Sciencey bit: Type 1 diabetes

First things first, what is diabetes?  Most people who have diabetes have diabetes mellitus which has to do with inability to regulate blood sugar. The sugar in question is glucose which is what cells use to make energy. Blood glucose is regulated by two hormones; insulin (which tells cells, including special storage cells in the liver, to take in glucose) and glucagon (which tells the liver to give back the glucose). In type 1 and type 2 diabetes insulin is unable to regulate glucose because there isn’t enough of it or the body doesn’t respond to it anymore. Insulin is made by beta cells (β-cells) which live in the islets of Langerhans in the pancreas, which is a little organ that makes a hormones (like insulin) and digestive enzymes. In T1D there isn’t enough insulin because the β-cells that make the insulin have been destroyed by the body’s immune system. It is, therefore, an autoimmune disease. The really interesting thing is that it is the β-cells that are destroyed by the immune system and the neighbouring alpha cells (that make glucagon) and exocrine pancreas (which makes the digestive enzymes) are left completely alone. This shows how good our immune systems are at destroying specific things.

 

Lots of children develop disease in their teens but children can be diagnosed as young as six months. Before this age diabetes tends to be caused by a ‘simple’ genetic problem. That is, simple in the sense of affecting only one gene, not necessarily simple to identify or treat. Individuals with T1D have to inject insulin to manage their blood glucose. Insulin was identified and extracted in 1922. However despite the effectiveness of this treatment it still isn’t as good as the homeostasis afforded by the β-cells. This means that people with diabetes can experience a host of complications later in life including blindness, kidney and heart disorders, and lack of circulation in the extremities. This is one of the reasons why it is so important to research this area. There are of course lots of medical research that could help a person with diabetes. For those who have progressed to complications you want to be able to maintain their eyes, kidneys, hearts or toes for as long as possible. For all people with diabetes you want to help them maintain their blood sugar the best they can so that they are less likely to develop complications and enjoy their current life. We therefore have people researching new insulins that can better mimic natural insulin release, people working on artificial pancreases, and people working on transplanting pancreases or islets of Langerhans (where the β-cells live). The other tactic to employ is to try and stop people getting diabetes at all. This doesn’t really help those people who already have disease but IF we were successful it would clearly be the best thing. This ‘if’ is a big ‘if’, but there are lots of people who are trying to make it happen and this is where my work fits in. Can we predict who will develop disease? Can we understand why and how disease happens? Can we find a way to stop disease? The answers are; yes - to a point (see the autoantibody and genetics sections), kind of, and one day!