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|Type 1 Diabetes|
The type 1 diabetes is one of many autoimmune diseases in which the immune system's recognition apparatus breaks down, and the body begins to manufacture T cells and antibodies directed against its own cells and organs. For type 1 diabetes, the misguided T cells attack insulin-producing beta cells in the pancreas, which then produces little or no insulin.
Currently, the type 1 diabetes is treated with taking insulin to replace the loss of naturally produced insulin. The insulin treatment must be continued indefinitely to control the level of blood glucose, preventing serious complications. It cannot cure the disease. Researchers are experimenting with pancreatic islet transplantation which, if successful, can cure the type 1 diabetes.
Insulin injection is preferred over insulin pill because after insulin pill enters the digestive system, it would be broken down before getting into the blood to lower blood glucose level. Traditionally, patients use a needle and syringe to inject insulin just under the skin. Several other devices for taking insulin are available and new approaches are under development.
Insulin pens provide a convenient, easy-to-use way of injecting insulin and may be less painful than a standard needle and syringe. An insulin pen looks like a pen with a cartridge. Some of these devices use replaceable cartridges of insulin. Other pens are prefilled with insulin and are totally disposable after the insulin is injected. Insulin pen users screw a short, fine, disposable needle on the tip of the pen before an injection. Then users turn a dial to select the desired dose of insulin, inject the needle, and press a plunger on the end to deliver the insulin just under the skin. Insulin pens are less widely used in the United States than in many other countries.
External insulin pumps
External insulin pumps are typically about the size of a deck of cards or cell phone, weigh about 3 ounces, and can be worn on a belt or carried in a pocket. Most pumps use a disposable plastic cartridge as an insulin reservoir. A needle and plunger are temporarily attached to the cartridge to allow the user to fill the cartridge with insulin from a vial. The user then removes the needle and plunger and loads the filled cartridge into the pump.
Disposable infusion sets are used with insulin pumps to deliver insulin to an infusion site on the body, such as the abdomen. Infusion sets include a cannula—a needle or a small, soft tube—that the user inserts into the tissue beneath the skin. Devices are available to help insert the cannula. Narrow, flexible plastic tubing carries insulin from the pump to the infusion site. On the skin’s surface, an adhesive patch or dressing holds the infusion set in place until the user replaces it after a few days.
Users set the pumps to give a steady trickle or “basal” amount of insulin continuously throughout the day. Pumps can also give “bolus” doses—one-time larger doses—of insulin at meals and at times when blood glucose is too high based on the programming set by the user. Frequent blood glucose monitoring is essential to determine insulin dosages and to ensure that insulin is delivered.
Injection ports provide an alternative to daily injections. Injection ports look like infusion sets without the long tubing. Like infusion sets, injection ports have a cannula that is inserted into the tissue beneath the skin. On the skin’s surface, an adhesive patch or dressing holds the port in place. The user injects insulin through the port with a needle and syringe or an insulin pen. The port remains in place for several days and is then replaced. Use of an injection port allows a person to reduce the number of skin punctures to one every few days to apply a new port.
Pancreatic Islet Transplantation
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. Spread all over the pancreas are clusters of cells called the islets of Langerhans. Islets are made up of two types of cells: alpha cells, which make glucagon (a hormone that raises the level of glucose in the blood), and beta cells, which make insulin.
In an experimental procedure called islet transplantation, islets are taken from a donor pancreas and transferred into another person. Once implanted, the beta cells in these islets begin to make and release insulin. Researchers hope that islet transplantation will help people with type 1 diabetes live without daily injections of insulin.