Pancreatic Islet Transplant

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Pancreatic Islet Transplant


What Are Pancreatic Islets? 


The pancreas, an organ about the size of a hand, is located behind the lower part of the stomach. It makes insulin and enzymes that help the body digest and use food. Throughout the pancreas are clusters of cells called the islets of Langerhans. Islets are made up of several types of cells, including beta cells that make insulin.


The pancreas is located in the abdomen behind the stomach. Islets within the pancreas contain beta cells, which produce insulin.


Insulin is a hormone that helps the body use glucose for energy. Diabetes develops when the body doesn’t make enough insulin, cannot use insulin properly, or both, causing glucose to build up in the blood. In type 1 diabetes—an autoimmune disease—the beta cells of the pancreas no longer make insulin because the body’s immune system has attacked and destroyed them. A person who has type 1 diabetes must take insulin daily to live. Type 2 diabetes usually begins with a condition called insulin resistance, in which the body has difficulty using insulin effectively. Over time, insulin production declines as well, so many people with type 2 diabetes eventually need to take insulin.


What Are The Benefits And Risks Of Islet Transplantation ? 

The goal of islet transplantation is to infuse enough islets to control the blood glucose level without insulin injections. Other benefits may include improved glucose control and prevention of potentially dangerous episodes of hypoglycemia. Because good control of blood glucose can slow or prevent the progression of complications associated with diabetes, such as heart disease, kidney disease, and nerve or eye damage, a successful transplant may reduce the risk of these complications.

Risks of islet transplantation include the risks associated with the transplant procedure—particularly bleeding and blood clots—and side effects from the immunosuppressive drugs that transplant recipients must take to stop the immune system from rejecting the transplanted islets.


Transplant Procedure

Transplants are often performed by a radiologist, who uses x rays and ultrasound to guide placement of a catheter—a small plastic tube—through the upper abdomen and into the portal vein of the liver. The islets are then infused slowly through the catheter into the liver. The patient receives a local anesthetic and a sedative. In some cases, a surgeon may perform the transplant through a small incision, using general anesthesia.

Islets begin to release insulin soon after transplantation. However, full islet function and new blood vessel growth associated with the islets take time. The doctor will order many tests to check blood glucose levels after the transplant, and insulin is usually given until the islets are fully functional.


What Are The Benefits And Risks Of Islet Transplantation ? 

The goal of islet transplantation is to infuse enough islets to control the blood glucose level without insulin injections. Other benefits may include improved glucose control and prevention of potentially dangerous episodes of hypoglycemia. Because good control of blood glucose can slow or prevent the progression of complications associated with diabetes, such as heart disease, kidney disease, and nerve or eye damage, a successful transplant may reduce the risk of these complications.

Risks of islet transplantation include the risks associated with the transplant procedure—particularly bleeding and blood clots—and side effects from the immunosuppressive drugs that transplant recipients must take to stop the immune system from rejecting the transplanted islets.


What is Diabetes?

Diabetes is a lifelong (chronic) disease in which there are high levels of sugar in the blood. Insulin is a hormone produced by the pancreas to control blood sugar. Diabetes can be caused by too little insulin, resistance to insulin, or both. Diabetes mellitus, commonly referred to as diabetes  was first identified as a disease associated with “sweet urine,” and excessive muscle loss in the ancient world. Elevated levels of blood glucose (hyperglycemia) lead to spillage of glucose into the urine, hence the term sweet urine.

Normally, blood glucose levels are tightly controlled by insulin. Insulin lowers the blood glucose level. When the blood glucose elevates (for example, after eating food), insulin is released from the pancreas to normalize the glucose level. In patients with diabetes, the absence or insufficient production of insulin causes hyperglycemia.


What are Symptoms of Diabetes?

Diabetes often goes undiagnosed because many of its symptoms seem so harmless. Common symptoms of diabetes include:

  •   Excessive thirst and appetite
  • Increased urination (sometimes as often as every hour)
  • Unusual weight loss or gain
  • Fatigue
  • Nausea, perhaps vomiting
  • Blurred vision
  • In women, frequent vaginal infections
  • In men and women, yeast infections
  • Dry mouth
  • Slow-healing sores or cuts
  • Itching skin, especially in the groin or vaginal

If you have one or more of these diabetes symptoms, see your doctor right away.


What are various Types of Diabetes?

The three main types of diabetes are

  •  type 1 diabetes
  • type 2 diabetes
  • gestational diabetes
  •   Type 1 Diabetes – Sometimes called insulin-dependent, immune-mediated or juvenile-onset diabetes. It is caused by an auto-immune reaction where the body’s defence system attacks the insulin-producing cells. People with type 1 diabetes produce very little or no insulin. The disease can affect people of any age, but usually occurs in children or young adults. People with this form of diabetes need injections of insulin every day in order to control the levels of glucose in their blood. If people with type 1 diabetes do not have access to insulin, they will die.
  •  Type 2 Diabetes – The most common form of diabetes is type 2 diabetes. About 90 to 95 percent of people with diabetes have type 2. This form of diabetes is associated with older age, obesity, family history of diabetes, previous history of gestational diabetes, physical inactivity, and ethnicity. When type 2 diabetes is diagnosed, the pancreas is usually producing enough insulin, but for unknown reasons, the body cannot use the insulin effectively, a condition called insulin resistance. After several years, insulin production decreases. The result is the same as for type 1 diabetes–glucose builds up in the blood and the body cannot make efficient use of its main source of fuel.
  •   Gestational Diabetes – Some women develop gestational diabetes late in pregnancy. Gestational diabetes is caused by the hormones of pregnancy or a shortage of insulin. Women with gestational diabetes may not experience any symptoms. Although this form of diabetes usually disappears after the birth of the baby, women who have had gestational diabetes have a 40 to 60 percent chance of developing type 2 diabetes within 5 to 10 years. Maintaining a reasonable body weight and being physically active may help prevent development of type 2 diabetes.


What are the Causes of Diabetes?

Diabetes occurs when the pancreas doesn’t make enough or any of the hormone insulin, or when the insulin produced doesn’t work effectively. In diabetes, this causes the level of glucose in the blood to be too high. What causes diabetes depends on the type of the disease.

  •    HereditaryThis is one of the factors that affect a good proportion of people affected by diabetes. If either one of the parents or both have the diabetes the chances of their offspring getting the same is quite high.
  •   Age : Increased age is a factor which gives more possibility than in younger age. This disease may occur at any age, but 80% of cases occur after 50 year, incidences increase with the age factor.
  •   Poor Diet (Malnutrition Related Diabetes) : Improper nutrition, low protein and fiber intake, high intake of refined products are the expected reasons for developing diabetes.
  •   Obesity and Fat Distribution : Obesity or excess body weight is one of the major contributors for people suffering with diabetes. In other words, a person who keeps a check on his weight has far lesser chances of being affected than someone who is overweight
  •   Sedentary Lifestyle : People with sedentary lifestyle are more prone to diabetes, when compared to those who exercise thrice a week, are at low risk of falling prey to diabetes.
  •   Stress : Either physical injury or emotional disturbance is frequently blamed as the initial cause of the disease. Any disturbance in Cortiosteroid or ACTH therapy may lead to clinical signs of the disease.
  •   Infection : Some of the strephylococci is suppose to be responsible factor for infection in pancreas.
  •   Sex : Diabetes is commonly seen in elderly especially males but, strongly in women and those females with multiple pregnancy or suffering from (PCOS) Polycystic Ovarian Syndrome.
  •   Hypertension : It has been reported in many studies that there is direct relation between high systolic pressure and diabetes.
  •   Serum lipids and lipoproteins : High triglyceride and cholesterol level in the blood is related to high blood sugars, in some cases it has been studied that risk is involved even with low HDL levels in circulating blood.

How to do Diagnosis of Diabetes?

The following tests are used for diagnosis:

  •   A fasting plasma glucose (FPG) test measures blood glucose in a person who has not eaten anything for at least 8 hours. This test is used to detect diabetes and pre-diabetes.
  •   An oral glucose tolerance test (OGTT) measures blood glucose after a person fasts at least 8 hours and 2 hours after the person drinks a glucose-containing beverage.
  •   A random plasma glucose test, also called a casual plasma glucose test, measures blood glucose without regard to when the person being tested last ate. This test, along with an assessment of symptoms, is used to diagnose diabetes but not pre-diabetes.

Test results indicating that a person has diabetes should be confirmed with a second test on a different day.

What Pre – Surgery Precautions to be taken before Diabetes Surgery?

Patients with diabetes are at a higher risk of complications during and after a surgical procedure, but many such patients undergo successful surgery every day. Assuming that your surgery is necessary, it is most important that your surgeon and your diabetes doctor work together before the surgery is performed to prevent problems. You should have a thorough medical checkup of your heart and kidneys, and you should make sure that your blood glucose control is good over the weeks prior to surgery. You should also be sure that you have had plenty of fluids to drink before reporting to the hospital. During the surgery, your doctors may control your blood glucose with intravenous insulin and glucose. Your diabetes doctor may even wish to be present during the surgery. After surgery, tight blood glucose control helps you reduce the risk of postoperative infections. By taking these precautions, you will have the best chances for a successful operation

What is the purpose of Diabetes Surgery?

Even with good medical treatment, diabetes goes on progressing. Diabetes affects all organs in the body like eye, brain, heart, kidney and limbs. Chronic renal problems and increased myocardial infarctions are also associated with diabetes, contributing to early death.

Surgery for Type 1 Diabetes –

Surgery for type 1 diabetes is done only in special situations.

  •   Surgery to replace the pancreas (pancreas transplant) may be done when a person is receiving another organ, such as a kidney.
  •   Surgery to insert working pancreas cells (islet cell transplant) is experimental.

Pancreas Transplant – Pancreas transplant is a surgical procedure to place a healthy pancreas from a donor into a person whose pancreas no longer functions properly. Type 1 diabetes results when your pancreas can’t make enough insulin, causing your blood sugar to rise to dangerous levels. When the transplant takes place, the patient no longer has diabetes and is unlikely to get it again. Insulin shots and frequent blood glucose testing are no longer necessary. The surgery for a pancreas transplant takes about 3 hours. However, the operation is usually done at the same time as a kidney transplant in diabetic patients with kidney disease. The combined operation takes about 6 hours.

Islet Transplantation – Islet transplantation is the transplantation of isolated islets from a donor pancreas and into another person. It is an experimental treatment for type 1 diabetes mellitus. Once transplanted, the islets begin to produce insulin, actively regulating the level of glucose in the blood. Islets are usually infused into the patient’s liver. If the cells are not from a genetically identical donor the patient’s body will not recognize them as foreign and the immune system will begin to attack them as with any transplant rejection. To prevent this immunosupressant drugs are used.

Intensive Insulin Therapy – Intensive insulin therapy is an aggressive treatment approach designed to control your blood sugar levels. Intensive insulin therapy is a therapeutic regimen for diabetes mellitus treatment. This newer approach contrasts with conventional insulin therapy. Rather than minimize the number of insulin injections per day (a technique which demands a rigid schedule for food and activities), the intensive approach favors flexible meal times with variable carbohydrate as well as flexible physical activities.

Lastly, it is important to note that individuals that receive a pancreas or islet transplant must take immunosuppressive medications as long as the pancreas or islets are functioning.

  •   Surgery for Type 2 Diabetes

Type 2 diabetes can be strongly improved using surgery. Medical treatment is usually attempted first, but the surgery could be an effective treatment option for people with diabetes .

Bariatric Surgery – Bariatric surgery should be considered as a treatment for diabetes, according to new recommendations issued by the International Diabetes Federation. Since 9 out of 10 patients who suffer from type 2 Diabetes are either overweight or obese, there is a definite connection between carrying excess weight and being diabetic. Bariatric surgery, also referred to as lap band or gastric surgery, is a surgical procedure which is gaining acceptance as a treatment for type 2 diabetes at the same time it effectively helps the patient to lose weight.

Ileal Interposition – It’s a surgical procedure where a section of one the three parts of the small intestine the ileum is snipped and placed closer to the stomach. The ileum produces the hormone GLP-1, which helps in insulin secretion. This means food from the stomach takes just 10 minutes to reach the ileum instead of an hour earlier. This reduces the dependence on insulin injections. This simple procedure of transposition has been proven effective as type 2 diabetes treatment strategy. Long term clinical studies and data have suggested that the procedure has been effective in control of blood sugar even after 14 years. The success rate ranges between 80% – 100% depending upon the post surgical care and levels of activity maintained by the patient.

What Follow Up Care to be taken Post Diabetes Surgery?

Follow the healthcare provider’s treatment recommendations. Keep records of blood sugar levels as often as recommended by the healthcare provider, including the times the levels were checked, when and how much insulin or medication was taken, when and what was eaten, and when and for how long the patient exercised. Call the healthcare provider if the patient has any problems with their treatment or symptoms that suggest poor glucose control.

Attend diabetes education classes at the local hospital. The more educated the patient and their family are about the disease, the better they are likely to do. If the patient takes insulin, they should see the healthcare provider about every three months or more often. For other diabetics, every three to six months is generally adequate, unless they are having problems.

What are Benefits of Diabetes Surgery?

Since its earliest description several thousand years ago, diabetes has remained a chronic progressive disease. The disease now affects 200 million people worldwide, and diabetes-related death is expected to increase by 50% in the next 10 years. Diet modification and oral hypoglycemic medications have proven inadequate, whereas insulin therapy only solves the problem temporarily.

A large body of evidence now demonstrates surgery for type 2 diabetes can achieve up to complete disease remission, a goal almost unheard of in current diabetes care. Evidence collected over decades of bariatric surgery demonstrates the effectiveness and durability of diabetes control gained after gastrointestinal bypass surgeries. “Metabolic surgery” is now emerging as an area dedicated to the establishment of surgical procedures specifically aimed at treating diabetes.

Surgery should now be looked at as a viable therapy for not only the morbidly obese, but also for diabetic patients who fall outside current BMI guidelines. The potential benefits of metabolic surgery are in fact enormous. However, its implementation requires a rethinking of diabetes treatments goals and strategies. In the meantime, investigation into the pathophysiological basis of diabetes continues, with the hope of discovering the optimal therapeutic targets and best-suited interventions.

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