How does our body normally maintain proper glucose homeostasis? The body maintains proper glucose homeostasis by using insulin to keep the blood sugar at a constant level. Insulin works by signaling the uptake of glucose into the cells of the body. Without insulin, proper glucose control cannot be achieved. Insulin is manufactured in the islet cells of the pancreas, and is necessary every minute of our lives.

Type 1 Diabetes Definition. The definition of type 1 diabetes is a state of absolute deficiency of insulin. In this scenario, the pancreas is unable to produce sufficient insulin to maintain proper glucose homeostasis in the body. As a result, individuals with type 1 diabetes must rely on insulin taken by injection to stay alive.

Why Does the Pancreas Fail? The exact cause of type 1 diabetes is not known for certain but the available evidence suggests that some type of autoimmune reaction is generally involved. This results in damage to the islet cells that produce insulin, and eventually cause failure of insulin production.

Is there a cure? One way to treat the disease is to have a pancreas transplant. This is a procedure where a whole pancreas is donated from a brain-dead organ donor and transplanted into a person requiring the pancreas. Someone who is living is not able to donate a whole or part of a pancreas as we each have a single pancreas that is required for our survival. A pancreas transplant is a major operation and requires that the individual stay in the hospital for a week or more and be on anti-rejection drug therapy for the rest of their life. Once a person receives a new pancreas that is functioning normally, they are no longer considered diabetic and no longer need to take insulin. Their blood glucose levels are regulated by the islet cells in their new transplanted pancreas.

More Recently. A new procedure has evolved that shows some promise as an alternative to a whole pancreas transplant. This procedure involves the isolation of islet cells from a donated pancreas and the transfer of those cells through a blood vessel to the liver where the cells will live and produce insulin in the recipient's body. Although these individuals must also be on anti-rejection therapy there are several advantages to this procedure. These advantages include a less invasive procedure, a lower cost, and a much shorter hospital stay.

The Islet Cell Transplant Procedure. There are several steps in the islet transplant procedure that will be outlined as follows:

• The Donor. The islet cells used for the procedure are obtained from a brain-dead donor.
• Before the Transplant. The process prior to transplantation includes an assessment by the transplant physicians with a physical examination, eye examination, and blood work.
• The Transplant. The Transplant. The transplant is performed by a radiologist in the hospital. A catheter is placed in a vein in the abdomen. Islet cells are injected into the vein and end up in the liver where they will live. This procedure is performed using a local anesthetic in the skin of the abdomen, similar to the anesthetic in a dentist's office. It is otherwise painless.
• After the Transplant. Recipients of a transplant will be seeing the transplant physicians and team on a regular basis after the transplant. They will be taking medications to keep the islet cells functioning and free of rejection. The exact medications used are currently being studied and are changing and improving with time and research.

How many transplants are required? From previous research, it appears that most people will require more than one islet transplant for successful treatment. Some people have required up to three transplants.

Risks of Transplantation. The risks associated with any transplant are infections and increased risk of developing cancers. These risks are side effects of the medications used to prevent transplant rejection. It is not clear at this point how common these risks will be in people receiving islet transplants. So far, there have been no reports of any such complications. However, this is a risk that all people who receive a transplant will be made aware of and will need to accept.

The Hypothesis for the Islet Cell Transplant Study Program. Intuitively we may assume that the islet cell transplant will definitely make a huge improvement in health and quality of life. That may not be true! Will it delay complications? What about the anti-rejection drugs? In terms of costs are the benefits to the patient really there? It may be found to be a great improvement in diabetes care, but we will not know if this in fact is true until studies are performed to look at this question.

Who is eligible for the research study? The trial population to be enrolled will include approximately 50 subjects, male and female, between 20 and 80 years of age who have Type 1 diabetes. Patients must also have some problems with their eyes and kidneys, related to diabetes, but those patients who have heart trouble or are considering pregnancy will be excluded. Patients must also reside in the greater Vancouver area.