Diabetes Research Institute aids in life-saving procedure on Thanksgiving

(December 15, 2009)  A 21-year-old airman severely injured while serving his country in a remote area of Afghanistan is recovering at Walter Reed Army Medical Center (WRAMC) in Washington, D.C. after several surgeries and an unprecedented transplant. The extraordinary care is an example of military and civilian medical experts working together in the first known case of a successful isolation and transplantation of insulin-producing cells following a severe trauma requiring complete removal of the pancreas.  Camillo Ricordi M.D. and his team at the Diabetes Research Institute played a major role in the life-saving effort.

The airman was struck by three high velocity bullets on November 21 and was operated on twice by surgeons in forward combat medical bases in Salerno and Bagram, both in Afghanistan.  The surgeries included a rare but life-saving trauma Whipple, in which the head of the pancreas, a portion of the stomach, gallbladder, and entire duodenum were removed.  In addition, a portion of the airman’s large and small bowels were also removed.

A procedure to prevent infection was later performed at a military base in Germany, before the wounded warrior was transferred by the Air Force Critical Care Air Transport teams to Walter Reed four days after the initial injury.

The airman was taken back to the operating room at Walter Reed by Dr. Craig Shriver, chief of general surgery, to have his entire intra-abdominal structure reconstructed. During this operation, what was remaining of the airman’s pancreas was found to be damaged beyond repair from the gunshot wounds. “The optimal procedure at this point was to remove his entire remaining pancreas to prevent further leakage of the pancreatic enzymes and control the bleeding, which could be fatal,” said Dr. Shriver. “We knew that the procedure would lead to the most severe and life-threatening form of diabetes, which tends to be very brittle and difficult to control in this type of situation.”

At this point in the operation, Dr. Shriver sought the opinion of Dr Rahul Jindal, a transplant surgeon at Walter Reed and a clinical professor of surgery at George Washington University in Washington, D.C.  Dr. Jindal had training and experience in islet cell transplantation, which is considered the best hope for curing diabetes.

In islet cell transplantation, the insulin-producing islets are isolated from a donor pancreas and then reinfused in a patient’s liver where they later begin to produce insulin.

“Isolation and purification of pancreatic islets is a very intricate procedure which requires a specialized laboratory, and there are only a few such facilities in the United States,” said Dr. Jindal.  “I knew the Diabetes Research Institute at the University of Miami Miller School of Medicine had such a facility and I put a call in to its director, Dr. Camillo Ricordi, for his assistance in isolating the islets from our airman’s removed pancreas.”

Dr. Ricordi, scientific director at the Diabetes Research Institute, developed the method for isolating the islet cells from the pancreas and is considered a pioneer in the field. He immediately agreed to help, in his words, “anything to help a wounded warrior.”

Dr. Shriver proceeded to remove the remaining portion of the pancreas; and Drs. Jindal and Eric Elster, a Navy transplant surgeon, flushed the harvested pancreas and intact spleen with a special preservation solution, packed it in ice and transported it by courier to Miami.

“The organ arrived at 11 o’clock the night before Thanksgiving, and my cell processing team at the Diabetes Research Institute spent the next six hours performing the islet isolation and purification procedure,” explains Dr. Ricordi.  “More than 220,000 purified islets were then suspended in a specialized cold solution and flown back to Walter Reed.”

Late in the afternoon on Thanksgiving Day, the cells were successfully injected into the patient’s portal vein into his liver with Dr. Ricordi and his team coordinating the procedure via an internet connection with surgeons at Walter Reed.

Less than one week after surgery, there was clear evidence of pancreas islet function in the wounded warrior’s liver, as shown by the presence of a specialized blood test called c-peptide. Fifteen days after the procedure, that same blood test indicated the transplanted islet cells were functioning in the normal range. As time goes on, the pancreatic islets in the liver will take up new blood supply and the patient’s requirement of exogenous insulin is expected to further decrease, facilitating diabetes management and preventing the onset of complications of the disease, and improving his overall quality of life.

Teamwork and close coordination between the many professionals in the entire Military Trauma System at Walter Reed and at the Diabetes Research Institute at the University of Miami made this possible. This procedure may allow for more cases of islet transplantation following traumatic injury to the pancreas, where purification and transplantation of the insulin producing cells from even a segment of the rescued organ could prevent the development of severe diabetes and its complications.

Changing your insulin pump company is a hard decision even under the best of circumstances. If you are a Deltec Cozmo user, you now find yourself in a very difficult position with the recent announcement that Smiths Medical will no longer be producing insulin pumps. Here at Roche Diagnostics, the makers of ACCU-CHEK® brand diabetes care products, we understand the challenge you now face and we want to do everything we can to make your transition as simple as possible.

To that end, we’ve designed the ACCU-CHEK Alliance Program just for Deltec Cozmo users offering an easy and affordable transition to a brand new ACCU-CHEK Spirit insulin pump system. If your Cozmo insulin pump is still in-warranty, here’s what you’ll receive when you sign up for the program:

• The ACCU-CHEK® Spirit insulin pump system* without charge with the trade-in of your Cozmo Pump.
• 2 Year Warranty
• 30 Day Supply Starter Kit
• Upgrade certificate for a new insulin pump system launched in the future by Roche Diagnostics without additional charge with your trade-in of the ACCU-CHEK Spirit insulin pump. Certificate expires 2 years from shipment date of ACCU-CHEK Spirit insulin pump.

*The system includes the ACCU-CHEK Spirit insulin pump, ACCU-CHEK blood glucose meter of your choice, Palm^® PDA and the ACCU-CHEK Pocket Compass Software with bolus calculator.

So not only are you receiving a new insulin pump system (brand new, not refurbished!), but you’re alsogetting the peace of mind in knowing that you’ve got a future upgrade at no additional charge when new technology becomes available.

If you’d like to learn more about this special offer or about the ACCU-CHEK Spirit insulin pump system, please call us at 866-703-3476. This is a limited time offer and only available to current in-warranty Deltec Cozmo users, so contact us today!

Terms and Exclusions:

• This promotion is effective from August 1, 2009, but may be discontinued or modified at any time without notice.
• Only in-warranty Deltec Cozmo insulin pump users are eligible.
• Available to U.S. residents only. Persons covered by federal, state or government-funded healthcare programs (such as Medicare, Medicaid, Veterans Administration) and the residents of Massachusetts may not participate.

Diabetes Living Today is happy to have our friend Manny Hernandes, co-founder of TuDiabetes.  Manny has written an “exclusive guest post for our reader’s: 

Call Me Patient, Not Consumer

(or why trust is key for Health 2.0 to continue to make progress)Last year, I had the honor to present TuDiabetes at Health2.0 2008 in San Francisco (http://tudiabetes.com/video/tudiabetes-at-health-20-2008). The conference dealt with empowering patients through support, tools and information to help them better manage their health.You would imagine that technologies and platforms for patient empowerment would have patients at the center. And they do to a great degree, except for the fact that patients were routinely referred to as consumers, not as patients, throughout the conference. Most of the people I pointed this out to didn’t notice it. Some didn’t think it was an issue.So, is it a big deal that patients are called consumers? It is if you THINK of them as consumers first and patients second. That puts a bigger emphasis on how much profit the patient can make a company, which can lead to less-than-optimal decisions on behalf of the patient later on.There is nothing wrong with profits resulting from offering products or services to patients to help them improve their health. But this is a case where the order of the factors affects the final result. If this sounds to you like an extreme view, consider your own experience when dealing with insurance companies (http://tudiabetes.com/forum/topics/health-insurance-social).What does this patient and consumer talk have to do with diabetes? As one of the most common chronic diseases, I want to see diabetes turn into an example of the direction Health 2.0 will take, with patient health improvement as the most important goal.

Support

Healthier lives result from connections with other patients: people you not only can relate to but people that you trust. Clay Shirky, author of the book, “Here Comes Everybody” puts it in very clear terms: “… whenever people decide to trust one another, information will flow.”This is why one of the fastest growing areas in Health 2.0 has to do with patient communities. Networks like TuDiabetes and DiabetesDaily (structured spaces where patients get support from others they trust) and slightly more organic networks, like Twitter , where patients share what they do with their diabetes management in 140 characters or less are very good examples of this trend. You can join the growing number of Twitter users with diabetes at: http://tudiabetes.com/group/twitterbeticsIn 2009, networks and platforms that keep on improving the channels for patients to support each other will continue to grow and positively impact the lives and health of many more.

Tools

In the course of 2008 there was a lot of talk in Health 2.0 circles about electronic Personal Health Records. Microsoft took a stab at them with HealthVault. Google tried to tackle them through Google Health . A lot remains to be done, but with the emphasis placed by the new administration on health care and PHRs specifically, I would not be surprised if we see important progress in this front in 2009.If the element of trust is important in the case of support networks, it becomes critical in the case of tools like these. Before people feel comfortable letting their health information reside online, important progress needs to be made to make everyone comfortable with this idea. This is an area where treating the patient as a patient and not a consumer is fundamental as well.

Information

Google, WebMD, HealthLine, RightHealth, OrganizedWisdom, HealthLibrarian. There are tons of resources: from the generic search engines to the specific sites that focus on health. This makes life for patients searching for information about their symptoms or disease harder than necessary.Sure it’s easy to find information, but is it the answer to your specific question? Is it reliable? Is it raw information or has it been edited? Who gets to edit it and why? So many questions come up that patients commonly resort to support communities to post their questions when they feel overwhelmed or they simply cannot trust the information they have found.These kinds of online queries cannot substitute asking a medical professional. But between appointments, resources that can be trusted to answer important questions need to be available. In 2009, I foresee support networks stepping up to the plate to start filling this need through content vetted by medical professionals. Along with this, the concept of virtual visits (also called e-visits to the doctor) will continue to pick up steam throughout the year and into 2010.

Patients First

There is no doubt: the health space has changed and it is not going back. If anything it’s going to keep changing. I hope the changes will be for the better, but considering how much more empowered patients are becoming, I feel this will be the case.Now, through our blogs, communities and the diabetes OC at large, we need to work hard to make the promise of Health 2.0 available to everyone. Until then, to all providers: please don’t call me consumer. Call me patient.

Diabetes Living Today is happy to have our friend Kerri Morrone Sparling as our guest tonight, Tuesday December 30, 2008.  She has written an “exclusive guest post“, Why I Blog for our reader’s.

Why I Blog

Kerri Morrone Sparling

The human body is absolutely amazing in the way each organ works together with such precision, maintaining our homeostasis and keeping us kicking.

But the mind of a diabetic is pretty amazing, too. We have trained our minds to think like a pancreas. We are the people who know how many carbs are floating around in a bowl of cereal. We are the ones who can take a blood sugar number and fold it into any situation - 140 mg/dl on the soccer field means more orange slices while 140 mg/dl at the dinner table means correcting the high and navigating the meal. We are the ones who are trying to compensate for some cells that simply gave out on us. Crawling inside the thoughts of a working pancreas and trying to mimic its performance is not an easy task.

When I was diagnosed with type 1 diabetes in 1986, my parents and I were instructed how to inject insulin into oranges, handed a generic meal plan, and given a “Bill Nye the Science Guy” test tube set to check my urine glucose. Over the course of the last two decades, I have seen remarkable advancements in diabetes technology, from fast-acting insulins like Humalog and 5 second glucose meters to insulin pump therapy and continuous glucose monitoring systems.

But despite this influx of information and technology, I was still one of the only diabetics I knew, completely loved but not completely understood by my friends and family. I didn’t feel sick. I felt frustrated. And alone. I have had diabetes for most of my life, so by necessity I knew the technical essentials. But where were all the people who were living with this disease, like I have been since I was small?

When I first researched diabetes on Google, the page filled with a litany of links and lists of ways I could become “complicated,” urging me to take fastidious care of my feet, to schedule annual eye exams, and discussing the benefits of testing my blood sugar at least four times per day. It wasn’t that this information was useless to me, but it was mostly clinical statistics and besides, who were these people writing this stuff?

At the recommendation of my now-husband, I started a blog called Six Until Me, referring to my age when the first signs of diabetes presented themselves. Six years until diabetes - six until me. How it touches every day life, from the spotty scars on my fingertips to the dots of past infusion sets on my thighs that tell a silent story.

Blogging has changed my perception of diabetes from one of loneliness to being embraced by a network of support. It’s about sharing these feelings and forcing me to deal with these emotions, keeping diabetes from being an isolating force in my life. In addition, what started as a means of connecting with other diabetics ultimately grew into a terrific career as an editor and columnist at dLife, where I see daily the profound and empowering effects of a strong and empowered community.

Every day we, as people with diabetes or their caregivers, face this disease. And every day is easier knowing there are people out there who understand completely.

This is why I blog.

Photo Above:  Kerri Morrone Sparling

Kerri Sparling writes the widely-read and award-winning diabetes blog Six Until Me, about her life as a twenty something with type 1 diabetes. In addition to her blog, she is also an Editor and columnist for dLife, and a columnist for several diabetes publications. Recently married, Kerri currently lives in Connecticut with her husband and their army of cats.