What’s wrong with our a-cells of the pancreas

[TypeZero.]

So the cause of type 1 diabetes is well established apart from a few mysteries as to why the immune reaction starts in the first place.

However I’ve read on some online websites how about in T1D the beta cells are destroyed while the alpha cells don’t work as efficiently. So what actually happens to the alpha cells, if anybody knows? I thought only our beta cells were affected but apparently not. I’m researching this and cannot really find any answers.

Our beta cells also secrete amylin which increases satiety and slows glucagon release, how does the body compensate for the lack of amylin? Shouldn’t insulin-using diabetics also have amylin added to their insulin to best mimick the pancreas?

Sorry if I’m asking too many questions but I’m just curious and can’t find anything online.

 

[MarkMunday]

... in T1D the beta cells are destroyed while the alpha cells don’t work as efficiently. So what actually happens to the alpha cells, if anybody knows? ....

The issue with alpha cells in T1s is that they don't get the right signals. The Alpha cells secrete Glucagon, which increases blood glucose. They stop doing this when they see insulin. But T1s inject/infuse insulin under the skin, which is a long way from the Alpha cells. So Alpha cells continue to be overactive and Glucagon levels are too high. That is the basic problem for Alpha cells in T1s and it makes controlling blood glucose more difficult. We have to fight against glucose from the liver much of the time too.

It also seems Alpha cells lose their ability to detect glucose, which should also switch them off. This comes from T2 research and is not well understood. Perhaps glucose detection in Alpha cells is down-regulated in people with consistently high blood glucose. It means the liver keeps producing glucose even after a meal containing carbohydrate, increasing injected insulin requirements. This is why ketogenic eating produces good results.

 

[MarkMunday]

... how does the body compensate for the lack of amylin? Shouldn’t insulin-using diabetics also have amylin added to their insulin to best mimick the pancreas? ...

Pramlintide, which is analogue Amylin, became popular a while back. The idea is that it helps reduce glucagon after meals and also slows stomach emptying. Studies didn't show much benefit, though. One showed a 0.3% reduction in HBA1c and another showed no benefit. As T1s we don't make Amylin and we compensate by adjusting bolus/correction insulin dosage.

Insulin is pretty much our only tool and it is a blunt instrument. It makes lifestyle, like diet and exercise important for supporting insulin treatment.