November 16, 2013
Transplants For Diabetics
November is National Diabetes Month and if you have read my latest post, you know that it now holds special significance for me. I am among the nearly 26 million US citizens who have diabetes. Another 79 million of you are at risk of developing the disease.
Doctors and researchers are working on better drugs to control the disease all the time, but the truth is simple. The diagnosis is like being handed a time bomb. For a Type II diabetic like me, the fuse is long, and I have control of how fast it burns. For a Type I diabetic, however, that fuse is burning from a young age and it burns much faster.
Type I diabetics do not produce insulin, the hormone that converts sugar and starches into energy. The disease causes the white blood cells in their bodies to attack and destroy the cells that produce insulin in the pancreas. Type I’s learn to control diabetes with insulin injections and constant monitoring.
Michael Schofield, a 53 year old man who for AT&T in Scottsdale, Arizona, was diagnosed as a Type I diabetic in 1982. Despite medicine and monitoring, CNN reports that Schofield still experiences hypoglycemic attacks when his blood sugar levels get too low. These episodes were like living in a fog that he couldn’t escape until someone helped him. Hypoglycemic episodes that go on too long can lead to a loss of consciousness, seizures, coma or even death.
As Schofield aged, his body adapted to the extremes lows in his blood sugar levels, meaning that the typical symptoms of hypoglycemia took longer and longer to manifest. He didn’t realize he was in danger until he passed out.
“Over time, your body just starts to break down,” he says. “They say (diabetes) is a slow killer, and it is.”
This process happens with Type II diabetics as well, just (hopefully, I say with my fingers crossed) it takes longer to get to that point.
So, what can be done?
Doctors have tried pancreas transplants, but they are typically not an option because they are difficult to perform, according to Dr. Michael Rickles, associate professor of medicine at the University of Pennsylvania. An experimental procedure called the “Edmonton Protocol,” which uses the pancreas’ islet cells, is being tested at medical centers around the country. If the Food and Drug Administration (FDA) approves the procedure, it could make a difference for patients who are no longer able to successfully manage their diabetes.
The pancreas’ islet cells contain beta cells that produce insulin and alpha cells that produce a hormone called glucagon. Both insulin and glucagon are used to regulate the body’s glucose levels. Since researchers in Alberta, Canada discovered how to isolate these cells from a deceased donor’s pancreas and transplant them to the liver of a diabetic patient in the 1990’s, scientists have been trying to improve the survival rates of the cells during transplantation. Currently, the typical patient needs two infusions of islet cells to maintain normal glucose levels long-term.
Rickles and his team published a study in Diabetes detailing a new protocol. The islet cells are given three days to “rest” before they are transferred to the living patient. All of the participants in Rickles’ study came off insulin therapy for at least a year after a single injection.
Islet cell transplant has been approved in other countries already, and the data reveals that some patients can stop using insulin for five to ten years.
Cut back to Michael Schofield. After a particularly scary hypoglycemic episode one Saturday, he filled out a questionaire to see if he qualified for a trial being funded by the National Institutes of Health (NIH). Two days later, the UCSF Medical Center emailed him back.
Schofield met with Dr. Andrew Posselt, director of the Pancreatic Islet Cell Transplant Program at UCSF. Posselt told him that the procedure would take less than two hours, and that Schofield could go home in two or three days. Like any other transplant, he would have to take immunosuppressant drugs for the rest of his life, however.
For the next year, Schofield underwent a barrage of medical tests. He did not receive a donor pancreas in time to participate in the government trial, however he did find out that his employers insurance would cover the experimental islet transplant. He submitted a request to the FDA for approval of the procedure.
This story takes a bit of turn with the donor.
Michael Schofield’s donor was 23 year-old Michael Baptiste from San Francisco. He signed up to be an organ donor without question when he got his first driver’s license. His death was an accident. He was out with friends, goofing around, hanging out of the window of a friend’s car when he fell and hit his head. The doctors kept him alive for six days, then pronounced him brain dead.
Schofield’s first infusion of islet cells happened a few days later. Within two weeks, he was off insulin. For the first time in 30 years, he saw a flat line on his insulin monitor.
Grateful for this second chance at a normal life, Schofield sent a note to his anonymous donor’s family, thanking them. He also began publicly speaking about the transplant, urging FDA approval.
“People need to be aware that this is an effective alternative treatment,” Posselt said. “Funding is very difficult to get for this kind of procedure in the U.S.; as a result, we’re falling behind other countries.”
This is not an answer for every diabetic. Type II diabetics still produce insulin, their bodies just don’t handle it properly, so this procedure would not help them. For Type I’s, however, this could be life changing. Rickles hopes that we will see FDA approval within the next two to three years.
Schofield’s note to the Baptiste’s family started an exchange that ended at Pier 39 in San Francisco when he met Elizabeth Baptiste, Michael’s mother. The strangest part, she also works for AT&T.
“It’s a happy moment that I got the transplant, got to meet her, say thank you,” Schofield remembers. “It’s a sad moment because having three children of my own, I can’t imagine the pain.”
Baptiste found the meeting to be therapeutic. None of the other organ recipients have contacted her family.
“I’ve told people, ‘I know my son is dead,’ ” she says. “But I know other people have his parts, so I know he’s still alive. Michael came to me at the right time. … I needed a hug from my son, and that’s what he was there for.”
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