OCDEM (Oxford Centre for Diabetes, Endocrinology and Metabolism and the Oxford DRWF Human Islet Isol

26

LIVING

home there by establishing a new

blood supply and after a few weeks

start working as if they were still in

the pancreas"

"Although the operation is quite

quick, taking less than an hour, the

patient is kept in for a couple of days

after it takes place. Initially they

remain on a very tight insulin regime

so that the islet cells are able to settle

in, as we have learnt that if we expect

the cells to start working too quickly,

they tend to become overwhelmed

and fail. Then we put the patient back

on their previous insulin doses while

we carefully monitor the glucose

levels as the islet cells start to work.

We also keep a close eye on whether

the cells are being rejected. The

patients usually go home after two or

three days. After about a month, we

do a glucose tolerance test to check

how much insulin the patient's new

islets are producing by themselves,

and we use that as a measure of

how well the islet cells are working.

Hopefully we have started to reduce

the patient's insulin by then and

some patients are able to stop their

insulin altogether."

A numbers game

Approximately 45 islet transplants

take place in the UK each year. The

reason why these are so limited are

down to several factors. The main

reason is that due to the fact that

patients need life-long antirejection

drugs afterwards, the main indication

for this ground-breaking treatment

is life-threatening hypoglycaemia

(dangerously low blood sugar)

unawareness. As insulin pumps and

sensors become more sophisticated,

it is now possible for many patients

to reverse this without the need for

a transplant. However, there are still

patients who clearly need and benefit

enormously from an islet transplant.

Most people who have an islet cell

transplant will also require 'top-ups'.

Professor Johnson says, "While

this is not currently a permanent

cure for Type 1 diabetes, it certainly

can be life-saving for some people,

and for those people who come

off insulin altogether after an islet

transplant, for the period of time

this happens is the nearest thing to a

cure that they can have. The reason

we transplant islets other than just

the insulin-producing cells, is that

islets not only secrete insulin, but

also produce glucagon which helps

refine glucose stability by acting

in partnership with insulin. That

means the insulin brings down blood

glucose levels, but if blood glucose

levels drop, the islet cells can also

address that problem by promoting

the production of glucagon to raise

the level again without the patient

needing to take extra sugar by having

food or drink. This is something that

insulin treatment cannot achieve".

"The justification for an islet

transplant is to try to reverse

life-threatening hypoglycaemic

unawareness in the patient, and we

have shown that the procedure is

very successful in achieving this.

After the transplant, more than 90%

of patients no longer have severe

hypos without warning. However,

it is really important to tailor the

right diabetes treatment for the

right patient. Diabetes technology is

improving every year and I consider

all Type 1 diabetes treatments

as being complimentary to each

other, rather than in competition.

Treatment decisions must always be

about what is best for the individual

patient and I feel strongly that all

treatments should be available for all

patients, rather than patients being

limited by where they happen to

live. In fact, we have many patients

who have had an islet transplant, but

fine-tune their glucose control by

continuing to use the most advanced

insulin pumps and as a result get the

very best control. This in turn keeps

them safe but also helps prevent the

long-term complications of diabetes

further down the line."

Another important upshot of the

clinical islet isolation programme is

that if the process is undertaken, but

insufficient islets cells are isolated

to be able to do a transplant, then,

provided there is research consent

from the donor family, the precious

human islets are distributed to

different diabetes research groups

around the country for them to

undertake vital studies to try to

understand the causes of Type 1

and Type 2 diabetes. This in turn is

essential in order to develop other

novel treatments that eventually may

truly cure diabetes altogether.

Ongoing work

The Oxford team has decades of

experience of both islet isolation

and islet transplantation, and several

of the techniques used worldwide

within the islet field were first

developed in Oxford. For many years,

the Oxford isolation programme has

been considered as one of the world

leaders in the field.

The Oxford group has also been

central to a number of important

international research initiatives,

including providing islets to

important European collaborations

which are investigating the use of

islet- containing implantable devices

which aim to prevent the need

While this is

not currently

a permanent

cure for Type

1 diabetes, it

certainly can be

life-saving for

some people ~

Professor Paul

Johnson

Index

  1. Desang diabetes magazine, Making Carbs Count, Diabetes KIT, non-invasive glucose testing, OCDEM, Sig
  2. Desang diabetes, magazine diabetes information, Sue Marshall diabetes
  3. Desang diabetes, magazine diabetes information, Sue Marshall diabetes
  4. Desang diabetes magazine, diabetes news, beta cells, Abbott FreeStyle LIbre 3, FSL3
  5. insulin pump, Dana i system, artificial pancreas, Advanced Therapeutics UK, CamAPS FX, Dexcom G6
  6. diabetes news, diabetes research news, diabetes information, diabetes kit, diabetes technology, JDRF
  7. Dexcom G6 CGM, continuous glucose monitoring
  8. Dexcom G6 CGM, continuous glucose monitoring
  9. Medtronic Guardian Connect CGM sensor for diabetes
  10. diabetes news, diabetes research news, diabetes information, diabetes kit, diabetes technology
  11. Diabetes UK
  12. ViaCyte being bought by Vertex to advance cure for type 1 diabetes.
  13. Medtronic MiniMed 780G System Automated for an easier way to stabilise glucose levels
  14. ViaCyte being bought by Vertex to advance cure for type 1 diabetes.
  15. JDRF UK, DigiBete solutions for children and young adults with Type 1 diabetes.
  16. Hallmark Care Homes, DUET Diabetes, National Advisory Panel on Care Home Guidance, Professor Alan Si
  17. Hallmark Care Homes, DUET Diabetes, National Advisory Panel on Care Home Guidance, Professor Alan Si
  18. Problems facing people with diabetes in high weather temperatures from Diabetes UK.
  19. Ascensia GloucoContro diabetes blood test result sharing software
  20. Sigi Insulin Management System, AMP Medical, Sigi insulin pump.
  21. Desang diabetes, Inside Diabetes guides
  22. donation to UK diabetes charities JDRF and Diabetes UK.
  23. donation to UK diabetes charities JDRF and Diabetes UK.
  24. OCDEM (Oxford Centre for Diabetes, Endocrinology and Metabolism and the Oxford DRWF Human Islet Isol
  25. OCDEM (Oxford Centre for Diabetes, Endocrinology and Metabolism and the Oxford DRWF Human Islet Isol
  26. OCDEM (Oxford Centre for Diabetes, Endocrinology and Metabolism and the Oxford DRWF Human Islet Isol
  27. Insulet Omnipod DASH insulin pump with insulin pods, podders, Omnipod DASH Personal Diabetes Manager
  28. OCDEM (Oxford Centre for Diabetes, Endocrinology and Metabolism and the Oxford DRWF Human Islet Isol
  29. DRWF wellness days and events
  30. Desang Diabetes Magazine, free diabetes magazine, living with diabetes
  31. Desang Diabetes Magazine, free diabetes magazine, living with diabetes
  32. diabetes food news, diabetic diet, counting carbohydrates
  33. Diabetes technology education from Diabetes Technology Network DTN
  34. diabetes food news, diabetic diet, counting carbohydrates
  35. Medtrum Touchcare Nano Patch Pump and CGM
  36. Page 0036
  37. Abbott Freestyle Libre 2, Flash Glucose Monitoring, FSL2
  38. Desang Diabetes Magazine, Making Carbs Count, carbohydrate counting for diabetes
  39. Desang Diabetes Magazine, Making Carbs Count, carbohydrate counting for diabetes
  40. Desang Diabetes Magazine, Making Carbs Count, carbohydrate counting for diabetes, anchovies and diab
  41. Desang diabetes kitbags, bag for diabetes kit
  42. Desang Diabetes Magazine, free diabetes magazine, living with diabetes

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