How dead are the insulin producing cells in a person with Type 1 diabetes? Has the immune system in its autoimmune reaction killed them all and for good? Is there no way that they can regenerate, or would the immune system kill them as soon as they form?
Just suppose it would be possible to "teach" the immune system that the insulin-producing cells were okay, that they are not foreign invaders that need to be killed. Would the insulin producing cells be able to regenerate?
What exactly happens in the honeymoon period? Have not all the beta cells been killed yet, or do they regenerate and what would be the effect of giving so immune system suppressing drugs?
By the time a person becomes clinically diabetic, that is to say they have constant glucosuria and hyperglycemia, the beta cells of the Islands of Langerhans are almost completely destroyed. Some minimal residual function can be detected after this stage for as long as a year in the form of C-peptide which is the fraction that breaks away from proinsulin as insulin itself is formed.
Islet cells can regenerate from pancreatic ductal tissue and a good deal of research is being devoted to exploring the mechanism for this. At the present any application to diabetes in man looks a long way off and all the evidence is that it would not be successful as long as the autoimmune process continues.
To understand the honeymoon period, you have to realize that the process of autoimmune destruction of insulin-producing cells usually occurs gradually over several years. At the time that clinical diabetes first becomes apparent, there is usually a small amount of insulin producing capacity that remains. The rather simplistic explanation of the honeymoon period is that when insulin is given by injection the bodies own insulin production is 'rested' and thus contributes to total daily needs.
Original posting 30 Aug 97
Last Updated: Tuesday April 06, 2010 15:08:54
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