How does Type 1 work?

Are our beta cells always being regenerated and then killed off simultaneously by our immune system? Is this why some Type 1s continue to produce a tiny amount of insulin while others don't (speed at which their cells are regenerated versus destroyed)?

I suspect that it works a little bit differently for everyone. I'll be intrigued to see what the people who are more informed about this stuff have to say!

Great question Jen, looking forward to hearing the answer(s).

That's pretty much the cornerstone behind Dr. Faustman's trial to cure Type 1. She thinks if she can stop the autoimmune attack, the beta cells are regenerated and produce insulin and don't get destroyed by our immune systems.

I know I test negative for GAD antibodies, but according to Johns Hopkins, there are at least 3 other autoantibodies that come into play:

ICA (Islet cell antibodies) - against the antigen present in the cytoplasm of the endocrine cells in pancreatic islets.
IAA (Insulin autoantibodies)
GAD – autoantibodies to glutamic acid decarboxylase
IA-2A (Insulinoma associated 2 autoantibodies) - against the protein tyrosine phosphatase

I also test very low for C-peptide. C-peptide is a protein that is produced along with insulin. I got an email from Dr. Faustman's lab that indicated my C-peptide results:

1/25/10 – <1.5 pmol/L 10/6/11 - 3.47 pmol/L They went on to explain that: "...non-diabetics will have concentrations in the thousands, newly diagnosed diabetics will have concentrations in the hundreds, and then it starts to decline over the next 40 years." This is interesting to me, because my endo tested my C-peptide level a few years ago and it read "<.1", but I don't know what the measurement was in. I suspect it was in nmol/L.

You got a letter teling you about your c-peptide level, gigeman? . I donated blood to the Faustman Lab in 2009, 2010, and 2011; and have not received any letter about my c-peptide level. Good for you! I am assuming that mine is low, but then I do not know. I never had any prior C-pepetide testings;, as I have been diabetic for almost 44 years; and such tests were not at all a part of diagnostic work-ups at the time. I guess you have to have a decreased level for your blood to be "useable" in the Faustman study(???); to compare it to a "normal" person without auto-immunie issues?. Is that why after the first visit I did not need a control subject with me?
As to Jen's quesion, I do think that for some of us type ones,those with 40+++ years of moderate ,so-so contol yet minimal complications, (like me) , maybe the beta cells do regenerate to an extent, then get whacked off. by the "rogue T-cells"? ( Dr. Faustman's term for the little killers. I ,of course,woukd like to surmisde that this happens to ALL type ones, but maybe it does or doesn't.
This disease is in many ways inexplicable as to who and how it affects the most. or the least. .Our esteemed Richard1957, Type 1 over 60 years, knows a lot about this. He is in the Joslin study to discover why there are a number of long term type ones( over 50 years) who have stayed relatively healthy.
A very interesting discussion, Jen. I am glad you posted.

God Bless,

Brunetta, I just sent an email to Sophie and asked her for the results of my C-peptide and any other things she could tell me. One of the things they are looking at is the "A2 protein".

Sophie explained:

"Being A2+ means that one of the surface proteins on your bad T-cells is A2. This is significant to us because our current method for T-cell detection (bad T-cells that is) takes advantage of the presence of the A2 antigen, so being A2+ increases the likelihood that we will be able to detect your bad, autoreactive T-cells."

Fascinating stuff, I think. BTW, I've only had DM for 27 years - can't quite compare to your 40+!


Final note: I've yet to take a control with me. Can't afford to take anyone from here, and can't find anyone in the Boston area to go with me. I've asked about 3-4 folks, and they all declined.

I heard that after 10 years or so no one has any beta cell life left to regenerate.
I have been diagnosed 25 years and I have no C-peptide at all. Ive heard some vaccines can interupt the beta cell death march and some people regain some betacells.

Bernstein claims that he has only seen two diabetics with no detectable c-peptide in all his years of practice.

Beta cells do regenerate, but once your body develops an autoimmune reaction it doesn't just go away. As soon as some cells regenerate, the autoimmune reaction will flare up and kill them off. While the cells may be able regenerate in place, it is not clear that they would ever grow into the mass that you were born with.

From the Joslin 50 year meadalist study: “A study published in Diabetes last August demonstrated that many in this group show production of c-peptides (a marker of insulin production), blood glucose levels that rise less after a meal than would be expected in the absence of insulin, and signs of autoimmune attack. More directly, insulin-containing cells have been found in every one of the 19 pancreases willed by Medalists to the program, Keenan said.”

While I have no proof I have always suspected that I would have very minimal production of insulin. I suspect that the level endogenous insulin may be a big contributing factor to the YDMV line. For instance: compare a T1 with 2% of normal insulin production to a T1 with 10% normal insulin production. I would expect that both would require external insulin to live, but the T1 with greater insulin production would be able to maintain more stable BGs.

I wonder if those autoimmune reaction "flare ups" are what cause some of those random highs or lows that some of us see sometimes. Does anyone know? THAT would be an interesting study.

According to Dr. Denise Faustmann they have found small traces of C-peptide in most T1 diabetics. This was possible with very sensitive lab equipment. In addition pathologists have always claimed that they have seen functional beta cells in T1 patients.

I wonder the same thing about variations in control and such being related to insulin production. I've never been tested but I would be curious if I make any insulin. I don't think I would make much (I mean on a T1 scale), if any, mostly becuase my blood sugar is so hard to control—it doesn't seem like I'm getting even 1% help from my pancreas!

I also asked because I have other "hyperactive" immune system problems (mostly allergies and asthma that are acting up and super annoying lately!). So I got to wondering, since my immune system seems so bent on freaking out at allergens and inflaming my sinuses and lungs, maybe it's doing the same thing to my pancreas all the time.

Yesterday at work everyone was talking about how they feel like they're fighting something nad I was sitting there like, "I feel totally fine, not even remotely sick." I harely ever get sick (and I don't take any supplements or vitamins) and I like to think it's because my immune system is so effective at attacking things.

That's very interesting. I've never had a c-peptide test done and after 21 years there's not much point. I wonder how easy it is for people in Canada to get just out of curiosity.

Yes, the Joslin study of T1D with more than 50 yrs post diagnosis has shown that some of those are producing a small amount of insulin as found in their c-peptide testing after drinking something much like a can of "Boost" liquid supplement. I am a study participant but my test shows no insulin production. I suspected that although as referenced above by Capin101, they have found study participants who donated their pancreases to the Joslin study with insulin-containing cells even when their c-peptide said none was produced. Fascinating stuff!

That's how they measured my C-peptide. It was measured in picomol/L as opposed to nanomol/L. Pretty darned sensitive.

I think when my endo ordered the test a few years ago, it came in at <.1 nmol/L.

It is an easy and cheap test to take. Just ask your doc to run one, but I guess the ultra sensitive one is the one to do if you are T1.

I also have other auto immune troubles, I have eczema and allergies to tree pollen and and extreme allergy to shell fish. I am also allergic to the adhesive on my Mm pump site.

I also have an on going relationship with Varracella. I had chicken pox as a kid but I have no sign of antibodies or antigens. SO I got a vaccine thinking I only thought I had it, But 5 years later I have no antigens or antibodies to it again. I don't even know if getting another vaccine makes any sense,