Steph has Type 1 diabetes - his pancreas doesn't produce insulin, which is necessary for the body to use sugar to fuel its cells. Islet cells occur in clumps, like islands in a sea, and comprise just 1 percent of the cells in the pancreas. But they're the cells that tell the body when to produce and secrete insulin, so they are essential to well-being. The more common Type 2 diabetes usually begins in adulthood and has a strong link to obesity. With Type 2, either the body does not produce enough insulin or the cells ignore it. For most of the last 23 years, Steph has had to inject himself with insulin six or seven times a day, whenever his blood sugars were too high and he started feeling as if he were walking through quicksand. Often, he gave himself too much and he would get hyperactive, the signal that he needed to eat peanut butter, crackers, juice or potato chips - a combination of quick-acting and slow-acting sugars that brought him back into balance. Four years ago, Steph got an insulin pump. Instead of preparing a needle several times a day, he only had to push a button on the pump whenever he felt the need for insulin. But he still couldn't control the highs and lows. Sometimes he just didn't want to give himself the insulin he knew he needed. He's had car accidents in the past that he says were the result of hitting a high behind the wheel. The danger he posed to himself and others made him an ideal candidate for islet cells, said Dr. Alexander Wiseman, a transplant physician at University of Colorado Hospital.

The first islet cell transplant was done four years ago in Edmonton, Alberta Canada. A study of 36 islet cell recipients found that 19 remained insulin independent a year after the procedure, said Dr. James Shapiro, director of the program in Edmonton. Of the 17 who still need insulin, seven of those have derived some benefit and improvement in quality of life. A whole pancreas transplant is another option, but the pancreas is a fragile organ, and typically just 10 percent are suitable, he said. So, Steph got on the list for islet cell transplant. "I got the call in the middle of the night on Halloween eve," Dr. Wiseman recalled. An organ donor had just died and his pancreas couldn't be used, but might be suitable for harvesting islet cells. A five person team that is on call 365 days a year sprung into action, injecting the pancreas with a collagenase to break it down. It took them seven hours to harvest the islet cells from the pancreas and get them into a small sterile tube. With the help of diabetes specialist Dr. Peter Gottleib, an interventional radiologist, and a team of nurses, DR.Wiseman prepared Steph for the procedure. A needle poked through the skin in Steph's abdomen and went into a vessel next to his liver. A catheter slid in, the needle came out, and the islet cells dripped in from an IV bag.

For diabetics who have good control over their blood sugars, islet cell transplants probably aren't worth the trade-offs, Dr. Wiseman said. Still, the waiting list for the transplant is growing weekly, he said. "We'll never have enough cadavers to meet demand," he said. For his part, Steph hopes he has seen the last of the days when, once or twice a day he'd slow to a crawl and couldn't raise his arms until he got another dose of insulin. "I'll be able to drive anywhere and not have to worry about it now," he said. "This means everything." .

Source diabetesnews