A cure for type 1 diabetes that costs you your immune system

Islets are clusters of cells in the pancreas, the gland behind the stomach
that makes the hormones controlling blood glucose. Among the cell types in an
islet are beta cells, which make insulin — the hormone that lets your
cells take in glucose and keeps blood glucose at a safe level.

In type 1 diabetes the immune system attacks and destroys the beta cells. The
pancreas can no longer make insulin, blood glucose climbs to dangerous levels,
and insulin must be taken every day to stay alive.

Islet cell transplantation replaces the destroyed cells with healthy islets
from a donor. The transplanted beta cells may start making insulin, reducing
or ending the need for daily injections.

The FDA approved it in 2023. Before that it existed only inside research
studies. It is not the same operation as a full pancreas transplant.

How it is done

Healthy beta cells are taken from the pancreas of someone who has died and
agreed to donate their organs. The islets are injected into a large vein in
the abdomen that leads to the liver, and once there they begin making and
releasing insulin. More than one treatment may be needed to end up with
enough working beta cells.

Who it is for

It is approved only for **certain adults with type 1 diabetes whose blood
glucose is very hard to control even with careful daily management**. That
narrowness is deliberate, and the next section is why.

Where someone does qualify, it may bring:

• Better blood glucose control
• Less need for daily insulin injections, or no need at all
• A better ability to feel the warning signs of low blood glucose
• Better quality of life

The trade

You must take immunosuppressant medicines for the rest of your life. They
stop your immune system attacking the new cells — the same immune system that
destroyed the original beta cells. They also weaken your immune defences
generally, which raises the risk of infections and other serious side effects.

So the choice is not "injections versus no injections". It is daily insulin
against lifelong immunosuppression, and which is worse depends entirely on how
badly the first one is going.

Not everyone with type 1 diabetes is a good fit. Certain health conditions, an
already weakened immune system, or certain medicines can rule it out. The
benefits and risks are a conversation with your provider.

*Source: National Institute of Diabetes and Digestive and Kidney Diseases,
via MedlinePlus.*