The auto-immune response that devastates the islets of Langerhan, the part of the pancreas that harbours the insulin-producing beta cells, obliterates them as surely as a surgeon’s knife. So complete is the destruction of the pancreatic beta cell producing area that this condition seemed to be an ideal target for transplantation.

The concept was that once the patient had a secondhand pancreas transplant, all would be well. However, initial research with pancreatic transplantation was disappointing, and major problems were encountered with rejection, the large doses of immuno-suppressant drugs that would be needed for a lifetime and the repeated transplants that became necessary.

The development of adult stem-cell therapy, and therefore stem-cell therapy without any of the ethical considerations of embryonic stem-cell work, is the latest way of overcoming the sudden destruction of the beta-cell producing pancreatic cells that leaves a patient entirely dependent on artificially given insulin for the rest of their lives.

Inevitably, it is difficult to find the correct dose of insulin. Too much and the patient develops symptoms suggestive of aggressive drunkenness before lapsing into a coma. Too little and the body’s electrolyte balance, its fluid balance and its carbohydrate metabolism, which provides energy for every cell in the body, is thrown out of kilter.

Nearly all patients with type 1 diabetes need at least two types of insulin. The regular long-acting insulin dose to give a baseline of long-acting insulin, together with, at appropriate times, additional doses of short-acting insulin to achieve the fine-tuning that provides a near normal blood glucose level, and prevents the onset of the lethal complications of diabetes. The additional doses enable someone to adapt to life’s circumstances that need different doses of insulin. In someone without diabetes this is automatically regulated by the beta cells that cope with eventualities including changing levels of exercise, emotional stress and diet so that the body’s changing insulin demands are always met.

If adult stem cells could be grown into beta-pancreatic cells to replace the islets of Langerhan destroyed by the auto-immune response, the body would again be enabled to do its own fine-tuning of insulin production. The work from Chicago and Brazil is only in its early stages but it is encouraging.

Meanwhile, inhalation of Exubera, the recently introduced artificial human insulin, which offers the chance that the multitude of injections will become something of the past, offers immediate hope. Inhaled insulin gives better control with fewer complications without a multitude of injections. Snorting insulin through the nose, as if it were cocaine, has been tried but the nasal mucosa proved to absorb insulin badly and unpredictably.

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