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Diabetes International Foundation - Pancreatic Islet Transplantation Info  What are pancreatic islets? The pancreas, an organ about the size of a hand, is located behind  the lower  part of  thestomach. For about 20 percent of couples, there's no obvious reason why it's taking so long to conceive. The lesson: "Blood type serves only as an alert -- it's not a risk factor," stresses Lubna Pal, MD, the study's senior author and a researcher in reproductive endocrinology, who doesn't want healthy women to worry needlessly.
For prospective dads, the usual fertility workup (sperm count, volume, concentration, motility and morphology) doesn't reveal the whole picture, says Sheena Lewis, a professor of reproductive medicine at Queen's University Belfast.
The lesson: Consult with your doctor about a test such as the comet assay, which, Lewis says, measures the amount of DNA damage in individual sperm. In the winter, couples who live near the Arctic Circle don't conceive as often as usual -- and it's not because they don't have sex in the nearly-round-the-clock dark, report scientists at Austria's University of Graz. The lesson: We're exposed to many sources of BPA throughout the day -- and levels constantly rise and fall with exposure, Hauser says. Unfortunately, other hormone-altering chemicals -- PCBs (polychlorinated biphenyls) and similar pollutants -- linger in the body, says Germaine Louis Buck, PhD, at the National Institute of Child Health and Human Development. The lesson: Louis Buck says the best thing to do is to limit exposure by cutting away the fat from meat or fish (how to prepare fish to reduce PCBs) and eat fewer animal products overall.
Among some researchers, there’s a concern that electromagnetic radiation (EMR) may scramble a man's sperm, with the cell phone being a primary offender.
The lesson: Research is ongoing, but to be safe, keep laptops and cell phones away from privates. Doctors believe that the number of eggs you have at birth determines the length of time you will remain fertile. For those with type O who have been struggling to conceive, she says, the best thing to do with this information is to weigh it with other factors known to reduce fertility. Problem is, those tests don't detect sperm DNA damage, which Lewis and her colleagues pegged as the major culprit behind "idiopathic infertility" (when doctors have no clue why you're not pregnant yet). The slowdown may happen because they're deficient in vitamin D, which the body synthesizes from sunlight.
But because it can be hard to get enough from the winter sun or from food, the Endocrine Practice Guidelines Committee recommends a moderate 1500–2000?IU daily supplement.
Keep your daily load as low as possible and find BPA-free alternatives to those water bottles, cans…and, yes, that pocket rocket. Regardless of diet or exposure, a delay doesn't mean doom: About 80 percent of the couples conceived within a year of trying. Keep up the regimen when you're pregnant; that same bacteria-triggered inflammation is associated with miscarriage, low birth rate and premature birth. Several studies found a connection between sperm damage and the habit of carrying a cell phone in a pocket or hip belt, near the reproductive organs.
Your fertility is mostly determined by genetics, which influences how many eggs you are born with.
But a study at Yale University School of Medicine got our attention when it found that, among female fertility patients in their 30s, those with type O were twice as likely as other blood types to have a hormone profile that made their ovaries seem older than their age. For instance, if you also smoke or your mother reached menopause at an early age, this finding might prompt you to adopt a healthier lifestyle and to talk to your doctor sooner than you might otherwise. In their study, a striking 80 percent of cases with that diagnosis were resolved after testing for sperm DNA damage. Traces of PCBs are nearly everywhere, but a major source is animal fat, where toxins can accumulate. Periodontal (gum) disease delays a positive pregnancy test by two months or more, found an Australian study. Another study targeted that other indispensable EMR-emitting tool: the WiFi-enabled laptop computer.
For every egg ovulated during your reproductive life, about 1,000 eggs undergo programmed cell death. Islets are made up of several types of cells, including beta cells that make insulin.  The pancreas is located in the abdomen behind the stomach. Or otherwise have contact with -- and absorb too much of—things that contain the estrogen-mimicking plastic-softening chemical BPA (Bisphenol A). While women with healthy mouths took an average of five months to conceive, those who had periodontal disease took a little over seven months.
Compared to non-users, men who used laptops on their laps—for four hours with WiFi on -- had 25 percent immobile sperm (vs.
Other things, such as smoking cigarettes and certain types of chemotherapy, can accelerate egg cell death and promote an earlier menopause. Islets within the pancreas contain beta cells, which produce insulin. Insulin is a hormone that helps the body use glucose for energy. Vitamin D-deficient rats have elevated FSH levels, take much longer to conceive, and more often miscarry. In one investigation that took place at the Massachusetts General Hospital Fertility Center, patients with the highest BPA levels produced 24 percent fewer eggs than average; of those eggs, 27 percent fewer could be fertilized, and fewer embryos implanted. Diabetes develops when the body doesn't make enough insulin, cannot use insulin properly, or both, causing glucose to build up in the blood. And in IVF studies, low vitamin D is a predictor of failure, while sufficient levels are associated with a four-times higher success rate.


In another study, scientists exposed immature eggs to BPA; the higher the dose, the likelier those eggs were to degenerate or, oddly, act as if they were fertilized even though they weren't. Swollen gums and deep pockets around the teeth breed bacteria, which enter the bloodstream and trigger inflammation -- potentially reducing an embryo's chances of implantation. In type 1 diabetes-an autoimmune disease-the beta cells of the pancreas no longer make insulin because the body's immune system has attacked and destroyed them. The good news is that our bodies metabolize BPA rapidly, explains study author Russ Hauser, MD, MPH, ScD, a professor at Harvard School of Public Health. Type 2 diabetes usually begins with a condition called insulin resistance, in which the body has difficulty using insulin effectively.
Over time, insulin production declines as well, so many people with type 2 diabetes eventually need to take insulin.  What is an islet cell transplant?An islet cell transplant is a treatment for people with type 1 diabetes who have trouble controlling their glucose (blood sugar). There is a limited supply of islet transplants available, so transplant centers are careful to select only those patients who really need the procedure and will be most likely to benefit. Islet transplants are done alone or after a kidney transplant (islet alone, or islet after kidney). This means that it has not been proven to be the best way to treat type 1 diabetes.  How does a person get an islet cell transplant?Most centers require patients to enter a clinical trial, also called a study.
A clinical trial is a research study where doctors try experimental drugs or medical treatments to learn more about diseases and their cures. During your clinical trial, transplant doctors will watch how your body reacts to different tests and treatments. You have to visit the clinic a lot and have extra blood work done. When you sign up for the clinical trial, you will be given an application package. The tests and exams are different at each center. Blood testsThe blood tests are done on the first day of your assessment.
The total amount of blood that is taken is less than the amount given during a regular blood donation.
After you are done, you will go back home and wait while the doctors look at your test results. Once all tests are done, the islet transplant team will look at the results and decide what to do next. In 3 or 4 days, the transplant coordinator will let you know your test results and what will happen next.  What happens if I am a good match for a clinical trial?If you are a good match for a study, you will meet the doctors who are running that study.
After you sign the consent form you will meet with a coordinator to go over the plan for your transplant. When you get the call, you will need to go to the hospital quickly (within a few hours at most).
Keep this list with you at all times.Make sure you know ahead of time what you need to pay for and have the money with you. If you have any questions about this, talk to your transplant nurse coordinator or the social worker at the program.Have a bag packed and ready to go.
You will need to monitor your blood sugar regularly, even while in the hospital.   Being on the list does not mean you will get an islet transplant. Know which friends and family members can help at any time. If your health changes, see your regular doctor soon. Your center might have a glucose meter with memory, which would allow them to download your readings and compare your glucose control before and after the islet transplant.  THE  TRANSPLANT  PROCEDURE It is your responsibility to be ready when the center calls. This way, if the transplant is cancelled, you can be reached while you are on your way to the hospital. Even if the center calls you, you may not get the transplant. This is because sometimes doctors cannot get enough cells from the pancreas to make the transplant work. The transplant might be cancelled at any step, and you will be sent home.  Islets extracted from a donor pancreas are infused into the liver. Once implanted, the beta cells in the islets begin to make and release insulin. Islets begin to release insulin soon after transplantation. However, full islet function and new blood vessel growth associated with the islets take time. The doctor will order many tests to check blood glucose levels after the transplant, and insulin is usually given until the islets are fully functional. Where does the pancreas come from?The pancreas comes from the same deceased donors that give hearts, lungs, livers, and kidneys. These people tell their family and friends that they want to give their organs to someone else after they die. By donating, these people are giving you a chance to have your islet transplant. Transplant centers need one, two, or sometimes three pancreas organs for every islet transplant patient. Because one transplant needs one whole pancreas, a friend or family member  cannot donate a section of their pancreas. This is different from a kidney transplant, where people can donate one kidney and still be healthy with the one they have left.  What happens when I get to the hospital?When you arrive at the hospital, you will be registered and given a room.
Your nurse will ask some questions about your medical history, then start an intravenous line (IV) for your medicines. Your care team will draw blood, perform an EKG and take a chest x-ray. Islet cell transplant is done in the Radiology Department or in the Operating Room.
You will also be asked to monitor your glucose and tell the nurse what your level is each time. In the Radiology Unit, you will get a local anesthetic. This is a drug that will be injected into the right side of your abdomen where the liver is located.


The radiologist will then place a needle and a tube into the main vein (portal vein) of the liver.
Using a special x-ray machine (fluoroscopy) and dye, doctors will inject the solution containing the islet tissue. Then they will remove the tube and take you back to the Nursing Unit where you will remain for several hours.
If you do not take the anti-rejection drugs, your body will destroy the islet cells. You need to monitor your blood sugar levels very carefully.
The transplant team will help you adjust the amount of insulin you need. Remember that the islet cells will take some time to settle into their new home in your liver. We do not want to put stress on the islet cells, so it is important to keep your glucose at a good level. You do not want to make the new islets work too hard in the beginning. Taking care of your islet cells is like planting seeds in your garden.
If you take good care of the cells right after your transplant, you have a better chance of good islet cell function. You can do this by sticking to a healthy diet and taking your medications.  What is rejection?Rejection is the body's natural defense against foreign cells or particles like bacteria and viruses.
Your immune system knows that your new islet cells are not part of your own body, so it may reject and destroy them.  What can be done to keep my body from destroying my new islet cells? The doctors will use medicines that slow down your immune system enough to keep it from rejecting your islet cells. Some immunosuppressants are taken by mouth every day and others are given by vein less often.
Because islet transplantation is experimental, it is not yet known what the best immunosuppressive drugs are to prevent rejection. The center will monitor your blood levels closely to make sure you do not reject your islet cells, or have too much of these drugs in your system.
Over time, you will need less monitoring.  What can I do to prevent infections?You need to be careful about infections. Here are some things you should do: Use sunscreen (SPF 15) to avoid burning or even tanning. Not every center gives the same drugs, so ask your center to tell you which ones they prefer to use. Before having your blood drawn, ask your center what time you should stop eating before blood tests and how you should take your medicines.As your islet cells begin to work and your drug levels stabilize, you will need fewer blood tests. After a while, you may be able to get your blood work done in a lab closer to your home. You will also have your lipids (fat levels) tested. You are more open to getting infections and cancer due to suppression of your immune system. This can make it harder for you to get another transplant because the immune system will respond much quicker the next time your immune system sees these antigens. This can affect the success rate of a kidney or other organ transplant.  Weight gainBecause patients can eat a more normal diet after a successful islet transplant, some patients will gain weight. Researchers need to collect more safety data before these transplants are considered standard care in the United States. We also need to increase our supply of islet cells. We need to do more research so we can learn more about these medicines and develop medicines with fewer side effects. What an islet cell transplant patient gets to do is exchange insulin shots for immunosuppressive drugs and glucose monitoring. Patients who used to have irregular glucose levels now take immunosuppressive drugs so they have stable glucose levels. This is a possible long-term treatment for people who suffer from type 1 diabetes.  Can I buy an islet transplant?No. Patients cannot buy a transplant or pay to have their name put on a transplant list.  Are there risks involved?Yes. As more patients are having transplants, more risks are being observed  How much time does it take to be in a study?The first assessment takes about 10 days.
Some centers have patients who have combined kidney and islet transplants, either at the same time or one after the other. They can also be made ready at a later time, from a different donor, once the new kidney is stable.  What does an islet cell transplant cost?The costs for a transplant are different at each center. The patient usually pays for transportation, housing, and medicines after leaving the hospital. If you need financial help, ask your transplant team if there are other programs that can help you pay for some of your costs. Sometimes the drug companies or clinical trial sponsors pay for the drugs, at least for a while. Diabetes develops when the body doesn't make enough insulin, cannot use insulin properly, or both, causing glucose to build up in the blood. In type 1 diabetes-an autoimmune disease-the beta cells of the pancreas no longer make insulin because the body's immune system has attacked and destroyed them.



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