Updated: Jun 8, 2018
Dr. Dana Webb at the Center for Nutrition and Diabetes Management, January 17th, 2012
Dr. Dana Webb, a podiatrist who has been practicing for over twenty years, has been living with Type 1 diabetes since he was a boy. Three years ago, he became one of the lucky recipients of a pancreatic islet cell transplant (#pancreaticisletcelltransplant) that has since kept him free of insulin therapy.
Webb was an invited speaker at a recent meeting of the insulin pump support group run by Roberta Silber, CDE, at the Center for Nutrition and Diabetes Management at Hunterdon Medical Center in New Jersey. A New Jersey resident, Webb’s experience with his islet cell transplant (#pancreaticcelltransplant) has been so positive that he is eager to inform that it is a viable option for people who have Type 1 diabetes.
Webb recalled the story of his diagnosis for the group. In the summer of 1974, when Webb was 10 years old, he returned from a two week stay at band camp. His mother, a nurse, noticed that he had lost fifteen pounds during that short period and was continuously hungry and thirsty. Checking into his local hospital, Webb received the diagnosis of Type 1 diabetes.
While he was practicing giving an injection to an orange, his doctor entered the room to reassure Webb that “they are working on it, not to worry. There will be a cure in five years.”
“Ten years went by,” says Webb, “then twenty years, thirty years, and now it’s been thirty-seven years since Dr. Messingham made that statement.”
A turning point in Webb’s life occurred when he read the book Showdown with Diabetes by Deb Butterfield. Butterfield describes her experience with diabetes; her book’s premise is that too much money and effort is being spent on improving needles, glucometers and pumps, when research should be focused on a cure. Butterfield’s life changed dramatically after a pancreatic transplant, and her book lists pancreatic transplantation research centers in the United States.
Webb felt that he was a good candidate for an islet cell transplant, mainly because of a condition he had developed called hypoglycemic unawareness. (#hypoglycemicunawareness) A person with hypoglycemic unawareness does not feel the warning signs and symptoms of hypoglycemia, thus increasing his or her risk of dangerously low blood glucose levels. Related to the autonomic neuropathy of diabetes that interferes with the secretion of counterregulatory hormones that would normally trigger awareness of hypoglycemia, this condition was destroying Webb’s professional life and marriage.1
As a podiatrist who performs surgery, hypoglycemic episodes posed a risk not only to himself but to his patients. Doctors had no advice for Webb other than “Watch your [glucose] numbers better,” because there is no treatment or cure for the condition.
Out of sheer desperation, Webb started calling program after program. As luck would have it, the Islet and Pancreatic Cell Transplant program at the University Of Illinois College Of Medicine responded, telling him that they were about to enter a Phase III clinical trial, where the treatment is given to large groups of people to validate its effectiveness, monitor side effects, compare it to conventional treatments, and collect data that will allow the treatment to be administered safely.2
Webb applied to have a pancreatic cell transplant, was accepted into the program, and on February 27, 2009, he received a call on his cell phone from the secretary of Dr. Jose Oberholtzer, the Director of the Islet and Pancreas Transplant Program and the Chief of the Division of Transplantation, who told him, “Dana, we have an organ.”
Because of a three-hour delay, Webb was able to obtain the last seat on the last flight to Chicago, and by 6AM the next morning, was on the operating table. While he was flying to Chicago, the team was processing the pancreas in a germ-free room. Through enzymatic degradation, they removed the living islet cells and concentrated them into a syringe. When Webb was in surgery, a specialized radiologist visualized the hepatic portal vein through ultrasound. He was then able to place a catheter between Webb’s ribs and into the vein, pushing the cells into his liver. The transplanted islet cells now reside in Webb’s liver and produce insulin on an as-needed basis.(#pancreaticisletcellstransplantprocedure)
Islet cells were injected into the liver and not the pancreas because the liver is a safer harbor for them, ensuring a better survival rate for the cells and allowing for milder anti-rejection medication. The liver is an organ that is not typically attacked by the immune system, acting as a filter mechanism in the body, while the pancreas of someone with diabetes is vulnerable to more attacks. In an earlier study, the Chicago team tried encapsulating islet cells within a semipermeable membrane in hopes that while insulin could travel out of the cell, the immune system would not be able to enter. The cells were then implanted into various organs, including the liver, but unfortunately this procedure caused the immune system to wreak havoc.
The day after the procedure, Webb was weaned off insulin therapy completely. After three days in the hospital, he was discharged to his hotel room, where he stayed for another ten days to monitor his drug protocol. Eventually he was weaned off all drugs except a daily dose of Januvia, an oral anithyperglycemic used for Type 2 diabetes, and a combination of the immunosuppressants Prograf and Rapamune. Since steroids are contraindicated in transplant patients with diabetes, Prograf and Rapamune are usually prescribed for islet cell transplant patients because they are not steroids and thus do not raise blood glucose levels. “These drugs make it possible for the research to continue,” says Webb.
After discharge, Webb has to travel to Chicago periodically for follow-up monitoring. While he checks his glucose frequently, it is mainly for research purposes. Dr. Oberholtzer uses Webb as a subject in his lectures because not all people in the study have had quite so effective an outcome, though by and large most subjects have stayed independent of insulin therapy. Dr. Oberholtzer has told Webb his numbers are that of a normally healthy person. “The numbers are getting really boring,” says Webb, “I haven’t had a low blood sugar since. Occasionally I may see a little spike after a large meal but it always comes back down.”
Webb has had a second graft, which is typically performed and is dependent upon attrition of the transplanted cells. In the weeks following the first graft, there will be an immune response and only a certain percentage of islet cells will survive. The second graft adds to the existing number of cells and reinforces the treatment.
The main criteria to be admitted into an islet cell transplant program, according to Webb, are hypoglycemic unawareness, state of health, and an insurance plan that supports the expense of the follow-up medications. After the transplant, his medications run an estimated $8,000-$10,000 per month.
Because of the immunosuppressants, Webb no longer eats sushi, dines at buffet tables in restaurants or drinks alcohol. However, he feels that it is a small price to pay to be free of insulin therapy and the high risk of hypoglycemic unawareness.
Webb’s intent in visiting the group at Hunterdon Medical Center was to say, “Possibilities exist. Take the best care of yourself that you can, because as the cures become available, you need to start with a clean slate. Diabetes (#diabetestreatment) is a challenging and difficult disease, and if too many bad things happen to you, you may not qualify for an islet cell transplant.”
Webb went on to tell the group that he has had many eye exams over the years, and the doctor said he had never seen someone with diabetes for as long as Webb has had it with no retinopathy. “The point is that didn’t happen by accident,” says Webb, “It took a lot of work to get there. I know it’s difficult, but stay with it, folks.”
For more information about the pancreatic cell transplantation, see the clinical trials website .
1Lewis, Heitkemper, Driksen, O’Brien, Bucher, Medical Surgical Nursing, Seventh Edition,Mosby Elsevier, St. Louis, Missouri, 2007, http://www.elsevier.com