[nursebedlam]

Diabetes treatment injects energy into local nurse's life

By Claudia Pinto / Daily Progress staff writer
June 17, 2004

After living with type 1 diabetes for 32 years, Lori Ratliff became accustomed to insulin injections and checking her blood sugar up to six times a day. But she never got used to losing consciousness.

“Once I took a nap before dinner and didn’t wake up,” Ratliff recalled. “I came around as my husband was driving me to the emergency room.”

“It’s scary,” she said. “People have died from it.”

Ratliff, a 48-year-old nurse, may never again have to give herself insulin injections or worry about passing out from low blood sugar. The Albemarle County resident was the first person in Virginia to undergo a treatment that allows her body to produce insulin. She had the procedure June 3 at the University of Virginia Medical Center.

The treatment, dubbed pancreatic islet transplantation, involves taking insulin-producing cells from donor pancreases and transplanting them into the liver of a person with type 1 diabetes. Once implanted, those cells begin to make and release insulin.

“It typically takes two to four weeks for the cells to settle in and begin producing insulin,” said Dr. Ken Brayman, a UVa professor of surgery and director of the Human Islet Transplant Program. “It’s been almost two weeks and she’s already producing some insulin. Right now she’s taking one-third to one-half the amount of insulin she was taking before the transplant.”

“Things couldn’t be going any better,” he said. “It’s very exciting.”

Only about a dozen centers in the United States perform islet transplants. UVa is the only facility in Virginia that offers the procedure.

“Only about 300 worldwide have been performed,” Brayman said. “Early results show about 80 percent of people will be off insulin at one year. And about 50 to 60 percent will be off insulin at three to four years.”

More than 1 million Americans have type 1 diabetes. People with the disease can’t produce insulin and require several injections a day to live. The condition is typically diagnosed before the age of 20.

Brayman said he hopes to perform five of the procedures at UVa in the first year. Candidates must be 18 to 65, cancer-free and have normal kidney function. They also must have severe hypoglycemic unawareness, meaning they can’t detect when their blood sugar has dropped and they are in danger of losing consciousness.

“We are in the process of evaluating more candidates now,” Brayman said.

The procedure has drawbacks: Patients are required to take anti-rejection medication for the rest of their lives. The drugs can cause mouth sores, diarrhea, high blood-cholesterol levels and decreased kidney function.

It’s also expensive. The one-hour procedure can cost anywhere from $80,000 to $100,000. Insurance does not cover the cost, but Brayman said that grants are available.

Ratliff believes the downsides are worth it.

“When your blood sugar levels are erratic, it affects your mood. It affects your energy level,” she said. “I forgot what sustained levels of energy were like. Now that my blood sugar levels are more even, I feel more energized. I feel like I can do more than I normally do.”

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