A question by e-mail:

Dear Mr. Scott King,

I'm a recently diagnosed type 2 diabetic. I managed to self diagnose rather early, however, already have a mild complication developing. I'm 'controlling' through diet, exercise, and oral meds.

After several months of *intense* study it finally became obvious to me that one definition of this disease could be simply be insulin secretion levels which fail to meet metabolic requirements. Type 1 diabetics have 100% hyposecretion, while Type 2 diabetics have at least 25% hyposecretion. T2s can reduce insulin requirements through diet, exercise, and oral meds but such measures cannot 'cure' them of the disease, and in a significant number of patients, insulin hyposecretion worsens until exogenous insulin is required.

Close, but many of us think that the initial problem in type 2 is a reduction in insulin sensitivity with compensating increase in insulin secretion. (For historical reasons the loss of sensitivity is called an increase in insulin resistance!) Only when the islets fail to make enough extra insulin do you get type 2.

In light of this, I read the Encelle description on the Islet Foundation website with *considerable* interest. When I called them I was stunned to find that, for the time being, work has been suspended due to lack of funds.

After the call I had to leave my office because I couldn't help crying. I can count on one hand the number of times in my adult life that I've cried, but the anger and frustration were overwhelming.

I've been lurking the Islet message board for awhile, and don't want to post yet, but simply don't know what to think. Could you please enlighten me: what's up with all this?

Mitch Funk

Scott's reply:

The problem, Mitch, is that the geometry of the Encelle device will not permit enough insulin secreting tissue to be implanted. They never got a dog off insulin. I honestly consider our sheet to be a better design.


P.S. See our evaluation at http://www.isletmedical.com/Pages/encell.htm

A question by e-mail:

Dear Mr. King:

I have a couple of questions:

(1) Have any of your executive or marketing staff contacted medical insurance companies to query about their coverage of such a cure/treatment? It would seem that with the long-term expense of diabetes they would sign you up with enthusiasm. Not long ago, though, 6.5 years to be exact, I had to request that my HMO cover glucose strips.

Scott's reply: I think it is likely they will pay, but we have not asked them yet. Their first question will be the length of time the treatment is effective, and we have not yet proven that.

(2) At this point in your research, can you safely estimate that the surgery to implant the sheet would be outpatient and that because of the laporascopic (sp?)procedure, minimal pain and scarring would occur?

Scott's reply: We think it is likely that all the surgery will be done with short incisions and minimal invasion.

(3) Are you researching possible tests/protocols/ methods for determining the longterm success of the sheets once implanted? I, in my layperson way, consider 5+ years without additional surgery to be successful.

Scott's reply: Yes. The main test will be serial metabolic workups. If the sheet is effective at 12 months, and the metabolic parameters at the same as 6 months, we can project it will work for years.

(4) You might want to include the cost of doctor visits, dialysis, eye surgeries, and so on in your table for the average annual cost for diabetic care. The table you currently have that includes test strips, insulin, etc. is a pretty ho-hum comparison (~$2500) to the suggested $20,000 for the sheet. If you add $12,000 for a vitrectomy or $15,000 for some other procedure, and then add the cost of supplies, your $20,000 for the sheet implant starts looking really comparable. I understand that an executive summary cannot include every data point but for longterm diabetics, annual cost is much more than just what the supplies cost.

Thanks for your time. By the way, I have had type 1 diabetes for 34 of my 36 years. I am cautiously hopeful about what your group is doing.


Shelby Rinehart

Scott's reply: Thank you for your well considered comments. I hope we do not disappoint you.

Scott King

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