Re: Joslin - Residual Islet Cell Functioning in 50-Year Medalist
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Posted by klausen on 11:36:07 2006/06/15
In Reply to:
Joslin - Residual Islet Cell Functioning in 50-Year Medalist posted by Sliderule
When I was first at the Joslin's Clinic as a patient in 1966, the consensus among the doctors there was that the medals should be phased out, since, as one doctor put it, "We are just rewarding people for having been genetically lucky, not for anything special they were doing." Now, perhaps because the ideology of the blood sugar police has taken over the field, this wise idea has been dropped.
The fact that these patients have not only survived unusually long but also have unexpectedly high residual beta cell function shows that it is indeed the luck of the kind of type 1 diabetes you have which determines survival. If for genetic reasons your beta cell reserve is more resistant to autoimmune attack, or your immune system is less powerful in its autoimmune role, or the environmental trigger which set off the autoimmunity in the first place was less strong, then your oeverall disease is just milder.
What is telling here is that the blood sugar contral was no better in those with the better beta cell preservation than those without, This strongly suggests that what is preventing complications is the not the degree of blood sugar control, but the strength of the overall autoimmune assault on the body. If the autoimmunity is not strong enough to destroy all the beta cells after 50 years, then it is also not strong enough to inflame the intima of the vascular system sufficiently to cause serious complications. Higher blood sugar on this hypothesis could then be seen as not a causative factor in complications, but just as a marker for worse autoimmunity and fewer beta cells, which would then be the real cause both of the more difficult to control blood sugar and the complications.
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