Got questions about navigating life with diabetes? Ask D'Mine! That would be our weekly advice column, hosted by veteran type 1, diabetes author and community educator Wil Dubois. This week, he answers some science-y questions about pancreas transplants and whether an immune-suppressant drug for HIV/AIDS and hepatitis could impact someone's type 1 diabetes honeymoon. You might very well be surprised at what you learn...

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Kim, type 2 from Illinois, writes: I'm new to diabetes and confused about transplantations. Is it possible to get on a list for a pancreas transplant? Is it available as a treatment?

Wil@Ask D'Mine answers: Sorry, Kim, no transplant for you. It won't work because  your pancreas actually still works. It's the rest of your body that's screwed up. Type 2 is a disease of insulin resistance and replacing your functioning pancreas with someone else's functioning pancreas doesn't address the underlying problem.

So who can benefit from a transplant? Type 1s. Well, at least some type 1s. The details on who can, and should, get one, and what's involved varies.

Check out this graphic from the Mayo Clinic Website (click to enlarge the image):

Why, it's as simple as 1-2-3! All they've left out is the quick stop at Starbucks on the way home from the hospital. You know, after a several-day stay in the intensive care unit and another week in a normal hospital room.

Actually, pancreas transplants are fairly rare — only about 1,200 a year are done because the treatment is almost as bad as the disease. Pancreas transplants, are the treatment of last resort. They're generally reserved for type 1s with very serious complications, and are usually done as a bonus add-on to a kidney transplant. (Hey, while you're in there anyway...)

FYI, the word "transplant" suggests that your old no-good pancreas is removed and thrown away and a brand spanking new one—from a dead person—is sewed into place where yours was. Wrong. You keep your original. It still helps with digestion, even though it's really not doing its insulin job. Very few body organs have a single job, and the pancreas is no exception.

The "new," or maybe I should say the "pre-owned," pancreas comes complete with a small section of the previous owner's small intestine which is attached either to your own small intestine or your bladder. It's then hooked up to the blood vessels that supply your legs. The whole job takes three hours and costs $125,000. Annual maintenance will set you back another $6,900 a year. On the bright side (?) if you qualify, both Medicare and most commercial insurance plans do cover the cost.

Does it "cure" type 1 diabetes? It can for a time. People who've had transplants no longer need insulin injections. But instead of insulin, you have to take lifelong anti-rejection meds that have a host of scary side effects themselves. They are immunosuppressants (which shut down your immune system), so you're also open to more infections of every kind. And the underlying yet-to-be-understood mechanisms of type 1 diabetes have not gone away. Diabetes can come back and wipe out the beta cells in your pre-owned pancreas. And to top it off, the average pancreas-solo transplant lasts only around five years. At ten years, only 35% are still on the job. (Oddly, when done with kidneys at the same time, the statistics improve, with more than half lasting a decade.)

So it's rare, expensive, somewhat dangerous, and only a temporary fix. Clearly, this isn't for everyone. But for a type 1 with wickedly difficult to manage diabetes, and a host of side effects, it may be the best choice. A God-send, even. So I'm glad the option is on the table for those who need it, but I'll be sticking with sticking myself with pens and needles.


Thomas, type 3 from Pennsylvania, writes: I read somewhere about a clinical trial that was done using Interferon alpha (I think this is an immune-suppressant drug used for HIV/AIDS, Hepatitis B and C) to prolong the honeymoon phase for that illness. Is there any known way to prolong the honeymoon phase for type 1 diabetes?

Wil@Ask D'Mine answers: Interferon is a combo drug that is part antiviral and part immunodulative. It's front-line therapy for Hep. It's a wickedly difficult drug to take, side effect-wise, has to be taken for a long time, and is expensive—but it works. It can cure Hepatitis. We treat and cure Hepatitis patients with it at the clinic where I work.

As to HIV/ADIS, I don't claim to be an expert as just trying keeping up with all the diabetes happenings takes all my time, but it's my understanding that Interferon's role in AIDS treatment is in addressing AIDS-related Kaposi's sarcoma rather than tackling the underlying HIV virus itself. Doing a quick search this morning, I couldn't find anything about using Interferon to delay AIDS onset, but that doesn't mean someone isn't looking into it.

Would it work to slow down the diabetes honeymoon, so that it would continue on longer?

Well, if type 1 turns out to be triggered by a virus, an anti-viral could help. And we know that the immune system is the beta cell assassin, so a drug that clamps down on the immune system could help, too... so... why not? And at least one study was set up to look at Interferon for diabetes. But I'm not finding any published results, so I'm guessing it didn't work out as well as the Interferon stock holders might have hoped for.

That said, a boatload-and-a-half of resources are being pumped into prolonging the type 1 honeymoon. That's one of the goals of TrialNet study, in which researchers are building a database of genes from type 1s and their close kin to try and unravel just what the eff is going on with our stupid DNA. So far, they have discovered that type 1 is a slower-onset process than previously believed. Bio-markers for the impending auto-immune response show up at least two years before the beta cell slaughter reaches critical proportions, and maybe even longer.

Slightly off topic but pretty damn interesting: TrialNet recently topped the 100,000 mark on screening and has identified more than 5,300 people who are autoantibody-positive. That means they are ticking type 1 bombs.

So at least there's a window of opportunity to intervene, and many researchers think that delaying the onset of type 1 diabetes will prove to be the first step in discovering a cure. That said, taking that first step successfully is not proving to be so easy.

Most research into immune-suppressant meds to slow the onset of type 1 has focused on the experimental drug Teplizumab with mixed results. TrialNet and others continue to look into it. And TrialNet is also experimenting with other ideas, too: oral insulin, omega-3 fatty acid, GAD protein, the rheumatoid arthritis drug Abatacept, the CAPS drug Canakinumab, early intensive glucose control, and even low-fat cottage cheese...

OK, I made up the part about cottage cheese, but they really did look into all the others.

So, is there any known way to prolong the honeymoon phase of type 1 diabetes? Not today. But check with me tomorrow. I think the wind is about to change.

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

Disclaimer: Content created by the Diabetes Mine team. For more details click here.


This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.