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Rest the pancreas of newly diagnosed diabetics.

Rest the Pancreas of Newly Diagnosed Diabetics

A newly diagnosed insulin-dependent diabetic stands a better chance of having pancreatic production of insulin preserved if the pancreas is put at rest by aggressive insulin therapy soon after the diagnosis is made. That was the finding of Dr. Shirish C. Shah of the University of Florida Health Sciences Center in Tampa and colleagues.

In nondiabetics, pancreatic beta-cells produce insulin, the hormone that allows sugar to be burned as energy. In insulin-dependent diabetics, the beta cells are believed to be destroyed by the body's immune system gone awry. Attempts so far to preserve beta-cell function have centered on still-experimental efforts to suppress the body's immune system. But now, the Florida researchers believe that the process through which the cells self-destruct can be slowed, and insulin production preserved, at least for a while, without suppressing the immune system.

In the study, 14 newly diagnosed adolescent diabetics received the conventional treatment of two shots a day of long-acting rigorous regimen of continuous insulin infusion delivered by a machine that acts as an artificial pancreas. The machine delivered varied doses, depending on the patients' needs, so that blood sugar levels were maintained within a narrow range of normal limits.

During those two weeks, the tightly controlled diabetics ended up receiving four times as much insulin as was given those who were treated conventionally. A blood test at the end of the two-week treatment measured the amount of insulin produced by the diabetics' own beta-cells. The test revealed that those whose insulin needs were calculated and met by the machine produced just one-seventh the amount of insulin as those who were receiving the two-shot-per-day standard treatment, indicating that their pancreases were put to rest.

After the initial two weeks, the tight-control group was switched to conventional treatment and both groups were treated the same for a year. At the end of the year, researchers found that the diabetics who had been tightly controlled during the initial two weeks were producing twice as much of their own insulin, indicating better pancreatic function. "We conclude that suppression of endogenous insulin by intensive, continuous insulin treatment during the first two weeks after the diagnosis of (insulin-dependent diabetes melitus) may improve beta-cell function during the subsequent year," the authors wrote. "The mechanism accounting for the success of our approach is uncertain but may involve the suppression of beta-cell activity."

Level of control is increasingly suspected to be predictive of whether a diabetic wil be struck by any of the various complications for which they are at higher risk. These include blindness, kidney disease, and heart disease. An artifical pancreas is not the only route to tight control. Some diabetics are able to achieve comparable metabolic control by using continuous-infusion insulin pumps or multiple shots a day at doses determined by blood sugar measurements. (New England Journal of Medicine March 2, 1989; 320:550-554.)
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Publication:Nutrition Health Review
Date:Sep 22, 1989
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