Forty years ago I was diagnosed with type 1 diabetes. I was told -- as we all were -- that the cure was five to 10 years away. There still is no cure, but I just interviewed the man who may be a breath away from preventing type 1 diabetes.
"Right now we can diagnose who will develop type 1 diabetes within five years." -- Diabetologist Itamar Raz.
Last month after I was in Dubai to cover the International Diabetes Federation Congress, I went to Israel where Professor Raz's secretary, working extremely hard, found 30 minutes for me to meet with Raz.
Professor Raz is Director of the Hadassah University Hospital's Diabetes Unit and one of the world's leading researchers and clinicians in diabetes. Raz's work is changing the future of type 1 and type 2 diabetes.
But what I remember from the almost 50 minutes we spent together is the warmth that radiated over his desk toward me. His bright blue eyes that never left mine and how intensely present he was, wanting me to understand both his work and the fact that he is still a simple doctor who wants to ease patient's pain.
This is Part I of a two-part interview and the 14th in my series of profiles on diabetes change leaders.
Q: Tell me about the work you're doing to prevent type 1 diabetes.
Itamar Raz: Before you develop type 1 diabetes, for most people and mainly in children, you develop antibodies against your pancreas. Most of the time it is two or three antibodies. When these antibodies are seen in a child you know that he/she will most likely develop diabetes within three to four years. If you follow such children you can track how fast they respond to glucose with their own insulin secretion. The moment they are not responding as quickly as before you know it's only another year before they will develop diabetes.
We have an assumption about how type 1 diabetes occurs. When the beta cell is under stress, current theories suggest from a possible viral disease or early exposure to cow's milk (rather than breast milk) we don't really know yet, a part of the cell and a protein inside the cell get exposed in a way that the white blood cell sees the beta cell as an invader and attacks it.
Now we're trying to stop this attack. Simply, we're injecting an antigen (a foreign molecule that triggers the body's production of an antibody) that the cell expresses when it's under stress. Then we're stimulating the part of the protein inside the beta cell that goes into action to prevent the attack. When we inject this antigen into animals we can prevent diabetes.
Different studies have been done with other antigens but they have all failed. But three weeks ago we were the first in the world to show in our study that what we are doing works in newly-diagnosed diabetic patients. We are in trials now and soon hope to try it in young children before they develop diabetes to see if we can stop the disease from occurring.
Q: Do you think we will see a cure for type 1 diabetes in your lifetime?
IR: I think it's a hard question. Hoping that my life will extend for another 20 or 25 years, I'm sure we will see many treatments emerge to stop the attack on the beta cell without causing damage to the patient. Whether we will have a full cure I don't think so, but I don't know.
A cure may come in three ways. Either we'll turn stem cells into beta (insulin-producing) cells, or infuse beta cells, or it will be some kind of artificial pancreas. Stem cell therapy is still very far away from being a solution. Islet cell transplantation is a big disappointment. We learned that within three years most patients are insulin dependent again.
I think we're going to have an artificial pancreas within five or 10 years that will make the life of someone with type 1 diabetes much easier. You won't have to check your blood sugar and you'll be able to live more or less a normal life. You won't have to deal with diabetes all day long and you'll have an A1C that will probably protect you most of the time from complications.
Photos ©Riva Greenberg
Q: Why did you go into this work?
IR: I went into medicine because I love to help people. This is me, I love people and I love to give.
When you are a doctor you are like a god, and you can be a good or a bad god. You are a bad god if a patient comes to you and you say, "Why don't you do this! Why don't you do that! What you are doing now, you are killing yourself!" You can be a good god if you show your patient that most of the time things are not so bad and you take whatever he worries about and help him worry less. You have a lot of strength in your hand to do good for people.
I went into diabetes for two reasons. I found it very interesting and I thought that this was going to be the main disease the world would face. I saw how our lifestyle was changing. I was right, but 30 years ago no one thought this way.
The other reason was I thought I'd like to have a little time for myself. If I was a cardiologist I'd be running to my patients all hours of the day and night. I didn't go into cancer because at the time I thought what can I do about cancer? But, diabetes, I thought I'll have a little time for myself. Of course do I have any time for myself? No, but I love it.
Part two of my interview focuses on Raz's work in type 2 diabetes and helping general practitioners understand diabetes and how to work with patients.
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Riva speaks to patients and health care providers about flourishing with diabetes and is the author of "50 Diabetes Myths That Can Ruin Your Life and the 50 Diabetes Truths That Can Save It" and "The ABC's Of Loving Yourself With Diabetes." Visit her website DiabetesStories.com.
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