American Medical Association Family Medical Guide - American Medical Association [608]
For a pancreas transplant, the diseased pancreas and the upper part of the small intestine (duodenum) to which it is connected are removed through an incision in the upper abdomen. The donor pancreas and duodenum are inserted in place and attached to the recipient’s blood vessels and bladder. The procedure usually takes about 5 to 7 hours, and the person is hospitalized for about 2 to 3 weeks to enable doctors to monitor the transplant.
Experimental treatments
Because type 1 diabetes is an autoimmune disease that results when the immune system mistakenly attacks the insulin-producing cells in the pancreas, researchers are looking for ways to intervene to prevent the abnormal immune response from occurring in the first place or to control or reverse diabetes once it develops. Several promising studies are under way.
Because of the complexity of pancreas transplant surgery and successfully suppressing the immune system to prevent organ rejection, researchers are looking for ways to transplant just the insulin-secreting cells into people with diabetes to enable them to go without insulin.
Pancreas transplant
In most cases, a pancreas transplant and a kidney transplant are performed at the same time. The donor pancreas and duodenum usually are implanted first, in the right lower abdomen, and connected to the recipient’s blood vessels and bladder. The donor kidney and ureter are then implanted in the left lower abdomen and connected to the recipient’s blood vessels and bladder.
Type 2 Diabetes
Nine out often people with diabetes have type 2. In type 2 diabetes, the body does not respond appropriately to the hormone insulin, and there may be a corresponding lack of insulin secretion to compensate for the degree of resistance. Insulin enables cells to take in and use glucose, a simple sugar that is the body’s main source of energy, or store it as fat.
The incidence of type 2 diabetes is reaching epidemic proportions throughout the world as more and more people adopt a lifestyle of exercising too little and eating too much—and getting fatter. More than a third of the 15 million Americans who have type 2 diabetes do not know they have it because the disease has no noticeable symptoms in the early stages. More and more American children are developing type 2 diabetes because they are increasingly less active than children of previous generations; eating more high-fat, high-calorie fast foods; and becoming obese. Just a few years ago it was rare to see children affected by this form of the disease, which used to be called adult-onset diabetes. However, today one out of five children who develop diabetes has type 2.
As people gain weight, the extra weight causes their cells to become resistant to the effects of insulin. The pancreas responds by producing more and more insulin, which eventually begins to build up in the blood. High levels of insulin in the blood, a condition called insulin resistance, can result in problems such as high blood pressure and harmful changes in the levels of the different kinds of fats in the blood. Insulin resistance, which doctors sometimes refer to as syndrome X or the metabolic syndrome (see page 53), is the first step toward type 2 diabetes.
The second step toward type 2 diabetes is a condition called impaired fasting glucose (also referred to as impaired glucose tolerance or prediabetes), which occurs when the pancreas can no longer produce enough insulin to get glucose out of the bloodstream into cells. Glucose begins to build up in the blood. If not diagnosed and treated, it is this gradual rise in glucose that will eventually lead to type 2 diabetes, high blood pressure, and heart disease—in any order and in any combination. It is estimated that as many as 16 million Americans