A pancreas transplant will cure type 1 diabetes. So why doesn't everyone with type 1 diabetes get a pancreas transplant? There are two reasons. First, there are only a limited number of donor pancreata available—a few thousand—whereas there are about a million people with type 1 diabetes. Second, people who get an organ transplant have to be on medicines to prevent the body's immune system from attacking and rejecting the organ. These immunosuppressive medicines have serious side effects, such as making the individual more susceptible to infections and increasing the risk of developing a cancer in the future. You are likely to be offered a pancreas transplant if you have kidney failure and you are on a list for a donor kidney. Because getting two organs simultaneously has additional risks, some restrictions do apply. For example, if you have a history of heart attacks or strokes, you may not be a candidate for simultaneous pancreas-kidney transplant. A pancreas transplant alone—that is, getting a donor pancreas when you have normal kidney function—is also occasionally done. You may be a candidate for this if you continue to have frequent severe hypoglycemic reactions despite all efforts by you and your medical team to prevent them, or if you have life-threatening complications due to uncontrolled diabetes.
Islet transplantation is currently an experimental procedure that can also cure type 1 diabetes. In islet transplantation, instead of transplanting the whole pancreas, the islets that make the insulin are isolated from the pancreas and injected into the blood vessel that supplies the liver. The islets lodge in the liver and work normally, releasing insulin in response to changes in glucose levels. Islet transplantation is a much simpler procedure compared to pancreas transplantation. It is done in the x-ray department of a hospital rather than in an operating room. Also, if islet transplantation proves successful in curing both type 1 and type 2 diabetes permanently, there is the possibility of creating islets in a test tube from stem cells, making the treatment available for many more people with diabetes. Currently, with few exceptions, the "cure" seems to be temporary, with islet function declining with time so that most people need to go back on insulin after a couple of years. This may change in the future as we better understand the factors that cause the islets to fail. People who get an islet transplant have to take antirejection medicines, and therefore researchers restrict this procedure to people who have a history of frequent severe hypoglycemic reactions or complications due to uncontrolled diabetes.
humans consuming a normal diet, and so the relevance to human diabetes is unclear.
• Since nutritional supplements are not regulated in the same manner as pharmaceutical medicines, supplements may vary in terms of potency.
• Just because a compound is not regulated and is natural does not make it safe—there could be serious side effects, and the supplement could also affect the metabolism of other drugs that are taken at the same time.
In 2003, the ADA published a review of thirty-six different herbs and nine vitamin/ mineral supplements used for glucose control in diabetes. The reader is directed to this review for further information (see Resources). I will briefly discuss here some of the more popular supplements.
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