疾病的类型和严重程度差别很大, need professional assessment

[00:00:00] 主持人安珀·史密斯: Here's some expert advice from transplant surgeon Matthew Garner from 上州医科大学. How can a person with diabetes know if they need a pancreas transplant?

[00:00:12] 马修·加纳医学博士: 你真的不能. 你一定要来看我们. Because it is so challenging to be able to determine whether or not you would benefit from one that I can't even expect most kidney doctors to have a good explanation of that.

我能告诉你的是，如果你有肾衰竭, 如果你要做肾移植手术, 你还患有糖尿病, you should be seen at a center that does both pancreas and kidney transplants. Because you want someone to look at you from the perspective of, 这个人可能是胰腺的候选人吗? 答案很可能是否定的. 这没关系. Because ultimately what we want to do for you is to give you the best treatment we can. And for some patients, that is doing a pancreas transplant. 对于其他病人, 而是说, “看, that's a too high risk surgery for you because it is a much bigger operation, so that what we're going to do instead is just work with your endocrinologist to get better glycemic control after the kidney transplant."

But if you go to a center that just does kidney transplants, there's not a good way to then get a pancreas transplant. And it is a little easier to get the kidney and the pancreas done at the same time than to do the kidney first and the pancreas later. 我们可以这么做. But it's a little bit more complicated because every time you do a surgery, it places that kidney transplant at a little bit of risk. And that risk is easier to tolerate when it's all at once. 当你做完之后, 然后肾脏就因为一个问题不能工作了, 这是一颗难以下咽的药丸. So we will do it if need be, because there are some patients that still benefit from that. But we preferentially try to do both at the same time to avoid that.

另外, 你从同一个捐赠者那里得到肾脏和胰腺, 减轻了患者的免疫负担, because they only have tissue from one donor as opposed to from two donors.

Now the way that we describe diabetes can be a little confusing. So in general, we refer to type 1 diabetes as someone who produces no insulin. They have had destruction, usually from an autoimmune process, which is the body attacking itself. 它们不再产生任何类型的胰岛素.

Type 2 diabetes is more characterized by insulin resistance. What insulin resistance is, when your body gets used to producing a lot of insulin. 这在超重人群中更为常见, but it can happen to people that are of normal size as 好吧. And what that resistance means is your pancreas needs to produce more and more insulin in order to achieve the same effect. And at a certain point, the engine is running as fast as it can. 它在尽可能多地制造胰岛素. And yet it's not making enough in order to control the blood sugar, and you get diabetes. And then you have to take additional medicines or potentially even insulin to supplement that.

There is a term that some people use called diabetes 1.5, which is not an official term because it is kind of confusing. 这实际上指的是2型糖尿病, someone who does make insulin and had insulin resistance, 但不再分泌胰岛素了. So when your pancreas gets to the point where it has to work as hard as it can to make insulin because you have insulin resistance, 随着时间的推移会发生什么呢, 用外行人的话来说, 有点累了. 燃烧殆尽. And so the amount that it can produce, just like an engine, you run too hard and too fast. 它产生的胰岛素越来越少.

有时我们会看到2型糖尿病患者, and their insulin production is so low they are basically functioning like a type 1 diabetic. And that's really important because when we put in a new pancreas 它产生 insulin normally, 但这只是一个正常的胰腺. 它不是一个超级胰腺. It's not going to produce any more insulin than your old pancreas could at its best. 如果你是2型糖尿病患者, 这仍然会产生大量胰岛素, 好吧, even if I put in another pancreas and it's working at full volume, 这对你来说可能还不够. Then I've done this surgery, and you're still on insulin, you still have diabetes. 我并没有真正帮助你. 所以我们尽量避免这样做.

另一方面, if you're the sort of person who was a type 2 diabetic, 看到你在, 减肥, 控制住了你的其他糖尿病, 但它仍然存在, 当我们测试你的时候, 我们发现你分泌的胰岛素不多, now you're the sort of person that even though you're a type 2 diabetic, 你的行为有点像1型血. 那是一个人，因为你的问题, 尽管最初是胰岛素抵抗, 现在更多的是生产问题. 你没有产生足够的胰岛素. So what we do is we can put a pancreas into that person, and that extra insulin 它产生 is now enough to sort of make up for what was lost. 你可以带一个人去纠正他们的糖尿病.

Now those patients will have a higher rate of recurrence, 很明显, because they do have some of that insulin resistance that a type 1 diabetic doesn't usually have. But in careful patient selection, you can find people that can still benefit from that. But in general, the average type 2 diabetic will not benefit from a pancreas transplant.

[00:05:24] 主持人安珀·史密斯: You've been listening to transplant surgeon Matthew Garner from 上州医科大学.