BACKGROUND: Between 5 percent and 10 percent of all diabetics are afflicted with type 1 diabetes, or juvenile diabetes. Type 1 diabetes is an autoimmune disorder that occurs when insulin-producing beta cells in the pancreas are damaged or destroyed. Without beta cells, the body is unable to produce the hormone other cells need to absorb glucose and convert it into usable energy. Lack of insulin causes sugar to accumulate in the bloodstream and can lead to serious complications like heart disease, blindness, high blood pressure, nerve damage and kidney failure. The causes of type 1 diabetes are not completely understood, but scientists believe type 1 diabetics may have a genetic pre-disposition to the disease that remains dormant until an environmental trigger, like a virus or chemical, attacks the immune system in ways that cause it to destroy essential beta cells in the pancreas.

TRADITIONAL TREATMENTS: Most type 1 diabetics rely on daily injections of insulin to live and avoid the many complications associated with type 1 diabetes. Although effective, insulin therapy is not perfect, since patients can still have above-average glucose levels that put them at risk for long-term complications like hypoglycemia and a loss of symptoms that warn them blood sugar is dropping. Some patients taking insulin have labile, or brittle, type 1 diabetes, which causes their blood sugar to swing from high to low despite the best-laid insulin plans. Patients with severe forms of type 1 diabetes may be good candidates for pancreatic islet transplantation. This procedure requires physicians to harvest many insulin-producing islet cells from deceased donors pancreases and infuse them into the portal vein of the patient's liver, so they can flourish and begin producing insulin. The procedure begins when the patient is anesthetized. Next, doctors use specialized enzymes to remove islets from the donor pancreas and infuse the islets into the body via catheter. In general, a patient receives 10,000 islets per kilogram of body weight, which means more than one pancreas is often needed to complete the procedure. Unfortunately, there is a severe shortage of donor pancreases in the United States, which means there are not enough islets to go around for every type 1 diabetic who needs them.

NEW TREATMENT: Recently, researchers at the University of Minnesota conducted an experiment that shows single donor islet cell transplantation may be as effective as multiple donor islet cell transplantations. Researchers found 100 percent of participants were free of insulin injections after one year even though they only received islet cells from one donor pancreas. Researchers believe the effectiveness of single donor transplants may be due to the fact that the pancreases used came from individuals who were younger than 50 and were stored for fewer than eight hours before the transplant took place. According to Bernhard Hering, M.D., director of the islet transplant program at the University of Minnesota in Minneapolis/St. Paul, islet transplantation is beneficial because it has the power to reverse diabetes not only for weeks and months, but possibly a lifetime. "Literally, the minute the islets are infused, the problem is eliminated," he says.

POTENTIAL DRAWBACKS: One of the downsides of both single and multiple islet cell transplantation is patients have to take immunosuppressive drugs to keep their body from rejecting the new islet cells. These drugs can be dangerous as they put patients at risk for infection and certain types of cancer. If a patient stops taking immunosuppressive drugs, the body will reject the new islet cells, and he/she will no longer produce insulin. Some people experience declines in islet functioning over time, while others never succeed in getting their newly transplanted islets to function properly. Islet transplant can also be costly because it might take more than one transplantation to get the proper number of working islets into a patient's body.

Some people will also need two infusions of islets at different times to obtain enough functional islets, which means more donor pancreases may be necessary. Even then, there is no guarantee the islets will take. Today, researchers are looking into the possibility of using pigs as islet cell donors to increase the availability of donor pancreases and help more type 1 diabetics achieve insulin independence.