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Diabetes: The Problem

microscopeType 1 diabetes mellitus afflicts the lives of more than one million Americans. Type 1 diabetes usually is diagnosed in children and young adults, leading to the term "juvenile diabetes." The more common form of diabetes is type 2 diabetes, also known as "adult-onset diabetes." In both forms of diabetes, the body is unable to keep the blood sugar levels under proper control. High blood sugar levels can damage many parts of the body. Patients with diabetes often suffer from kidney failure, blindness, nerve problems, hardening of the arteries and other problems because the blood sugar is too high.

The pancreas gland makes insulin, but also has many other functions. Most of the pancreas gland makes juices that help digest food. Many years ago, a doctor named Langerhans first looked at the pancreas with a microscope. He saw small groups of cells scattered throughout the pancreas gland that looked different from the part of the gland that makes digestive juice. He thought these groups of cells looked like little islands, or "islets." Doctors now call these groups of cells the "islets of Langerhans." Doctors now know that special cells found within the islets, called beta cells, make the hormone insulin that keeps the blood sugar under proper control. In type 1 diabetes, doctors think the patient's own immune system destroys the beta cells. All patients with type 1 diabetes need insulin shots to keep the blood sugar under control, leading to the common name "insulin dependent diabetes."

Transplantation is well suited to the treatment of type 1 diabetes. The transplant provides the recipient with replacement beta cells. Transplantation of the whole pancreas gland now provides many type 1 patients with freedom from insulin treatment. Transplantation of only the islets after separating them from the rest of the pancreas is under study.

Type 2 diabetes is different. Type 2 diabetes has many causes. Diet, weight loss and exercise can often help type 2 patients get their blood sugars under control. If the blood sugars are still too high, pills can often help. If none of these treatments helps keep the blood sugar under control, then patients with type 2 diabetes may need insulin shots. Even though some patients with type 2 diabetes may eventually need insulin shots, many refer to type 2 diabetes as "non-insulin dependent diabetes." Although doctors are now finding type 2 diabetes in teenagers, the onset of this disease usually occurs in adults, leading to the other common name of "adult-onset diabetes." Doctors know that insulin resistance characterizes type 2 diabetes, meaning that the body does not use the insulin produced by the beta cells normally. Eventually the beta cells in type 2 patients may wear out from overworking.

Although the beta cells in type 2 patients may become exhausted and fail, transplantation is not yet widely accepted in the treatment of type 2 patients. Doctors think that the transplant may become exhausted and fail as well.

In summary, a lack of insulin producing beta cells causes type 1 diabetes (also known as juvenile-onset or insulin-dependent diabetes mellitus), and replacement of the beta cells through transplantation is the only current treatment that provides freedom from insulin therapy. Insulin resistance characterizes type 2 diabetes (also known as adult onset or non-insulin-dependent diabetes mellitus), and transplantation is not a widely accepted treatment option for these patients.


The United Network for Organ Sharing (UNOS) provides a toll-free patient services lines to help transplant candidates, recipients, and family members understand organ allocation practices and transplantation data. You may also call this number to discuss problems you may be experiencing with your transplant center or the transplantation system in general. The toll-free patient services line number is 1-888-894-6361




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