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Diabetes


The treatment is complicated by the fact that tissue glucose demands vary with food eaten, physical activity, emotional state, stress, and other factors that are hard to assess or predict. Dietary control, including the regulation of the type of food, time of meals, and amount consumed, can help reduce oscillations in blood glu ­cose levels. Modern insulin pumps can be programmed by the user to compensate for changes in activity and eating patterns. However, it remains difficult to maintain stable and normal blood glucose lev ­els over long periods, even with an insulin pump. Blood glucose lev ­els are checked to determine the amount and type of insulin needed. :.
             Since 1990, pancreas transplants have been used to treat diabetes in the United States. The procedure is generally limited to gravely ill patients already undergoing kidney transplantation. The graft suc ­cess rate over five years is roughly 50 percent, and the procedure is controversial. Pancreatic islet transplantation has recently shown promise, but it requires a large number of islets (two cadaver or ­gans are needed to serve as source), and, as with all transplants, su-pression of the immune system to prevent rejection is necessary.
             Another approach is the use of a biohybrid artificial pancreas. This procedure has been used to treat Type 1 diabetes in dogs. Islet cells can be cultured in the laboratory and inserted within an artificial membrane. The membrane contains pores that allow movement of.
             fluid, but prevent interactions between the islet cells and white bioo cells that would reject them as foreign. The islet cells monitor the bin glucose concentration and secrete insulin or glucagon as needed, II biohybrid artificial pancreas can be located almost anywhere thai fa an adequate blood supply; in human trials, it is inserted under the sid of the abdomen. In 1994, a human patient became independent of
             • sulin after the insertion of artificially encapsulated human islet odb Type 1 diabetes most commonly occurs in individuals under 4 years of age.


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