Type 2. Those with essentially the same heredity on the Mexican side have far lower Type 2 rates.


 * Poverty (but not too much), malnuitrition (but not too much), perhaps enough of one or the other to prevent much exercise, ... would probably do the trick. Too many countries more or less fit the bill. Much of the Horn of Africa is a candidate, the Sahel where the Sahara is advancing steadily, some parts of the Arctic now that it is turning into a monster bog as the permafrost loses its perma and as the trees to the south are being ravaged by insects and other parasites they've never encountered as they used to die off during a cold sub-Arctic winter if they were unfortunate enough to be blown or other wise transported north. Been getting closer and closer to an environmental disaster, if not already, for about a decade. Satellite photography is definitive. And so on and so on.


 * Actually, it would be a good thing in respect of Type II to note in this (or some sub article) just what is now thought to be the connection with fat tissue (self-inflammation, if I understand correctly), what it is in "Western diet" which pushes toward Type 2, and what it is about exercise that helps. I personally suspect all that high fructose corn syrup, as fructose is not under the same controls as is glucose (again as I understand it), and couch potato culture with a gazillion cable TV channels, and even more on the Internet. ww 07:35, 20 November 2005 (UTC)

You realize don't you that type 1 is not evenly distributed. The highest incidences occur in northern temperate climates. Finland has a per capita rate of type 1 that exceeds that of most equatorial countries by more than 10 fold. The rate of type 2 in the general population in the US is approaching 1 in 20 in some states, while the rate of type 1 in the US is about 1 in 300 and the rate in some equatorial countries a fraction of that. You are going to have a lot of difficulty finding a country with a rate of type 1 above type 2. Hence my challenge above. alteripse 07:56, 20 November 2005 (UTC)


 * A, Nope, I hadn't realized Type 1 distibution was quite so uneven. I knew about Finland, of course, but... Perhaps it's the minor infections that result from confinement with others in temperatures not causing frank frostbite? Did Finnish Type 1 rates change as central heating became available? German measles is one of those viruses which can trigger Type 1 in HLA susceptible individuals, and there are several in the (euphonious) Coxsackie family. Or, in the case of Finland, it might be infections resulting from all that birching when they rush out into the frozen world from the sauna?


 * I was concentrating on Type 2 in the observations above, and got led astray a bit by the pending ecological catastrope. Oh well...


 * Good to see you're a nightowl as well. Insomniacs of the world, unite! ww 08:25, 20 November 2005 (UTC)

The most intriguing recent hypothesis about the higher risks in northern Europe is that subclinical (i.e., not severe enough to cause rickets) vitamin D deficiency predisposes to autoimmune diseases like diabetes. Your suggestion of increased viral infections in indoor winters or excessive cold exposures is not borne out statistically-- in fact the hygiene hypothesis of autoimmune vulnerability suggests the opposite. alteripse 17:57, 20 November 2005 (UTC)

chinese addition
I removed the following recently inserted sentence: Also, Dr. Lou Bin, Ji lingong, and Mao Tingchea of China also helped discover treatments to maintain insulin stabillity.   for two reasons: too vague and no historical context. Please tell us what they did and whether it was comparable in importance to the people mentioned. Please tell us when they did it. Thanks alteripse 14:15, 6 December 2005 (UTC)

recent reversion
I reverted following paragraph

''The most important forms of diabetes are due to decreased production of insulin (diabetes mellitus type 1, the first recognized form), or decreased sensitivity of body tissues to insulin (diabetes mellitus type 2, the more common form). The former requires insulin injections, otherwise death will occur within a month; thus insulin dependant for survival. The latter is generally managed with decreased carbohydrate intake and oral medications; it is only treated with insulin if the dietary and tablet(s) recommendations are ineffective. However, for type 2, lack of insulin treatment does not result in death in less than 1 month; insulin is a treatment option, although still commonly used.''

to the previous version because
 * 1) Death does not always occur within a month if insulin is omitted in type 1. Although uncommon, there are enough circumstances when this does not occur that we should not make such a flat claim. The most notorious example is the honeymoon period. A hedged statement or insertion of "nearly always in established cases" would rectify that sentence.
 * 2) It is difficult to make simple generalizations about type 2, but a large proportion of people who develop type 2 have enough of an insulin deficiency to require insulin injections. Sometimes insulin sufficiency can revive with a combination of normoglycemia and improvement in insulin sensitivity; often it cannot. There is much evidence that early use of insulin can promote recovery of exhausted beta cells more effectively than ineffective use of oral medications, and this course is often recommended.
 * 3) Currently the traditional GP and internist management of type 2, sometimes caricatured as "treat to failure", leaves the majority of insulin-deficient people with type 2 chronically hyperglycemic by presenting insulin as a "patient option" differently than we do for type 1. The sentences seemed too redolent of that approach.

If you think this was too hasty a reversion I am open to compromise or modification on the wording. alteripse 23:25, 11 December 2005 (UTC)


 * I agree with Alteripse's version, although there could be some emphasis on the fact that type 1 diabetics are likely to deteriorate rapidly without treatment (cue to teenager stopping her insulin due to IV drug use jokes by peers). JFW | T@lk  23:55, 11 December 2005 (UTC)


 * Deterioration once beta cells are exhausted needs only hours. And, as stated, the honeymoon can even be years. I'd stick with the current version! InvictaHOG 03:03, 12 December 2005 (UTC)

milk
I'm not sure why the cow's milk issue is back, it seems to be part of a larger debate over diet in general. Recent study (2006):
 * Absence of breast-feeding is associated with the risk of type 1 diabetes: a case-control study in a population with rapidly increasing incidence

Recent (2005) review article:
 * Is type 1 diabetes a disease of the gut immune system triggered by cow's milk insulin?

2004 review article:
 * Bovine serum albumin and insulin-dependent diabetes mellitus; is cow's milk still a possible toxicological causative agent of diabetes?

Older work: --JWSchmidt 14:02, 22 January 2006 (UTC)
 * Nutritional risk predictors of beta cell autoimmunity and type 1 diabetes at a young age
 * Cow's milk and type 1 diabetes: the real debate is about mucosal immune function
 * Lack of association between duration of breast-feeding or introduction of cow's milk and development of islet autoimmunity
 * Nutritional factors and worldwide incidence of childhood type 1 diabetes

This is only a controversial hypothesis and should be presented as such. Here are some sources:
 * Vaarala O. Is type 1 diabetes a disease of the gut immune system triggered by cow's milk insulin? Adv Exp Med Biol. 2005;569:151-6. Review.


 * Truswell AS. The A2 milk case: a critical review. Eur J Clin Nutr. 2005 May;59(5):623-31. Review.
 * Persaud DR, Barranco-Mendoza A. Bovine serum albumin and insulin-dependent diabetes mellitus; is cow's milk still a possible toxicological causative agent of diabetes? Food Chem Toxicol. 2004 May;42(5):707-14. Review.
 * Wasmuth HE, Kolb H. Cow's milk and immune-mediated diabetes. Proc Nutr Soc 2000 Nov;59(4):573-9. Review.
 * Truswell AS. The A2 milk case: a critical review. Eur J Clin Nutr. 2005 May;59(5):623-31. Review. Andreas 14:25, 22 January 2006 (UTC)

I'm not an expert on this; however, from experience with diabetics I have found that cow's milk is regarded as to be avoided. It is not cow's milk that directly causes the diabetes, but it changes the environment inside the human body to allow for such symptoms as diabetes (and other non-related cases). This is more common(?) in those that only show diabetic symptoms but do not have a case of diabetes. Some of the sources above seem to hint at that. Instead of a view directed at cow's milk, I suggest a view directed at diabetic symptoms with those that are lactose intollerant and if there is any equality with those that are not lactose intollerant. &mdash;  Dz on at as  15:46, 28 January 2006 (UTC)

Thanks
Thanks you all who done the website.