My Child was Just Diagnosed With Type 1 Diabetes. Now What?Every year, 13,000 children in the US are diagnosed with type 1 diabetes, while more than 1 million kids and adults deal with it every day in our nation. There is no prevention for type 1 diabetes,…
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August 01, 2016
Kids Health Dr. Gellner: You just learned that your child has type 1 diabetes, or you're worried that your child might have it. That's a scary diagnosis for any parent to consider. What you really need to know on today's Scope. I'm Dr. Cindy Gellner. Announcer: Keep your kids healthy and happy. You are now entering "The Healthy Kids Zone," with Dr. Cindy Gellner on The Scope. Dr. Gellner: Every year in the United States, 13,000 children are diagnosed, and more than 1 million American kids and adults deal with this condition every day. In type 1 diabetes, your child's own immune system attacks and destroys the cells in the pancreas that produce insulin. Once those cells are destroyed, they won't ever make insulin again. Although no one knows for certain why this happens, scientists think it's a combination of genetics and other external factors combined that triggered this immune system reaction. Type 1 diabetes cannot be prevented, and there's no real way to predict who will get it. Parents often feel guilty that they've done something to cause this, but parents need to understand it's nothing they did. Unfortunately, type 1 diabetes is a lifelong condition. Kids and teens with type 1 diabetes will depend on daily insulin shots or an insulin pump to control their blood sugar levels. Parents often ask me to check their children for diabetes because their children drink all the time and urinate all the time. It's an excessive amount of drinking that we often see and the urination isn't just drops of pee in the toilet. It's a full bladder of urine. Kids who have long been potty trained and have never wet the bed all of a sudden start to have accidents day or night. Kids will often seem to eat a ton as well and never gain weight, or they might actually lose weight. Now, parents all the time are concerned that their child isn't eating like they should, but it's what happens on the growth curves that lets pediatricians know if this is a normal phase that kids go through, or if it's something more worrisome. Sometimes, these symptoms are easily identified and pediatricians catch the disease early with a simple finger stick to check your child's sugar level. If diabetes isn't caught, chemicals called ketones can build up in your child's blood and cause stomach pain, nausea, vomiting, fruity smelly breath, breathing problems, and even loss of consciousness. This is a serious condition called diabetic ketoacidosis, and it requires fast action in the emergency room to correct. The good news is that treating diabetes and keeping your child's sugar level in check can help prevent long-term damage seen in adults, especially to the heart, eyes, and kidneys. The bad news is there are going to be a lot of needles to do this. Your child will need to learn to check their blood sugar levels several times a day and give themselves insulin shots since their bodies aren't making it anymore. They need to eat a healthy diet low in carbohydrates and sugars. And we all know that's a challenge for anyone, especially a kid. You and your child will start seeing a doctor called an endocrinologist. This is a pediatrician with additional training in hormone issues, including diabetes. The endocrinologist, you, and your child will all work together to come up with a plan on how to keep your child's diabetes in check. Living with diabetes is a challenge no matter what age a person is, but young kids and teens often have special issues to deal with. They may have a hard time understanding why they need so many needles, why can't they eat what their friends are, why did this happen to them. If you have a teen with diabetes, they may feel different from their peers, and they may want to live a more spontaneous lifestyle than their diabetes allows. Not to mention that puberty hormones can make diabetes control even harder. Having a child with diabetes can seem overwhelming at times, but you're not alone. Your child's diabetes care team is not only a great resource for the medical side of things but also for support and helping you and your child cope with this long-term condition. Until scientists have figured out a better way to treat, and possibly defeat diabetes, you as a parent can help your child lead a happy, healthy life, by giving constant encouragement, and helping them stay on top of their blood sugar control every day. This will let your kids do all the things that the other kids do and remind them to enjoy being a kid instead of feeling like a pin cushion. Announcer: Thescoperadio.com is University of Utah Health Radio. If you like what you heard, you should get our latest content by following us on Facebook. Just click on the Facebook icon at The Scope Radio. |
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Debunking Old Wives' Tales: 10 Myths About DiabetesYou have probably heard the old wives’ tale, “Do not let your child eat sugar, or they will get diabetes.” Is this true? Is it true that there is a cure for diabetes? Access to…
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C-Section Babies’ Immune System May Be Improved by Vaginal Microbial TransferBacteria help build babies' immune systems. During a natural birth, the passage through the birth canal allows mom’s bacteria to colonize the baby. But what about babies born by cesarean…
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February 25, 2016
Womens Health Dr. Jones: Good bacteria and bad bacteria. We are being bombarded by information about the bacteria with which we share our bodies, but what about our babies? This is Dr. Kirtly Jones from Obstetrics and Gynecology at University Healthcare, and this is Babies and Good Bacteria on The Scope. Announcer: Covering all aspects of women's health, this is The Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope. Dr. Jones: We have previously talked about how babies benefit from exposure to different kinds of bacteria. Babies who have a wider exposure to bacteria may have less obesity, diabetes, asthma and autoimmune disease. So it is okay to put your baby on the floor, and it is okay, mostly, to let your dog lick your baby. Now, a baby in the uterus the day before it is born is living in a mostly sterile environment. The passage through the mom's birth canal during labor allows mom's bacteria to colonise the baby, and breastfeeding allows some more. The vaginal bacteria in healthy pregnant women are largely lactobacillus, which is a bacteria that can help babies metabolize milk, but what about babies that are born by cesarean section? There are some data to suggest that babies born by cesarean, and that is about 30% of babies in this country, may have more autoimmune diseases like asthma, type 1 diabetes and other conditions, and food allergies than babies that were squeezed out through the mom's vagina, especially babies that were born via cesarean, without moms having been in labor for a while. Okay, so it isn't a huge difference in which babies get some diseases, but if you were planning a caesarean, could you do something about it? A short report has just been published in the Journal of Nature Medicine suggesting that you can. This was a very small study of 18 moms and their babies at the University of Puerto Rico in San Juan. Seven babies were born vaginally and 11 babies were born by elective cesarean section without labor. Four women who were scheduled to have a caesarean had a bit of gauze put in their vagina, then removed and put in a sterile container before the cesarean was performed. A few minutes after the babies were born they were dried off and four of the babies had gauze wiped over their skin. Eleven other babies did not. Over the following month, the moms and their babies had their microbiome, their bacterial ecosystem, assessed. The babies who were treated with the gauze had skin bacteria more like their moms and more like the babies born vaginally. The babies born from cesarean who did not have the gauze treatment had bacteria more like that from the hospital environment, and less like their mom's vaginal environment. The babies who had the gauze treatment weren't exactly like babies born vaginally in that their gut bacteria weren't as varied and abundant as babies born vaginally. This could be for several reasons. One is the fact that moms getting a cesarean often get antibiotics to decrease the risk of infection in their cesarean incision or their uterus. Infection is relatively common in cesarean incisions, and that is why we give women antibiotics routinely who are having a cesarean. So lots goes on in labor that involves moms exchanging bacteria with their babies. Now we don't know if these babies with the gauze treatment will grow up to be healthier or not. And we don't know if there are some moms with bacteria or viruses in their vagina that shouldn't be shared with their babies. A bigger study is ongoing right now at New York Hospital. However, this idea is being disseminated in mothers' blogs and magazines, and women are asking for it. The professional medical organizations haven't recommended it yet, and I am pretty sure I would add the statement, "Don't do this at home," but if you're interested you should ask your OB. There is so much to think about when you're going to be a new mom, and this wouldn't be number one on my list, but it is something to know as we learn more and more about the world in which we live and into which we bring our babies. Announcer: TheScopeRadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com |
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Do You Urinate a Lot? It Might Be DiabetesIf you have diabetes, one of the common problems is either frequent urination or the feeling that you always have to go to the bathroom. It’s so common for diabetics that this symptom is an…
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November 18, 2021
Womens Health Dr. Jones: Diabetes and the bladder, you never think of these two things going hand in hand. You think of a cupcake and diabetes, not the bladder and diabetes, but today we're talking about diabetes, the bladder. This is Dr. Kirtly Jones and this is The Scope. Here in The Scope studio, we have Dr. Sara Lenherr, who is a urologist by training, but subspecialty trained in neurology. Today we're talking about diabetes because diabetes is a complex disease. It affects every part of the body and the bladder is the final common pathway of both nerves and sugar and trouble. Welcome to The Scope, Sara. Dr. Lenherr: Thank you for having me. Dr. Jones: I think in my own practice sometimes I diagnose diabetes because of women's urinary frequency. So can you tell us a little bit about how the first signs of diabetes might affect the bladder? Dr. Lenherr: Sometimes women with poorly controlled diabetes end up having a bladder that spasms too frequently, and that can be very bothersome. It makes them feel like they have to go more frequently and urgently. Dr. Jones: Also, sometimes people who don't know they have diabetes yet, their sugars are high, the kidney is trying to dilute that sugar, and they just pee a lot. Dr. Lenherr: Yes, frequently these patients make too much urine because their kidney function is affected, and so they just make more urine than the bladder can handle, and it makes them feel like they need to go more frequently, and they do. Dr. Jones: So peeing a lot in large volumes, for me, I remember that from medical school, was you better make sure they don't have diabetes. Dr. Lenherr: Exactly. Dr. Jones: Over the long term, though, diabetes affects your nerves in your feet and affects other parts of your brain, but talk about the bladder in long-term diabetes. Dr. Lenherr: Diabetes in patients that have had it for a long time can affect the fingers and toes, and all that sensation also affects all of the nerves that go to the bladder, and so the bladder doesn't necessarily contract at the right time. Either it's overactive, or it's underactive. It doesn't contract well enough, and so therefore it doesn't squeeze when you want it to and you don't empty your bladder completely. Dr. Jones: So in terms of diabetes, we certainly want people to be in good control, because that might help early on a lot of their bladder symptoms, meaning if their sugars are in good shape, their bladder will probably be in good shape. But for people who have been diabetic for a long time and they weren't in such great control and now they have more permanent damage, how do you make that diagnosis? Dr. Lenherr: Usually, we check and see whether or not the bladder empties completely, so once you go, we can then check and see if you have a residual left over in your bladder, and then we can also check bladder function tests where we measure the pressures inside the bladder and see how your bladder behaves with filling and then trying to empty your bladder. Dr. Jones: Is that very comfortable? Reassure me that that's not going to be a painful test. Dr. Lenherr: It's a very simple test that's done in the office. We put a very small catheter that's smaller than the mouse cord that goes to your computer, and we place that inside your bladder, and we place also a very similar small one inside the rectum. This helps us look at how the bladder behaves with filling and emptying to measure those pressures and see whether or not your bladder nerves are not working properly. Dr. Jones: Okay, maybe I would have this test. Okay, I'll have this test. So, I had this test and my bladder isn't contracting very well. What are you going to do? What can you do to help me with this? Dr. Lenherr: Depending on how much your bladder is injured, sometimes we have to have patients actually just pass a small catheter every four hours while they're awake to empty their bladder as opposed to trying to pee it out. But if you have a little bit of bladder function, then sometimes we can actually give you a bladder pacemaker that helps your bladder contract in a much more efficient manner, and therefore you're able to empty without having to use that catheter. Dr. Jones: How about as people get older? I think of the elderly patient with what we call comorbidity, so they're older, they have diabetes, they have heart disease because it's affected their heart, maybe they had a stroke. Urinary incontinence is the number one reason to be admitted to a nursing home. So what do we do for older people? Can they do their own catheterizations, or is this something a family can help them with? Dr. Lenherr: The complex patient with incontinence is definitely some of the more challenging cases that we have, and it's a balance between figuring out what the goals of care are. Some patients are very happy to have family help them catheterize if they need that to be done. Sometimes patients would rather not have their family members be going down there and helping them pass a catheter, and depending on how the bladder works, it can be a very good option to leave a chronic catheter in place. Usually we try to place that in a suprapubic location, so right above the pubic bone below the belly button, and that helps drain the bladder and improves quality of life in a lot of patients. But these are really specialized conversations that we have with both the patients and their families to determine who is going to help out the patient and who is going to be able to help keep the patient safe and happy. Some of the more rewarding conversations are having these discussions where you have patients understand these are my choices and this is what my goals of care are, and it's not always a quick fix, and it's not always the most complicated solution. Sometimes it just needs to be something simple that everyone agrees this is what I want to have my life be like, and I'm there to offer those solutions for them.
If you have diabetes, one of the common problems is either frequent urination or the feeling that you always have to go to the bathroom. It’s so common for diabetics that this symptom is an indication to doctors that you might have the disease. Young or old, diagnosed or not, if you have urinary problems related to diabetes, there is help available to make your life better. |
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Scientists Develop "Smart" Insulin that Automatically Adjusts Blood SugarFor patients with type 1 diabetes (T1D), the burden of constantly judging when and how much insulin to self-inject is bad enough. Even worse, a miscalculation or lapse in regimen can cause blood…
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February 13, 2015
Clinical Trials
Health Sciences Interviewer: A new smart insulin could change diabetes treatment. Up next on The Scope. Announcer: Examining the latest research and telling you about the latest breakthroughs. The Science and Research Show is on The Scope. Interviewer: I'm talking with Dr. Danny Chou, USTAR assistant professor in biochemistry at the University of Utah. Dr. Chou, your discovery could really make a big difference in the lives of people with diabetes. Tell us about what you found. Dr. Chou: So, we used a chemical approach to modify the native insulin molecule, and what we're trying to do is to have insulin that will be activated when the blood glucose level is high, so in the way that further regulate blood glucose level better for diabetic patients. Interviewer: So, already, your work in mice would suggest that what you've developed is, I think, better than anything that's out there right now. Is that true? Dr. Chou: Yes, because right now in the market, there are fast-acting insulins for meal-time use and there are long-acting insulins for basal level use. So basically there's no such insulin in the market right now that could provide any kind of glucose-regulated or glucose-responsive way. Interviewer: And it seems like the results that you saw in mice were pretty striking. What did you see? Dr. Chou: So what we see is that we could only do one single injection of this modified insulin, and then what we see is we could do three glucose tolerance test, which is kind of like a meal for the mice, and then we could see that one injection could be good for three different meals within a 13-hour span. So we really think this a very amazing and a very exciting result. But as we just mentioned, this right now is only in mice work and then we would try to see whether we could prove the safety of these insulins and one day we could put it into the clinical phase. Interviewer: So, how long do you think it might take to get to the clinical phase? Dr. Chou: So, we are thinking about a three-to-five year range. Interviewer: For those of us who may not be familiar with living with diabetes, can you explain what some of the problems are that you're trying to address? Dr. Chou: So, in the case of Type 1 diabetic patients, they do not have any insulin production inside their bodies. So, people with Type 1 diabetes, they have to totally rely on external source of insulin. And insulin is a drug that is not like you could put as much as possible and then you would still be okay. The thing is that you need to maintain your blood-glucose level in the normal range. So, when you inject too much insulin, that will give you a case of hypoglycemia, which will kind of cause dizziness, or in coma, or even death. So that's why people are afraid of injecting too much insulin inside a body. Interviewer: You know, as it is, what you've developed is really incredible, but it sounds like you're also going to work on improving it. Dr. Chou: Yes. So right now, I think we have already done a pretty good job in developing an insulin that could be used to reduce the high glucose level back to normal range during the meal time. But I think what we could still improve is in the hypoglycemic end. So what we try to do is we try to have the ideal insulin that the activity of insulin will be stopped or blocked when the glucose level is around, say, 80 milligram per [inaudible 00:04:33]. So, we will never need to worry about inducing hypoglycemia with this insulin injection. Announcer: Interesting. Informative. And all in the name of better health. This is The Scope Health Sciences Radio. |
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Pancreas Transplant: An Alternative Treatment for Type 1 DiabetesThe University of Utah now performs pancreas transplants for qualified patients with type 1 diabetes. When other therapies have been exhausted, a pancreas transplant can eliminate the need for…
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September 10, 2014
Digestive Health Interviewer: Coming up next on The Scope, if you are a brittle diabetic, a possible treatment option. Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope. Interviewer: If you suffer from a kind of diabetes called brittle diabetes, you might want to consider a different type of treatment you might not have heard of before. We're with Dr. Jeffrey Campsen from the University of Utah Health Care. He's a transplant surgeon here. The process is called pancreas alone surgery. What exactly is that? Dr. Campsen: What we're talking about today are patients with type I diabetes that have very unstable diabetes, meaning they've tried their best to control it but they're still very brittle. What that means is they have swings in their sugar levels, their glucose levels, whether they go too high but more importantly they go too low. If you have too low sugars, it's known as hypoglycemia and that can be deadly. If you have the inability to control this with standard therapies, which is insulin and insulin pumps, one therapy we may offer you is a pancreas transplant. Interviewer: All right. So if some of these other things haven't been working for whatever reason, a pancreas transplant might be the key. How would somebody know if this is something that would be right for them? Dr. Campsen: Well I think first of all, there's two types of diabetes. There's type I diabetes, which means that your pancreas doesn't actually make the hormones that you need, insulin and glucagon and other things. Then there's type II diabetes, which means that you're resistant to the insulin. So a pancreas transplant doesn't work very well if I'm giving you a pancreas and you're already resistant to insulin, so we're just talking about the type I diabetics. Interviewer: The name pancreas alone sounds interesting to me. Why is it called that? Dr. Campsen: Historically the diabetes will attack the patient's kidneys over time. As their kidneys go into failure, we can give them a kidney transplant. But a kidney transplant in a type I diabetic doesn't work as long as it does in non-diabetics because the diabetes comes back and attacks the graft, the kidney transplant, and shortens the life of the kidney transplant. So historically we would give both a pancreas and a kidney to those patients that would need it to protect the kidney. The other school of thought is, why wait until your kidneys have already failed? Why not give you a transplant sooner, a pancreas transplant alone, that then protects your kidneys so you never need a kidney transplant? Interviewer: So kind of the old school way of thinking was, when it gets to the really dangerous situation, that's when you do the transplant. This is a little bit more proactive. Dr. Campsen: That's right. And you have to understand that there's a balance, because transplant surgery is a big deal. The surgery itself is a large vascular surgery, and on top of that you have to take immunosuppressive medications for the life of the transplant. So you're kind of trading diabetes for the disease of transplant. However the disease of transplant is much smaller and safer than this brittle diabetes that people talk about or kidney failure. Interviewer: So if catching the patient before things get terrible is the key, how soon could somebody get one of these transplants? Dr. Campsen: Many type I diabetics are diagnosed when they're children. That's probably too young because you have to have someone who's very responsible who can take care of the transplant. So we like to see the patients get at least towards their late teens if not into their 20s. They have to really show that they've really tried to manage their diabetes aggressively and very good compliance with their insulin and they've still failed. Interviewer: All right. What should a patient know at this point? This isn't something that necessarily a lot of physicians would refer. Dr. Campsen: Right. I think the interesting thing about type I diabetics is the only way that they survive is by really managing their disease. Obviously physicians, endocrinologists, medical doctors have to help them and support them to do this. But they're living every second of their day and their lives with this, and if they're able to control it, then they know a lot about diabetes. They know whether or not they're brittle. They know whether or not their other organs are starting to fail because of the diabetes. Then I think a patient who has this needs to realize that we now offer this as a therapy to help cure the diabetes. Interviewer: What would be your one takeaway for somebody listening to this? Dr. Campsen: I think if you're a brittle diabetic, and you know who you are, then pancreas transplant may be an option for you and you should come talk to us. You'll meet our transplant team, the professionals that manage different types of transplants at the University of Utah, and we'll sit down and see if you qualify for this and more importantly will you benefit from an organ transplant? Interviewer: What are some of the benefits of getting the transplant versus not? Dr. Campsen: Well I think that basically there's nothing better than a human organ. Everything that we do outside of transplant is approaching the quality that a human organ can give you, but there's nothing better than that. So if you're having trouble with your diabetes and you're noticing it's still damaging you, whether it's giving you heart disease, eye disease, nerve disease, all the kind of things that really happen because of type I diabetes, the fact that you're married to your insulin pump, then a pancreas transplant is an option that then will cure your diabetes. The moment that you have the transplant you're off insulin. Interviewer: It sounds like the sooner that you contact somebody and talk about this, the better because I would imagine there is a wait time for pancreas transplants. Dr. Campsen: There is a wait time. First of all you have to go through the workup, and then once you're listed the available organ has to be offered to you. It can be a year or two. Announcer: We're your daily does of science, conversation, medicine. This is The Scope, University of Utah Health Sciences Radio. |
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Should You Get a Pancreas Transplant for Type 1 Diabetes?You’re considering a pancreas transplant to cure your type 1 diabetes, but have questions – This episode of The Scope is for you. Dr. Jeffery Campsen, surgical director of transplants,…
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December 02, 2013
Family Health and Wellness Announcer: Interesting, informative and all in the name of better health. This is The Scope Health Sciences Radio. Interviewer: A lot of people with Type 1 diabetes believe that the insulin shots and a pump is enough, but there might actually be a better option, a pancreas transplant. We're with Dr. Paul Campsen, Surgical Director of Pancreas Transplant Surgery with the University of Utah. That option is pancreatic surgery. Dr. Paul Campsen: That's correct. Right now we do pancreas transplants for Type 1 diabetics. Type 1 diabetics can't survive without insulin, so they give themselves shots and they can administer this sometimes through am insulin pump which is a very good way to keep them alive. The control that they get from that is not a replacement for the human organ, the pancreas. That's where the pancreas transplant comes into play in the sense that you can help yourself stay alive just like dialysis helps with kidney transplant, or with failure. A pancreas transplant gives you back the human organ that you actually need. Interviewer: Plus, also a better quality of life. Dr. Paul Campsen: A much better quality of life. Over the long term the pancreas transplant itself is completely correcting the diabetes, so any of the sequelae of diabetes, whether it be peripheral vascular disease, damage to your eyes, damage to your nerves, damage to your coronary arteries, all of that stuff is stopped with a pancreas transplant. Interviewer: Not with the insulin shots or the pump? Dr. Paul Campsen: No, I think that the insulin helps a lot. It slows down the damage. Obviously it literally saves their lives by giving them insulin, but it doesn't stop the diabetes because you're still a diabetic. The pancreas produces a variety of different enzymes and secretes many things that actually help the body including insulin, also glucagon, which keeps the sugars from going too low which can be life threatening, and any of the pancreatic enzymes that help with digestion. None of that' s given with the insulin pump. When you replace the pump with a human pancreas you get all of those benefits. Interviewer: It sounds like a great solution. Why aren't more people doing it? Is it a dangerous surgery or is it fairly safe? Dr. Paul Campsen: The diabetics who come to us hate their diabetes so much and they're so scared by it, and their so scared by brittleness of their, meaning they go too high with their sugar or too low, that they would do almost anything not to have to use insulin anymore, but they're scared because surgery is a big deal. The vast majority do very well with this surgery. It's very safe. They stay in the hospital for about a week afterwards, but the moment that they leave surgery they're not a diabetic anymore. Interviewer: That's pretty amazing, isn't it? Dr. Paul Campsen: It is pretty amazing. Many of the patients that come to us, their diabetes has also ruined their kidneys, so they're on dialysis at the same time. We'll do a simultaneous pancreas and kidney transplant. The moment that they leave the surgery the next morning they're cured of their diabetes and they're cured of the their renal failure and they're not on dialysis. The other thing that's very interesting in these patients is if you just give them a kidney transplant their Type 1 diabetes will still attack the kidney transplant. Interviewer: It just kills that organ. Dr. Paul Campsen: That's exactly right. The pancreas transplant added on top, because it cures the diabetes, actually protects the kidney transplant. Then both organs survive much longer. Interviewer: Who would be a good candidate for this type of surgery? Dr. Paul Campsen: I think anybody who has Type 1 diabetes. We're talking about unfortunate people who were diagnosed with diabetes probably before they were 20. We'd like to see these patients well before they get into their 30's. The earlier we see them the better. Interviewer: OK. What are your final thoughts for somebody that has Type 1 diabetes and is a little on the fence? Dr. Paul Campsen: I think basically this is a safe surgery. Coming and seeing us doesn't mean we're going to trap you and give you the surgery, but it's something where we can talk about it and see if this is the right surgery for you. If it is, we can cure your diabetes. If you have kidney problems we'll take care of those too. Announcer: We're your daily dose of science, conversation and medicine. This is The Scope University of Utah Health Sciences Radio. |