Surgical Procedures for Type 1 Diabetes
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Generally, type 1 diabetes is managed with insulin therapy, diet, and exercise. However, in some cases, transplant of the pancreas or islet cells might be an option.
A pancreas transplant is done only in a few medical centers in the US. This procedure is an acceptable alternative if you:
- Have developed severe renal disease especially if you may need a ]]>kidney transplant]]>
- Have tried insulin treatment, but it has failed to prevent acute complications, like ketoacidosis
- Have severe emotional problems due to insulin treatment
- Have frequent, potentially life-threatening complications, like repeatedly getting ]]>pneumonia]]>
Kidney damage is a common complication of type 1 diabetes. Many people with diabetes end up with ]]>kidney failure]]> that requires regular ]]>dialysis]]>. In most cases, a pancreas transplant is done along with a kidney transplant. There is good evidence that quality of life significantly improves if these two transplants are done together.
Some doctors, though, do transplant only the pancreas. This is done in cases where the patient does not have kidney failure. Compared to pancrease-kidney transplant, the benefits of just a pancreas transplant are not as clear.
If you receive one or more transplanted organs, you will need to take immunosuppressive drugs for the rest of your life. These drugs prevent the immune system from attacking your new organ. However, these drugs have many severe side effects, including ]]>high blood pressure]]>, hearing loss, nausea, gastric ]]>ulcers]]>, and bacterial and viral infections. Also, some of these drugs may increase your blood sugar level.
Islet Cell Transplant
There has been a great deal of research into ]]>islet cell transplant]]>. Islets are a mass of cells located in the pancreas. Only 1%-2% of the pancreas is made of islet cells. About 75%-80% of these are beta cells, which are the cells that normally produce insulin. Alpha cells make glucagon, a hormone that raises blood sugar. Transplanting islets are technically easier to transplant than an entire pancreas.
Unfortunately, beta cells are very fragile. Many do not survive the transplant procedure. In addition, the immunosuppressive drugs seem to impair the insulin-producing ability of the new cells and cause many side effects. Researchers are investigating the best ways to transplant islet cells.
American Diabetes Association website. Available at: http://www.diabetes.org/home.jsp .
Harlan DM, Kenyon NS, Korsgren O, Roep BO. Current advances and travails in islet transplantation. Diabetes. 2009;58:2175-2184.
Nathan DM. Isolated pancreas transplantation for type 1 diabetes: a doctor's dilemma. JAMA . 2003;290:2861-2863.
National Diabetes Information Clearinghouse website. Available at: http://diabetes.niddk.nih.gov/.
National Institute of Diabetes & Digestive & Kidney Diseases website. Available at: http://www.niddk.nih.gov/health/diabetes/summary/pancisl/pancisl.htm .
Last reviewed December 2009 by ]]> B. Gabriel Smolarz, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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